D-MER {No, You Are Not Crazy}

by Birth Without Fear on March 27, 2013

Newborn Nursing

We all hear about the joys of breastfeeding. The bonding, the flow of love hormones, and the feeling of accomplishment that often comes to mothers upon reaching goals. Breastfeeding can be tough the first weeks of your baby’s life (or longer), but after that it is smooth sailing right?

This promise of positive emotional connections to breastfeeding is true for the majority of women who breastfeed. But there is a small population of women who experience just the opposite – for seconds to minutes – every time their milk lets down. It is not a physical sensation (such as nausea or pain, which can happen with strong letdowns) and it is not a psychological reaction to breastfeeding (not an aversion or part of PPD or baby blues). It is also not related to past abuse or history. It is a purely hormonal response that is independent of any other stimulus.

D-MER stands for Dysphoric Milk Ejection Reflex.To break that down – you get a feeling of dysphoria (negative emotions) just as your milk “ejects” (lets down) and it is a reflex – meaning the mother cannot control this. It can come in degrees – from feeling disconnected to feelings of self-loathing. There is also a spectrum of types of emotions the mother can feel – which are fully explained here.

So what causes D-MER in the first place? Preliminary studies suggest that the natural drop in dopamine at the start of a feeding, which happens so that prolactin can rise, is sharper in women with D-MER. Dopamine is the mood “stabilizer” of our bodies and prolactin is the hormone mainly responsible for milk production and let down. Normally, this small drop in dopamine is never noticed by mothers and it stabilizes again a few moments after the initial let down of milk. But in D-MER mothers the drop is larger, faster, and noticable in the wave of emotions that wash over them right before and as the milk lets down but quickly dissipates as the milk begins to flow.

Nursing d-mer

The treatments, both natural and medical, are based on the assumption that the dopamine drop is the cause of D-MER. Some of the treatment suggestions include:

  • Education – many times a woman with mild or moderate D-MER is able to manage the episodes better simply by knowing what is happening and that they are not “crazy”. Mild to moderate cases also tend to resolve on their own within 3-6 months.
  • Tracking your episodes. How often do you have them, and what were you doing before the feeding or let down? Does pumping effect you the same as feeding at the breast? Do you get D-MER with spontaneous let down (you know, the kind where you hear a baby cry in the store or watch a sappy commercial). Things like stress or dehydration can also aggravate the condition, so it is important to note those in your log.
  • Herbs used to treat D-MER: (ALWAYS consult with your care provider first)
    • Rhodiola or Golden Root: this builds dopamine in the body naturally and has a marked effect on D-MER.
    • Evening Primrose Oil: increases levodopa in the body, which converts to dopamine.
    • Ginkgo: helps with blood flow to the brain and may help dopamine flow better as well.
  • Supplements and Diet Changes:
    • B-Complex: B6 is needed for brain function and B-12 promotes dopamine activity in the brain.
    • Adding young Fava Beans to your diet – these contain high levels of levodopa.
    • Other foods which help dopamine production include chicken, turkey, almonds, oats, dark chocolate, yogurt, bananas and several others – full list here.
  • Placenta Encapsulation
  • Acupuncture
  • Distraction – find a way to distract yourself for the start of the feeding. Reading, TV, and talking on the phone, etc.
  • Exercise can naturally increase dopamine and receptors in the brain.
  • Prescription treatments options are available – see options and discussion here.

While there are a few published studies out, the full documents are not available online for free. In any case – the evidence in those studies and even more information is available on this wonderfully helpful site: D-MER.org

The newest edition of The Womanly Art of Breastfeeding has a section on D-MER (which is a great read for those who plan to breastfeed in any case). For those mother’s interested in herbal treatments for D-MER (with consultation from your care provider of course), the book The Nursing Mother’s Herbal by Shelia Humphrey is a great guide to start your research.

Reaching out to a support group, be it on Facebook or a local breastfeeding group is highly recommended as well. And above all – know that you are not “crazy” and you are not alone. You can get through this with support and love. Your choice of treatment, even if that means weaning, is one to research and approach with an open heart and armed with information.

Ashley Nursing

*Pictures shared by Anna M. and Ashley O. Do not copy or use images without permission.


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