Tag Archive for: breastfeeding

Understanding D-MER: When Breastfeeding Triggers Unexpected Emotions

Authors: Nicole Woznicki, Women’s Health Nurse Practitioner | Editors: Romina Garcia de leon, Janielle Richards (Blog Co-Coordinators)  | Expert Reviewer: Magdalena Martínez García

Published: May 9, 2025

The postpartum period is full of choices a mom must make for her new baby. One of these choices is whether they want to try breastfeeding. The World Health Organization (WHO) and the American Academy of Pediatrics (AAP) recommend exclusive breastfeeding for the first six months of life, with the introduction of appropriate complementary nutrition starting around six months postpartum, and continued breastfeeding up to two years or beyond. Some mothers would like to adhere to this recommendation but encounter challenges that hinder them from doing so. Among these challenges is dysphoric milk ejection reflex (D-MER), an under-recognized condition affecting an estimated 15.4% of breastfeeding mothers.

What is D-MER?

D-MER  is a neuroendocrine condition that causes sudden, intense negative emotions and physical symptoms that occur during milk letdown, whether from breastfeeding, pumping, or spontaneous expression. These symptoms can include, but aren’t limited to:

  • Anxiety 
  • Depression 
  • Hopelessness 
  • Anger
  • Agitation
  • Irritability
  • Homesickness 
  • Intense feelings of dread
  • Nausea
  • Extreme food aversion 

These feelings typically dissipate minutes after the milk ejection reflex begins. While some women experience D-MER throughout their entire breastfeeding or pumping journey, some report that these symptoms decrease in severity or go away entirely around three months postpartum. 

What are the risk factors of D-MER?

In a survey of nearly 1500 lactating mothers, the following were found as risk factors for developing D-MER:

  • Having postpartum depression 
  • Having the baby blues 
  • Having a reported mental health disorder prior to pregnancy

What causes D-MER?

Unfortunately, there hasn’t been enough research on D-MER to know what causes this condition. Several hypotheses suggest that a hormonal imbalance occurs during the milk ejection reflex, also known as milk letdown. Prolactin, the hormone responsible for milk production, is released in response to an infant’s suckling or stimulation by a breast pump. This release depends on the suppression of dopamine, a hormone closely linked to feelings of pleasure and reward. This has led researchers to believe that the sudden drop in dopamine during the milk ejection reflex may be what triggers the intense negative emotions reported by mothers experiencing D-MER.

The effects of D-MER on the mother

D-MER can have substantial adverse effects on the mother’s mental health. Many mothers report feeling disappointment in themselves, shame, worthlessness, and guilt. Some of these mothers even experience suicidal ideation or thoughts of self-harm or harm to others.  

D-MER has been known to disrupt the bonding experience between mother and infant and may lead some mothers to stop breastfeeding. Some women quit altogether, and some women may reduce the frequency of breastfeeding or pumping in an attempt to minimize these feelings. The latter has the potential to cause a decrease in their milk supply, leading to increased stress and/or breastfeeding cessation. 

Is there a treatment for D-MER?

D-MER is not well researched; therefore, there is no medically proven or approved treatment. Anecdotally, some women have found some symptom improvement with the use of bupropion, an antidepressant, and pseudoephedrine. Some research suggests that lack of sleep, stress, and caffeine can make the symptoms of D-MER worse. Other research indicates that exercise, staying hydrated, and having a diet with protein can also help improve this condition. 

Clinical recommendations and considerations

Education is crucial for supporting women with D-MER, and it’s essential for any healthcare professional working with postpartum women to be informed about the condition. This includes, but isn’t limited to, OB/GYNs, nurses, lactation consultants, and mental health providers.

By educating more healthcare professionals, we can better inform new mothers. Teaching women about this condition has already proven to be an effective intervention. It can be helpful for these mothers to hear that there is nothing wrong with them and that this is a physiologic reaction they cannot control. 

It is also crucial for providers to be able to distinguish D-MER from postpartum depression to ensure appropriate diagnosis and treatment. While both conditions may present with similar symptoms, such as feelings of sadness and anxiety, the pattern and duration of symptoms differ significantly. D-MER symptoms occur exclusively during milk ejection reflex and typically resolve within minutes, with women maintaining normal mood between breastfeeding or pumping sessions. In contrast, postpartum depression is characterized by persistent symptoms that occur throughout the day, independent of breastfeeding activities. This distinction is crucial, as misdiagnosis can lead to inappropriate treatment approaches and delayed care. However, it’s important to note that these conditions can coexist, and the presence of one does not exclude the other.

D-MER remains a largely under-recognized condition, yet it has profound effects on the emotional and physical well-being of mothers during the postpartum period. By increasing awareness and understanding of D-MER among healthcare professionals and new mothers alike, we can help reduce the feelings of confusion, guilt, and shame that many women experience. 

 

*If you are experiencing D-MER and need support or want to learn more, visit d-mer.org, a website created by Alia Macrina Heise, the lactation consultant who first identified the condition in 2007. You can also contact your healthcare provider or a lactation consultant for personalized support.

 

How to Set Yourself and Baby up for Breastfeeding Success During COVID-19

 

Author: Carrie Miller, Ph.D., RN, CNE, CHSE, IBCLC, Seattle University-College of Nursing | Editors: Negin Nia, Arrthy Thayaparan (Blog Coordinators), and Kiranjot Jhajj (Blog Reviewer) 

Published: May 6th, 2022

We exist because someone fed us when we were born. In the beginning of our lives, our caregivers make the best decisions possible on our behalf. A newborn is influenced by the environment that they are born in, and COVID-19 can impact that, whether they like it or not. So, how can the breastfeeding relationship thrive as we continue to battle the COVID-19 pandemic? 

Birth Practices

The goal is for labour to be as safe as possible for the birthing parent and the baby. No matter how delivery occurs, it is essential there is time for the baby and parent to bond, feel safe, and protected. Birth practices vary globally, and giving birth is intimate, personal, and remembered forever. Hospital and Birthing Center policies are intended to protect and maintain safety, but we have to carefully consider the impact of these practices. 

In March 2020, COVID-19 was declared a pandemic. Birthing parents were isolated without adequate labour support because of fear of transmission. Parents and newborns were separated if the parent was COVID-19 positive or suspected to have the virus. Hospitals and Birth Centers scrambled to change policies out of safety concerns. COVID-19 policies removed trusted support from the labouring person’s side and reduced their ability to be part of the overall decision-making process.

There are four tenets any parent needs to consider before giving birth: being able to know what to expect during labour and delivery, having trusted support persons in attendance, being cared for by skilled and competent caregivers, and being part of the decision-making process. So, what is essential to get breastfeeding off to the best start with COVID-19 around?

Golden Hour

The first moments of life set the tone for the next several days, weeks, and months. The Golden Hour is when a medically stable infant is placed on the birthing parents’ chest right after birth. Throughout Golden Hour, a newborn will self-regulate heart rate and respiratory rate and stay warm against a birth parents’ chest. The first feeding at the breast can also take place during this time. During the height of COVID-19, babies were separated from their birth parents if there was a confirmed or suspected diagnosis. 

If a parent is COVID-19 positive, an infant can still be placed on the birthing parent’s chest if the parent is well enough. Currently, the Centers for Disease Control and Prevention recommends being masked if an infant is placed skin-to-skin.The American Academy of Pediatrics recommends maintaining normal couplet care [parent-infant dyad] with confirmed or suspected COVID-19 status. However, policies are constantly changing given the evolving knowledge around COVID-19.

Breastfeeding

The current recommendations recognize the importance of providing human milk to infants during COVID-19. The World Health Organization’s current recommendation is to initiate breastfeeding no matter what the COVID-19 status is. The Centers for Disease Control and Prevention reports breastmilk is not likely to spread the virus to infants. If a lactating parent chooses to breastfeed, handwashing and wearing a mask is strongly recommended. 

Furthermore, if a parent chooses to provide pumped milk, a trusted caregiver should provide the pumped milk to the infant if the lactating parent is COVID-19 positive. Parents can also discuss options with caregivers about protective practices. These include having someone help to care for the infant if needed, rooming-in with the infant, using good handwashing, wearing a mask when providing care to the infant, and staying six feet away whenever possible.  

The possibility of transmitting COVID-19 through breastfeeding is uncertain. However, multiple studies such as ones by the American Academy of Pediatrics and Reproductive Health Journal suggest that the risk is low. The science also reveals that the benefits of breastfeeding outweigh the risk of not breastfeeding. Breast milk provides antibodies to protect a newborn against disease. The first feedings with colostrum establish the immune system, which is what protects the baby from the beginning well into childhood and ultimately adulthood. Colostrum contains the key immunologic components to establish the immune system and gut as it is rich in protein and nutrient-dense. 

The first feedings to the newborn are small. The newborn has a tummy the size of a cranberry for the first few days, so a teaspoon can be a full feeding on day one. By day three of life, the newborn has a tummy as big as a ping pong ball and can most likely take about an ounce in a feeding. A newborn does not eat on a schedule either, so one must watch for feeding cues. A newborn may eat 6 to 8 times on the first day and may want to eat 12 times on the second day. 

So, what can you do if a birthing parent needs to be separated from a newborn? Well, you can hand express or pump breastmilk. Even if you are COVID-19 positive, your colostrum and breastmilk are essential for a baby to have a good start. 

Conclusion

A nourished newborn sets the tone for the future. Providing colostrum and human milk to an infant can create a pathway to a healthy start. The journey may be different than planned, but having a solid start is possible, no matter the circumstances. Even with COVID-19, the breastfeeding relationship can thrive if you take the right steps.