Wednesday, May 2, 2012

The Letdown of All Letdowns

I have nursed two babies. I nursed my son until he weaned himself at age three. My daughter, Squishy, is currently 8 months old and we have been happily nursing since she was a few minutes old. I never had issues nursing my son. I was a sucky pumper - I still am - but breastfeeding itself has always been easy. It's been quite easy with my daughter as well. There was one odd bump in the road in the beginning.

In my daughter's first few months of life, I would notice that I would get extremely anxious when I would start nursing her. It would happen almost as soon as she would latch on and would last a few minutes and then stop. What would happen? As she nursed, I would get this overwhelming sense of anxiety and impending doom. All sorts of scenarios would pop into my head. I would start thinking about war, the end of the world, natural disasters, the death of my children, my death - scary, scary stuff. It did not help that we actually ended up with a few natural disasters in the first few weeks of my daughter's life. By the time my daughter was 2 weeks old, she lived through an earthquake, a hurricane and several tornado warnings. Not much help there for quieting my anxious mind.

I couldn't understand why I was having scary thoughts. Here I was, deliriously happy that my daughter was Earthside and healthy, yet I was having these negative feelings whenever I nursed. I had post partum depression after my son was born. I had severe post partum depression and rage after my miscarriage. I had feared post partum depression again, which is why I had dehydrated and encapsulated my beautiful placenta. I also made sure I was eating well and getting some good old vitamin D, sun style. I was determined to fight depression this time. I thought, could these feelings be the start of post partum depression? Dear God, I hope not. I started to wonder why it was happening whenever I nursed. My logic was that nursing forced me to sit down and focus my mind a little bit, so maybe that's what allowed those thoughts to come in. It was frustrating. And as soon as those thoughts started, they would go away. It would only happen for just a few moments after my daughter latched on. I worked hard to clear my mind, to focus on her beautiful face and to think happy thoughts. Even thinking happy thoughts, I would still end up with butterflies in my belly. It was by chance that I came upon a friend's Facebook posting about the same thing happening to her. She had found something online that explained everything.

It turns out, I had Dysphoric Milk Ejection Reflex, a hormonal reflex that occurs with the letdown of breastmilk. It is also known as D-MER and I will refer to it as such throughout this post. When you are lactating, several hormones are dancing around your body. The hormones involved in D-MER are oxytocin, prolactin and dopamine. Oxytocin will rise as your baby latches on. It tells your body, "hey, we need milk over here." Prolactin is responsible for making milk. Dopamine is a neurotransmitter that has many functions, including making you feel a bit happy. When dopamine levels drop, you may feel a bit anxious or bummed out. What does it have to do with breastfeeding? Dopamine has another name - Prolactin Inhibiting Hormone - it functions to control prolactin levels. Obviously, we can't have dopamine getting in the way of prolactin when we need to make milk. Your body, being wonderfully designed, generally has this equation balanced and the dopamine levels know to decrease just a wee bit right before letdown in order to allow prolactin to rise during a nursing session. However, in some women, our bodies failed algebra and don't remember how to balance equations and our dopamine drops a little too low as the prolactin rises. This quick drop of dopamine to a lower than ideal level is what leaves women feeling anxious, scared, negative or depressed just before letdown occurs. Our brains quickly scramble to remember how to balance this equation and eventually get it figured out - usually as letdown is finishing and milk flow is established for that nursing session. Despite the fact that this imbalance stirs up negative feelings, it actually has nothing to do with a woman's true emotional state. It is not linked to postpartum depression, though it may often be mistaken for it. It can be a problem if misdiagnosed because it may lead to a mother receiving improper treatment and it can also risk the breastfeeding relationship if the mother is advised to quit nursing.

There is a wonderful site called that contains a lot of valuable information about this issue. It lists variable treatment options, of which prescription treatment is rarely advised, and resources for getting through it.They note that there is little success with pharmaceuticals, though they have been used in extreme cases, and that many mothers find more success with natural therapies such as herbs, placenta ingestion and diet. Whole fat dairy products and eggs are notably helpful in managing D-MER. The site has a good list of foods and other therapies that are believed to be helpful. I do find it interesting that among the listed food therapies are those whole fat dairy foods and eggs. Good quality dairy and eggs are sources of natural progesterone and it makes me wonder if there is also a low progesterone component in D-MER. As in, perhaps women with lower progesterone are more likely to experience dopamine levels dropping below normal. Things that make you go hmmmm. They also suggest altering things within your life to make the sensation more manageable. I don't want to copy direct from the site, but some of the noted helpers are drinking tons more water, consciously distracting yourself while nursing, self-hypnosis, exercise and allowing yourself some "me time" even if only for a few moments at the end of the day.

I can tell you that distraction worked for me. I would make sure I had my phone with me and I would either text someone or play on Facebook during those first few moments of nursing. The distraction most definitely helped push the negative feelings aside. They were still there, but they were more like a hazy shadow in the background and nothing like I felt before. It made it so much easier to deal with. The thing that made the biggest difference was knowing exactly what was going on. As soon as I heard about and read about D-MER I felt a little better. I knew what I was dealing with. I knew why it was happening and that there was nothing wrong with me. I knew that many women eventually overcome it. I knew it didn't mean I needed psychological help or that I was going to have post partum depression. Having that knowledge was power and made everything less scary for me.

D-MER subsides at different times for all women. In my understanding, many women find relief within the first three to six months after the birth of their baby. Some women do experience it for over a year, but this is not as common. They say that women can experience a relapse now and then. For me, it was over by the time Squishy was about three months old. She is now 8 months old and I have not experienced D-MER again.

I am telling you this because it is something that few know about. Look at me. My mother worked in maternity care for over 30 years and was a lactation consultant. I was doing breastfeeding counseling for Barbie was I was 6. I was doing real breastfeeding counseling as a teenager. I've read just about every breastfeeding book out there from cover to cover, I have been a member of La Leche League for 6 years, I have been a subscriber and a fan of Mothering Magazine since I was a teenager. You would think that I would have come across this information at some point in the past 20 years. Nope. It's not commonly talked about and it's definitely something that is misdiagnosed. I am willing to bet that many obstetricians, pediatricians, midwives and lactation consultants are not aware of this issue. It's actually a bit scary. D-MER is way more common than we realize, yet the majority of women are probably not getting the proper information about it. It's being swept under rugs, it's being mistaken for post partum depression or it's just plain not talked about because the moms experiencing it are feeling ashamed. We need to change this.

Please take a moment to look over Can you relate to this experience? Did you have D-MER without ever knowing it had a name? Please share this information with other mothers and fathers. Women who have D-MER should not have to feel ashamed or alone. The fact that this is not talked about or widely known is probably harming a lot of breastfeeding relationships. I would imagine that many women either stop nursing because they are afraid of these feelings or they are being counseled by health care providers to quit. This doesn't have to happen. Armed with the knowledge about D-MER, women will be able to learn how to work through it and, hopefully, continue nursing successfully.

Remember, if you have D-MER there is nothing wrong with you. This is a small quirk that happens to many women. You are not crazy. You are not a bad mom. You are not a failure. You can overcome this.

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