The Motherwear Breastfeeding Blog

When breastfeeding causes bad feelings: Dysphoric Milk Ejection Reflex.

Today I'm pleased to bring you an email interview with Alia Macrina Heise.  Alia is a mother of three who lives in the Finger Lakes region of New York.  She is a WIC breastfeeding counselor, a postpartum doula and a certified lactation counselor in private practice.

Alia has been working with a team of physicians and lactation consultants to identify a problem recently termed Dsyphoric Milk Ejection Reflex, or D-MER.  She runs the website, DMER.org.

What is D-MER?

The official definition of D-MER (Dysphoric Milk Ejection Reflex) is a newly recognized condition causing a brief surge of dysphoria, or negative emotions, that peak before the milk ejection reflex, or letdown, in a lactating woman and then dissipates quickly after the milk release.

But put more casually, what a mother with D-MER experiences is a wave of unpleasurable emotion that hits when she begins to breastfeed and then fades a few minutes later. The feeling varies for each D-MER mother to some degree but can include a sinking feeling in her stomach, a feeling of hollowness, anxiety, panic, sadness, restlessness and self disgust. This wave of feelings corresponds with her release of milk, but many mothers don’t make that connection.  There are three reasons for this: Firstly, because the mother also has the feelings with spontaneous releases when she is not breastfeeding; secondly, because not all mothers feel a letdown tingle in their breasts to connect the emotion with letdown and thirdly, because the emotional overload happens just prior to milk release, making it something that is not always easily connected for some mothers.

  

What was your experience with D-MER?

I began experiencing what is now known as D-MER when my third baby was born almost a year ago.  I did not experience the same reaction to letdown with my first two babies. As a lactation counselor it seemed to me that there ought to be information somewhere on such a phenomenon, but I could not find any. I did find however, within about one month’s time, about 100 other mothers who experienced the same thing and they had all thought they were alone in their experience. So I sought out the more qualified lactation professionals to help me investigate D-MER and since then D-MER has gained a large amount of attention and is continuing to gain recognition.

 

How common is D-MER?

It seems that it is more common than anyone would have guessed. We are finding is that this is one of breastfeeding’s best kept secrets. Women have been embarrassed, fearful and self conscious about bringing up the negative emotions they feel while breastfeeding, even to their best friend or mother. This is because there is a strong message that breastfeeding feels 100% pleasurable, even warm and fuzzy, and so a mother who experiences the exact opposite, things like guilt, anger, irritation, hopelessness and dread, feels very much like a “freak” and a “weirdo.”

What is known about the causes of D-MER?

We have come very far in a short amount of time, but we surely haven’t come far enough in terms of knowing what the exact mechanism of D-MER is. We probably know 1000 things or more that aren’t the cause of D-MER and that brings us that much closer to finding out what is.  Oxytocin is involved, but not as the culprit, more as the messenger.  We can know this because mothers experience D-MER before a letdown, probably about the same time oxytocin is being released in the brain. The rest of the puzzle will be figuring out the other parts of the hormonal milieu involved. Prolactin, dopamine, the pituitary, the amygdala and others are all being investigated.

Does D-MER go away?

It can self-correct, but that varies from mother to mother. For mothers with mild D-MER it is likely to self-correct around the third month. For severe D-MER it often won’t self correct until well after the first year, or sometimes not until weaning.

Where can mothers get more information about D-MER?
D-MER.org is the largest source for D-MER support at this time, as D-MER is still gaining recognition.  Not only does it contain comprehensive information about D-MER, but it has quotes from other mothers, informational handouts available for download, a forum dedicated to D-MER, a survey for mothers who have experienced D-MER to take to help with the investigation of D-MER, and a lot more.

Belly balls, new milk storage guidelines, and another Ideablob finalist needs your vote.

There isn't much of a theme tying these three things together, but here goes:

Back in 2006 I wrote about belly balls made by Ameda, and provided some ideas on making your own set.  They're a great educational tool for showing how small a newborn's stomach is, which can calm new parents' fears that their newborns aren't getting enough milk in the early days.  The Ameda belly balls aren't offered for sale, and have been hard to get unless you work in a hospital.  The good news is that Childbirth Graphics is now selling their own version, called "Baby Bellies."  Ameda recently revised the size of the balls (they're now bigger than the ones in my first post) and Childbirth Graphics' set reflects the new sizes.

La Leche League has released new breastmilk storage guidelines.  A big thank you to Angela at Breastfeeding 1-2-3 for posting about them.  The new guidelines say that breastmilk can be kept out at room temperature for 4 hours (ideal) to six hours (acceptable); in a refrigerator for 72 hours (ideal) to 8 days (acceptable); in a freezer for six months (ideal) to 12 months (acceptable).  More information is on Angela's site.

Remember the Ideablob contest which I wrote about endlessly in January - the one which won the Mothers' Milk Bank of New England $10,000?  I got about 10,000 gray hairs worrying about that one, but it all ended very well.  Anyway, there's another breastfeeding-themed project in contention this month which deserves your vote.  La Leche League leaders in Washington state are proposing to use the prize money to get a children's book published which depicts breastfeeding babies and toddlers.  One of the mothers behind this effort was told that some publishers will not allow depictions of breastfeeding, male nipples, or even cow udders i children's books!  Proceeds from book sales would benefit the Seattle LLL toddler group.  Check it out and vote!

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California company fined $4,000 for violating workplace pumping law.

And speaking of pumping...

A California company has been fined $4,000 for violating the state's law requiring employers to make a reasonable effort to provide a clean, private space for pumping (that is not a toilet stall) and a reasonable amount of break time to do so.

The Sacramento Bee reports:

"In the first citation of its kind, California's Labor Commission on Friday fined a Santa Clara-based company $4,000 for violating a state law that requires employers to reasonably accommodate employees who are breast-feeding.

The commission cited International Security Services Inc., a private security firm, after investigating a complaint by one of its employees.

The woman, who was not named in a press release, said she had to express breast milk in a room monitored by security cameras and didn't get the time she needed."

This reminded me of the discussion I had with Jake Marcus about enforcement provisions in laws protecting breastfeeding mothers in a recent podcast interview.

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The 17th Carnival of Breastfeeding: Taking a bottle.

Welcome to this month's Carnival of Breastfeeding!  June's theme is pumping, and since all that pumped milk has to go somewhere, I thought I'd write about breastfed babies and bottles.  Be sure to check out the great posts from other bloggers on the topic of pumping at the bottom of this post.

Whether you're introducing a bottle because you're going back to work, or you want to share some feedings with your partner, there are some tips below that can help.  I've also included some strategies for dealing with a baby who won't take a bottle.

Speaking of which, here's a great example of a baby who isn't at all interested in bottles.  Thanks to Alicia for posting it!

Tips for introducing a bottle:

• Wait until roughly the end of the first month to try a bottle.  Before that time, some (not all) babies develop a nipple or flow preference and may have a hard time latching on to the breast correctly, or even refuse it.  The danger of this is greatest in the days and weeks right after birth.

• Don't wait too long, since at some point babies will reject the bottle.  In my experience this happens most often with babies who haven't tried one by six weeks.

• If it's important that your baby be able to take a bottle (for example, you'll be returning to work), after introducing the bottle at four weeks, continue to re-introduce the bottle at least a few times a week.  Don't go overboard with it, though.  Up to a bottle a day is usually fine, but too many may cause latch difficulties or breast refusal.

• Have someone other than yourself introduce the bottle.  Babies are smart, and some won't take one from you because they know you have the goods.  Some books recommend that you stay out of the room when a bottle is given.

• Practice "paced feeding (halfway down page)," which helps the baby manage the flow of milk.

• Use a bottle nipple which is more like a breast (with a wide base), and use the slowest flow nipple at first.  You'll probably also want to look for bottles that are BPA-free.

• If you're going back to work, gradually increase the frequency of bottle feedings so that your baby is solidly taking the bottle by the time you return to work.

Tips for babies who refuse bottles:

• Don't force it.  This doesn't work, and often makes the situation worse.  If your baby refuses, like the one in the video above, take a break and try again at a better time (see below).

• Experiment with different nipples, different size nipple openings (for flow).  Try to match the nipple shape and flow with your own.

• Use distractions like movement, talking and singing, going outside.  The Nursing Mother's Companion has a good picture of an outward-facing hold which seems to work for some babies.

• Try at times when the baby is sleepy, in a good mood, or not hungry.  In general, the more hungry and distressed a baby is, the more "disorganized" he/she is likely to be.  In that state a baby is less likely to do something new or difficult.

• Make sure that your milk doesn't taste or smell "soapy."  This may mean that you have excess lipase in your milk. 

• In a pinch, try other feeding devices, like a medicine cup, finger feeder, syringe feeder, or sippy cup.

• Know that your baby will be fine even if she/he only "sips" while you're gone.  He/she will make up for it when the two of you are together, a pattern known as reverse cycling.

• Say to yourself, "this too shall pass."

Be sure to check out these great posts from our blogging friends (updated throughout the day):

• Raising Baby Bee writes about pumping at work (and shares a great 'do not disturb' sign).
• Breastfeeding Mums says "electrify me!"
• Breastfeeding 1-2-3 writes about exclusively pumping for a baby with a cleft palate.
• Hobo Mama writes about donating milk for an adopted baby.
• Adventures of a Breastfeeding Mother shares her pumping tips.
• The Attached Mother writes about pumping and becoming a milk donor.
• Mama Knows Breast invites you to enter to win a free Medela Freestyle pump.
• Mike and Toni's writes about how a pumping experience turned into a business idea.

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Nursing tank and camisole sale.

Motherwear is having a great nursing tank and camisole sale, now through Tuesday.

Time to stock up!

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The things they say.

You've sent me some great stories about the things your kids say about breastfeeding!  Here they are:

My daughter Julia came into my bed one morning, took a big drink of milk, popped off, looked adoringly at my breast and said, "My coffee!"  The latest in funny nursing stories in our house is that when I put on my sports bra before going to the YMCA, Julia says, "NO Y bra!  Mama wear 'nursie' bra. PLEASE!"  Recently, during a heat wave, she woke up from her nap and asked to nurse.  When she was nursing she looked up at me and said, "Mama's breast SO HOT!" - Gina

Just the other day Gray, 2 1/2 pointed and said that when the new baby is born he will take "that side" (my left side) and baby can have the other one. "Take turns," he said. - Stephanie

Every couple of months, I ask my 2.5 year old what "momma milk" tastes like, out of curiosity.  Last month he popped off, grinned widely, and exclaimed, "SUGAR!" - Maureen

In order to get a full night's sleep myself, I have night weaned Sara Ellen who is 2 1/2.  It's been so refreshing but usually she will still want milk in addition to stories.  She'll ask for a "little bit drink."  If I take of my shirt to change she'll say, "look at that mommy milk" which is what she calls my breasts, seeing as that's how I ask if she wants to nurse. - Rebekah

This wasn't me, but a story that was relayed to me by a friend.  She said that her son who as almost five said once:  "I know why mommy milk is so good."  Mother:  "Why?"  Son:  "Because you have lollipops in there!" - Trevor

While I was nursing my third child, my second child (about 2.5 or 3 years old at the time) started to refer to breastfeeding as "beauty breast".  I think he heard the phrase "beauty rest" somewhere and misunderstood it.  Since I'm always very matter-of-fact with my kids when it comes to breastfeeding and body parts, I guess he got the two phrases "breastfeeding" and "beauty rest" confused.  I didn't really correct him, I just asked that he only talk about that kind of thing when we were at home.  I love the phrase!  I'm glad that even my 3 year old son could see the beauty in it! - Alli

My younger son, at about a year, began to associate being laid on the bed and then having me take my shirt off to nurse and cuddle on the bed with him nursing.  As soon as I'd lay him down and take off my shirt, he'd clap and say "Yay!"  I told my husband, "Geez, no one's been that enthusiastic in years!"  Now, at 18 months the says "Mo? Mo?" and pats my chest when he wants to nurse.  He's also been known to point to my breasts and say "Mines!" - Jennifer

When I ask my son what breastmilk tastes like he says, "Cannoli!"  He also calls it "delicious drink" and "delicious sip."  And he's very specific, sometimes asking for "lap boobs" vs. "couch boobs." - Amanda

For my own stories and others from our carnival on this topic, see this post, and feel free to leave your own story in the comments section!

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New CDC data shows many hospitals not doing basic things to support breastfeeding.

You don't have to be a rocket scientist to figure out the basic things you need in a hospital to support breastfeeding.  For years, UNICEF and the World Health Organization have promoted the "10 Steps to Successful Breastfeeding," proven strategies for increasing breastfeeding rates and getting breastfeeding off to the best start.  You're most likely to find them at hospitals which are certified "Baby Friendly."

The 10 steps are common sense things like keeping mothers and babies together after birth, having a breastfeeding policy, having trained staff to help mothers, helping mothers initiate breastfeeding within an hour after birth, not giving anything but breastmilk unless medically indicated, and not giving pacifiers or bottles.

But new data from the CDC shows that many hospitals aren't doing these basic things.  The study analyzed responses from nearly 2,700 birth facilities.  WebMD reports:

For instance, 24% of the facilities reported routinely giving other drinks (such as sugar water) to more than half of healthy, full-term newborns. And 70% of the facilities reported sending breastfeeding moms home with samples of infant formula. Those practices aren't supportive of breastfeeding, notes the CDC.

The CDC noted some significant regional differences in the practices of hospitals:

"The study found that hospitals and birth centers in many southern states scored lower in practices supportive of breastfeeding compared to other regions of the nation... Seven southern states Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma and West Virginia also had the lowest percentages (less than 30 percent) of children who were breastfed for 6 months, according to the 2006 National Immunization Survey.

Western and New England states generally had higher scores compared to other parts of the country. Vermont and New Hampshire tied for the highest overall maternity practice scores (81), followed by Maine (77) and Oregon (74). In addition, Oregon, Maine and Vermont report that more than 75 percent of children were ever breastfed."

Above is a map showing how each state did, and you can get a more detailed chart of how each state scored.  And here's a great handout (pdf) called "A Mother's Ten Steps to Successful Breastfeeding - Even if your hospital isn't Baby Friendly."

So, how did your hospital do? 

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"Aren't you just doing that for yourself?"

You may have heard this idea before - a mother breastfeeding because she wants to, not because the baby wants to, or for any benefit to the child.

A variation goes something like this:  "After a baby is (six months, one year, 18 months) it's just about what the mother wants, not what's good for the baby."  Sometimes we even say it to ourselves: "I just can't bring myself to wean her.  I guess I'm being selfish because I can't let go."

I've been thinking about this idea a lot recently, prompted by some of the discussion on weaning spurred by this post on weaning. 

I've been thinking about where this idea comes from.  Here are my ideas:

1) The misconception that a mother can choose to breastfeed a child who doesn't want to.  I can say from experience that if a baby doesn't want to nurse, you simply cannot force it to.  Any of you who have had babies with "breast refusal" will know exactly what I mean. 

2) The misconception that formula is as good as breastmilk.  Of course you know that this isn't true, but as a result of some effective marketing, the percentage of mothers who say that it is has increased by 50% between 1999 and 2003.  So, if there's no real difference between the two, the mother must be breastfeeding for herself.  Diana West did a good job of pointing this out in a podcast interview I did with her.

3)  The misconception that, at a certain point - one year, or 18 months - breastmilk declines in quality. This assumption, which mothers sometimes hear even from doctors, can easily lead you to the conclusion that a mother who nurses beyond that point is doing it for herself.  The facts are that breastmilk continues to provide important nutrition and immunological protection, and that some immunologically important components of breastmilk actually increase as the amount of breastmilk the child gets decreases.  Nature is no dummy.

4)  The view that a mother could be breastfeeding solely for her own health.  Until a reader left a comment reflecting that idea, it had never occurred to me that the research showing benefits like a reduced rate of cancer and faster weight loss could be turned around to blame women for wanting to nurse.  As for the concept of a mother making a child nurse, see #1.

5)  Discomfort with "extended" breastfeeding.  Extended breastfeeding, which is really the historically normal course of breastfeeding, is so uncommon in this country that the idea of a nursing two year old just doesn't compute.  It can only be explained by the mother's desires.

Mothers nurse their babies for all kinds of reasons - for good health, for financial reasons, for environmental reasons, among them.  And yes, being successful at breastfeeding, however one defines it, can make a mother feel good about herself.  But to accuse mothers of breastfeeding solely "for themselves," especially when so many mothers struggle valiantly to do it, and if anything put aside their own needs to be able to breastfeed, is just misguided and even cruel, in my view.  I'd love to hear what you think.

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Summertime at Motherwear.

Motherwear's summer line of nursing clothes is here!

Check out the new line, which is modeled by nursing moms Marni (top left), and Sophie (top right) and their babies.

We just made it through a heat wave here, and everyone is in the mood for some cool summer clothes.

You'll find some great new swimsuits - very handy at the beach and at the pool.

And Motherwear has a number of new summer dresses and tanks.  You'll find lots of layered-look nursing shirts, and some new comfy sleepwear, too.

There are a number of items made with bamboo fabric - a sustainable fabric which wicks away moisture and is very soft.  For more information on bamboo, see this post.

Watch for some great vintage covers on the site in the coming weeks, celebrating Motherwear's 25th year supporting nursing mothers in style!

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Preparing to breastfeed, when your sister is carrying your baby.

I feel so lucky to be able to present this guest post by Karma, author of the blog "She's Having our Baby."  Karma, who lives in Toronto, has been inducing lactation so that she can nurse her baby, who is being carried by her sister. 

My journey to becoming a mother will have taken approximately 1,825 days by the time our daughter arrives this June.

My husband and I are nearing the end of our third trimester, but if you saw us we would look no different than before we were expecting. That’s because it’s my younger sister who is now sporting the baby bump, our baby bump. She’s our gestational carrier - meaning the baby she's growing for us is biologically our child, but is in her uterus.

So back to the beginning, and I promise I'll be brief:

Diagnosed with Non-Hodgkin’s lymphoma at 30; had just met my now husband, then boyfriend only a month before so things were BRAND new; cancer treatment meant I'd lose my fertility so we had to decide in 24 hours what to do - did I mention we'd only be dating for a month? 

So we decided to move forward with an IVF cycle, which resulted in 20 embryos. Fast-forward a couple of years: now married, we decide to thaw some of our embryos out to see what could happen and we embark on what I honestly thought would be our baby-walk-in-the-park. Not even close...endless hormone cycles, transfers, tears, frustrations, and no success. We finally admitted defeat. Enter my sister - our savior and currently 38.5 weeks pregnant with our little girl. 

One of the things I’ve been very excited about is the prospect of breastfeeding our little girl. I had no idea this was even a possibility until our fertility doctor casually asked if I was planning on doing it. I was immediately like, “Yes! If I can…how can I?” That’s when I first heard about Dr. Jack Newman and learned that there are ways to induce lactation. 

I was on the accelerated protocol, which consisted of the birth control pill for about eight weeks, while also taking a drug called domperidone, normally used for digestion. Almost instantly I was STARVING – that’s just one of the side effects of domperidone, along with inducing lactation. Then after the eight weeks, I stopped the birth control pill and started pumping.

It’s been over six weeks of pumping six times during the day and once in the middle of the night. I’m using a double electric pump, which seems to be doing the trick. I got drops on my first pump session, and have now progressed to about 8-10oz per day, depending on the day. I’ve found Gatorade and daily oatmeal have made the biggest impact on my production, along with the 120mg of domperidone every day. The pumping hasn’t been easy – I work full time and trying to find time during the day to pump, amid meetings, has been a challenge. I’m tired from getting up each night to pump, but also know this will be good practice for the newborn phase. 

But whenever I’m feeling frustrated by the pumping, or by the production, I remember why I’m doing this. Number one, it’s the best thing for our little girl. Number two, breastfeeding is going to be the most “normal” part of having this baby so far, and I can’t wait to be like every other new mom.

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