As a mother, I enjoyed tandem breastfeeding my toddler and child…most of the time. Toward the end of the weaning process, I began to struggle when my toddler fed at the breast, especially when he would “tweak” my other nipple. It started as an itching sensation in my mouth and a resentful rage in my stomach that would build until I felt forced to unlatch him. Upon ending the feeding at the breast, I would experience immediate relief from these symptoms. However, I was left with feelings of guilt and confusion, wondering what was wrong with me. I consulted both my healthcare provider and the Internet, but there was no information available at that time; it was seemingly a dark side in the field of lactation that no one wanted to admit to or discuss. Years later, researchers are only beginning to study mothers’ antidotal reports, shining a light on what is now known as Dysphoric Milk Ejection Reflex (D-MER) and Breastfeeding/Chestfeeding Aversion and Agitation (BAA).
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” (D-MER.org, 2019). Before the initial and/or subsequent letdown(s) and subsiding shortly after milk ejection(s), parents affected by D-MER have described symptoms such as hollow feelings in the stomach, anxiety, sadness, dread, introspectiveness, nervousness, anxiousness, emotional upset, angst, irritability, hopelessness, and general negative emotions (D-MER.org, 2019). The onset of D-MER symptoms may be mild to severe, occurring within the first two weeks postpartum, with its duration lasting within three months postpartum or until weaning (D-MER.org, 2019). Although lacking in research, theoretical causes of D-MER, which is thought to be a physiological response to milk release, include a decrease in dopamine, a nutritional deficiency, and/or an environmental effect (D-MER.org, 2019). Current treatment options include educating parents about D-MER, tracking environmental triggers, making lifestyle changes such as hydration, nutrition, exercise, and rest, and/or obtaining a prescription to address dopamine levels (D-MER.org, 2019).
Breastfeeding/Chestfeeding Aversion and Agitation
BAA “is a phenomenon that some breastfeeding mothers experience, which includes having particular negative feelings, often coupled with intrusive thoughts when an infant is latched and suckling at the breast” (Yate, 2017). During the entire duration of a feeding at the breast/chest and subsiding shortly after unlatching, parents affected by BAA have described symptoms such as anger, rage, agitation, irritability, skin crawling, itching, wanting to unlatch the child, wanting to throw the child off, guilt, shame, confusion, and wanting to maintain breastfeeding/chestfeeding (Yate, 2017). The onset of BAA symptoms may be mild to severe, occurring at anytime, with its duration lasting once, intermittently, or ongoing (Yate, 2017). Although lacking in research, theoretical causes of BAA, which is thought to be a physiological and psychological response to breastfeeding/chestfeeding, include an increase in cortisol, a hormonal adjustment during postpartum, menstruation, or subsequent pregnancy, a nutritional deficiency, sleep deprivation, breast/chest or nipple pain, and/or breastfeeding/chestfeeding past infancy (Yate, 2017). Current treatment options include educating parents about BAA, ensuring proper position and latch, participating in psychosocial interventions such as individual and group support, tracking environmental triggers, making lifestyle changes such as hydration, nutrition, magnesium supplementation, exercise, self-care, distraction, and rest, and/or obtaining a comprehensive hormone panel to address hormone levels (Yate, 2017).
D-MER, BAA, and the CAPPA Certified Professional
Although it is outside the scope of practice of a CAPPA Certified Professional to give medical advice, it is important to be aware of D-MER and BAA and stay current on new published research. If clients express negative symptoms or feelings during letdowns or breastfeeding/chestfeeding, refer them to their healthcare provider for diagnosis and treatment. It is also appropriate to provide them with evidence-based resources such as www.D-MER.org and www.breastfeedingaversion.com. In addition, encourage them to join online support groups such as Dysphoric Milk Ejection Reflex (D-MER) Support Group from d-mer.org and Aversion Sucks! Breastfeeding Aversion peer-to-peer support. Future research is still needed to better understand the causes of D-MER and BAA with the goal of treating these conditions. In the meantime, clients diagnosed with D-MER and BAA can find relief and hope, choosing to continue breastfeeding/chestfeeding and avoid early weaning with proper education and support.
- What is Dysphoric Milk Ejection Reflex? (2019). Retrieved from https://d-mer.org
- Yate, Z. M. (2017, Nov-Dec). A qualitative study on negative emotions triggered by breastfeeding; describing the phenomenon of breastfeeding/nursing aversion and agitation in breastfeeding mothers. Iranian Journal of Nursing and Midwifery Research, 22(6): 449–454. doi: 10.4103/ijnmr.IJNMR_235_16.
CAPPA Faculty Ed.D, CPBF, CPFE, CCCE, CCTE, CLE®, CAPD, CLD, CPD, CHT, BPC, IBCLC, DSIII, RMT
Katrina Fuller is the owner and manager of Natural Nesters, providing pregnancy, childbirth, postpartum, and breastfeeding education, support, and integral therapy services in Hobbs, New Mexico since 2008. She also serves as the New Mexico CAPPA Childbirth and Lactation Educator Faculty Member, New Mexico Breastfeeding Task Force – Lea County Chapter Chair, and New Mexico Lead WIC Breastfeeding Peer Counselor. Katrina has a bachelor’s in Elementary Education, master’s in Curriculum and Instruction, and doctorate in Teacher Leadership. After attending a breastfeeding peer counselor training, she was inspired to obtain certifications as a Prenatal Bonding Facilitator; Pregnancy Fitness, Childbirth, Teen, and Lactation Educator; Antepartum, Labor, and Postpartum Doula; Lactation Consultant; Community Health Worker; Developmental Specialist; and Reiki Master. She strives to utilize her background in education to teach classes for families, facilitate trainings for professionals, and contribute to the body of current, evidence-based research. Katrina is happily married with three children, having experience as a single, teenage mother; married, stay-at-home wife; and work-at-home tandem nurser. To contact her, please visit www.naturalnesters.com or email firstname.lastname@example.org.