D-MER :: The Postpartum Condition That Made Me Feel Sad and Disgusted Every Time I Pumped

Moms' Minds Matter. Mental health Awareness Month. Houston Moms blog. A photograph of hands holding a flower. When I was pregnant, I decided early on to remain open-minded on the breastfeeding topic. As a Maternal-Fetal Medicine Specialist and a woman pregnant with twins, I knew that I could deliver early. I knew that I may not produce enough milk for two babies. I knew that one might latch on and the other not. And I knew any one of these things could interfere with my ability to produce milk and their ability to breastfeed. I simply didn’t want to put too much pressure on myself.

Turns out, I was right.  

A photograph of a mother and father each holding a baby in the NICU.
Roberto + Lori Photography, Alvin, TX

I delivered at 31 weeks. The twins were in the NICU for 5 {baby boy} and 6 {baby girl} weeks. She never latched on, but he did. Although I did well, I did not produce enough milk for two babies, so I supplemented with formula. But most importantly, they both needed to gain weight so I wanted to know exactly how many ounces each baby took with every feed {I have a touch of OCD}. For me, pumping and feeding them from a bottle was the best route to give them my breastmilk. Unfortunately and unexpectedly, pumping took a serious toll on both my body and mind. So much so that when I recently visited my sister and her newborn baby, the sound of her pumping had an immediate effect on me—and not in a good way.

My first memory of pumping was shortly after delivery. My dutiful husband helped me pump every two hours for those first few days until my milk came in and took every drop to the twins in the NICU. It took about a month to establish my pumping routine, and I finally settled on pumping every four hours. It was around that time that I noticed I was feeling an overwhelming sense of dread and profound sadness every time I got ready to pump. In fact, I even felt disgusted when I looked at the pumping equipment, saw my own breasts or felt my milk let-down. Those feelings were so overpowering at times that I would just sit and stare into space barely blinking while I pumped. It was almost like I left my own body during those 20-30 minutes and fell into a black hole. I even got so sad that I often cried while pumping.

I thought that maybe I had postpartum depression. I thought maybe I was just tired, or maybe it was my constantly trying to find a way to feed them every four hours AND pump every four hours, which essentially meant I was either feeding babies or pumping every two hours. All I knew was that the very thought of pumping made my skin crawl. I know it sounds awful, but I sometimes wished my breasts did not exist so I did not have to pump. I constantly felt extreme guilt and shamed myself for even having those feelings. I told myself I should be happy to be able to provide my babies with breastmilk. I should be happy they were doing well and growing. I should be feeling ANY way other than what I was really feeling. I soon found myself in a vicious cycle of dreading pumping, feeling sad and disgusted while I pumped and feeling guilt and shame after I pumped. It was simply awful.

For me, pumping was the most negative experience I had as a new mother, and I just didn’t understand why.

Because of my profession, I should have had better insight into what was going on with me, but I simply did not. Looking back, it seems as though everything I learned as a Maternal-Fetal Medicine Specialist meant absolutely nothing when it came to my own health, well-being and motherhood. So, like any other woman who tries to self-diagnose, I went to “Dr. Google” to figure out what was wrong with me {something I always tell my own patients to avoid}. To my surprise there it was. I found my diagnosis…

Dysphoric Milk Ejection Reflex or D-MER…

What the…???

D-MER is a rare condition occuring in breastfeeding/pumping mothers that involves intense feelings of sadness, anxiety, dread, irritability, hopelessness, depression, agitation, or a pit in the stomach with milk let-down. I experienced all of these emotions during the 8 months I pumped. According to KellyMom, the mother has feelings of dysphoria or negative emotions that lasts a matter of minutes when breastfeeding or pumping. It is a physiologic response associated with an inappropriate abrupt decrease in the hormone dopamine {the release of prolactin for milk production is dependent on the inhibition of dopamine} that occurs immediately before milk let-down; it is not a psychological condition. In other words, D-MER is not a form of postpartum depression or anxiety since it only occurs with milk let-down.

For most women who experience D-MER, symptoms subside by 3 months postpartum, and symptoms can range from mild to severe. For others, like myself, it can last for the entire time a woman is breastfeeding or pumping. I had these feeling every 4 hours for 8 months, and my symptoms were severe. D-MER can be severe enough to affect bonding with the infant and/or the willingness and desire to continue breastfeeding or pumping.

I can with confidence say that, as an obstetrical care provider, I know a lot about pregnancy and the postpartum period, but I had never heard of this condition. Unfortunately, breastfeeding education is not typically a subject that doctors discuss with their patients—it is left to nurses and lactation specialists. Overall, there is little known about the exact cause of D-MER and the condition is poorly understood by obstetrical care providers, making many unable to recognize the signs. Sadly, I have the feeling that many women who want to wean early or do not want to breastfeed at all may be experiencing or have experienced D-MER, but are still feeling pressured to breastfeed anyway due to failure to recognize this condition.

If you think you have D-MER, there are online support groups and certain activities, foods and medications available that may prevent the abrupt decrease in dopamine with D-MER. There are some natural treatments available and one prescribed medication that may help maintain or increase dopamine levels for those women who desire to continue breastfeeding or pumping despite the symptoms of D-MER. Lifestyle changes include hydration, sleep, exercise, decreasing caffeine intake, stress reduction, and activities that can distract the mother while breastfeeding or pumping. If you do not get any relief, please discuss your symptoms with your obstetrical care provider.




Australian Breastfeeding Association

Previous articleSearching For My Inner-Calm, One Breath at a Time
Next articleThe Truth About Kids and Therapy
Shannon M. Clark, MD is a Professor in Maternal-Fetal Medicine at UTMB-Galveston, TX where she is an educator, researcher and clinician. As an ACOG media expert, she contributes to multiple websites, news outlets and magazines regarding pregnancy-related topics. More recently, she has taken a special interest in fertility, pregnancy and motherhood after age 35, which according to age alone, is considered a high-risk pregnancy. She was inspired not only by the experiences of friends and patients, but also by her own personal experience of trying to start a family at the age of 40. Because of her personal and medical knowledge of the fertility and medical concerns surrounding pregnancy after age 35, she started Babies After 35 -a site dedicated to fertility, pregnancy and motherhood after age 35. Sharing her medical expertise and personal experiences, she has written for Huffington Post, Mind Body Green, The Washington Post and Glamour. Dr. Clark became a mother at age 42 to twins Remy Vaughn and Sydney Renée {September 2016} via IVF. She is a full-time working mother with a passion for world travel, writing, amateur photography and her first baby, a pit bull named Cru, who crossed the rainbow bridge 4/17/2018.


Please enter your comment!
Please enter your name here