Does breastfeeding arouse intense negative feelings in you?

Breastfeeding is suppose to be a natural, effortless experience, but for a small percentage of women, it may be highly unpleasant due to certain conditions. — Photos: Freepik

The benefits of breastfeeding to both mother and child are numerous, well-studied and irrefutable.

Every year during World Breastfeeding Week, newspapers, magazines and social media are flooded with copious amounts of information advocating the wonders of this act, painting an image that it is both graceful and effortless.

Although breastfeeding seems like the most natural thing to do, for many, it is no easy feat.

For some, the journey may be tortuous and like ascending a mountain.

No single breastfeeding experience equates with another, and this applies regardless of the number of times a mother has gone through it.

Let us delve into two challenges that are not often discussed, yet may be endured by women during their breastfeeding journeys.

It is important to acknowledge the existence of these challenges, as only by doing so can they be addressed, methods to cope with them be sought, and the breastfeeding experience for mothers and children around the world be improved overall.

Dysphoric milk ejection reflex

It is only in recent years that the term “dysphoric milk ejection reflex (D-MER)” has been making its appearance in the medical literature.

It describes a sudden intense onset of negative emotions, just before “let down” or the release of milk occurs.

An estimated 5% to 9% of breastfeeding mothers experience this at some point, and it can take place during direct feeding, expressing of milk or whenever let down occurs, e.g. in response to a crying child.

As its name suggests, D-MER is a reflex, and thus is seen as a physiological response, rather than a psychological condition.

The symptoms last only for a few minutes and disappear when milk flow is established.

Many different words have been used by affected lactating mothers to describe the wave of negative emotions that they experience.

The common symptoms mentioned are the feeling of sudden anxiety and irritability, sadness or hopelessness, anger, self-hate or low self-esteem, and a sinking feeling in the stomach or dread.

In some cases, the symptoms can be severe, such as suicidal ideation.

Not much is known as to why D-MER occurs, but it is postulated to be due to a sudden drop in the level of dopamine, or “happy hormones”, in the brain.

The suckling action during direct feeding or as mimicked by a breast pump causes the secretion of the hormone oxytocin, which stimulates milk production and release.

Studies have shown that it also inhibits dopamine release.

Most women who have experienced D-MER report that it decreases in frequency after the first three months, although it can persist as long as breastfeeding or pumping continues.

It is vital that women are able to talk about these negative emotions with their partners without feeling judged.

Breastfeeding aversion response

A similar yet separate phenomenon that breastfeeding mothers may experience is the breastfeeding aversion response (BAR).

BAR is a complex experience that has yet to be well-research-ed, making it difficult for healthcare providers and affected women to understand and manage this condition.

It is described as a feeling of aversion while breastfeeding, which occurs the entire time the child is latched on, resulting in a compulsion to unlatch the child.

An empirical study done in Australia that observed the lived experiences of women with BAR concluded that this response is unexpected and difficult for mothers, and may result in detrimental effects on maternal identity, mother-child bonds and intimate family relationships.

Some of the participants in this study described the experience as “skin-crawling”, while others reported negative sensations that were “visceral”, “overwhelming” and “uncontrollable”.

This phenomenon has been shown to occur in a worrying number of women, with a study in Australia reporting that the prevalence of BAR is one in five women.

In Malaysia, the rate of exclusive breastfeeding for up to six months is only 47%, lower than the national Key Performance Index set at 58%.

As of now, there has been no research done to study the prevalence of BAR among Malaysian women, and if BAR may be a key factor for the low rate of exclusive breastfeeding.

Potential factors that have been linked to an increased risk of developing BAR include breastfeeding the first child, breastfeeding two or more children at the same time, menstruation, and breastfeeding during pregnancy.

Coping with D-MER and BAR

The difference between these two conditions and postpartum depression is that the wave of negative emotions and sensations only occur during breastfeeding or pumping.

However, the guilt of feeling contemptuous towards their baby, albeit for only a brief period, may trigger a spiral into, or worsen, pre-existing depression.

Unfortunately for some, all three conditions might coexist.

Recognising these conditions is an important first step.

The main takeaway message for women who experience them is that it does not equate to them being a bad mother.

On the contrary, the feeling of guilt itself and the fact that some do persist with their breastfeeding journey despite the negative experiences, signifies the immense maternal love they have for their child.

Having said that, no woman should act as a martyr to the breastfeeding cause.

There is an urgent need for effective strategies and interventions to help women cope with the complex challenges faced when breastfeeding.

Experts have recommended self-help strategies like meditation, positive self-talk, and personal distraction during the feeding or pumping sessions, to manage these emotions better.

It may be something simple like listening to their favourite music or watching an episode of the latest Korean drama while breastfeeding or pumping.

Drink a soothing cup of tea, or better yet, indulge in a piece of chocolate.

These little actions can help to increase the level of “happy” hormones, as well as give something positive to look forward to during the next breastfeeding session.

It is also important that women do not face these challenges alone.

It is essential that they feel safe enough to talk about these negative emotions with their partners and loved ones without feeling judged and receive ample support from them.

Do seek help from healthcare professionals such as lactation consultants, nurses, counsellors or therapists if needed.

Dr Aishah Mohd Hafiz is an emergency medicine physician and Dr Durga Vettivel is a family medicine specialist at Taylor’s University’s Faculty of Health and Medical Sciences. For more information, email [e-mail]. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.