The experience of feeling intense dread, anxiety, or an overwhelming physical sensation just as milk begins to flow is a common but rarely discussed phenomenon during lactation. Many people describe this reaction as a sudden wave of sadness, agitation, or a strange, hollow feeling that comes on abruptly when the infant latches or the pump turns on. These powerful feelings are not a psychological failure; they are a biological response rooted in the complex hormonal cascade that governs milk release. Understanding the science behind the milk ejection reflex and related conditions provides the context to address these uncomfortable sensations.
The Physiology of the Milk Ejection Reflex
The process of milk release, often called the “let-down,” is a neuroendocrine reflex depending on the coordinated action of two primary hormones: prolactin and oxytocin. When an infant suckles, sensory nerve endings send signals to the hypothalamus in the brain, which prompts the pituitary gland to release these two hormones.
Prolactin, released from the anterior pituitary, is responsible for the ongoing production of milk. To stimulate milk production, the brain must decrease dopamine levels, as dopamine naturally inhibits prolactin. Oxytocin, released from the posterior pituitary, triggers the milk ejection reflex.
Oxytocin travels through the bloodstream, causing specialized myoepithelial cells surrounding the milk-producing alveoli to contract. This muscular contraction forces the milk out of the alveoli and through the ducts, resulting in the physical sensation of let-down. This hormonal interplay, particularly the rapid shift in dopamine, is where intensely negative feelings can originate for some individuals.
Decoding Dysphoric Milk Ejection Reflex (D-MER)
Dysphoric Milk Ejection Reflex (D-MER) is a physiological condition causing an abrupt wave of negative emotions immediately preceding the milk let-down. It is classified as a reflex because it is hormonally driven and involuntary, making it distinct from a mood disorder. The feelings experienced are intense, including sadness, anxiety, agitation, dread, or a sinking feeling.
The leading theory suggests D-MER is caused by an exaggerated drop in dopamine, which is necessary for prolactin to rise. Since dopamine regulates mood and pleasure, an overly rapid dip in its levels can temporarily trigger dysphoria. This feeling is quick, typically lasting 30 seconds to two minutes, and vanishes as soon as the milk begins to flow and hormonal levels stabilize.
Understanding D-MER as a biological glitch, rather than a psychological issue, alleviates the guilt and confusion many people feel. While D-MER involves feelings resembling depression or anxiety, it is not the same as postpartum depression. The defining characteristic is the timing: the negative emotions are strictly tied to the moment of milk ejection.
Other Intense or Uncomfortable Breastfeeding Sensations
Beyond D-MER, other physical and emotional reactions contribute to discomfort during feeding. One experience is Nursing Aversion and Agitation (NA or BAA), characterized by an overwhelming urge to stop nursing, along with feelings of anger, irritability, or a sensation that the skin is crawling. Unlike D-MER, Nursing Aversion often lasts for the entire feeding duration and is frequently described as feeling “touched out” or trapped.
Nursing Aversion is often triggered by physical exhaustion, lack of personal space, or hormonal changes, such as those occurring during pregnancy or the return of the menstrual cycle. The feelings associated with aversion create conflict for many who desire to continue breastfeeding but find the response unbearable.
Another cause of intense physical discomfort is vasospasm, which involves the abnormal constriction of blood vessels in the nipple. This condition, sometimes called Raynaud’s phenomenon of the nipple, causes a severe, shooting, or burning pain that may occur during or immediately after a feeding. The pain is caused by temporary restriction of blood flow, which may also result in the nipple tip turning white, blue, or red as the blood returns. Vasospasm can be triggered by cold temperatures, stress, or trauma from a shallow latch.
Management Techniques and When to Consult a Specialist
For those experiencing D-MER or Nursing Aversion, coping strategies focus on distraction and self-care. Actively distracting oneself with a phone, a book, or a conversation during the let-down phase helps mitigate the brief wave of negative emotions associated with D-MER. Ensuring adequate sleep, nutrition, and hydration helps manage the fatigue and hormonal fluctuations that trigger Nursing Aversion.
Immediate action, such as drinking cold water or having a small snack right before the let-down, is a simple technique helpful for D-MER symptoms. For physical pain related to vasospasm, ensuring a deep latch and keeping the breasts warm immediately after feeding reduces the frequency and severity of vessel constriction.
If negative feelings are severe, persist beyond the feeding session, or interfere with daily life, consulting a healthcare professional is recommended. A certified lactation consultant (IBCLC) can help rule out issues like poor latch or physical injury. A medical doctor should be consulted for signs of infection or persistent physical pain. If feelings of sadness, anxiety, or hopelessness last for weeks, evaluation for a mood disorder may be necessary.