This post was prompted by a discussion I observed recently on Facebook. A pregnant woman wrote about how unhappy she had been while breastfeeding her previous baby, and the onslaught of advice started at once. She should encapsulate her placenta this time, they told her. She should take vitamin supplements. She should think about any deep-seated issues that might be causing her problems.
I wondered, though, if it might be D-MER: dysphoric milk ejection reflex.
In most women the milk ejection reflex works like this: the anterior pituitary secretes prolaction, stimulating on-the-spot milk production in response to a suckling baby, and then the posterior pituitary secretes oxytocin, triggering contractions in the myoepithelial cells of the breast. They squeeze the milk out in what's more commonly called a letdown. You can think of it as a baseball team: the center fielder (that'd be the anterior pituitary) whips the ball to the second baseman (posterior pituitary), who tags out the guy from the opposing team (failure-to-thrive heads back to the dugout, shoulders sagging).
For a subset of women, the process unfolds a little differently. It's thought that their dopamine levels plummet in association with this hormonal dance, causing a surge of negative emotion just before each letdown. To continue the baseball example, it's as if the shortshop runs over to get in on the action at second base and injures himself along the way.
There's a range of severity: for some women, it's a mildly unpleasant wave that passes quickly. For others, it's crippling. As you might expect, there's also a range of possible treatments. For some women, just knowing what's going on is enough to make the feelings manageable. Others report that improved self-care can ease the unpleasantness. For women with more severe cases, prescription medication can help. It's important to note that the antidepressants most commonly prescribed for lactating women are unlikely to help with D-MER: Zoloft and Paxil can affect serotonin levels, but serotonin is the wrong neurotransmitter to tackle when D-MER is the problem.
So is it possible that some women hate breastfeeding because they have deep-seated psychological issues? Sure, it's possible. It's also possible that some women might find vitamin supplementation helpful. (All I'm going to say about the placenta encapsulation idea is "to each her own.") But it's also possible to hate breastfeeding because every letdown -- we're talking maybe three or four of them per feeding or pumping, ten or twelve times per day, plus the times when the baby sleeps too long or cries too loudly and her breasts say, "Hey, did somebody need some milk around here?" -- every one of those letdowns triggers feelings of hopelessness or anxiety. Knowledge is power, and ignorance about D-MER is widespread. Find out more here.
[Update: here's a follow-up post on nursing happily despite D-MER.]
Recent Comments