Breastfeeding is often the first word that comes to mind when someone talks about motherhood. Elders often advise nursing mothers to start nursing the infant as soon as possible. They also say that it is very easy and comes naturally. Unfortunately, the journey of breastfeeding can be difficult for many.
Dysphoric Milk Ejection Reflex or D-MER is considered a taboo, especially in India and it often goes undiagnosed. It is a condition wherein they experience negative emotions like sadness, dissatisfaction, anxiety, and restlessness while nursing.
What do the experts say?
“Symptoms vary from woman to woman,” says Dr Surabhi Siddhartha, Consultant Obstetrician & Gynaecologist, Motherhood Hospital, Kharghar. “The negative feelings can sometimes go away within 10 minutes of initiating feeding. Unfortunately, there is no test or method to confirm the diagnosis of this condition. One must consult a lactation expert to get a confirmed diagnosis,” she says.
“It is a serious and distressing issue, which should not be dismissed as postpartum,” says Trish Ware, Nashville, Tennessee-based labour and delivery registered nurse and birth coach.
Sometimes the feelings are mild like frustration, but in extreme cases, some women may experience severe negative emotions. Ware who is a mother of seven, says that the condition affects one’s self-esteem and women tend to feel worthless.
For Kerala-based psychologist and special educator Rachel Chackochen, the birthing sessions at Birthvillage in Kakanadu, Kochi, helped with her pregnancy, postpartum and lactation. “I attended birthing classes and the experts did mention this bit about anxiety while nursing but we got more information once we started consulting our lactation expert,” she says. “I don’t think women know that there is a term for this condition.”
“In India, everyone just worries about milk supply; no one cares about how the mother feels. I am sure that this is often misdiagnosed as postpartum depression,” says the breastfeeding mom. “It is a physiological reaction that causes a psychological response.”
Chackochen had experienced anxiety in her initial days of feeding. It lasted for a little over three weeks before subsiding gradually. “I was so worried about getting the latch right,” she says. “With proper guidance from a lactation consultant, one can resolve this low mood and anxiety while nursing.”
Ware of Tennessee also recommends approaching a lactation consultant early on during the gestational period and getting guided by experts on pregnancy, birthing and post-birthing.
According to Chackochen, cultural factors also make D-MER an undiagnosed condition in our country. “We had a close door policy till I was confident of letting others in, including my in-laws and relatives,” she says. “I feel this is often tagged (disrespectfully) by people.”
The dopamine factor
According to Dr Rita Bakshi, founder and in-vitro fertilisation specialist, RISAA IVF, Delhi, D-MER occurs because of inappropriate activity of the hormone dopamine that occurs whenever milk is released. “It is more of a physical rather than a psychological condition,” she says. “When women breastfeed, dopamine levels decrease for prolactin (a milk-producing hormone) levels to rise and for some women, dopamine drops excessively. Low dopamine levels can cause low mood and other negative emotional responses.”
Dr Bakshi stresses that D-MER is not to be confused with postpartum depression. “In depression, you experience symptoms of rage, sadness, irritability and despair most of the time while D-MER only occurs when milk is about to release, and usually lasts less than a couple of minutes, vanishing as quickly as it arrives,” she says.
Oxytocin and prolactin are the two hormones that are released in response to breastfeeding. “Oxytocin is responsible for ejection of milk,” says Dr Bakshi. Once oxytocin is released, it inhibits dopamine — a brain hormone and neurotransmitter that helps to boost and stabilise mood. Normally, dopamine drops properly, and breastfeeding mothers never notice anything, but in women with D-MER, it drops faster than normal, which causes a brief wave of negative emotions. The condition is temporary, and the dopamine levels bounce back when prolactin levels increase while feeding.
What should you do?
According to Ramya Ramachandran, Chennai-based registered dietician and certified lactation counsellor, and founder of Nectar Integrated Health Services Pvt Ltd, it is not only first-time mothers who go through this issue, and it does not become easy with consecutive births.
“Mothers are usually blamed for feeling low while nursing. This can cause more harm than good as mothers are silenced and made to believe that the feeling is normal.”
Ramachandran believes that good quality sleep and a strong support system are essential to overcome this condition. “Nursing mothers must be given the safe space to talk about their emotions as identifying the issue is important. There are many medical professionals who confuse D-MER with ‘breastfeeding or nursing aversion and agitation’(BAA). While D-MER is an abrupt drop in emotions just before milk ejection, BAA happens throughout the feeding session wherein women have an overwhelming urge to de-latch,” she says.
The intensity of the condition varies in different women. “Since it is not a visible condition, it is pushed off as imagination or a mere feeling sometimes,” Ramachandran says. “It is a purely hormonal condition but that does not mean it is not to be resolved. Mental health is also important during and after the gestational period. Women with D-MER have a spectrum of emotions — depression, anxiety and anger.”
He recommends following up after doctor visits, therapy right after birthing and consulting a lactation counsellor when experiencing warning signs like improper latching, bleeding and injured nipples.”
Spouses also play a major role when it comes to dealing with D-MER. “Accepting and acknowledging the issue is essential,” says Ramachandran. “Partners must listen to the nursing mothers and reassure them. Surely, lifestyle changes make a difference, especially correcting sleeping patterns, but talking and enabling the mothers to identify the problem helps to resolve it,” she says. She also suggests music therapy and staying away from caffeine for a little while during the postpartum phase to mitigate this issue.
Dr Siddhartha recommends skin-to-skin contact with the baby while nursing to alleviate the effects of D-MER. Such a bonding can lower heart rate and cortisol levels in mothers and infants. Meditation, focussing on breathing and even soaking feet in warm water also reduce stress and relax the body.
NIMHANS psychosocial support and mental health services (PSSMHS) Helpline – 080 – 4611 0007
AASRA – 91-9820466726. 022-27546669
Sneha (Chennai) 044-24640050
Sumaitri (Delhi) 011-23389090
Cooj (Goa) 0832-2252525
Jeevan (Jamshedpur) – 065-76453841
Pratheeksha (Kochi) – 048-42448830
Maithri (Kochi) – 0484-2540530
Roshni (Hyderabad) – 040-66202000
Lifeline (Kolkata)- 033-64643267