I had approached my preparation for birth the same way I had much of my post-secondary education—reading books, reviewing articles, listening to podcasts and feeling hopeful that if I worked hard I would be able to overcome the challenges ahead.

In the “Breastfeeding 101” class I attended, we covered the basics like how big a babies stomach is at different ages, what triggers milk to be produced, how long it takes for milk to “come in,” and how to tell if your baby is getting enough. We then moved on to common issues and how to troubleshoot them. I felt well prepared for cluster feeding, low supply, improper latching, sore nipples and mastitis. I knew the lactation support line number, had purchased my electronic and manual pumps and nipple guards, and had mentally prepared to give myself grace for any frustrations I felt while we were figuring this thing out.

Anything I felt during the first few days in the hospital during feeding sessions, I chalked up to that frustration. With the help of the hospital lactation consultant, we fine-tuned the latch, slowed the milk down with the aid of a nipple guard, and learned how to manually pump and deliver some feeds through a tiny syringe so she wouldn’t be too hangry while we both got the hang of it. 

With my upcoming residency training start date weeks away, I knew I would need to pump while at work if I wanted to continue offering breastmilk. I tried triple feeding but that was unsustainable for me, so switched to exclusively pumping. In the classes I had taken and through online research, I was led to believe that breastfeeding would be this magical bonding experience that released the “love” hormone oxytocin which would make me feel calm, happy, and closer to my baby. What I experienced was anything but that.

Regardless of what was triggering my let downs, I would consistently feel this intense, overwhelming sense of dread and sadness in my chest and stomach for about 30 seconds prior to it dissipating. I counted down the months until I reached the one year mark I had set for myself. With an average of 6 pumping sessions a day, that’s over 2,000 episodes of this horrible feeling I came to learn was called the Dysphoric Milk Ejection Reflex (D-MER).

D-MER is not the same as breastfeeding aversion or a dislike of breastfeeding. It’s also not a type of postpartum depression or anxiety. And while I thought I was alone, it’s estimated that up to 9% of lactating women experience it. Despite this, awareness remains low. I certainly didn’t hear anything about this in any classes or professional resources I came across. My own providers had never heard of it. By the time I was about to give birth to my second child years later, my OB and the hospital lactation consultant looked at me quizzically when I asked if I would be likely to experience it with this child, too. (Spoiler alert: I did but it wasn’t as bad).

Experts hypothesize that D-MER is caused by a rapid drop in dopamine or shift in one of the other hormones or neurotransmitters involved in lactation. While there’s still much research to be done and no cure/treatment as of yet, the following can definitely help:

• Eating a snack just before and during letdown
• Staying very well hydrated and drinking cold water during
• Watching a show or playing an engrossing game
• Talking with a friend or loved one on the phone
• Reminding yourself it is transient and not reflective of your true feelings or underlying emotional state

For many women, this gets markedly better or goes away after the 3rd month postpartum. For others, myself included, it can continue through until weaning. Simply knowing this is something you experience can take a big weight off of your shoulders through validation and lessening the anxiety around it. Talk to your therapist and healthcare team to let them know if this is something you cope with, and remember that you have more to offer your baby than just milk if D-MER takes away from your mothering experience and you aren’t sure if you want to continue. 

You can find a Facebook support group community here.