1. I have been able to laugh and see the funny side of things.
2. I have looked forward with enjoyment to things.
These are the statements I am supposed to mark with a number, from 0-3, to indicate their frequency. My eyes scan the list, and I click my pen anxiously as I decide what to do.
3. I have blamed myself unnecessarily when things went wrong.
4. I have been anxious or worried for no good reason.
I am glad they are asking these questions, glad that someone has acknowledged the emotional turmoil that comes with giving birth. But the statements listed don’t match what I am feeling. I am experiencing symptoms that aren’t on this questionnaire. And that scares me.
The Edinburgh Postnatal Depression Scale is a screening tool each new mother in America is supposed to receive around six weeks after giving birth. While it can be a helpful resource for indicating the ever-common postpartum anxiety and depression, I soon learned that other physiological symptoms can impact new motherhood — symptoms I had never heard of before and that are left largely unscreened. So, on this day, six weeks after giving birth to my daughter, I write nothing on the questionnaire and turn it in.
I am aware of the roller coaster of hormones that accompany the postpartum period, but I don’t anticipate them. My pregnancy is uneventful. No mood swings or medical concerns. My daughter is born on a sunny morning in late August with a cool breeze blowing through the window at the community hospital. Exhausted with tear-streaked faces, my husband and I gaze lovingly at this marvellous being we have created. She was later than her due date (firstborns often are) but came out tiny and shrieking, a firecracker in our peaceful little world.
The nurses show me how to get the screaming pink creature to nurse, shoving more of my breast into her mouth than I assume is necessary. She suckles right away, smart as a whip, just like I imagined.
I don’t realise something is wrong until day six when the wave of complete exhaustion starts to subside. Don’t get me wrong, I am still tired. But the brain fog is starting to clear, and I am more aware of my feelings and my surroundings.
The baby is good and healthy. I recognise her cries now, when she wants to be held, and when she needs a diaper change. The problem comes when she is hungry.
“There are so many benefits to breastfeeding,” everyone has told me, from the Mommy Blogs to the random man at Starbucks who seemed to be strangely interested in my pregnancy. “They get so many antibodies that way. So much nutrition they wouldn’t otherwise receive.” I nod my head and agree. Of course I will breastfeed. Of course I will do what’s best for my baby.
The hungry cries come, and I press my nipple into her mouth, just the way the nurses showed me how. My brilliant daughter suckles right away. But something strange is happening when my daughter latches onto my breast and starts to suck. I feel it in the pit of my stomach first, dark and foreboding. And then it travels to my shoulders, creating a tension that I can’t seem to release. Then, I feel it rolling down my cheeks, salty tears on my already thirsty body.
Something is wrong.
I look down at my daughter, sucking slowly and peacefully: eyes closed and soft fist clenched. I pull her off my breast, and she starts to cry, but relief washes over me as she releases her latch. I am OK. I am safe. My daughter is well. I wipe the tears that burn my cheeks and start to comfort the baby, frustrated by her interrupted meal. We will try again in an hour or two. This was just a strange moment in time.
But the strange moments keep occurring. The joyful exuberance that connects me to my blue-eyed girl vanishes the moment she latches on to feed. My calm happiness disappears, and I am overcome by excruciating dread the moment she starts to suck.
I try to hold out as long as I can. I know my daughter needs to eat, and the benefits of breastfeeding keep flashing through my mind, but it is getting harder. Soon, there is despair before the latch — the anxiety of the horrible feelings that will surely come as my daughter eats. Sometimes, anticipating the dread that comes with her suckling almost feels like too much to handle.
My husband gently recommends formula, and I cry even harder, feeling the pressure of a society that asks too much of a mother.
“I can do this,” I say, not only to my husband, but to my baby girl who is eager to eat and grow. “I can learn to feed my baby.”
At night, my Google searches are alarming. “Why do I hate feeding my baby?” I type, and the search comes up with all sorts of articles commenting on a caretaker’s resistance to making dino nuggets even one more time. “Why do I dislike breastfeeding?” yields similarly helpless results.
But one search provides turns up an unexpected result. I type in “Nursing makes me sad,” and wait for the screen to load. Suddenly, the page populates not with disgruntled and sleep-deprived mamas but with medical journals. Dysphoric Milk Ejection Reflex, or D-MER, fills the headlines.
It’s midnight, and I need sleep, but I feel like I have finally stumbled upon an ounce of hope. I read like I am ravenous.
D-MER is thought to occur in breastfeeding people when dopamine drops so milk can be let down. While most people are fine during this transition and don’t notice the dopamine drop, up to 9% of nursing individuals experience negative symptoms as their child suckles. The symptoms include hopelessness, self-loathing, impending doom, and thoughts of suicide.
D-MER is a physiological condition, meaning it is not circumstances that create this feeling, but the hormonal transitions that take place in the body. Because of this, the feeling only lasts when the baby latches on, and subsides when the baby releases their latch.
I read on and on, article after article. And the more I read, the more validated I feel — a surge of hope in my chest that lets me know that these symptoms weren’t all in my head. That others have felt the same thing I have felt. I do not hate my daughter and am not resistant to feeding her. It is the chemical complexes of my mind that are making things difficult.
I am starting to feel giddy. For the first time since she was born, I feel I have resources to support me. I laugh out loud because I truly can’t help it. My husband rolls over in bed to ensure everything is OK.
“Yes,” I whisper into the dark, “I just found out that I am not alone.”
The next few days pass in a blur of hope and tears. I work up the courage to reach out to my OB-GYN, and the self-consciousness of new motherhood proposes my symptoms like a quirky tendency instead of debilitating symptoms.
“It’s so funny,” I say. “Every time I breastfeed, I feel really...” I think of how to end the sentence without raising too many alarm bells. “I feel really sad. It’s not all the time, not like postpartum depression,” I am quick to add as if that label would decrease my “good mom” status. “It’s only when I pump or nurse.”
He nods knowingly and confirms what my research indicated: Dysphoric Milk Ejection Syndrome has its claws in deep. The validation comes like a wave of relief.
Either due to stigma or stubbornness, I determine I want to pursue other coping tools before taking medication. I tell myself that now, when I nurse, I can take comfort in the fact that it is a chemical occurrence, and I love my baby with all of my being.
All of the articles say the utter hopelessness starts to subside by month three, and they give some practical recommendations on overcoming the intense moments of sadness. “Distract yourself,” one article says. “Find a snack or watch TV while you nurse to get your mind off the mood swing.”
But even with distractions, the despair is relentless, and I cannot handle the dopamine drop. Soon, I find myself back in the OB-GYN’s office requesting nursing-safe antidepressants that can help with the chemical imbalances. I intentionally don’t see what the internet has to say about being a breastfeeding woman on meds. I don’t need shaming or judgment right now. I need hope.
Friends came over for dinner a few days after I started the medication. It is one of the first times my husband and I have invited people over since welcoming the baby girl into our world, and I bask in the presence of something from my old life.
“I didn’t know you were struggling with postpartum depression,” my girlfriends say as I tell them about the antidepressants. “You always seemed glowing the few times we have seen you.”
“It’s different,” I try to explain. “I’m only depressed when the baby is sucking. When she’s not latched, I’m totally fine.”
My friends have a million questions. They had never heard of this condition either, despite having a sibling struggling with postpartum mental health issues, and their own pregnancy journeys. I repeat what I have learned from the countless articles I have read: “It’s a physiological condition that is common and extreme and different from the postpartum challenges that are regularly talked about.”
They nod their support. But they can’t quite wrap their minds around the mood swings.
Then, as dinner nears an end, I hear a small cry on the monitor, and my heart sinks. That’s the hungry cry that I have grown to dread. I try to hold it down — the dark feeling of despair that starts when I know a milk letdown is soon to come — but I can’t hold it back and the tears flow down my cheeks, smearing the mascara that I have put on for the first time in weeks.
Only then are my friends able to conceptualise the impact that this condition is having on my life. It is more than the baby blues, and it is not as simple as distracting myself with a TV show and some ice cream. D-MER is taking over my life, and I can see the concern on their faces.
Modern day medicine is a miracle and about a week and a half after I started taking the antidepressants, I feel the fist in my chest slowly release. Soon, I don’t associate anxiety with her cries. With much apprehension, I look my daughter in the eyes while she nurses. I gently rub her soft head or play with her toes while she suckles. Finally, I can stand in awe at how my body can provide for this beautiful child.
Reflecting back, I can’t believe I was able to maintain a breastfeeding schedule with the mental state I was in before the meds started working their magic. Feeding in public was especially daunting as I choked back tears while I nursed her on the nearest park bench or in the front seat of the parked car.
In retrospect, I would’ve started supplementing her meals with formula and given myself a break from the constant despair. But at the time, I believed that my suffering correlated with laziness or lack of effort, especially since I suffered in a way I couldn’t easily define. Now I know that when it comes to new motherhood, nothing is more honest than the struggle.
My daughter is nearly 8 months old, and we still nurse. For a woman who previously believed she could not make it through another night of feeding her baby, where we are today is truly a miracle.
The gratitude I feel for having access to information about D-MER and the medical resources to help me overcome a dark period is overwhelming. But I can’t overlook the fact that my hesitancy to reach out for help in the first place was due to unspoken pressure in our society that I needed to be everything for my new baby without missing a beat.
I’m a firm believer that this world does not need more lists of advice for overwhelmed mamas, or unrealistic social media posts that show us a perfectly happy family without the behind-the-scenes tears. What we do need more of is honest first-hand accounts about the impact of motherhood on the mind, body and soul. Not so we can judge and correct, but so our true experiences can be seen, and felt, and validated.
Today, I tell my story to let other mamas know about the challenges that I faced and to shed some light on something so wildly common and yet relatively unknown as D-MER. But more than that, I tell my story to let other caregivers out there know that no matter what you are experiencing, you are doing a great job. And I promise, you are not alone.
Ella Rachel Kerr lives, writes and surfs on the Big Island of Hawaii. She is a freelance writer, writing coach, and nominee for the Pushcart Prize in Literature. She lives with her husband, daughter, cats and chickens. In her free time, she spends as much time in the water as possible. You can read more of her work at www.ellakerr.com.