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I wanna tell you guys a little story, a personal, you know, relatively vulnerable or kind of humbling story as well. But I think it's valuable to hear it from, you know, let me put my nurse hat on for a minute, but an OB nurse perspective, because what you're gonna hear is that. This is part of the ob maternal, you know, fetal healthiness world, what I'm about to share.

Okay. She's growing, she's thriving. Breastfeeding's going great. I did have two under two. So that had its whole own set of challenges, and we could talk about this on another podcast episode, but my one to two transition was my hardest. It's very possible that what I'm talking about today was part of that.

But definitely having two under two kind of rocked my. Type A. Can't you all just sleep when I want you to do what I want, when I want you to world. But ultimately, I'm eight weeks postpartum. Things look like they're going well from the outside, right? And my husband looks at me one day and he says, what is wrong with you?

Why don't you get ahold of yourself essentially. And you know, I don't really fault Kel. I mean, he could have been more gracious than kind, but he wasn't wrong. I had a horrific attitude about breastfeeding my girl. And I had not been this way when I breastfed my first girl, right? So to him. In some, you know, indirect way.

This was his call out of, you don't seem okay, there's something going on, so can we figure this out Because this isn't normal. And to be honest, I was angry. I do remember thinking, okay, you're being a jerk. You have no idea. Hard it's to breastfeed baby. I have two babies under two. Like get off. But also I felt a lot of shame because Cal called out something that was true and I could not figure out why.

I did not look forward to it. Every time I had to, it was this eye rolling, Ugh, I don't want to, I hate this. I don't want to, when's she gonna be hungry again? Like, it was a miserable experience. And if you're like me, I mean, I've definitely bought into, and honestly, I believe in, as long as these narratives don't, you know, put chains around our necks, I believe in the narratives that.

Breastfeeding is a gift and it's a privilege, and if we can do it, we wanna do it. We should be doing it right. It's a. Great, beautiful thing for both our babies and ourselves and , if you can breastfeed, you should be breastfeeding and good mothers breastfeed. Okay. Again, there's some, you know, negative connotation and narratives in there that can lead to a lot of, burden.

Like, get off, don't talk to me about this. But ultimately, the voice underneath right, is you're not wrong. And I also don't know why I feel this way, so I'm scared and I'm freaked out because I shouldn't feel this way, right? So long story short, let's not, you know, withhold what was going on here. I had something called dysphoric milk ejection reflex.

I had not experienced it with my first baby, and it is something that had just shown up the second time and it kind of, I don't wanna use the word revolutionized 'cause that sounds positive, but it completely flipped my breastfeeding experience on its head. So dysphoric milk ejection reflex is also referred to most commonly by the acronym DMER.

Your let down there is let down happening. Okay? So regardless of whether or not you feel it, it's happening. And basically this letdown occurs and then your milk starts flowing and this happens. Once every feed twice, three, four, sometimes there's some people up to like 8, 9, 10 times a feed. So your body continually does this little system of letting down while you're feeding.

You could also have spontaneous letdowns, which just happen. This is kind of, you know, those moms who say, oh my gosh, I start leaking every time I hear a baby. Cryer hear my baby cry. So let down is not always specific to actually having a baby on the breast or pumping, but it is typically most often occurring during breastfeeding, pumping, and of course it is.

Want to believe, right? Or have even discovered yet. Right now, research is, eh, it's, I wouldn't say confusing, but it's a little bit ambiguous about how common DMER is. Estimates range between like three and 12%, six to nine, stuff like that. When you look at individual papers, so I like to say it's up to or around like 10% of people have this breastfeeding condition.

Now this is pretty significant. You guys like, think about it. If one of every 10. Of you like standing in a group of friends has something you would think that you would know about it, right? Like that is pretty darn common when you think about the massive number of breastfeeding moms who are dealing with this.

Here's another thing to worry about. I think that potentially that can slow this conversation down a little bit, right? Or you kind of tiptoe into it 'cause you just don't wanna add to the burden kind of, of preparing to breastfeed. But that's a disservice to you guys and honestly. I think it was a disservice to me, right?

And yes, we'll get into this is simply awareness and that can just change everything. So as with all things breastfeeding, DMER needs to be a part of the conversation because the hard stuff and the good stuff are all. Part of the breastfeeding story and we have the right to know what may or may not be coming for us, and then we can choose to what to do with it.

Right? That's what I'm always saying here. You get the information, you decide what you wanna do with it, that's on you. But I wanna be someone who can help throw things in front of you and say, now go do what you want with that. Okay. All right, so let's get more specific about what is DMER. Let's define this a little bit better.

So it was discovered in oh seven, like I said, by a lactation consultant. Her name is Alina Akre heis. She discovered it with her third baby, which I think is really interesting because DMER doesn't necessarily happen with your first baby, and that's just your story for however many babies you have.

That's been true for me. I've heard people say differently, so I don't, that's not fact. Okay. I am not putting that out there as fact. But just to give you a little idea of kind of how this shows up. Randomly. But then what happens once it does show up is that that then kind of puts you in a risk category for having it again.

I do wanna mention, Alina has a book about this 'cause she really was this front runner about DMER and I'll link it in the show notes, but if you think this is you or you're curious about it, it's a quick, easy read. Her book's called Before the Let Down Dysphoric Milk Ejection Reflex and the Breastfeeding Mother.

I've given you the definition, but I want you to hear that it is a physiological response. Physiological response. So this is not a mental disorder. This is not something else going on. This is physiological within your body. It's a physiological response that causes negative emotions just before your milk let down.

Which I know I already told you guys all of that, but I want you to hear that physiological part. This is chemical, this is hormonal, this is reflexive, but it is not a mental health disorder, and that is important to understand. It is not something that you can just treat the way that we treat A-P-M-A-D, right?

So the hormonal part too, I think is important because what you are feeling when you are experiencing DMER. Is not a reflection of how you actually feel about breastfeeding. And again, you guys know, I just mentioned I had all this shame, right? I thought this is a reflection of me as a mother. I hate breastfeeding.

I'm a bad mother, right? Maybe you think that's dumb. Don't make that leap. But that's the leap I made. And I know that other moms have made that leap too. But this is a hormonal response, right? So we can't control what's going on and our feelings are caused by something else and not. Because of what we think or feel about breastfeeding or a baby, our bond with them, et cetera.

We don't use the word hate in our home, but that's essentially, it was this really powerful, negative emotion to having to breastfeed. And then when I was actually breastfeeding, when I was actually experiencing. That DMER experience, which again, is right around let down. I felt this knot in my stomach, this like deep sense of homesickness.

People can be anxious, irritable. There's a lot of ways that people describe this. I've heard people say, oh, it made me really introspective, which typically that introspection leads to some sort of negative interpretation of some situation in your life, but ultimately this is this overall. General negative experience, right?

That's where the dysphoric and DM OR comes from. You are feeling this intense dysphoria. This can happen when you have baby at the breast or when you are pumping, and it can actually happen with those spontaneous letdowns that I mentioned as well. It's kind of interesting. I don't really remember feeling it as much pumping with my second baby, but because I had also with my third and my fourth, I do remember having it pumping with them.

I have no idea if that's true, but it was really interesting. That there was such a spectrum to this condition. But what I found to be true as I was, , reading into this more, is that, that's actually the whole point is DMER is a spectrum condition. So you can have it mild, moderate, or severe. Okay.

So there's a severity spectrum associated with it. And then you can also have, there's this emotional spectrum. So you can have despondency, deemer, anxiety related deemer, or agitation related deemer. So. Clinically, let's say someone were gonna, you know, in theory diagnose you, they might say she has like mild despondency, deemer or severe agitation, deemer, and you can kind of put those.

So you fit on this DMER spectrum. You can say. I have DMER if you're experiencing this, but your experience of DMER is probably gonna look and feel very different than mine. And we both have it. It's just wildly different in how it shows up in our body. I was reading some research on this topic, the, you know, kind of how does it actually feel once, and I'm gonna read you this quote.

That is how DMER was for me at times. End quote. So what she's referencing is these things called Dementors and Harry Potter books, and essentially they like latch onto you and suck your soul out of you. It's like this very dark, gross characters in the books. But when I read that, I remember thinking, this is it.

She nailed it. That is exactly what it feels like. It feels like this overwhelming hollowness that I cannot get past. I cannot get through. And then just like that gone. And that's the wild thing about DMER. But it's also, the thing I want you to understand as you kind of consider is this going on in my own body, is that DMER is brief, okay?

They're latching, they're sucking let down happens. I. Letdown usually lasts. It's not over in 10 seconds, right at maybe 60 seconds or so. And then the feelings dissipate and as quickly as they come on, they are gone. It is the wildest, wildest thing, but that's such a tell for DMER. So I want you to hear that they come, they are intense.

They can like. Knock your feet out from under you. Honestly, you can. I, I would be laughing at my 20 month old. Ha ha. You're adorable. Latch baby on and boom. Like that. I am. Lost in grief and homesickness, and I feel hollow. I mean it. I have never experienced anything like this, but it was so clear once I knew about this condition, that is it.

It's actually really cool to understand. I. This hormonal part, I think, not because it necessarily tells you what to do, but it just reiterates this is not about you. This is about your body, and so you don't have to feel any shame or feel badly for what is going on. So essentially a big overview when we are breastfeeding.

Our oxytocin rising. That is what causes milk release, right? Because we need to make milk. We need to release milk. There's different things going on for breastfeeding, and this applies again, to expressing, okay, so pumping or breastfeeding. When I'm talking about that pumping is breastfeeding, so we're lumping it all together.

Dopamine is the big player when it comes to DMER. Okay. Oxytocin rises for milk release, dopamine falls so prolactin can rise and make more milk. And what happens with dimer is that that dopamine falls too far. For whatever reason I. That mom and that fall of dopamine triggers these feelings. And again, like I've told you, I didn't have it with my first baby.

So it's not necessarily like, oh, my dopamine always falls way too low. But yours doesn't for what? Yeah, it's just for whatever reason I. In these moments with those babies, my dopamine was falling too far, but we don't really fully know why. And again, your dopamine falls during all of your letdowns too.

I'm a fixer, right? Tell me what to do and I'll fix it. 'cause this sucks. I don't wanna do this. But it's a reflex, right? You tap your knee, your foot jerks, you can't stop it. You can be staring at it. You can know the cause. You can know everything that's going on physiologically, but you can't stop it. And I think that's valuable again, because you can let go right of the responsibility of it and just say.

I have this, what can I do to make it better or easier because I obviously can't stop it. I know I've mentioned risk factors a tiny bit already. And you know, prevailing one is really, if you've had dimer once I. You are pretty darn likely to have it again, my personal experience showed that to be true.

They're just not connected. This is this chemical hormonal thing. Things get out of whack for whatever reason. Then you end up being someone who has DMER, but it's not related to what's gone on in your health history, prior, medical, personal, any of that. I will say, and I thought this was really cool, I had read this on the website about DMER that Alina has if she, she talks about how I felt, like I told you, I felt this significant grief.

Almost can bring you back to like that idea of deja vu, right? Where you remember other experiences where your dopamine was too low, like after a significant loss or in some deep stage of grief or another situation where your feel good hormones are not. They need to be or they're not doing what they need to do.

And so you have kind of a similar experience in this breastfeeding situation to what you were experiencing during this other low dopamine situation. I hope that makes sense. When I read that, I thought, oh my gosh, that makes so much sense. I had not read that kind of my first time researching and digging into all this, and then it made so much sense for me because I've always felt like that.

'cause this is not something about a mistake you made. We're just gonna move forward and figure out what we can do with it before we get to those coping strategies, support, things like that. I do wanna clarify one last time that DMR is not a psychological, like perinatal mental health disorder. Okay. Or that PMAD that we use a lot for the, that full spectrum.

They kind of have a different physiology around them. Whereas DMER is just this reflexive condition that I keep, you know, reminding you of this is a physiological reflective thing, it is not a mental health disorder. I think it's also helpful to hear that it is not. The same thing as like breastfeeding aversion.

I think sometimes people can have that, you know, you're pregnant and all of a sudden you don't wanna breastfeed. Or you can have nipple aversions at different times in times where you don't wanna breastfeed, maybe because it's painful or whatever. And so you think, oh, I have anxiety around breastfeeding too.

You feel them throughout. So those are not the same, and it's really valuable to hear that because it can get a little confusing when you are struggling with maybe two of them, maybe three of them at the same time. What's going on? But for those of you who just have DMER, your tell is that brevity and how quickly it comes and goes, and that helps you kind of know a, what it is and then two, you know how to treat or how to move forward.

The other thing that I would tell you is that if you do happen to have A-P-M-A-D, it can make deemer that much harder to handle. And personally, that was my big struggle in that space too, is come to find out another thing that I was. Not necessarily ignoring. I like to be gracious to that broken, broken mama that I was back then, but I had significant anxiety and I didn't really realize that until later.

And so I think it's valuable again to understand the spectrum there. But I had that combo of a PMA emer together and pretty significant deemer, and it made probably my deemer a lot harder to handle. And I can tell you, you know, years later after having two more babies after that experience and having DMER with both those babies, baby.

Number two, that DMER experience was absolutely the worst. So probably a lot of things going on there, but it was the only one combined with a pma, and it was quite brutal. But that brings me to coping strategies, support, what do you do, right? Because I didn't just twirl around forever, aimlessly wondering what was going on.

You know, it was kind of, she wasn't unhelpful. I just don't think there was a ton of education for her about it. And so it was kind of one of those, it is a thing. Yeah. I think, you know, I've heard of this. Uh, you know, let us know if it's significant. It was kind of this, I don't wanna say a bad combo, but there wasn't a lot to it.

It still sucked. I still felt all of it, but that awareness of what was going on, that just changed. Everything. And so if anything, if there's a single goal for the podcast today, it's that, that I'm making you aware so that should you run into this, you're gonna say, she taught me about this. I remember this.

I don't like this. This sucks. But also this isn't about me. This is my body and you know, here's what I'm gonna do about it. There are other things besides awareness that can kind of get. Recommended to you. Let's say, people will talk about healthy lifestyle, proper nutrition, hydration, and rest.

Some people say, Hey, keep it log or a journal and kind of log your symptoms. Pay attention to, you know, is it worse in the morning? Is it worse at night? Is it worse when you haven't gotten any sleep? Maybe it's because you drink too much caffeine. Are you stressed? Essentially, you know, a healthier body.

So. I like, of course I'm gonna tell you there are some things you can do and think about, but I also wanna acknowledge this is very much often a do the best you can situation because Lord knows I could not always eat, drink, and rest the way that I wanted to with my two little girls under two. And so kind of like, okay, thank you for the advice.

I will do my best. Thanks. And so there is some of that. You can also, you can get support from a lactation consultant, maybe support group like other people who just can say, I get it. I had a big, for me telling Kelvin, Hey, I still feel so crappy. Like I have continued to do that with every baby. And every once in a while he'll say, how do you feel?

DMER such a silent thing so you can struggle and be hurting. And yes, it's brief and it goes away or whatever, but a year, let's say you breastfeed your baby for a year. Maybe you go eight months, maybe you go 18. If you do happen to experience it, the entirety of your breastfeeding experience, that is a long time to continually feel these waves of negative emotion.

And I didn't say this earlier, I may as well throw it in now. For some people you experience this dysphoria, the entirety of your breastfeeding journey. Other people, it gets milder and milder as the months go by. So again, back to that spectrum idea, it's very possible that you, I. We'll have a different experience than me, but regardless whether you experienced this for six hard months or for four or for 14, I think it's a lot to kind of carry that alone.

You know? I feel you in that. I think that that's super, super helpful. So I would encourage you to speak up and speak out. I remember talking about it at work once I had figured out what was going on and I had nurses. From all the decades, all the ages coming up to me. I love these older nurses in their fifties, in their sixties, they were coming up to me and they were Lo.

I think I had this 35 years ago with my son, and I had no idea. I still remember this one nurse, she was in her sixties and she was dumb founded. I. Because as soon as I started talking about it, it's like all these pieces clicked and she thought I had this. I had no idea. And even all these years later, I think there was this sweet relief for her of that wasn't about me.

The last thing I would say too is in terms of seeking professional help, I would reach out to your care provider straight away. You know, put this on their radar, just see if they have any ideas for you. Of course, if you have severe DMER, if it's causing any sort of ideation of harm toward yourself or baby.

Yes, of course you don't need me to tell you. That is an instant red flag. But if it's also causing you to want to quit breastfeeding when otherwise you would not want to, that's severe and significant as well. And your provider needs to know about that because they can potentially step in and help you mitigate that circumstance or figure out is there another solution.

So it's not just a blanket, you know, prescription that we give to everyone that has DMER, but it is a possibility, and particularly for those with severe deemer that should enter the conversation, those who have more mild or moderate deemer and are continuing their breastfeeding journaling without. Other issues, typically they're not gonna recommend a prescription for you, but it is something that can be brought to the table and if that's what you need because you do wanna continue or you know, you are having some significant issue, otherwise, uh, I think you need to know about that one.

You know, that's why I have my Breastfeeding Blueprint course, and that's why we teach about it on Instagram all the time because I think it's an incredible thing. And if that's what you want, I want that for you. I don't wanna help you get it, but. This specific situation, this steamer condition, I think it can challenge breastfeeding in such a way that it may lead you to wanna quit because you simply can't figure out why you don't feel the way you thought you would feel when you breastfeed.

And I would hate for you to quit. I. Only because this is going on and otherwise you want it so badly. So that's my hope here, right? Is this, this awareness. Let's continue this conversation and let's kind of keep sharing about this. Not necessarily because we want to terrify everyone, but because we don't want you feeling alone if you have it.

I get it. That one is rough. And if we can create those spaces for each other, then we are doing something right. Don't you think? So? Hopefully this is valuable. Hopefully it's more a message of hope than a Oh no. And I just, if you have a similar experience or something. You know, reach out. Let me know. I think the more we share these, the more we are going to continue to kind of support each other in this when it is something that comes up in our own stories.

If you aren't following along yet, make sure to tap, subscribe, or follow in your podcast app so we can keep hanging out together. And if you haven't heard it yet today. You're doing a really good job. A little reminder, opinions shared by guests of the show or their own, and do not always reflect those of myself in the Labor Mama platform.

Additionally, the information you hear on this podcast or that you receive via any linked resources should not be considered medical advice. Please see our full disclaimer at the link in the show notes.