Strategies for D-MER while Tandem Breastfeeding

English: Ágnes Geréb, Hungarian midwife and do...

One of my favorite things about birthing at home is being able to snuggle in bed with my new baby(ies), my older children and my partner. My midwives take care of us physically, spiritually, and emotionally. I am treated like a birthing goddess while they are respectful of our family bonding space. The midwives make sure there’s food for us and they clean up everything from the birth so I can concentrate on falling in love all over again with this new version my family.

My midwives also check in with breastfeeding, since that is my desire. With my first son, they helped me understanding good positioning and latch. And since we had a rough start, recommended an excellent IBCLC that I credit with saving my breastfeeding relationship. For the rest of my singletons, they were there in case I had any issues and supported me as I tandemed and then triandemed kids and newborns together.

When my twins were born, I found tandem nursing to be a different from what I had experienced before. In previous tandem and triandem breastfeeding relationships, one or even two of the nurslings was a well-practiced toddler or child who had control of their body, was verbal and could comprehend the delicate balance we maintained in our little circle.

But, with twins, I had two floppy, sleepy newborns who were not in control of their bodies, couldn’t understand much of what was going on besides their need for food, comfort, suck, and above all MAMA. These were also my smallest babies (6.2lbs and 8.3lbs) with the tiniest mouths I had ever dealt with (my previous smallest baby was 9lbs.) In addition, both babies had tongue and lip ties.

Tandem Breastfeeding my Twins

Tandem Breastfeeding my Day-Old Twins

So, I was concentrating intensely on getting two floppy, frantic newborns latched on at the same time. I was trying to avoid staggering solo feedings because I knew that that would be all I would do for the first few weeks. I needed to get the three of us used to tandem nursing right off the bat or I new my tentative grip on sanity would surely fail.
And sanity aside, I had three other kids whom I adore and I didn’t want to disappear from playing with them while I alternated feeding babies.

With all of this going on with breastfeeding, coupled with the usual lack of sleep and overwhelm that accompanies the newborn period, I had no time to check in with myself. Frankly, if I had, I would have chosen not to anyway, in favor of getting lost in the wonder of two newborns at my breasts.

But, after a few days, I couldn’t avoid noticing something more than post partum hormones and newborn overwhelm. Whenever I had letdown, I would feel what I can only describe as severe homesickness followed by crying in despair or rage. Then, shortly after, these feelings would disappear as though I hadn’t felt anything at all. It was bewildering and worrisome.

Fortunately, part of the birth goddess service provided by homebirth midwives is follow-up home visits. In tears, I shared everything that was going on and they listened. They helped me resolve many issues, including really listening to me about these feelings. They didn’t write it off as simply post-birth, new baby stress. They told me that it sounded like I had something called D-MER or Dysphoric Milk Ejection Reflex.

I had had feelings like these with my previous babies, but never this severe and the feelings went away while the babies were under a year old. There’s no scientific proof that double letdowns would make D-MER stronger, but it certainly was what happened to me.

D-MER is a physiological response of an extreme drop in dopamine levels that can occur before the spike in prolactin (the hormone signalling the body to make more milk.) Normally, dopamine drops less precipitously and the mother doesn’t feel an emotional reaction other than the bonding associated with prolactin and other feel-good hormones like oxytocin and vasopressin. D-MER occurs immediately before let down and ends within minutes after as prolactin and the other hormone levels rise.

D-MER is different than PPD or PPA because it lasts for such a short interval. Although PPD/PPA can occur at the same time as D-MER. Drugs used to treat post partum mood disorders have no effect on D-MER. So, it is important to have it properly diagnosed. I ended up having both D-Mer and PPA. Since I was already familiar with PPA, I leaned into my support system and came out the other side. (But, that is for a different post…)

In my case, my midwives were easily able to identify D-MER and help me to strategize ways to cope with the feelings. For some mothers, there is a feeling of despair. For others, it is anger or sadness. Crying and yelling are common reactions. I remember being mid-sentence to my midwives, describing the hopelessness I felt when I suddenly felt completely fine.

Discussion about prescriptions can be found here  and supplements here. My midwives suggested I try some dietary supplements and since they have not been researched, I do not feel comfortable recommending what I used and instead recommend seeking out an IBCLC, midwife or other care provider who is knowledgeable specifically about D-MER before considering supplements. This is easy to do online. I will say that I did notice a small change in the severity of the plummet into the hollow, sad feelings while using the supplements, but I had better results from the strategies listed below.

Once D-Mer has been identified and a care provider is working closely to monitor and support a nursing mother, there are practices that can help during D-MER incidents. Since the newborn period is overwhelming, I suggest writing down this list on a card and posting it where it can be seen during let down as reminders.

These strategies can be used together or separately. Some may work better for you sometimes rather than at other times. Remembering that the episodes of D-MER are short helps. There is nothing wrong with these feelings. They are caused physiological changes and will not harm you or your baby.

Strategies to cope with D-MER Episodes:

  • Keep a Log: write, if you have a free hand, or voice/video record your feelings and how they change. This has the benefits of tracking episode frequency, length, and changes over time, as well as reassurance that the sessions are short and real.
  • Distraction: watch a video, listen to music, flip open a magazine. Anything that works well to distract you until the feelings have subsided.
  • Make Exhales Longer than Inhales: Making your exhales slightly longer than your inhales lowers blood pressure, slows heartrate, and stimulates the relaxation response of the boy. Counting the length of inhales and exhales can also work as a distraction.
  • Sigh Series: Practice a series of inhales followed by making sighing sounds on your exhales. This triggers the body’s relaxation response and also works as a vocalization outlet for emotions.
  • Talking and Company: Having someone to talk with before, during, and after letdown can be distracting, supportive, and cathartic. Breastfeeding can sometimes feel lonely. Breastfeeding with D-MER can feel isolating. Bring someone who cares for you into your nursing circle. Get help. You are not alone.

More to Read:

Post for NaBloPoMo
(Since I’m writing most of these late at night, in bed, while tandem nursing twins, I’m choosing to concentrate on writing rather than proof-reading, researching or editing. Please forgive the extra typos and non-nonsensical grammar. Thank you.)

NaBloPoMo November 2013

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7 thoughts on “Strategies for D-MER while Tandem Breastfeeding

  1. This was something I’d only read about once before, and then it didn’t have a name attached to it. I don’t know if I’ll ever have the opportunity to nurse a baby again (I hope that I do!) but I’ll keep this in mind, and pass this along to any breastfeeding friends. I would think many of the suggestions might also be useful to try during a panic attack or other period of anxiety.

  2. Thank you so much for sharing your experience with D-MER, Zoie. This is (another) one of those not-talked-about topics when it comes to breastfeeding. I so appreciate your openness and helpful suggestions for coping with this challenge. (And thank goodness for the caring support of midwives!)

  3. Thank you for sharing this. I had no idea it existed. I will keep it in mind and hopefully I’ll be able to help someone one day. This also underscores the importance of midwives, and their follow-up practices.

I love comments and try to reply to each one. I look forward to connecting with you. Namaste

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