What is D-MER and How Can I Manage It?

A woman breastfeeds with D-MER

If you’ve ever felt a rush of intensely negative emotions right as your milk lets down, you’re not alone. This experience can be so disorienting, especially since we often think of breastfeeding as a calm, loving experience, but there are plenty of reasons that a mom might be stressed out about nursing – D-MER can make it even harder.

What is D-MER?

D-MER stands for Dysphoric Milk Ejection Reflex, a clinical condition that causes breastfeeding mothers to experience strong negative emotions as their milk lets down. This can be anything from intense sadness to self-loathing or anger.

Though you might think D-MER would be linked to postpartum depression or postpartum anxiety – after all, they all involve negative feelings during the postpartum period – it’s actually unrelated. There hasn’t been enough research done yet to know exactly why D-MER occurs, but experts suspect it’s linked to hormones and is a physical response rather than a psychological one.

Breastfeeding releases oxytocin, which triggers your milk to begin flowing. However, oxytocin has another effect: it lowers your levels of dopamine. Occasionally, some people’s dopamine levels drop so fast it causes sudden, strong negative emotions. Once the oxytocin levels return to normal, your mood stabilizes – usually within a few minutes.

D-MER vs breastfeeding aversion

While somewhere between 5% and 9% of breastfeeding moms have D-MER, even more – anywhere from 15-20% – experience breastfeeding aversion. Breastfeeding aversion and agitation (BAA) is different from D-MER in two main ways:

  1. While D-MER occurs only during milk letdown and often passes within two minutes, BAA can last for the entire feed.
  2. Unlike D-MER, breastfeeding aversion can be a psychological or physical response to a range of triggers around nursing, from physical pain in the nipple to the psychological stress of sensory overstimulation.

When will it go away?

In most cases, D-MER gradually eases over a few months as the mother’s body adjusts to the hormonal shifts in her nursing body. There have been cases of women experiencing D-MER for the entirety of their breastfeeding journeys, but those cases are outside the norm.

How to manage the symptoms of D-MER

Unfortunately, there’s no clear and easy treatment for D-MER, but that doesn’t mean you’re powerless against it.

If your symptoms are severe or you’re just not feeling up to continuing to breastfeed, you can also switch to formula – remember that however you’re able to keep your baby fed and healthy is the right way, and your experience is part of that equation. If you’d like to keep nursing, though, here are a few tips for coping with D-MER:

  1. Prioritize skin to skin contact. During breastfeeding, strip your baby down to their diaper and remove your shirt so your skin can touch theirs. This contact lowers cortisol levels in both mothers and babies and has a calming effect on your nervous system. You can also do skin to skin outside of nursing sessions to help increase your bond with your baby.
  2. Distract yourself from the feeling. Listen to an audiobook, watch TV, or have a conversation with your partner while breastfeeding. Distracting your mind can help you get through the letdown response more easily (and make it feel faster). 
  3. Work on relaxing your body and mind during and outside of nursing sessions. In addition to adding things like meditation, soothing baths, and massage to your day, try removing things that can make anxiety and stress worse, like caffeine or isolation. Focus on hydrating and nourishing your body as well as improving your mental health – the more regulated your nervous system, the easier it will be to cope with D-MER.

D-MER and breastfeeding aversion can make postpartum life so much harder, but we can help. At Prospera, our mental health coaches are trained in cognitive behavioral therapy (CBT) techniques, which are super effective for anxiety, depression, and anger issues. 

If you could use some support (and who couldn’t?), why not give us a try? Book your free consultation today.

Content reviewed by Dr. Sarah Stanger, Clinical Psychologist

Anne Godenham is a writer and editor with a passion for mental health awareness and accessibility