"Like the Clouds Covered the Sun": Maternal Experiences With Dysphoric Milk Ejection Reflex

Dysphoric Milk Ejection Reflex (D-MER) is defined as an undesirable feeling that some breastfeeding women experience within seconds of milk letdown. D-MER can impact maternal psychological well-being and breastfeeding continuation, but it is an understudied phenomenon.

To uncover and understand D-MER among breastfeeding women within 3 years of birth who self-identified as having experienced D-MER.

This descriptive qualitative research study was conducted to uncover and understand breastfeeding experiences of women who self-identify as experiencing D-MER. We conducted in-depth interviews with 13 women about their D-MER experience(s). Interview data were qualitatively analyzed using Braun and Clarke's thematic analysis for descriptive studies.

We found four themes that captured participants' perceptions, emotional reactions, and behavioral responses to D-MER: (A) Breastfeeding concessions and toleration; (B) Something does not feel "normal"; (C) I remember a feeling like this before; and (D) This is real, and recognition is validating. Themes reflected an outsized influence of D-MER on participants' breastfeeding goals, trajectories, and maternal identities. Participants expressed frustration about the lack of recognition and help for D-MER among healthcare providers, but relief in understanding, often through social media, that D-MER was considered a real, physiological condition. Participants were able to reduce, but not eliminate, D-MER symptoms through trial-and-error processes, including distraction, operant conditioning, and mindfulness/relaxation.

D-MER had a profound, negative impact on participants' breastfeeding experiences and led to decisions to stop breastfeeding or consider stopping before a participant had originally intended. Research is needed to develop interventions that reduce or eliminate D-MER symptomology.