Feeling yucky everytime you breastfeed? You might have D-MER.

Written By Kristal Lau

You might have waited for the feeling of love and bliss when you nursed your baby only to be greeted by the complete opposite.

Panic. Hairs on the back of your neck stand up. A shiver down your spine. Feeling yucky. Horrible. Sometimes, even the tears come.

And you noticed this seems to happen right before the milk let-down happens. Every. Time. You. Nurse.

This is D-MER. Dysphoric Milk Ejection Reflex.

It’s a real physiological phenomenon that can severely affect the quality of life of many mothers and parents who choose to breastfeed.

August is International Breastfeeding Month and to honor that, MBRNPC board members Dr. Kristal Lau and Tiffany Jordan join us to share their personal D-MER experiences. Read on to learn what D-MER is and how to find help.

What is D-MER?

D-MER is a biological response to the milk release from the breast lactation glands. The negative emotions that come with every milk letdown tends to vary in intensity in the beginning. And the sensation usually lasts a few minutes.

D-MER is not part of postpartum depression or anxiety. It is not a mood disorder.

D-MER can affect any mother and parent who breastfeeds. Past and current medical and/or trauma history does not dictate who gets or doesn’t get D-MER. It isn’t a mother’s or parent’s fault that they have D-MER. (1)

Most importantly, D-MER is real and support must be given to mothers and parents so that they can pursue the breastfeeding journey and experience they desire alongside D-MER.

Tiffany’s Story

My kids are now eight and five and I can vaguely remember their sweet kicks and hiccups inside my pregnant belly, but I distinctly remember the physical and emotional feelings of my DMER symptoms.

In fact, when I verbally explain it to someone in conversation so many years later, my body still instinctively reflexes with squeezing my shoulder blades and pinching my shoulders up to my neck, closing the gap between my head and shoulders. I can feel the surge of emotion as I write this and realize that I survived a lonely, personal time battling something that required me to mentally fight over and over all day & night long in order to care for my son and family. I can only hope that my words and experience bring validation and clarity to those who need to read them because if you are experiencing D-MER, you are not alone.

For me, DMER was insidious and foreign. I first noticed something was “off” a few months into my breastfeeding journey with my oldest. Something automatic within my body brought on a yucky feeling just before I felt my milk letdown. By yucky, I mean physically yucky and emotionally yucky.

“Yucky” isn’t a scientific term, but it’s the best way I can describe my experience in those pre-letdown moments. I struggled with breastfeeding as a first-time mama so, perhaps, I was too distracted experiencing other physical pain to notice my DMER symptoms.

Or perhaps the onset simply took a little while, but I specifically remember one of the first times I noticed it happening I felt this odd physical feeling overcome me just before my milk letdown as I was in the private pump room after I had returned to work. (And by “private pump room” I do mean my commander’s office, which he allowed me to use when he was flying since our squadron had no other private space aside from a bathroom.) 

The best way I can describe this “weird feeling” is creepy goosebump-adjacent prickles on the back of my neck and along my thoracic spine. The kind that causes a reflex of squeezing your shoulder blades together, pinching your shoulders tight up to your ears, tilting your chin up to decrease your neck exposure, or like someone has their hand on the back of your neck and you are trying to make them stop. This physical feeling was coupled with an emotional hint of despair. And then it was over as quickly as it began.

“That was weird” I thought. And thanks  to my 15 spare minutes of a pump sesh, I googled what this could be and learned about D-MER. I learned that D-MER is not that common (only around 10% of lactating people experience it), can last many minutes for some women at each feeding/letdown, can happen whether breastfeeding or pumping, can have varying symptoms at onset and can be powerfully intense for some. DMER is so rare and not talked about that years later my therapist, who is also a mother, had to look it up when I explained my symptoms to her.

Since my symptoms occurred after my six-week check up, I was not under the care of my OB/GYN and I had no desire to bring this to the attention of my flight doctor (PCM). I worried that it would be classified on the spectrum of post-partum depression and as a flyer I would lose my wings and thus jeopardize my career. I brought it up to my husband, and he did his best to understand. Honestly, just telling him when it was happening took some of the intensity away.

Thankfully, my symptoms only lasted for a few moments with my first son. My symptoms eventually went away as I weaned and I never thought about it again. 

That is, until I had my second baby three years later. At feeding time in the early newborn days with my second child, the creepy feeling was back. I knew immediately what that remarkably familiar feeling was. This time around, it was more significant, coupled with more pronounced dark thoughts and feelings of despair.

By then I was a yoga teacher, so I did what I knew best in the moment: took a deep breath down to my belly, and waited for it to pass. I noticed by the time I took 2-3 deep breaths; the yucky physical and emotional feelings were over. Then my milk would come in for the feeding session.

This happened every feeding session, and when a new (or new again) mom is in the newborn phase, this is approximately every three hours or eight times in a 24-hour period. Morning, noon, and night over and over I had to face this demon in order to feed my son.

I tuned more into my DMER with my second because my symptoms were stronger and I noticed them sooner in my post-partum period than with my first. It was like an equation: a physically creepy feeling in my neck/upper back + dark and twisty thoughts = here comes my milk.

Taking a deep breath and over-riding my dark and twisty thoughts  (such as, “I might die in a car accident and he won’t have a mother”) with positive ones (“this is temporary, breathe, yep, here comes my milk”) worked for me and I sustained breastfeeding and pumping for nearly a year.

D-MER is real, your feelings are real. Keep breathing mamas and if you are having similar feelings, speak up to someone who cares about you. Just verbalizing can help so that when it happens you can let them know and they can care for you while you care for your babe.

Dr Kristal Lau’S Story

My first child was born four years ago. That sensation of D-MER started after I got the hang of nursing in that first week, working through the pain of the initial breastfeeding. My first D-MER symptoms actually happened while I was sitting at the DMV waiting to renew my driver’s license.

I was sitting there when someone brought their baby. The baby cried, and I felt my milk letdown about to happen. Right before that, I felt the hairs on the back of my neck stand up. It felt like something was going wrong, like something bad was going to happen. I explained to my husband, "I feel a sense of impending doom." That's when the panic feeling came in too.

This memory is still fresh to me because even with my second child, the same feelings were there, just not as strong since I knew what to expect. But that first time was weird because it was in public. Thankfully, I had breast pads on, so there was some milk leakage, but at least it wasn't all over my clothes. I was also thinking, "Is something bad going to happen? Is an asteroid going to crash in? Is a sinkhole going to open up?"

The feeling was nasty. It was horrible.

At the time, I thought maybe I was just being nervous, so I put it off. When I went home, I noticed it happened every time I nursed my baby. I called my lactation consultant and asked, "What is this? Am I going crazy?" She said, "Oh, poor dear, you have D-MER."

I asked, "What is D-MER?" I never came across it in med school! I asked my OB at the six-week mark, and he had no idea what it was either.

Thankfully, I had a really good lactation consultant who guided me through it. She told me there's nothing I could do about it and that medications don't work. That was true for me because I was already on medication for postpartum depression, and it didn’t lessen my D-MER symptoms’ intensity nor frequency.

All I could do was live with this sensation every day and every time my baby needed a feed and when I pumped.

It took me a couple of weeks to get familiar with my D-MER symptoms and to reassure myself that nothing bad was actually going to happen when the feelings came. I literally had to psych myself out of it every time. My poor husband was worried that I was going crazy.

With my second child, I hoped it would go away, but it didn't. I just anticipated it and managed it better. So if we have a third child, I'll definitely have to brace myself for another possible round D-MER.

D-MER Resources

Alia Macrina Heise is the IBCLC who first coined the term D-MER in 2007. It is her effort, together with her colleague, that has given so many women and parents a name for this icky lactation experience. She continues to research and bring more light to D-MER today.

To learn more about D-MER:

  • Listen to the upcoming special podcast episode about D-MER on our Military Birth Talk podcast, dropping August 30th 2024!

  • Visit Alia’s website (1) www.d-mer.org

  • Get Alia’s book on D-MER titled: ‘Before The Letdown: Dysphoric Milk Ejection Reflex and the Breastfeeding Mother’. 2nd Edition out now on https://a.co/d/gAJXmZT

Where to get help for D-MER:

Kristal Lau
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