Experiencing intense negative feelings during breastfeeding led me to discover DMER

Picture this: I would be walking down the street on a summer day when the world would suddenly seem so dark, even though the sun was still out. Then, I would have a milk letdown and the sun would shine on me again, like the universe finally remembered to pay its electric bill.

I had this sensation repeatedly throughout the day, whether it was with a spontaneous letdown, when pumping, or when breastfeeding my newborn daughter.  

I had my daughter as a fourth-year medical student, while drowning in textbooks, surrounded by covid, and trying to keep it all together amid the stress of it all. It wasn’t that farfetched to assume I was imagining these transient but intense negative feelings that I experienced right before my milk letdowns. There were several factors supporting the idea that it was all in my head. I had not read about it in any of my medical textbooks, I hadn’t learned about it on my obstetrics or pediatric rotations, and neither my mom nor my siblings, who at the time collectively had 12 children who had all been breastfed, had heard of it or experienced it themselves.  

I had my daughter as a fourth-year medical student, while drowning in textbooks, surrounded by covid, and trying to keep it all together amid the stress of it all.

I was feeling alone, confused, and honestly, a bit crazy. 

Discovering the term ‘Dysphoric Milk Ejection Reflex’

Then, one day, my mother came across a description for Dysphoric Milk Ejection Reflex in one of her doula chat groups. She immediately sent it my way with the excitement of someone who just found the last slice of pizza in a room full of hungry doctors.  As I read the description of DMER, it felt like finding the missing puzzle piece to my breastfeeding journey. It was an actual thing, not just a figment of my exhausted imagination!   

As I read the description of DMER, it felt like finding the missing puzzle piece to my breastfeeding journey

There was hardly any medical literature on DMER

Armed with a name, I eagerly began researching medical literature on the topic, but to my disappointment, my search yielded minimal results. There were a few case reports and small case series, as well as some hypotheses regarding the pathophysiology behind this phenomenon. I was luckier with Dr. Google, finding some blogs and support pages, but I expected more from my medical peers.  

I eagerly began researching medical literature on the topic, but to my disappointment, my search yielded minimal results.

When I started my residency in obstetrics and gynecology, 10 months into my breastfeeding journey that ultimately went on for 27 months, I was disappointed to learn that none of my physician colleagues knew about it either. They were as oblivious to DMER as a newborn to the concept of personal space.

1 in 4 breastfeeding mothers have DMER

I was motivated to learn more about the condition and spread awareness, and I decided to create the research I thought was lacking. Fortunately, the lactation consultants I work with were familiar with it. I partnered with them to recruit patients, and we found that more than one in four had DMER, yet almost three out of four were not previously aware of the condition!

Fast forward two years, and here I am, a senior resident physician breastfeeding my second daughter with DMER by my side like a clingy ex. At least this time around I know what it is and what to expect. And my research findings were shared at a national medical conference and received positive feedback. A number of attendees even realized that they had experienced DMER and had not known there was a name for it! 

Fast forward two years, and here I am, a senior resident physician breastfeeding my second daughter with DMER by my side like a clingy ex.

I want DMER to be as well-known as the common cold

Now, six months in to breastfeeding my littlest, my episodes are a constant reminder and motivation to counsel my patients better, do more research about this condition, and get the word out. I especially want healthcare providers caring for those who are breastfeeding to be comfortable counseling about it and supporting them through it, because every lactating journey deserves a little less darkness and a lot more understanding. 

I am trying to spread awareness faster than gossip on labor and delivery, and I try my best to tell everyone I work with and everyone I know about it, but my personal reach is limited. With my goal of making DMER as well-known as the common cold, I launched @DMER.MD on Instagram, to provide comfort, community, humor, education, and awareness.