Postpartum and Breastfeeding

The Impact of Breastfeeding on Mental Health: Understanding D-MER and More

Kayla Thorngate

The Impact of Breastfeeding on Mental Health: Understanding D-MER and More

Breastfeeding is often portrayed as a beautiful bonding experience between mother and child. But for many mothers, it can also bring unexpected emotional challenges. Among these, Dysphoric Milk Ejection Reflex (D-MER) stands out as a particularly perplexing condition. Let’s dive into what D-MER is, how common it is, and how breastfeeding can impact a mother's mental health.

What Is D-MER? How Common Is It?

D-MER, is a condition characterized by a sudden wave of negative emotions that occur just before milk letdown during breastfeeding. These feelings, which can range from anxiety and sadness to anger and dread, typically last a few minutes. Unlike postpartum depression, D-MER is directly linked to the act of breastfeeding and the hormonal changes that trigger milk ejection.

According to a study published in Breastfeeding Medicine, D-MER is estimated to affect about 9% of breastfeeding women to some degree. Despite its prevalence, many mothers and healthcare providers are unaware of the condition, which can leave mothers suffering from this condition with feelings of isolation and a lack of support. This same study highlighted the need for increased awareness and support for mothers experiencing D-MER. Another recent report detailed characteristics, risk factors, and its association with depression scores and breastfeeding self-efficacy, emphasizing the complex nature of this condition.

How Hormonal Changes During Breastfeeding Impact Mood and Mental Health

Breastfeeding triggers a cascade of hormonal changes that play crucial roles in milk production and mother-infant bonding. However, these hormones can also impact a mother’s mood and mental health.

  1. Prolactin: This hormone is essential for milk production. Elevated levels of prolactin during breastfeeding can promote a sense of calm and relaxation. However, prolactin also inhibits dopamine, which can sometimes contribute to mood swings and feelings of dysphoria.
  2. Oxytocin: Often referred to as the "love hormone," oxytocin is released during breastfeeding and helps with milk letdown. It fosters bonding between mother and baby and promotes feelings of happiness and contentment. However, abrupt changes in oxytocin levels can sometimes lead to emotional fluctuations.

Dopamine's Relationship with D-MER

D-MER is believed to be linked to a disproportionate drop in dopamine levels just before milk letdown. Dopamine is a neurotransmitter associated with pleasure and reward. When dopamine levels fall rapidly, it can trigger the negative emotions characteristic of D-MER. Understanding this mechanism is key to addressing and managing the condition effectively.

Coping with Dysphoric Milk Ejection Reflex (D-MER)

While there is no specific treatment or medication for D-MER, there are several strategies that mothers can try to alleviate the intensity of their symptoms and cope with the emotional challenges:

  • Mindfulness and Relaxation Techniques: Practicing mindfulness meditation, deep breathing exercises, or progressive muscle relaxation can help reduce anxiety and promote relaxation during breastfeeding sessions.
  • Supportive Environment: Creating a calming and supportive environment such as dimming the lights, playing soothing music, or engaging in comforting rituals before breastfeeding can help mothers feel more relaxed and at ease.
  • Positive Distraction: Engaging in activities that distract the mind and foster positive emotions can help shift focus away from negative feelings during milk letdown.
  • Seeking Emotional Support: Talking openly about D-MER with a trusted partner, family member, or healthcare provider can help mothers feel validated and supported.
  • Professional Support: Seeking guidance from a lactation consultant or mental health professional can provide valuable support and resources.

It's essential for mothers experiencing D-MER to remember that they are not alone and that their feelings are valid. If breastfeeding challenges are severely impacting your emotional well-being, it's crucial to seek support and consider alternatives that prioritize your mental health.

Other Common Breastfeeding Issues That Can Affect Mental Health

Breastfeeding can affect a mother’s mental health in various ways beyond D-MER. Here are some common issues:

  1. Breastfeeding Pain: Conditions like mastitis, nipple pain, and engorgement can cause significant physical discomfort, leading to stress and anxiety. The Academy of Breastfeeding Medicine Clinical Protocol #36 outlines the broad spectrum of mastitis and emphasizes the importance of early diagnosis and treatment to prevent severe complications.
  2. Sleep Deprivation: Frequent nighttime feedings can disrupt sleep patterns, contributing to mood swings, irritability, and exhaustion.
  3. Lactation Insufficiency: Concerns about producing enough milk can lead to feelings of inadequacy and guilt.
  4. Social Isolation: The demands of breastfeeding can limit a mother's ability to engage in social activities, leading to feelings of loneliness.

What Are Some Ways New Mothers Can Navigate These Challenges?

Navigating the emotional and physical demands of breastfeeding requires a multifaceted approach. Here are some strategies that can help:

  1. Seek Professional Support: Consulting a lactation consultant (IBCLC) can provide personalized strategies for overcoming breastfeeding challenges. They can offer practical tips for improving latch, managing pain, and increasing milk supply.
  2. Build a Support Network: Joining breastfeeding support groups, either in person or online, can provide emotional support and practical advice from other mothers. Additionally, resources like Postpartum Support International offer a multitude of free online support groups to help mothers connect and find support from virtually anywhere. To view a list of their offerings, click here.
  3. Prioritize Self-Care: Ensuring adequate rest, nutrition, and hydration is crucial. Taking care of your own needs can help maintain energy levels and overall well-being. Simple practices like taking time for rest, nourishing the body with nutritious foods, staying hydrated, and engaging in appropriate exercise can make a difference in your body’s ability to cope with stress and support mental health.
  4. Mental Health Resources: Seeking help from a mental health professional, particularly one specializing in postpartum issues, can provide coping strategies and emotional support. In addition to support groups, Postpartum Support International offers a wealth of information and support options for new mothers facing mental health challenges.

Above all, remember that a mother's mental health is paramount. If breastfeeding challenges are severely impacting your emotional well-being, it's crucial to seek support and consider alternatives that prioritize your mental health.

For more insights on managing mental health challenges related to breastfeeding, check out this article on navigating maternal mental health.

What Does a Lactation Consultant (IBCLC) Do?

International Board Certified Lactation Consultants (IBCLCs) are health professionals specialized in the clinical management of breastfeeding. They provide:

  • Assessment and Counseling: Evaluating breastfeeding techniques and offering solutions to common issues like latch problems and milk supply concerns, in addition to complex situations involving medical concerns for mothers and their infants.
  • Education: Teaching mothers about the physiological aspects of breastfeeding and how to manage any difficulties.
  • Emotional Support: Offering reassurance and support, helping mothers feel confident and capable in their breastfeeding journey.

Becoming an IBCLC requires extensive education and training. Candidates must complete 90 hours of lactation-specific education, obtain clinical experience through mentorship or healthcare settings, and pass a rigorous certification exam. This sets IBCLCs apart from other lactation professionals, who have less extensive training and certification requirements.


Breastfeeding is a complex experience that can deeply impact a mother's mental health. Conditions like D-MER highlight the intricate connection between breastfeeding and mood, underscoring the need for awareness and support. Above all, it’s essential to remember that a mother’s mental health comes first. By leveraging resources such as lactation consultants, support networks, and mental health professionals, mothers can find the support they need to navigate the emotional landscape of breastfeeding.

Additional Resources


  1. Heise, A. M., & Wiessinger, D. (2013). Dysphoric Milk Ejection Reflex: A Descriptive Study. Breastfeeding Medicine, 8(4), 338-341.
  2. Heise, A. M., & Wiessinger, D. (2023). Dysphoric Milk Ejection Reflex: Characteristics, Risk Factors, and Its Association with Depression Scores and Breastfeeding Self-Efficacy. Breastfeeding Medicine, 18(2), 95-101.
  3. Groër, M. W., & Davis, M. W. (2006). Cytokines, Infection, and Mood Disorders in Breastfeeding Women: A Case Study. Journal of Women's Health, 15(4), 401-409.
Academy of Breastfeeding Medicine. (2022). Clinical Protocol #36: The Mastitis Spectrum.
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Kayla Thorngate , RDN , IBCLC, PMHC

Kayla Thorngate, RDN, IBCLC, PMHC is the owner of Nourished Mothers and a trusted expert in maternal and infant nutrition and lactation during the transformative years of early motherhood. Based in the Denver Foothills of Colorado, Kayla offers breastfeeding support and comprehensive functional nutrition services to new and expecting mothers. Her steadfast devotion to better physical and mental health empowers women to reclaim their energy, vitality, and overall wellness as they navigate the challenges and joys of motherhood. Outside of her mission to help mothers, Kayla enjoys spending time with her family and friends, being immersed in nature, hiking, practicing yoga, and enjoying a crafted cup of coffee.