October 10, 2013

All About DMER

When it comes to D-MER, there's a lot you can't see
During my second pregnancy, I had few to no worries about breastfeeding. I thought I'd been through it all with my twins. One perfect nurser, one vicious crocodile. I'd had clogged ducts and infections, I'd supplemented my preemies with both expressed milk and formula, I'd nursed exclusively for a few months, and they weaned themselves at almost ten months.

I might not have been the world's foremost breastfeeding expert, but I thought I had a handle on things.

Then came baby #3.

As the exhaustion of pregnancy wore off, and as I recovered from my second c-section, I simply couldn't get a handle on nursing. She was terrifying, she would root and latch poorly and then tear herself away, and in the first weeks I was a sobbing, hysterical wreck. But I reminded myself day after day, things would get better. They did with my little crocodile, after all.

Until, one night, it happened.

I was sitting on the armchair in the living room, watching my two and a half year old twins playing. The baby was in her swing. It was a perfect domestic scene.

And then it wasn't.

I felt hairs rise on the back of my arms, my shoulders hunched into my neck, my vision went flat and fuzzy. My heart pounded in my chest like I'd just run a marathon. I gasped for air, and the world seemed to funnel down into a tiny black spot before my eyes.

I screamed.

Then I felt the familiar clenching in my chest, my milk let down, and everything returned to normal.

My husband stared at me in shock. "What happened?"

"I think I just had a panic attack," I told him. I put my hand on my chest and felt my heart racing, and slowly returning to normal. "It's time to feed the baby."

The next day, it happened again. I was making breakfast for the twins, and a rushing sound filled my ears. I dropped my egg covered whisk onto the floor, and burst into tears.

For nearly a minute, the world spun. Then again, my milk let down, and the world came back into focus.

The third time it happened I thought I was ready for it. As the panic set in, I told myself, It's okay, this is only going to last a minute, in just a few seconds it'll be over... And it was. As quickly as the feeling came, it left. And I nursed the baby.

As the days passed, they came more and more frequently, until every single time my milk let down, it was preceded by a thirty to ninety second panic attack. I screamed, I sobbed, I collapsed on the floor. I couldn't control it. But I kept telling myself it was okay because they were so brief.

And each time, I began to fear that this time, this one, it would last forever.

I mentioned it to my doctor and he told me I must have PPD. I mentioned it to a lactation consultant, and she gaped at me blankly. I went to a La Leche League meeting, and while the women there sympathized, they had no idea what was happening to me. When I called a doula friend of mine, desperate for help after five months of near constant panic, she referred me to a website about something called "DMER."

Dysphoric Milk Ejection Reflex.

I read every word on the website, flooded with relief that I wasn't alone, that this was a real thing, a real problem, that I wasn't simply going crazy.

In general, women experience happy emotions when they're breastfeeding. The hormones that accompany the let down reflex cause feelings, connectivity and security and joy- euphoric sensations. But with DMER,  you get the opposite.

It was temporary. After the ejection, after the milk came in and the baby latched, the good feelings came too. I learned to connect with that feeling, to find it despite the exhaustion of ten to thirteen full fledged micro panic attacks each day.

It took the constant support of my friend the doula, my husband, and all my friends to keep me going. Each time I had a panic attack, my husband would bring me a glass of water and rub my shoulders and let me know it was okay.

I soldiered on through the DMER, and nursed my third child for just over ten months.

It was an incredibly difficult time, mostly because of how little awareness there is for the condition. It's terrifying and confusing to have such a wonderful thing, feeding your baby, cause your stomach to knot up in dread. Especially because once it's happening and the nursing is going well, everything is absolutely fine. It's just that tiny window, that one minute eternity.

Not all DMER is the same. Some women experience depression. For some women, it's a mild feeling of unease. But all of us deserve to know that what's happening is physical, that we are experiencing a real symptom of a real condition. You deserve the knowledge that there's nothing wrong with you, or with the bond between you and your new baby.

Make sure you family knows what's happening. They're support will keep you going. See your doctor, and ask them about your treatment options. The most important thing is education- just knowing what's going on with your body is half the battle to managing it.

For more information about D-MER, please visit d-mer.org.


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  1. I have been through panic attacks and I know how horrifying they can be, and I have been there in the doctor's office, being stared at blankly, as if I were crazy (mine seem to be related to my use of Omega-3 supplements, which seemed really weird to my doctor). I am so glad you got some answers and support, because it is such a scary thing to have your body be out of control like that. Thanks for sharing!

  2. This is a thing?!? I used to get that sinking nauseous feeling every time I nursed.... Never knew! Mine was no where near as bad as yours, so I never thought to ask about it.

    1. It's remarkably common! I just had a very severe case. I had no idea you had troubles like this! I'm glad you got through it! And that must have made R's digestion issues all the more difficult for you. Sending all my love!

    2. I made it through nursing for over 2 years with it. Mine was definitely a small case, just sinking and nausea, but I was set on nursing through anything. Didn't help that I was going through so much at the time. I'd do it all again though!

  3. I had DMER the first 6 months of nursing my second daughter. At first I thought it was PPD. I would get extremely sad right before my milk let down, and I would sob the entire time I nursed her. Whenever I went out or was with family, I'd go to another room to nurse her because I knew I wouldn't be able to hold back the tears. As soon as she was done nursing, everything would be fine. I felt like I was going crazy! I kept googling, asking people, and nobody could suggest anything other than PPD. Then I saw this website, and with every word I read it was like the answers clicking into place. I had felt like a horrible person, for not getting joy when nursing my baby. I didn't want to nurse her, I wanted to push her away from me, I wanted to give up, I was just so so sad. I hated myself for it. Finding that website helped me so much, and I was able to tell myself, "It's ok, this is normal. Not for everyone, but for some. It will pass, it is worth it." It was a long 6 months, and after that I still didn't get that intense bonding that so many breastfeeding mothers rave about. I weaned her three weeks ago at 10 months old because she wasn't satisfied with what I was producing, and I am so proud of myself for going that long. For sticking it out, for concentrating on her sweet and precious face and reminding myself how in love with her I am, when at those moments of nursing I wanted nothing to do with her. DMER is very real, and needs more attention brought to it!

  4. Whenever I nursed, the let down reflex came with excruciating pain. It got so I would start tensing up as soon as I knew it was soon time to nurse. I didn't get any blank stares -- the doctor just told me that this was uncommon, but not unheard of, and warned me that it would be worse with each successive child. He was right. I'm assuming it's a related condition.

    1. From what I've read, it can be related, but it's not the same. One does not necessarily come with the other.

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  7. Wow, I didn't realize it could take such different forms. I really appreciate this blog! My experience was similar to Squirrelymamas, but intense and lasted the whole time the baby fed. It felt horrible, not like a panic attack, but a horribly bad, empty, sinking feeling. I wouldn't have noticed a heart rate change because of an electrical problem that's since been surgically corrected. So I was used to erratic heart rates with many symptoms such as Supermommy described, but without fear or panic.

    I identify with Mommabee's description of feeling like she'd rather push the baby away or not wanting anything to do with it while breastfeeding. I breastfed a little over a year knowing it was good for the baby, it made her happy and content, it was more convenient and cost-effective than bottle feeding and mostly because I loved her. oh, the things love for our children help us overcome!

    It was awesome to find out the reason breastfeeding felt the way it did for me - even though it was years later. I had assumed it had to do with oxytocin because of the simultaneous muscle tightness in my chest (I also have asthma) and because it's the main hormone spoken of in regards to breastfeeding. If I ever mentioned what I felt to people, they assured me oxytocin makes you feel good, not bad and that breastfeeding should make a mother feel good.

    I hope this will eventually be included in all articles and classes that discuss breastfeeding. The information I heard or read made me realize something wasn't right; but I wasn't sure if it was me, my baby, or that the authors/speakers were idealistic idiotics (yep, I wondered that!) Maybe breastfeeding is more like pregnancy (or anything else for that matter), it can be anything from a euphoric to boring experience for some women, but for others it can be counted a little more as one of the sacrifices of love we make for our beloved children, and maybe even for some, an intolerable experience warranting bottle feeding - if mom so decides.

    My difficult breastfeeding experience (and pregnancy for that matter) continue to help me to be more compassionate toward mothers that have a harder time mothering or are unable to. Our physical bodies are all different and those differences can have profound effects on how we feel or think.

  8. Hi Jessica, do you mean that using omega 3 supplements made your panic attacks worse? Or did your D-MER symptoms worsen with omega 3 supplements? Thanks, I know it was long ago, but any info you have would really help me. I have D-MER and am taking an omega 3 supplement. Thanks

  9. Thanks for writing this. I've been suffering with DMER for 4.5 months now. At first I didn't know what it was and was very confused. Still to this day all of a sudden I'll feel panicky and anxious and not realize why until a minute later when my let down happens. So everyday, multiple times a day I go through this dread even while I'm not nursing my son. This did not happen with my daughter, so it's very different and difficult.

    Mine starts with the anxiety, a fast deep depression/sinking feeling, hand tingling and makes me want to cry (but doesn't last long enough to actually make me). It makes you under stand why people are depressed or even suicidal. If someone had to deal with this ALL the time... man oh man would that suck. I've heard it gets better, but so far that's not true for me. I'm still waiting and I am going to push through this and keep nursing my son, but still waiting! Very impatiently!


  10. With my 4th child I experienced this and had to stop breastfeeding it got so bad. Dr's just looked at me like I was crazy I finally put it together that it was only when I let down they told me it was PPD that there was no such thing. It helps to hear that I am not the only one. Now pregnant with my 5th I so want to nurse but I am so afraid of experiencing all that again it brings tears. Hopefully I can nurse but I have read that once you have had it it is likely it will happen for the next one if not worse.

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  12. I know this post is dated a bit now, but I had to chime in to say that I experienced this mildly with both of my girls. Whenever my milk would let down, I felt sick to my stomach, teary, irritated, and anxious all at once. Like you, it would last about a minute or less. It was terrible, but it's so common. I've talked to countless women who experience D-MER to an extent. I just wish doctors and lactation consultants were more aware of the condition and could offer greater support.



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