Dysphoric Milk Ejection and the Breastfeeding Mother

Time-frame: Can be tailored to 45-90 minute timeframe
CERP: yes

Dysphoric milk ejection reflex (D-MER), is not a new phenomenon. In the past, it was almost like Voldemort, the Problem That Must Not Be Named. But for over 10 years now, it has had a name and been brought into daylight. Though still not widely known or understood by many, the hypothesis of the mechanism and possible sustainable solutions are becoming better documented all the time. D-MER has been the subject of two case studies, one case series, and a qualitative research study. Two other studies as also in process at this time.

Mothers with D-MER feel, as a reflexive response with every single milk release, a wave of negative emotions ranging (depending on severity) from homesickness to hopelessness and despair, perhaps even anger and suicidal ideation.  These emotions dissipate shortly after milk release and reoccur with the start of every MER, whether with breastfeeding, expressing or with spontaneous releases. Many sufferers keep the problem to themselves preferring the weaning of their baby to being incorrectly labeled as depressed or victims of abuse. Upon experiencing D-MER mothers are initially convinced the problem is physiological and not psychological, and they are correct.

 As both a lactation consultant and a sufferer of D-MER, I first named and identified D-MER over 10 years ago. Now, through the case studies that have been done, collaboration with other medical and breastfeeding care providers, and the collection of information from the anecdotal reports from over 1,000 mothers, there is now a foundation of understanding of D-MER. Though the evidence base for D-MER is still mainly unestablished at this time, there are many professionals always working to bring evidenced-based information to the study of human lactation. This is exactly what the slow work and understanding of D-MER is about; the process of bringing new information into the light for further research and understanding.

In the PowerPoint presentation that I have to present, I discuss how D-MER presents,  its tell-tale manifestation, and its spectrum and intensities. The presentation also explains the currently proposed mechanism of the MER anomaly, how health care providers can identify a mother it D-MER and how to help and support mothers with the condition. 



Alia Macrina Heise


Country: United States
Phone number: 585-500-9435
Email: info@d-mer.org
Site: https://d-mer.org/
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Publications

Dysphoric milk ejection reflex: A case report

Dysphoric Milk Ejection Reflex (D-MER) is an abrupt emotional “drop” that occurs in some women just before milk release and continues for not more than a few minutes. The brief negative feelings range in severity from wistfulness to self-loathing, and appear to have a physiological cause. The authors suggest that an abrupt drop in dopamine may occur when milk release is triggered, resulting in a real or relative brief dopamine deficit for affected women. Clinicians can support women with D-MER in several ways; often, simply knowing that it is a recognized phenomenon makes the condition tolerable. Further study is needed.

Before The Letdown: Dysphoric Milk Ejection Reflex and the Breastfeeding Mother

Dysphoric Milk Ejection Reflex (D-MER) is a condition affecting lactating women that is characterized by an abrupt dysphoria, or negative emotions, that occur just before milk release and continuing not more than a few minutes. Before The Letdown is eleven chapters of information for mothers looking for support and understanding, for care providers who want to know how to best support their patients and for partners and family members who want to know how to best support a mother with D-MER. The book is written by Alia Macrina Heise, IBCLC who has been the forerunner in discovering and identifying D-MER since 2007. It includes a preface by internationally renowned lactation author and presenter, Diane Wiessinger, MS, IBCLC and is edited by Dr. Marcelina Watkinson, DClinPsy who did the first qualitative research study on D-MER.