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Ep. 3: Dysphoric Milk Ejection Reflex (D-MER)

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This is Maureen Farrell and Heather O’Neal and this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus, we laugh a little or a lot along the way.

How is it for a partner to see you crying every single time you breastfeed? Right? Like eventually your partner’s just going to be like, Hey, maybe this isn’t good for you

Hi, everybody. Welcome to episode five. Today I am really excited to talk about mental health and in particular, one condition that we call dysphoric milk ejection reflux. I know, I think this one is so underrepresented and I think that it is a bigger problem than we realize. And I think that women struggle with this in silence because there’s this guilt that goes along with maybe not feeling super happy when you’re breastfeeding.

Oh yeah. So maybe let’s start, Heather, like why, there might be some people wondering why are we talking about mental health? This is breastfeeding podcast, boobs and babies, you know? What does this have to do with anything?

Well, as midwives, we are with women and I am mom friendly first. Because I think that if mom isn’t happy, nobody is happy. And by happy, I mean, well cared for, balanced, able to care for herself so she can care for others. And I think that with all the hormonal changes that happen and the way we live in our society in nuclear, isolated families these days, I think that mental health, with all the changes in postpartum can be devastating for families. And I think we would be doing a disservice as midwives and lactation consultants to not discuss it.

Absolutely. And you know, your mental health struggles can really affect how you breastfeed and how you care for your baby. And also your, your mental health and happiness are important. You know, our care isn’t just about healthy uterus, healthy vagina, healthy baby, you know, healthy lactation. That, that really doesn’t, you know, it doesn’t go with this kind of full spectrum, holistic care perspective that I try to have with my clients. And I think that really goes with the midwifery model of care.

Yeah. We like to treat the whole person and that’s why our appointments with patients tend to be a lot longer than what you get in a regular clinic environment. Oh yeah. I’ve heard over and over. You know, clients will look at the clock and go, oh my gosh, it’s been an hour and a half. Are you sure this is okay? And I’m like, yeah, I actually scheduled you for two hours cause I thought you might need a little extra time.

Yeah. And can I just say that the new trend is to have postpartum clinics that are separate and apart from the prenatal and labor and delivery side of OB. And that seems really posh and cool, but from my perspective, and this is my personal opinion, I think it is, it’s a bunch of horseshit because there’s no continuity of care.

And when a woman has developed or when a person has developed a relationship over 40 weeks with a provider, and then that provider is going to be able to tell when some shit is going on with her, you know, like how many times have you seen this? Where your person comes into their postpartum visit and you’re like, whoa, what’s going on there, mama?

Yeah. Yeah. And, and it’s really, you know, even if you’re seeing a hospital-based practice. You know, push to see the same provider every time. You might automatically get scheduled with whoever, you know, just comes up first on their computer, but you can say, Hey, actually, when is Dr. Whatchamacallit it available? Cause I’d rather see them.

And also if you are already in your postpartum period, and you’re feeling some feelings of dysphoria or mental instability call, and when you make your appointment, I can’t promise that the reaction of whoever is booking the appointment is going to serve you, but I can tell you that it will help the provider be able to manage the schedule a little bit better and give you more time.

So you can say on the phone, I need to schedule an extra postpartum appointment. I want to talk about potential postpartum depression. That’s probably all I would say. It might not even be postpartum depression, but you can say that and say, so I might need a little bit more time. So that’ll give the front office person leeway to block more time, and then your provider won’t be as rushed. Because it sucks from the provider standpoint to know that you need to give more time and attention to a person, but there’s also 20 other people waiting for you.

Yeah. And it’s, it’s really hard. It is good to know that upfront as a provider. You know, or you can say like, you know, could I get the last appointment of the day? I’m afraid I might run over a little bit. Good one. Yeah. Or the one right around lunchtime. Yeah. And you know, if you have a good provider that you trust, it you know, it’s not fun as a provider to have to cut into your lunch or stay extra, but you know, most providers who are worth their salt will do that. Absolutely.

And you know, this is going to prevent them from rushing through and making you feel like what you have to say is not important. Yeah, because it is. It is, it’s so important. And it’s, it’s just, it’s a really important piece of your health.

So tell us about this specific thing that can happen specifically with breastfeeding. Yeah. So I recently did a lot of research on this condition called D-Mer or dysphoric milk ejection reflex because I had a client experiencing this. And I thought, wow I’ve heard of that, but you know what, let me go back and research it because I don’t feel really confident in what I know about it.

It turns out nobody feels really confident in what they know about it. And it’s extremely under reported and there’s just not a lot of information, but I’m going to give you a synopsis. And then we’re going to talk about it. So D-MER is a condition that affects people who are breastfeeding and it is specifically characterized by what we call a dysphoria or negative emotions that occur just before or during the letdown of your milk.

So sometimes it’s for a couple of seconds. Sometimes it’s a couple of minutes. It’s usually fairly brief, but it can be mild or very severe. Is it just hormonal? Right. So it is triggered by the hormonal change of the milk ejection. But we don’t fully understand it and it’s thought that it has something to do with a possible inappropriate drop of dopamine that accompanies that rise of oxytocin.

So the theory is that there’s some kind of inappropriate response from your body. Now this experience doesn’t necessarily require your baby to be breastfeeding or for you to be pumping. Some people experience a letdown if they hear a baby cry or, you know, if it’s just been a while since they’ve fed.

Oh, I didn’t even think about that. Yeah. So it’s anytime you have that led down, not necessarily, it’s not like associated with nipple contact necessarily. And, you know, like I said, there’s this really big spectrum. So that’s determined by the length of the experience, the intensity of your emotions, and then the duration of the dysphoria throughout your breastfeeding experience.

So in some mild cases, this might only last a month or two. And then in more severe cases, this would be throughout the entirety of however long you breastfeed. So what are some ways that we as providers can be listening for what our patients are saying? Like, how are patients describing this feeling that they have?

Yeah. So I, you know, usually what I first hear is I just don’t like breastfeeding. That’s kind of the first time I think I need to listen and lean in a little bit. And in order to hear that from your client too, like providers need to be saying like, how do you feel about it? How’s it going for you? Not just, okay, it’s fine.

I’m breastfeeding fine. Baby’s doing fine now. How are you doing? How do you feel when you breastfeed? You know, we really need to ask that. And yeah, sometimes people volunteer that information, but usually, unless it’s severe, they don’t tell me that unless I ask.

So what if you’re a patient that has a provider that is definitely not going to ask in that way. So how can you as a patient express to your provider, who might not be a breastfeeding guru? Right. So I think you need to be really clear if, if you’re listening to this right now and you’re thinking, Ooh, that describes me. That is not a normal experience, right? That’s not within the range of like of mental healthiness that we consider.

That’s something that you don’t have to keep experiencing. So you might be able to do something about that. So you should, you should talk to your provider and say, Hey, not only maybe do I not like breastfeeding, but I feel something really different when I breastfeed. My emotional state changes during that breastfeeding or while pumping or every time I have a letdown.

Or maybe that’s not your experience, but make sure you’re really clear that your emotional state is altered for that period of time and that you want more resources for that. And probably for providers not asking about this, they’re just going to say here’s the card of our counselor.

That’s okay. Go talk to them. Because that’s really the next step, right? Typically you know, we’re gonna say, you know, maybe you should think about cognitive behavioral therapy. Maybe you should think about some medication, you know, but, but also like if you’re seeing a midwife or you’re seeing a doctor who’s really responsive about this, you can talk about natural treatments, lifestyle changes, things like that. That just generally reduce stress and improve your health because anecdotally, so that means we don’t have a study to prove this, but people who suffer from this condition tell us this helps. Right. That’s what I’m saying. Whenever I’m going to say this a lot, anecdotally versus evidence based.

Anecdotally, those kinds of lifestyle changes can improve the symptoms of D-MER. So I haven’t seen this in real life with any of my patients, but what did it look like for one of your patients? Just so people can get a more clear picture. Sure. Right. So the most severe case that I’ve seen. A client was experiencing symptoms of postpartum anxiety and depression during their letdown.

Hmm. How long did it take her to recover from that? Like did it only last until the end of that feed? It was, it didn’t even last through the whole feed. It was probably about the first minute of the feed. Wow. What a roller coaster. Right? What that can look like for other people though, like a lot of people describe this as a hollow feeling in their stomach, like a feeling of dread.

Some people just describe it as like a little bit of sadness, introspectiveness or they just get a little bit nervous and anxious. For some people it feels like shame. It can feel like irritability or anger. It can feel like hopelessness. And the hard thing for a lot of people is that in the first two weeks it is normal to kind of experience some baby blues. And a lot of those feelings come and go with these crazy hormonal changes, sleep deprivation.

So some people just don’t even see the pattern until it’s been happening for a couple of months. I wonder how much of this is actually related to unresolved trauma. Girl I don’t know. I think everything is kind of related to unresolved trauma, but I think that’s, that’s something that we don’t really think about our breasts as being triggers.

And then suddenly when you’re using your breasts every couple of hours to feed another human coupled with emotional exhaustion and hormone changes, it doesn’t surprise me per se, that something like this exists. Right. And the thing is like this has only very recently been recognized as a diagnosable condition in the medical community.

So we don’t have the information about who is at greater risk for this. We don’t even know how many people experience this. And you know, Heather and I, if you don’t know, we run a Facebook group that provides breastfeeding support and I made a post on this and we got some responses. Yeah. Let me read a couple of, yeah, yeah.

So one, one person said, does anyone else get a dysphoric feeling when pumping? Now that baby is at daycare, I have to pump so much and I get really sad. I don’t get that feeling at all when breastfeeding. Right. And you know what, like we just don’t know if that is, if that’s something that is beyond this one person’s experience with what sounds a lot like D-MER, or if this happens a lot to people. You know, if their dopamine levels are different when they’re pumping versus breastfeeding, right.

When they’re not having that beautiful skin to skin oxytocin response with baby. Yeah. I mean, and when you posted that, we even had a comment from somebody that said, thank you for this post. Always thought it was strange that my let down triggered feelings of anxiety and irritability. Right? Yeah. You know, like, I feel like, you know, we’re told us providers like normalize everything, but I just, I, you know, with things like this, I want to say.

No, this is not the normal experience and yes, you can, you can do things to change this. And then another comment we had was somebody that said that every time they breastfeed, they have to close their eyes because they can’t stop looking around at the room and seeing what needs to be cleaned or organized.

Right. That’s anxiety. Right. That’s high-level anxiety. Very few cases of this have been officially diagnosed. And, you know, most people who experience this simply decide to ween because breastfeeding makes them feel horrible and they just don’t talk about it with their provider because maybe they don’t have a supportive environment.

Oh, yeah with their partner, like how, how is it for a partner to see you crying every single time you breastfeed? Like eventually your partner’s just going to be like, Hey, maybe this isn’t good for you. And let me just say, if you decide to ween because you have a dysphoric milk ejection reflex, that’s okay.

Yeah, I don’t want you to feel any shame for that. But if you have made the decision where you do not want to ween, you also don’t have to just suck it up and deal with it. Medications that increase dopamine levels are sometimes effective. Cognitive behavioral therapy is sometimes effective. Lifestyle changes, herbal supplements, cutting down caffeine, improving the health of your body, exercise, exercise, all of that can help.

If you want to keep breastfeeding with D-MER, I think that’s all worth a try. Absolutely. Yeah. I think anytime you have the option to feel better, like why not? Right. Right. Absolutely. And you know, I’m going to make sure that we post some resources and sources of this information in the show notes, because they’re very few but more informative than this.

And you know what, like, I want to hear from you guys. If you’re listening to this and you were like, Holy crap, I have D-MER. Tell us about it. Tell us what it feels like for you, because I think more people need to hear what that feels like. Right? I mean, if nothing else, this podcast should be able to tell you you’re not alone.

Yeah. You know, this thing that you’re experiencing by yourself, 8 to 10 times a day is horrible. Also, you are not isolated. Like there are other people going through this and we want to hear from you and we want to make sure that D-MER is something that’s talked about. So please remember that there’s another option and that we’re here for you.

Yeah, absolutely. You know, like, I wish I had known you when I was breastfeeding, Heather. It would have been so different. Well, now you guys all know us sort of, so please, you know, talk to us, email us, and we’re here for you guys. If you have, if you’re also thinking like, wow, I love these episodes. I want to hear about blank.

Email it to us. Oh yeah. We love ideas. Yeah. And we’ll do an episode on it, for sure. If we don’t know anything about it, we’ll research it and then we’ll do an episode about it. Absolutely. Yeah. All right. I need a snack. Okay, bye guys. Bye.

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