About the Speaker

Alia Macrina Heise has worked in the field of lactation since 2004. She is considered the international authority on the topic of dysphoric milk ejection reflex (D-MER). She has been the forerunner in identifying, naming and investigating the anomaly of dysphoria with milk ejection reflex since 2007. She has spoken on the subject at many notable conferences, including GOLD, has given several interviews on the subject for both print and podcasts and has been published through her work on a case study about D-MER for The International Breastfeeding Journal. In 2017 she released the first book on the subject. Alia’s passion and enthusiasm for the topic of D-MER are evident in the energy that she demonstrates in her presentations and the novelty of new information on a subject that is not yet well known or understood by many makes for an engaging and interesting presentation.

Official Bio for Brochure

Alia Macrina Heise is not only an expert on the topic of dysphoric milk ejection reflex (D-MER), but she is a former sufferer of the condition, herself. She has been in the field of lactation since 2004 and the topic of D-MER has been her sole pursuit since 2007 when she first identified and named the condition. Her passion is to bring more understanding of the condition to mothers and health care providers, as well as to spread awareness and education on the subject.

Bio for Introduction

Alia Macrina Heise has been working in the field of lactation since 2004. Her most notable publication, D-MER: A Case Study, was co-authored with Diane Wiessinger and appeared in the International Breastfeeding Journal. Alia is considered to be the first authority on dysphoric milk ejection reflex and she has been speaking about D-MER since it was first named and defined in 2008. Not only a former sufferer of the lactation anomaly herself, she is also the webmaster of d-mer.org and an active author and speaker on the subject. She works closely with mothers around the world who are suffering with the condition in order to support them and to better understand the variance of the experience. She is also in frequent contact with other professionals in order to spread awareness and to support further research and investigation into the subject. Outside of her work with D-MER, she is also in private practice as an IBCLC in the Finger Lakes region of New York. She lives in a small rural town where she enjoys country living with her three children.


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/
Download CV


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.