Breastfeeding: D-MER & Postpartum Depression

Breastfeeding is most often referred to as a compassionate and affectionate experience. Its myriad benefits have emphatically been talked about an incalculable number of times.

Right from providing the exact nutrition a baby needs to supporting its immune system and promoting cognitive development, breastmilk is an undefeated contender. For the mother’s part, breastfeeding facilitates faster and smoother recovery from childbirth and helps them bond with their baby better.

This being said, breastfeeding is non-arguably the best decision a mother can make, right? Ask yourself again. Is it? What if breastfeeding doesn’t give a mother the best feeling? What if the ‘priceless’ baby food is costing the mother a lot on her part? 

The world always looks at breastfeeding through rose-tinted glasses. It’s time we shatter the glass and look beyond. 

Breastfeeding Dysphoria

While most mothers share a warm breastfeeding experience with a few nibbles and bites along the journey, some cannot help but get saddened by it.

Breastfeeding to the latter group fills them with negative emotions. They get a gush of nonconformist feelings right before they let their milk down. These mothers suffer from Dysphoric Milk Ejection Reflex (D-MER). 

To start with, D-MER is a physiological reaction and not a psychological response. This means it’s a bodily reflex and has nothing to do with the mother’s mind or her feelings toward her child.

D-MER is a condition wherein a mother experiences an array of negative emotions right when her milk ‘ejects’, ranging from mild to severe. She may feel wistful, hopeless, angry, irritable, sad or indulge in self-loathing.

In extreme cases, symptoms may include panic, anxiety, paranoia, dread or suicidal thoughts. These symptoms start within a few seconds and can last up to 10 minutes. Some women experience D-MER for initial few days, some for a few weeks or months, while for some, it lasts the entire breastfeeding period.

Understanding D-MER

Experts link D-MER to an unusual drop in oxytocin levels. Yes, it’s the same ‘love hormone’ that helps a mother bond with her child! Oxytocin begins to be released almost immediately as the milk is let down (suckled by the baby or pumped out) and is released in small pulses for the first few minutes before prolactin takes over.

This oxytocin release inhibits dopamine, the ‘happy hormone’. In general cases, dopamine drops in a regulated manner but in women with D-MER, it drops faster than normal causing a brief wave of negative emotions. However, dopamine levels come back to normal once prolactin replaces oxytocin and thus the effects of D-MER recede. 

Unfortunately, there’s no formal diagnosis for D-MER which also says that there is no approved medication to treat it yet. However, most often, the mere acknowledgement that one is experiencing D-MER makes it easier to endure. Talking to a lactation specialist may also be helpful. There are a few coping techniques as well that may work favourably for perplexed mothers. 

Coping With D-MER

We understand how harrowing it can be for a mother who decides the best for her child and then realises she has D-MER. We just want you to know that you’re not alone.

Around 9 per cent of nursing mothers suffer from D-MER. There’s nothing that you could have possibly done wrong to cause this and this condition has nothing to do with how you feel about your baby. 

Here are a few ways you can reduce the effect of D-MER. 

1. Skin-to-skin contact

Dysphoric milk ejection reflex is also fuelled by a stress hormone called cortisol. Skin-to-skin contact reduces cortisol levels and stabilises the heart rate which helps counterpoise the negative reaction with positive emotions.

2. Mindfulness 

Mindfulness helps one focus on breathing and themself at the moment. This turns the discomfort into perspective especially when they know it’s only a matter of a couple of minutes. Deep breathing, chanting of mantras or meditation can relieve stress and override negative thoughts. 

3. ABC Technique 

The ABC technique is all about D – Distractions. Pick a broad category of things and/or objects like food, cars or actors and make an alphabetical list in your head.

For example, a food list would be something like an apple, burger, cake etc. If the anxiety comes back when one reaches ‘z’, start over with a new category. 

4. Relaxation Methods

Try relaxing the mind by soaking the feet in warm water or listening to music. Reading can also help some people distract themselves while for some talking over the phone keeps their minds off the breastfeeding process. 

5. Supported Surrounding

Being around our friends and family helps us feel better in general. Thus, a supportive environment with loved ones who understand the condition can help one put up with the distressing emotions. 

With D-MER as an example, we realise how a mother chooses to feed their baby can affect their mental wellness. Breastfeeding can have a positive or negative effect on mental health.

For instance, mothers who feel negative emotions while breastfeeding their babies, most often than not, blame themselves. Similarly, meeting breastfeeding goals can make them feel great but struggling to keep up the supply in case of a growth spurt may trigger self-doubt. Breastfeeding also has a complex relationship with postpartum depression. 

Depression Postpartum 

Postpartum depression (PPD) is a form of depression suffered by parents following the birth of their baby. Look at it this way, while the symptoms of D-MER are restricted to milk let down, those of PPD are persistent and last longer than baby blues. 

Baby blues is the brief period after childbirth where the mother experiences bouts of sadness, anxiety and mood swings and feels overwhelmed by everything around.

It is experienced by almost 80 per cent of mothers but thankfully doesn’t last more than 2 weeks. If the symptoms continue over 2 weeks, there are chances that one suffers from PPD. 

While some symptoms of PPD are the same as that of depression some are centred around the baby. 

Symptoms of PPD

• Severe mood swings
• Anxiety and irritability
• Unreasonable crying and sadness
• Change in appetite
• Trouble sleeping or insomnia
• Fatigue
• Feeling helpless or worthless
• Feeling unattached or unbonded from the baby
• Lack of interest in affairs of the baby
• Feeling distant from friends and family
• Suicidal thoughts
• Harmful emotions towards the baby or oneself

Postpartum depression is a serious health condition and can be caused due to a number of reasons like past trauma, distance from the spouse, hormonal imbalance, fear related to the newborn’s health etc. It is closely linked to maternal intention and the ability to breastfeed as well.

According to a study,  mothers who wanted to and could have the lowest rates of PPD, while those who wanted to breastfeed but weren’t able to have the highest. Postpartum depression may also contribute to a mother deciding to stop breastfeeding earlier than planned to find themselves caught in a negative loop. 

As in the case of D-MER, a mother suffering from PPD must be conscious that it’s not her fault. To understand this depression better, read this article on the causes of postpartum depression, its implications and ways to tackle it.

Breast Feeling?

Motherhood is shown to be synonymous with bliss and everything nice but it’s high time we admit that it’s only half truth. As seen above, it can and does take a toll on one’s mental health.

It’s time we make amends. It’s time we let the mother decide if breastfeeding is really the happy experience she has been told about. It’s time we let her express how she feels when she breastfeeds. It’s time we stop speaking for her and instead listen to her story. It’s time we don’t talk about what should be but rather focus on what is.