Pregnancy and Postpartum

What is happening with my mood?! D-MER and Breastfeeding

What is your experience with breastfeeding? Do you feel angry or tearful as soon as you start? Is there a sense of dread when you begin another pumping session? How intense is your anxiety during these moments? When it comes to nursing, there are many parents who enjoy the experience and feel it’s an opportunity to connect with their infants. However, there are also many parents who are frustrated and distraught by the same encounter. Before we assume that the reason we are struggling with nursing is due to postpartum mental health, we want to rule out a physiological illness called D-MER.

Signs of D-MER:

Dysphoric Milk Ejection Reflex (a.k.a. D-MER) is a breastfeeding struggle that occurs during letdown of milk. This includes nursing, pumping, or manual expression to release milk. Normally when lactating, parents experience the warm and loving feelings that come with an increase in oxytocin. However, with D-MER, a caregiver has a sudden drop in mood, and can experience any of the following difficulties:

Breastfeeding and D-MER. Anxiety, sadness or distress during pumping
  • dysphoria, or a state of unhappiness
  • panic
  • restlessness
  • hopelessness
  • anger
  • anxiety
  • sense of dread/doom
  • paranoia
  • thoughts/urges about suicide or self-harm

D-MER most commonly shows up as anxiety, agitation or sadness. The intensity of these experiences can vary from mild to moderate to severe. These symptoms can last anywhere from a few seconds to 2-3 minutes. It typically shows up about 30 seconds prior to milk release. D-MER struggles subside as you continue to nurse, but reoccurs as soon as another let down happens. Typically, parents start to feel better after 3 to 6 months once milk production regulates. Unfortunately, there are no specific tests or assessments to confirm you have D-MER. If you notice an abrupt shift in mood when you are pumping or nursing, it warrants considering whether D-MER is a factor for you.

D-MER versus Postpartum Mental Health

Breastfeeding and D-MER. Anxiety, sadness or distress during pumping

D-MER is a physiological issue. It happens because of hormonal and chemical changes in the brain during breastfeeding. This is not a psychological issue, although it certainly feels like one. Folks who have a history of mental health struggles are not more vulnerable to experiencing D-MER. It is completely by chance. Parents who have experienced D-MER with their first child have a higher likelihood of experiencing it again with future children.

D-MER is not the same as postpartum mental health. While an episode of postpartum anxiety can last for hours or days, D-MER lasts a few minutes and only occurs during the release of milk. Once breastfeeding is completed, parents moods regulate and they are able to re-engage in their daily activities. Unlike any prenatal or postpartum disorder which involves a combination of biological, psychological and social influences, D-MER is caused solely by hormonal shifts.

This does not mean that the two are mutually exclusive. Parents with perinatal mood and anxiety disorders can also struggle with D-MER. If this is the case, then a combination of treatment is useful in order to address both needs.

Why it happens:

D-MER has only recently been identified as a breastfeeding struggle, and research has started in the past 10 years. However, dopamine has been identified as the primary influencer to experiences of D-MER. Dopamine (a hormone connected to feelings of pleasure) must drop in order for prolactin (the hormone which helps produce milk) to increase. What research has found with D-MER is that the drop in dopamine is too significant during milk letdown, which triggers an abrupt drop in moods.

What you can do if you have D-MER:

The first and most important thing to remember about D-MER is that it is not your fault. You are not doing breastfeeding or parenting incorrectly. This is truly a chemical change that is happening outside of your will power. It is not a psychological issue, and there is absolutely nothing “wrong with you.” It’s an automatic reaction, and the emotions and thoughts that come with D-MER are not based on facts, reality, or any truth to your capacity as a parent.

Approximately half of nursing parents stop breastfeeding by 6 months. This can happen for a variety of reasons, and only you are the judge of what is right for your body. If D-MER is one of the reasons to stop breastfeeding, it may be helpful to know that most parents struggling with this issue feel an improvement of symptoms in 3 months once milk production regulates.

Connecting with your health care team:

Lactation struggles. Perinatal mental health. Speaking to physician

Knowing that this ailment is a chemical imbalance, it’s best to speak with your physician or lactation consultant about your experience. In moderate to severe cases of D-MER, treatment options will likely involve medication or herbal supplements to support adequate dopamine production.

Behavioural Strategies

With milder versions of D-MER, there are several behavioural strategies that can be used to support your nursing experience. Firstly, it is helpful to keep track of your symptoms. What varies on days when your D-MER symptoms are worse? Common factors that can improve or exacerbate D-MER include: stress, rest, caffeine intake, hydration, and exercise.

Changing the Pattern:

Using distractions to help during breastfeeding.

Secondly, we want to create a more positive experience when nursing or pumping. When we know we are walking into a stressful event, our system braces in anticipation. With enough occurrences of D-MER, parents are typically anxious about lactation. To break this pattern, we want to pair positive experiences with breastfeeding. While nursing or pumping, add in a pleasurable activity that you can use as a distraction. Options can include: listening to your favourite podcast, reading a novel, playing a game on your phone, watching your favourite TV show, eating a delicious piece of cake. Use this activity only when you are breastfeeding to help your system create positive anticipation.

Mindfulness

Thirdly, mindfulness practices can be used to help during this time. When our system anticipates threat, we are hypervigilant of all signs and symptoms related to the threat. Unfortunately, this can make things worse because we are fixated on every nuance that can go wrong. We can also get caught in a negative spiral after breastfeeding is done because we continue to think about the experience and fret about what did not go well.

Mindfulness involves choosing a neutral anchor to focus our attention. For example, you can focus on the sensation of holding your baby, or keep count of baby’s gulps during a feed. You can pay attention to your own body or breath. You may also focus on external anchors like listen to music or noticing what is outside in your backyard. Your mind may wander, and mindfulness involves re-directing your attention to the safe and neutral anchor whenever this occurs.

Breastfeeding is Tough

There are a lot of factors that can influence our postpartum year, including breastfeeding struggles and D-MER. At the end of the day, no one can or should make the decision to start or end breastfeeding other than you, the lactating parent. If you find your mental health is influenced by your breastfeeding experience, please reach out. You do not have to struggle in isolation.

Take care,

Kasi

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Parenting

3 tips to improve your parenting style

How do you find your parenting style? Does it meet the standards you’d set out for yourself? Are there times where you look back and cringe, wishing things had gone differently? Are there moments where you’re proud of how you handled a tough tantrum? In the next few posts, I will be sharing some strategies to improve your parenting style with your kids. Give it a try and see how your relationship can grow!

Strategy One: Be mindful of HOW you are talking.

STEP ONE

I challenge you to do absolutely nothing different except start observing the way you communicate with other people. Notice how your tone, posture, volume, eye contact, and other verbal/nonverbal communication skills shift when you’re speaking from one person to the next.

father talking to his son
Photo by August de Richelieu on Pexels.com

STEP TWO

Start noticing how you are talking to your kids. Surely they are not the only people in your life who you find baffling or irritating. How do you approach them versus anyone else outside of your home?

family preparing food in the kitchen
Photo by August de Richelieu on Pexels.com

STEP THREE

Write a list of communication changes that are manageable right now. Do not wait until the ‘perfect time’ to make these changes- your kids will not be around on only ‘perfect days’. Would this change involve having more eye contact when you speak with them? Do you need to switch to a gentler tone? Do you tend to multitask when you’re around them? Are there any passive-aggressive comments being made? (No judgement! We’ve all done it at some point.)

notebook
Photo by Suzy Hazelwood on Pexels.com

Pick ONE strategy and try it out consistently for two weeks. Check at the end of your two weeks to see if it made a difference. If it does, awesome and congrats! If it doesn’t, go back to your list and try another. Good luck, parents!
As always, feel free to contact me with any questions or comments.

Kasi

Anxiety

Calming the anxieties of our inner perfectionist

I have talked about the “perfectionist” part of me in previous posts. When this part of me gets going, it wants to set high standards and throw all concepts of work/life balance out the window. You may have a similar perfectionist inside of you. This perfectionist may say harsh comments like: Why are you not good enough? Why aren’t you trying harder? How are you making so many mistakes? Are you really taking a break right now? How are you screwing this up? You notice your anxiety continuing to increase with each and every question. It never feels easy to hear these criticisms, and the struggle to calm this part of you can feel like the biggest hurdle.

Calming the anxieties of our inner perfectionist. Kasi Shan Therapy offers counselling support online and in Kitchener, ON

There are a lot of components that go into creating this perfectionist. We all carry wounds and burdens from our past. The ways in which we were raised, our childhood experiences, our moments of distress, and many other factors collaborate to form this perfectionist. Ironically, this perfectionist is acting in ways that it feels are the most effective in getting results. It hopes that by yelling, criticizing, or nagging, you will improve. Despite these well-intentions, the perfectionist’s words are hard to hear, especially when they fly at you frequently and incessantly. There are many ways we can support this part. We can use counselling strategies like EMDR and IFS to learn what happened to create this part of our personalities. We can then provide it the space and tools it needs in order to feel less anxious. We can focus on exposure work to help this part of you learn that making mistakes is not the be-all and end-all that it fears. We can gently challenge some of its beliefs to change thought patterns. We can work on mindfulness to recognize when this part gets triggered, and support it much sooner.

Calming the anxieties of our inner perfectionist. Kasi Shan Therapy offers counselling support online and in Kitchener, ON

I want you to have support right now if your perfectionist parts are feeling anxious. Dr. Christopher Germer is an incredible practitioner who helped develop mindful self-compassion. I encourage you to take a few minutes for yourself and practice this exercise, and I hope that it resonates with you.


At the end of your counselling experience, I hold many hopes for your inner-perfectionists. I hope this perfectionist learns that it’s okay to screw up and to have regrets. Making mistakes is part of being human. I hope this part knows that there is a future beyond this moment and this mistake. I hope this part of you recognizes that this is a moment of suffering; there is a beginning, and there will be an end (even though, sometimes it feels like it lasts forever). I hope it realizes that this moment can be just that: one moment in a lifetime of many moments. I hope that it is able to look around and see that there is more to you than being perfect. I hope it notices the humor, the personality, the kindness, the patience, the efforts, and all the other factors that make you a well-rounded person. I hope it recognizes that these other factors do not go away because you have made a mistake. I hope this perfectionist inside learns to accept that you are not perfect, nor do you have to be perfect, or prove to others that you are perfect.

As always, if you have any questions or comments, please feel free to reach out.

Kasi

Anxiety

Simple daily mindfulness exercises

What would your life be like if you had control over your attention or thoughts? How could you shift your behaviours if you became aware of when your emotions started to take a downward shift? What would happen if you could become more present with your environment or the people around you?

Mindfulness is the skill of moment to moment awareness of what is happening (both internally in your system, and externally in your environment). It involves noticing what is taking place without judging or trying to change things. While this skill takes practice, it does not have to involve complicated or lengthy exercises. Here are some simple ideas of how you can practice being mindful daily:

1) Drinking your morning coffee (or insert beverage of choice).

Take a few minutes to bring your attention to the experience of drinking. What does your coffee taste like, smell like, look like? Can you slow the process down so you can notice all the steps in between pouring a cup of coffee to taking your first sip? How does your body move around your kitchen? What noises do you hear as you take out a mug? I encourage you to practice this exercise for 5 minutes. Of course, your mind will wander (don’t worry! It’s meant to wander!) Being mindful involves noticing when your attention wanders, and bringing it back to our set anchor (in this case, the experience of drinking coffee).

2) Listen to music.

Close your eyes to reduce distractions from outside and bring your attention to the song. Notice the shifts in your body as you listen to music. Are there moments when you feel activated? (Can you notice a spark of irritation? An urge to dance? Do you feel it is easier to breathe?) Are there moments when music calms your body, or perhaps leave you feeling unsettled? Take a listen to these two very different pieces of music. Mindfully observe the changes that happen in your body (and of course, try not to change the experience, or judge it!)

3) Describe a person you dislike nonjudgmentally.

How often are you critical? Do you tend to make quick conclusions about people? Has this behaviour gotten you in trouble? Being nonjudgmental involves describing what we observe with our five senses (therefore, sticking with objective facts) versus evaluating or interpreting people or things. Being nonjudgmental moves us away from relying on harsh, emotional language. Choose a celebrity, a teacher, a family member, a TV personality, or anyone that you have found annoying and describe them using nonjudgmental language (To learn more about the skill of non-judgement visit DBT Self-Help). Why am I mentioning mindfulness today? Well, let’s be honest, we’re all a little anxious right now because of this pandemic. Mindfulness is one of many strategies that can support our emotions at this time.

As always, please feel free to share or reach out if you have any questions!

Cheers,
Kasi