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ABSTRACT
Dysphoric milk ejection reflex (D-MER) results in waves of negative emotions that last from shortly before initial milk ejection until baby starts to feed vigorously. Symptoms may decrease by 3 months or they may continue throughout the breastfeeding period. This report is a case study of an Australian mother who experienced D-MER with her fourth child.
Keywords: breastfeeding, dysphoric milk ejection reflex
INTRODUCTION
M is a para 4 with no endocrine or medical condition that would impact on lactation and a history of breast surgery at 15 when benign breast tissue was removed from her axillae. She was an experienced mother with her first three children, all males, having breastfed for a total of 81 months. On examination she had pendulous breasts which hung laterally with nonprotractile nipples.
She was very committed to breastfeeding her children and was an Australian Breastfeeding Association (ABA) breastfeeding counsellor. She had overcome many breastfeeding problems with her first three children and managed to continue despite the breast surgery; her breast and nipple anatomy that had led to latch problems; bleeding and abraded nipples for over 12 months; blocked ducts, numerous bouts of mastitis and white spot; nipple vasospasm; and postnatal depression with her first two children.
M reported that after the birth of her daughter she was very emotional, as this was the first female infant in the family since the death of her niece from Sudden Infant Death Syndrome six years previously. She felt a lot of pressure to care perfectly for her new daughter to keep her safe.
During the labour she received one dose of pethidine for pain relief and then proceeded to a normal vaginal birth with non-significant blood loss. Mother and baby enjoyed skin-to-skin contact for approximately half an hour. Her daughter was sleepy and uninterested in finding the breast. Her partner then held their daughter while M showered and washed her whole body, not realising that it was important to leave her breasts unwashed so that her daughter could search easily for her breasts at following feeds (Varendi & Porter 2001; Varendi, Porter & Winberg 1994, 1996). Although her daughter would lick the nipple and nuzzle the breast on the first and second day, she did not latch until day 3,...