Abstract
Breastfeeding, given its biochemical and physiological basis, is known for its many benefits for both the lactating mother and the infant. Among the many challenges new breastfeeding mothers experience is the feeling of aversion in response to their newborn's suckling which has been termed dysphoric milk-ejection reflex (D-MER). Characterized by intense feelings of dysphoria which may eventually interfere with the mother's ability to breastfeed regularly, evidence suggests both the neurobiological and psychological basis of D-MER in an attempt to explain its complexity. Biologically, breastfeeding is expressed by the intracerebral release of oxytocin, an increased expression of oxytocin receptors in specific brain regions, increased mesocorticolimbic reward region activation, the secretion of prolactin and possibly the inhibition of dopamine. Hence, different theories explain D-MER in terms of disrupted neurotransmitter and hormonal activity. Breastfeeding has also proven to influence mood and stress reactivity in nursing mothers with a potential link with postpartum depression. Psychological theories attempt to explain D-MER from a sociopsychosexual lense shedding light on the significance of mother-infant attachment, the sexualization of the female body and the motherhood experience as a developmental stage in a woman's lifespan. The aim of this review is to provide a literature update of D-MER incorporating both neurobiological and psychological theories calling for raising awareness about the complexity of breastfeeding and for the need for mother-centered interventions for the management of D-MER and other postpartum-specific conditions.
Highlights
Breastfeeding, given its biochemical and physiological basis, is known for its many benefits for both the lactating mother and the infant
This is referred to as the Dysphoric Milk Ejection Reflex (D-MER) which is characterized by dysphoria starting shortly before ejection of milk and progressing for several minutes
Such symptoms have been described from a narrative perspective in different ways; as overwhelming, uncontrollable feelings that have strong influence on the mother, as a sense of obligation toward the baby, as an abnormal experience based on the assumption that a nursing mother should enjoy breastfeeding and as giving a sense of achievement when done
Summary
Breastfeeding, given its biochemical and physiological basis, is known for its many benefits for both the lactating mother and the infant. Among the many challenges new breastfeeding mothers experience is the feeling of aversion in response to their newborn’s suckling and their need to appropriately position the newborn, nurse and be patient This is referred to as the Dysphoric Milk Ejection Reflex (D-MER) which is characterized by dysphoria starting shortly before ejection of milk and progressing for several minutes. Symptoms may diminish by 3 months or may persist during the course of breastfeeding [7] Such symptoms have been described from a narrative perspective in different ways; as overwhelming, uncontrollable feelings that have strong influence on the mother, as a sense of obligation toward the baby, as an abnormal experience based on the assumption that a nursing mother should enjoy breastfeeding and as giving a sense of achievement when done. The first and only study examining the epidemiology of D-MER was published in 2019 suggesting a prevalence of 9.1% [9]
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