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How D-MER Manifests
Defining & Describing D-MER

D-MER presents itself with slight variations depending on the mother experiencing it, but it has one common characteristic - a wave of negative or even devastating emotion just prior to letdown. This emotional response is the consistent key component in D-MER.  The breastfeeding mother experiences this surge of negative emotions about 30-90 seconds prior to her milk release when  breastfeeding, pumping or with spontaneous MER. By the time milk  actually releases and the baby starts gulping, the feelings have dissipated, only to return just prior to another MER. Although mothers with D-MER sometimes express the emotions a bit differently, there are many similarities with the terms and language that they use. Also, it is important to realize that because the intensity of the D-MER experience is variable, the emotional responses experienced with D-MER fall within a three-level spectrum: despondency, anxiety and agitation. The most commonly used words used are: a hollow feeling in the stomach, anxiety, sadness, dread, introspectiveness, nervousness, anxiousness, emotional upset, angst, irritability, hopelessness and general negative emotions.

How D-MER Presents

The negative emotions, or dysphoria, that a mother with D-MER experiences often manifest "in the mother's stomach" - a hollow feeling, a feeling like there is something in the pit of the stomach, or an emotional churning in the stomach. Mothers report varying types of emotions with D-MER ranging from sadness and dread to anxiety to anger, these emotions fall on the D-MER spectrum which has three different common experiences. 

The common thread between these three different experiences is the wave of negative emotions. the dysphoria, prior to letdown. This happens when nursing and most often with expressing and spontaneous letdowns as well. The dysphoria then lifts within another 30-90 seconds, and then usually repeats with each letdown.

A key piece of D-MER is that a mother with D-MER feels absolutely fine except just before her milk starts to flow. D-MER is a brief feeling, not more than 30 seconds to 2 minutes, only and always beginning before let-down. This is not postpartum depression and most of these mothers feel perfectly fine except for that pre-milk moment. A brief interval after the negative feelings appear, the milk begins to flow.

What D-MER is Not

D-MER is different than the isolated itching or nausea some women experience with letdown, and although those problems can accompany D-MER, dysphoric milk ejection reflex is a separate problem by itself. DMER is also different from postpartum depression although, again, PPD and D-MER can occur in a mother at the same time. Mothers suffering only from D-MER feel quite happy and normal in-between D-MER 
episodes.

Milk Ejection Reflex Intensity and Duration

Some mothers have very mild D-MER, often describing it simply as a "sigh" or a "pang." However, on the other end of the scale of intensity, there are some mothers who feel extreme emotions resulting in suicidal ideation, thoughts of self-harm or feelings of anger. These feelings are usually brief and rarely do they act on them. These mothers need to be encouraged and supported and not treated as an abuse risk. They may also need to consider more serious treatment in order to more effectively manage their D-MER.  It is important to note that a mother's D-MER will be harder to handle if she also has PPD or an anxiety disorder. Most mothers notice the onset of D-MER within the first couple weeks of breastfeeding and for some it will be gone by the time the baby is three months old. Other mothers find that D-MER gets less severe and slowly dissipates as the baby ages and then at some point realize they are no longer experiencing it. For others it remains until weaning, regardless of the baby's age.