When Breastfeeding Feels Bad: A therapist explains D-MER

Elizabeth Stallone-Lowder MSW, LCSW Sage Tree Therapy

This blog post from the perspective of a maternal mental health therapist explains Dysphoric Milk Ejection Reflex (D-MER) in a compassionate, clear way to highlight an often confusing and mysterious - and often ignored - postpartum condition.

As a maternal mental health therapist, one of the things I hear most often from newly postpartum moms is: “I didn’t know this was a thing…” — especially when it comes to Dysphoric Milk Ejection Reflex, commonly called D-MER. So many women experience it during their first breastfeeding or pumping experience, yet few have ever heard the term, let alone understand what it is or why it happens.

If you’ve ever felt a wave of dread, sadness, anxiety, or irritability just as your milk lets down—only to have it pass within seconds, you may have experienced D-MER. You are not alone, and this experience is real and physiological rather than “just in your head.”

What Exactly Is D-MER?

Dysphoric Milk Ejection Reflex is a reflexive emotional reaction that some people experience just before or during the milk let-down reflex that occurs during breastfeeding or pumping. Let down isn't referring to the point at which milk flows from the nipple into a baby's mouth or a breastpump, but is the hormonal process where the milk is released from the glands and proceeds to the ducts and then goes through the nipple.

Typical let down can feel like a dull aching inside the breast tissue or a feeling on tingling or fullness. In addition to happening when preparing to nurse, the sensation of let down can also happen when hearing a baby cry (even someone else's baby!), thinking about your baby or even looking at pictures of baby. Unlike postpartum depression or anxiety, D-MER happens abruptly and specifically around the moment milk releases, and it typically passes in a few minutes even though the emotional intensity can feel overwhelming while it’s happening.

It doesn't mean you're failing at breastfeeding. It is not a sign that you don’t love your baby. It's also not your fault or a reflection of poor maternal instinct.

Symptoms Moms May Experience

D-MER symptoms vary, but they all revolve around sudden, unwanted negative emotions tied directly to let-down Common emotions include:

• Sadness, hopelessness, or dread

• Anxiety and nervousness

• Irritability, agitation, or frustration

• Feelings of self-loathing or guilt

• Panic or a feeling of hollowness in the pit of the stomach

• In rare but serious cases—suicidal thoughts during the moment of let-down

Importantly, these feelings usually begin just before the milk begins to flow and dissipate within a couple of minutes—as soon as your prolactin and oxytocin levels begin to normalize.

How Common Is It?

Because D-MER is under-recognized and under-reported, research is still growing.

Estimates show about 5–9% of breastfeeding individuals experience D-MER. Some research suggests prevalence as high as 14–15% in larger samples of postpartum women. In one observational study, more than 1 in 4 participants screened positive for brief negative emotions during milk let-down — though many had very mild symptoms. Some data suggest that up to 45% of women with D-MER discontinue breastfeeding because of the symptoms, simply because they didn’t know what was happening. Can you blame them? This isn't just a slight distaste for nursing, this is an intense physical and emotional reaction every time you start to feed your baby.

This isn’t rare at all—it’s just not widely talked about... yet.

D-MER is likely underreported due to lack of awareness, from providers and parents alike. In my private practice, Sage Tree Therapy, I've been noticing an uptick in my clients reporting 'weird feelings' during breastfeeding and not really enjoying the closeness that nursing can often provide. Which makes sense. If you don't know D-MER is a thing, why would you mention it to your partner or doctor? The moms I work with in therapy usually just assume they suck at breastfeeding (no pun intended) and really don't like it. If providers aren't asking the right questions nursing moms are going to fall through the cracks.

What Causes It? (It’s Hormonal)

D-MER isn’t psychological distress in the common sense—it’s a hormone-driven reaction. When your body prepares to let milk down, levels of oxytocin (the hormone that triggers milk release) rise, which causes dopamine (a mood-regulating neurotransmitter) to go wonky and fast. In some mothers, this rapid temporary decrease in dopamine triggers negative emotional reactions before things balance out again.

This is a physiological reflex, not a character flaw or evidence that you don’t want to breastfeed. It’s your brain chemistry responding to a let-down.

Awareness Is Crucial

Because D-MER is linked to breastfeeding moments only, it’s often mistaken for postpartum depression or anxiety and can lead moms to isolate, feel shame, or even prematurely wean. Knowing this is particularly important for moms who already have stress, lack of sleep, pre-existing anxiety or a history of mood disorders. These factors can make the emotional responses feel more intense and harder to manage.

What Helps D-MER

There isn’t a magic medication that “cures” D-MER, but there are ways to manage and reduce its impact.

1. Talk About It

   Knowing what it is makes a massive difference. Many moms feel relief just from recognizing it’s real and temporary.

2. Support & Self-Care Around Feeding

   Sometimes partners, friends and family can inadvertently send the wrong message. Just because a mom has complaints about D-MER or breastfeeding in general, doesn't mean she wants to stop. Conversely just because a nursing parents isn't endorsing symptoms of D-MER doesn't mean she isn't freaking out and needs to stop. Ask them. Talk to them. Ask how you can support them.

3. Sleep Longer Not More Often

   You knew I was gonna bring this up right?! Birthing parents getting 5-6 hours of consecutive sleep as often as possible (versus little chunks of sleep here and there equaling more than 6 hours per night) serve as a protective factor for PMAD and possible D-MER.

4. Stay hydrated, avoid caffeine, drink more than you think you need.

5. Practice grounding techniques right before a feed. Here's a few good exercises to try.

6. Talk with a therapist or lactation consultant about coping strategies.

   
   

At Sage Tree Therapy, we’re seeing more moms bring up D-MER not because it’s new—but because awareness is finally catching up with lived experience. Many first-time moms don’t realize that the emotional shock they feel during nursing has a name, and once they do, the reaction loses some of its power. As clinicians, we work with mothers to:

• Understand the difference between D-MER and mood disorders

• Normalize physical responses to breastfeeding

• Build coping strategies that reduce anxiety around feeding

• Support mental health alongside lactation goals

No mom should feel abandoned by her own body, and you certainly don’t need to suffer in silence.

If You’re Reading This…

If you believe you might be experiencing D-MER—whether you’re breastfeeding or pumping—please reach out to a provider, lactation consultant, or a mental health professional. You deserve clarity, understanding, and compassionate support through this part of postpartum life.

You’re not “overreacting,” and you’re not alone. We're here for you.

Elizabeth Stallone-Lowder MSW, LCSW

Clinical Director & Lead Therapist

Sage Tree Therapy, llc