Breastfeeding and D-MER

Most of us who breastfeed, or work with breastfeeding parents, are on the look out for the symptoms of postnatal depression, but we aren’t always fully informed when it comes to a condition known as D-MER. This week I’m joined by two guests with personal experience of D-MER, experiencing waves of sadness and emptiness that only coincided with breastfeeding or the letdown reflex.

Mum of three, Jen Hall, joins me to talk about her experience with D-MER in the UK, which was improved greatly by the work of my other guest, Alia Macrina Heise. Alia is a retired IBCLC who, together with Diane Wiessinger, coined the term Dysphoric Milk Ejection Reflex after she experienced it herself while feeding her third child. We talk about what symptoms feel like, the state of current research, and what you can do to mitigate the feelings of D-MER.

Find out more about D-MER at https://d-mer.org/

My latest book, ‘Supporting the Transition from Breastfeeding: a Guide to Weaning for Professionals, Supporters and Parents’, is out now.

You can get 10% off the book at the Jessica Kingsley press website, that's uk.jkp.com using the code MMPE10 at checkout.

Follow me on Twitter @MakesMilk and on Instagram  @emmapickettibclc or find out more on my website www.emmapickettbreastfeedingsupport.com

This podcast is presented by Emma Pickett IBCLC, and produced by Emily Crosby Media.

Transcript

This transcript is AI generated.

[00:00:00] Emma Pickett: I'm Emma Pickett and I'm a Lactation Consultant from London. When I first started calling myself Makes Milk, that was my superpower at the time because I was breastfeeding my own two children. And now I'm helping families on their journey. I want your feeding journey to work for you from the very beginning to the very end.

And I'm big on making sure parents get support at the end too. Join me for conversations on how breastfeeding Breastfeeding is amazing and also sometimes really, really hard. We'll look honestly and openly at that process of making milk and of course, breastfeeding and chest feeding are a lot more than just making milk.

Thank you very much for joining me for today's episode. Today there are three of us. Um, I'm going to be talking with Jen Hall, who's a mom of three with some personal experience of D-MER and also Alia Macrina Heise, who is a retired IBCLC from the United States. and a leading expert on this topic. I'm really honored to have you with us, Alia.

So, Alia has spent nearly 20 years researching D-MER and educating others on this topic. Now, I'm aware that some people listening to this episode will be really familiar with the topic, and it's probably due to Alia's work that that's the case. Others may have heard about it and are looking to know more.

And I'm also aware that we may have someone listening to this episode who is struggling with it and didn't even realize that they were. And actually listening to this episode is a bit of a kind of what Oprah Winfrey used to call an aha moment. If you are this last person, we're hopefully going to signpost you to some information and I'm aware that might be quite an overwhelming experience to be listening to this episode and sort of diagnose yourself as you go along.

So just, just, I want to make sure you're aware that we are knowing that you're out there and that possibility is out there. Let's start with some basics, if that's okay, Alia. So I've been saying DMER, D M E R, pronounced D MER. Am I saying it right? And what do those letters stand for? I don't know. 

[00:02:07] Alia Macrina Heise: So you're not saying it wrong, but you're not saying it the way I say it.

So when, when we first coined the term, uh, dysphoric milk ejection reflex, um, sometimes, uh, in lactation, you shorthand the term milk ejection reflex to the MER. Um, and so those who have been working with the information from the beginning refer to it as DMER, but the internet does what the internet does, and that's absolutely fine.

So I would say that the majority of women and people talking about DMER now say DMER. I accept it. I can't switch over, so either or. 

[00:02:45] Emma Pickett: So, so DMER, is that a phrase that, that you were part of creating? 

[00:02:52] Alia Macrina Heise: Yes, yes. Me and my, my team slash co author and I worked to, we had to, We had to call it something as we were defining it and realizing that I was not the only person.

I'm special, but not that special. So, uh, since it was something that was clearly affecting lactating women, we had to stop calling it the thing that happens to you. Uh, so we worked on. Understanding that it's, that it, that it's a general negative emotional state, hence dysphoric, and that it happens because of and in conjunction with the milk ejection reflex caused by.

So, dysphoric milk ejection reflex. 

[00:03:37] Emma Pickett: Okay. And if someone is asking you for a definition, a sort of, we have some people listening to this episode who will be lactation professionals and health professionals and some people who will be regular parents. What's the sort of definition that you like to give if someone says, okay, well, what is DMER?

[00:03:55] Alia Macrina Heise: So it's a wave of negative emotions that is, uh, triggered by the onset of a mother's milk ejection reflex that generally lasts about a minute long before the mother's emotional state returns to normal. 

[00:04:09] Emma Pickett: Okay. And it's kind of amazing to hear that it didn't have a name. I have to say, I thought I'd done my reading.

I did not realize it literally didn't even have a label. And how disempowering that is for people to not even know what to call it and what a transformation it must be for people to be able to go out in the world of the internet particularly and find a name for it. So before we do anything else, I just want to thank you.

On behalf of all the parents and mothers that you have, have helped by doing this work. And how amazing that is. I mean, lactation, there are so many things that are under researched or not researched at all. But this one particularly is so isolating and so difficult emotionally if someone is struggling with it.

So to not even have a name for it is just a, must be just a horrifying thing. So thank you, Ali. I'm really grateful for the work that you've been doing. And we're going to talk about it in a bit more detail now. I remember one mum I spoke to described it as very similar to a feeling of homesickness. That just kind of wave of emotion that comes from nowhere and it so happened that she wasn't living in her home country, so she thought she was having homesickness and it was only when she sat down and thought, hang on, this is always happening when I'm breastfeeding.

It's always happening at the beginning of a breastfeed and it took her a really long time to make that connection. Um, Jen, I know you have had personal experience of DMER. When someone asks you for your definition, how do you describe it? 

[00:05:36] Jen Hall: Um, I would describe it definitely as that wave like feeling. It seems to come from nowhere.

Um, and it's quite abrupt and it sort of feels like a sense of doom. Um, I feel like my stomach drops. My heart would start racing and I would feel really like helpless and really all the feelings would be directed at myself. It wouldn't feel like I was even thinking of breastfeeding. Um, I mean, obviously I was, or, um, I was pumping.

But it wouldn't feel like, um, an issue with breastfeeding, it was like an issue with myself. All the emotions were directed at me, sort of not feeling very worthy, feeling very hopeless. I guess like feeling really detached from my normal life and my usual self. And then after like a minute or two, I would feel completely fine again.

Um, such a bizarre thing to do and obviously several times a day throughout the day. 

[00:06:41] Emma Pickett: So, yeah. I mean, when did you sort of realize what was going on? When did you realize you were struggling? Tell us a bit about your experience. 

[00:06:50] Jen Hall: So, with my first baby, I fed him just for three, four weeks, um, and then I stopped breastfeeding.

He seemed really refluxy, um. Looking back, it was like, it's definitely a solvable problem, but I just didn't know what I was doing, if you like. So we switched to, um, formula and he was fine with that and I never sort of figured it out. Whereas with my second baby, I was more committed to breastfeeding.

When I was pregnant, I thought, right, I'm gonna try and do the first month, see how that goes. Um, and within that first month, I did start to notice, like, just not feeling well. Most of the time, I felt really good in myself, you know, like, my mood was good. I got back into running quite early on, and I loved having, like, two children under two.

Being in that baby toddler bubble was amazing. But, uh, it became kind of apparent to me that I was just Sort of sometimes feel completely off and not myself and that detached feeling, but then it would just come and go like it would happen if I was breastfeeding, pumping. Or just, like, having a random letdown, which for me was a lot in the early days, so it made it difficult the first few weeks to pinpoint something was wrong.

And then I started to figure it out probably after a month or so. 

[00:08:20] Emma Pickett: And do you remember the sort of day when you figured it out? Were you sort of sitting there going, hang on, I mean, did you sort of have that kind of connection and little fireworks and a realisation? How did that process happen for you?

[00:08:31] Jen Hall: There was probably two moments really. So one of the moments, um, I was like breastfeeding in bed. It was the morning and I said to like my husband, I, I don't feel well, like something isn't right. Um, and this was as I was breastfeeding and he was like, okay, well, you know, we can phone the health visitor, see what she says.

She will have seen it before. And then after I'd like finished or the feed had gone on, I sort of realized I felt completely fine and I thought, where did that come from? And how did it disappear so fast? So then I started to realize it, it was a breastfeeding problem. And 

[00:09:11] Emma Pickett: did you? Talk to somebody who helped you kind of give it a name and and point you to sort of discussions about it online What happened 

[00:09:19] Jen Hall: next?

So then I like after a couple more days, maybe even weeks I sort of plucked up the courage to phone the health visitor. Um, she was like, she was a lovely lady She was so approachable. She had a good sense of humor that sort of rapport that you need with new parents Um, I phoned her up and told her how I felt, I was quite emotional and it, she later told me she had never heard of it before, um, I think she perhaps thought I might have had postnatal depression, but because I felt fine the rest of the time, like it was only a fraction of the day spent like that, you know, just minutes here and there.

So it didn't affect the rest of me, but, um, so she, she just checked in with me regularly and really grateful that it was her, with her personality, that was the first person I kind of opened up to, um, the first professional I spoke to. And then later on when my second baby's weight slowed down. I phoned the health visitor and said, I'm really worried about this.

And she said, it doesn't sound like too much of a concern, but I'll book you in with the infant feed and lead who was a lactation consultant. And, um, when I went there, she sort of reassured me that the weight actually wasn't that much of an issue. And. Then I told her how, I think I started to get worried that perhaps professionals would maybe think I wasn't feeding my baby or, you know, I was trying to delay feeds because of the emotions I was having when breastfeeding, which wasn't the case at all.

Um, so I told her. that lactation consultant and she was wonderful and she just gave me like the nugget of information I needed at that time. I wasn't ready to talk about it in detail or even talk about how I felt um she told me to go on the Kelly Marm website and then dmer. org Um, and she said just read other people's stories, like look at the definition and sort of see how that sits with you.

[00:11:32] Emma Pickett: So it's great that she knew about it. I'm really glad that you found someone because I'll be honest, there are some people who work in the world of infant feeding support that don't know what it is. But actually your, your first support, you're that health visitor. It's a wonderful example of how an empathic practitioner doesn't need to know necessarily very much detail.

If they're empathic, they are listening to you and they're hearing what you're saying and they're going to be meeting you where you are. I mean, she would have been trained in diagnosing postnatal depression. So quite quickly she would have realized that, you know, if you did the sort of, is it the Edinburgh test, you would have not met any of the criteria for postnatal depression.

So she obviously felt comfortable eliminating that. But still wanted to support you and listen to you, which is great. Yeah. And, and then that conversation with the infant feeding coordinator. So she said, there's a thing called DMER, go and have a look at this link. And, and how did it feel to sort of read those materials for the, for the first time and realise that this was an actual condition condition?

[00:12:30] Jen Hall: I think I like cried with relief really, sort of like reading the stuff on the website, hearing other people's stories. It was like, Amazing, these mums across the world were describing it so much better than what I could at the time. Um, I couldn't believe what I was reading, really. It was such a, like, comforting feeling, almost.

Not knowing other people are in the same awful situation, but just like you're not alone with it. There are other people with it that feel the same. 

[00:13:03] Emma Pickett: Yeah, yeah. Is this someone's washing machine going by the way? Is that a spin cycle? I'm hearing something. Oh gosh. No, listen, don't worry. I'd like to leave that in the recording because we are working women.

We have washing machines. We have spin cycles. You have an American washing machine, which I happen to know is the size of a Boeing. It's not a problem. As I said, we are working women who need clean clothes. This is absolutely fine. I just want to check that the listeners know that there isn't an ever jet engine taking over in the local garden.

Um, not a problem. Um, okay. So, I mean, Ali, you have made women cry all around the world for a very long time in the absolute best way because that feeling of relief of, Oh my God, I'm, there's a thing. 

[00:13:44] Alia Macrina Heise: I'm not crazy. 

[00:13:46] Emma Pickett: Yeah, exactly. 

[00:13:47] Alia Macrina Heise: That's what I hear more than anything. 

[00:13:49] Emma Pickett: I am literally not crazy. I don't have depression.

I don't hate my life. I don't hate my baby. This is a thing that is beyond my control. I mean, how special it is to suddenly have that feeling of, whoa, oh my God. And not only, whoa, that explains the wave of negativity, but the fact it stops so abruptly is quite disconcerting for a lot of people that it's, you know, that it doesn't linger beyond that, you know, literally first kind of minute, you know, or not more than a minute.

It also can sometimes feel a bit, bit strange and a bit weird. So you read those articles, Jen, you had that. conversation. And we'll talk in a minute about what might help. Alia, let's talk a little bit about, um, what's commonly misdiagnosed. So what, how DMER is often misdiagnosed for other things. Now, Jen's touched on how it's often confused with postnatal depression.

How common is that? 

[00:14:39] Alia Macrina Heise: Well, I first want to, to touch on Jen's story and affirm that that is. It's pretty much textbook. Um, I really appreciate her articulate way and her self awareness of identifying the sense of self directed emotions. Um, because that is a hallmark of DMER in the sense that you You have this short period of time where you feel like you are doing something terribly wrong, or you are terribly wrong, or something is about to go terribly wrong, and there's all this self projection and introspection, because it's normal and natural for us as human beings that when we have an emotional experience, especially a sudden one, We're supposed to get curious.

We're supposed to look out for what needs to be fixed, what needs to be changed, what we're supposed to do, how we're supposed to be to react. That's what emotions do. Um, so the, the freeing part of learning that you have DMER. is that you don't have to take any of that seriously. You don't have to dig into that.

You don't have to solve a problem. You don't have to question your life or your life's decisions. Um, and I think that that's the most important part of being able to give their experience a name is being able to Then sit back and just get through it, breathe through it, distract yourself through it. Um, with finding relief from the emotional experience coming afterwards, hopefully finding some relief from the emotional experience.

I think it's that understanding of your experience that's most impactful. Would you agree, Jen? 

[00:16:31] Jen Hall: Yeah, I think once I even, I don't think I thought of it as a wave until I'd read the things online describing it as a wave and I thought that sums it up perfectly and even now I would still think of it a bit like a contraction wave sort of it starts off I mean it comes from nowhere it feels like an abrupt wave but like understanding it and even later on when I kind of just I knew it was going to pass, you get some comfort for that when you feel like, it's strange because for that minute or so you feel like your life is just falling apart even though nothing has changed, but now I just try and really ground myself thinking it's going to pass, um, and it always does pass, so, 

[00:17:20] Emma Pickett: yeah.

Word grounding is a good word. And you, you've got three children, Jen, and tell me what happened with, with number 

[00:17:28] Jen Hall: three. Oh, so, number three, he's, he's nearly one, he'll be one in a couple of weeks, um, but rewind to when I was pregnant, I was quite scared of breastfeeding again, I, I am really nervous about having the same experience I had with my My daughter, my middle child, um, because that was like months of emotional upset in the journey of learning what it was, trying to get some support.

So when I was pregnant, I waited for the midwife to ask the question, how do you plan on feeding your baby? Um, and I said, I would like to breastfeed, but I have this condition that I don't think you'll know about. Um, She hadn't heard about it. She knocked on the door to ask the midwife next door if she'd heard about it.

She hadn't. And I think then I was a little bit disappointed because I was kind of asking for that help when I was pregnant too. I knew what was coming. I knew I would have it again. Uh, looking back, had it with my first baby. I had it with my second baby. So we just left it at that. And then. Luckily, it was the same midwife I saw for all my appointments, which was helpful.

And she came out on day five, weighed the baby, and, um, asked me if I could feel it. They said I could feel it a little bit, um, but for me, the emotions of the DMER sort of peak, I don't know, a few weeks in, right up until The first few months, you know, when hormones start to settle down. But I knew that that would be the last time that I was going to see her.

Um, so I sort of played it down a little bit. I thought that. There's no point going into this with someone that I'm going to be signed off from the baby Like Leo's weight was absolutely fine. I think he'd gained a tiny bit of weight on day five So, you know that her job was done with me. So I thought oh, okay.

Um, we'll leave it there with her 

[00:19:38] Emma Pickett: Yeah, and You've met people obviously were, who didn't know and were supportive and didn't know and, and weren't necessarily in the, in the place to give you the right support. Did you have any negative experiences with finding support in the uk? Um, 

[00:19:52] Jen Hall: yeah. Yeah, so there's a lady that, um, the health is to referred me to her, um, with my second baby and then again with my third baby.

But, um, this woman didn't have the same sort of. mannerisms as their health visitor. Um, she sort of really, I think she doesn't understand DMER and she would talk to me as if I had like breastfeeding aversion or agitation. We saw her when, like, my third baby, Leo, was eight weeks old and she, I was, at the time I was quite desperate for some help, I wanted the symptoms to improve, I didn't know what I could do and she kept on using the example of some women feel like they want to unlatch the baby and throw it across the room and that wasn't what I was there asking for help with my, like, tiny little newborn.

And she just kept on using that example and I said to her, I don't feel like that. I didn't feel like that at all. All the emotions were directed at me. So I was quite upset that this woman who had supposedly supported me through my previous breastfeeding journey was using this repeatedly as an example.

And I left that appointment, got to my car and just cried. I phoned my mum. And said, this woman has no idea what I'm talking about. She just didn't listen to me at all. I really didn't feel heard. But it was actually from that conversation, probably being so upset and frustrated that I actually got some much better support and that's where my story kind of takes a better turn.

[00:21:40] Emma Pickett: Yeah, I'm so sorry that you had that experience. And I mean, just the idea that you would hurt your baby. I mean, that kind of, Silly reference to wanting to throw your baby across the room is something that people often say in the context of aversion and agitation, which is upsetting enough. But the idea that you're just not being listened to is so sad.

Ali, I'm guessing that that's a familiar story that you've heard other people being dismissed like that in your research. 

[00:22:05] Alia Macrina Heise: Yeah, I'm glad that we were able to toss it back to Jen for another, uh, snippet of her experience because that means that in both of her experiences, We were able to touch on the two things that DMER is most commonly misdiagnosed for.

And I would say first and foremost it's going to be, um, postpartum depression, postnatal depression. At least here in the U. S. and I don't know what the experience is there when it comes to women in healthcare and, you know, the, the general vibe of hysteria that has persisted through the centuries with women and their emotions.

Uh, which means if we're having some kind of emotional experience, then clearly it's a woman problem. Um, and postpartum depression is a woman problem. So you want to talk to a healthcare provider about difficult emotions that you're having after having a baby. The awareness that we've been able to bring to postpartum depression throughout the years is wonderful, but it's also become quite a scapegoat for healthcare providers as well if they're Um, using it to move patients along, um, especially since again, I don't know the difference between the two countries, but here, um, antidepressant prescriptions are handed out.

You don't, you don't even have to see a mental health care provider. Um, your OB can prescribe them, your general physician can prescribe them, and then sometimes you could even get a prescription over the phone just based on the fact that you had a baby and used the word sad in a phone call. Um, and, uh, drugs that are prescribed to treat postnatal depression, um, do not impact DMER, so it becomes unnecessary medicating.

Um, and then breastfeeding aversion, um, there's actually been a study done by somebody in the UK. Who compared the difference in emotional experience between breastfeeding version and dysphoric milk ejection reflux. But not only is there a difference in the emotional experience, which is quite stark. And with my third baby, that was the only one I had DMER with.

I did breastfeed her long enough that by the time she was two and a half, I started to have breastfeeding aversion. Was able to actually feel the two, the two differences for myself. So not only is the emotional experience different, but the timing is completely different. Breastfeeding version doesn't happen when you have a brand new baby who is solely reliant on you for its only source of nutrition.

Um, that's something that happens with a much older baby who is going to definitely be taking solids and have other options for nourishment at that time. Uh, but those are going to be the two things that people are more familiar with, with postpartum depression being the easiest. Uh, for misdiagnosis, uh, because generally doctors aren't going to be aware of breastfeeding aversion.

That's going to be more lactation professionals, whereas, uh, doctors all around the world know about postpartum depression. 

[00:25:11] Emma Pickett: Yeah. I mean, aversion and agitation, I guess there are, there's going to be a very small group of women who may have other underlying causes for aversion that may happen when babies are younger.

But I guess one of the key things is that aversion doesn't happen just in the first minute and then go away again. I mean, if anything, it's as the feed continues, you're more likely to have issues and, and, and struggle as, you know, as the minutes go by. But there's something very unique about DMER in that is, it is because it happens during the let down reflex.

When the oxytocin release is going to be happening, so for anyone who doesn't know, the letdown reflex is your pituitary gland releasing oxytocin, which goes through your bloodstream into the little muscles around your milk storage area, squeezes the milk down the milk ducts, and that's how the milk is going to be released and helping the baby to receive the milk, so that wave of oxytocin And oxytocin is normally a hormone associated with bliss and pleasure, which, so it must seem a little bit unfair that these poor, you know, women and parents are getting this burst of oxytocin causing the, you know, the exact opposite sensation.

[00:26:13] Alia Macrina Heise: So the prevailing theory when it comes to the chemical and the hormone that's disrupting the normal letdown experience, normal emotional letdown experience from others, um, is actually not, uh, Blaming oxytocin. Oxytocin can actually help mothers with DMER, um, have a lesser experience of DMER, uh, skin to skin with the baby, raising the oxytocin levels.

Uh, a lot of moms who pump away from the baby may have a worse DMER experience because oxytocin levels are not as strong. 

[00:26:49] Jen Hall: Okay. 

[00:26:49] Alia Macrina Heise: But the other, uh, hormone that's coming into play when a milk release is triggered is prolactin. So oxytocin is the hormone that's going to move the milk from the back of the breast to the nipple so that it can exit the breast and the baby can drink.

But at the same time, in order to tell the body that the baby will need more milk later on, more milk will need to start being made and prolactin starts a slower climb in levels in order to start that preparation. But there is a inherent connection in the human body between prolactin and dopamine. Uh, prolactin is a dopamine inhibiting factor.

It's It's considered sometimes dopamine's the gatekeeper. So prolactin basically has to knock on the door of dopamine and say, Hey, I need to come through. I need to climb the ladder. I need to raise my levels. And dopamine has to drop just a tiny little bit in order to let prolactin go through that gate.

And then as soon as prolactin has started climbing, dopamine levels stabilize. And they've seen this in lactating rats, they've seen it in lactating ewes, and they actually use this measurement in other forms of research, like with athletes, when they're trying to increase dopamine levels for better performance, they do so by affecting prolactin levels.

So, it seems that DMER is actually Um, being caused by an inappropriate activity in dopamine when it makes that drop in order to let prolactin rise, a mother who doesn't have DMER never feels that tiny little change in dopamine levels. It's too subtle, but whatever's happening with mothers with DMER, the dopamine level, which is dopamine is a mood stabilizer is somehow falling too far too fast and is creating this.

It's a horrifying emotional experience and the reason why it is so brief is that as soon as prolactin has started that climb. Dopamine levels stabilize and the mother feels normal again. 

[00:28:58] Emma Pickett: Okay, okay. Thank you very much for clarifying that. I know some of the, some of the galactagogues do play around with dopamine, so that, that relationship between prolactin and dopamine is recognized in other areas, but, but not necessarily being, being seen here by everybody.

That's, that's really helpful. So, can I just ask you, you mentioned yourself that you'd had some personal experiences of DMER. Um, is that what led you into this research in the first place? What was the kind of beginning of your journey with this area? 

[00:29:25] Alia Macrina Heise: So I have three children and I had two fairly unremarkable lactation periods with my first two.

Um, but kind of similar to Jen, the further I got into mothering and parenting, the more invested I got. Um, and The better I wanted to do. Um, so for my third, I actually had a home birth with no interventions. Actually, it was so smoothly. I didn't even have my cervix checked. Um, and there was no separation of mother and baby, and I had.

Set up meals and childcare in order to have a baby moon, uh, for a full two weeks where everything was covered. It takes a lot of work when it's your third. Uh, but during that time, I would say once I kind of came out of that initial postpartum haze and, uh, You know, like Jen said, you feel it kind of a few weeks in when you're.

Um, when that transition to lactogenesis three and you have that full milk supply really there, I started to Google postpartum depression that comes and goes, which isn't a thing postpartum depression does. But I had at least identified that I kept having these immense drops in mood. That then went away and then another immense drop in mood and then went away.

And I had been on the mothering. com forum and I had been in the postpartum depression forum trying to find something that made sense, something that explained my experience, something that sounded like me. And there had been this thread that was entitled only when breastfeeding. And I hadn't opened it and I hadn't opened it and I hadn't opened it because I hadn't connected it to only when breastfeeding, but finally, at one point, I was like, well, you know what, I am a peer counselor.

I was a peer counselor, um, working with the U S organization, WIC, women, infants, and children. And I was like, if there's somebody who's feeling depression only when breastfeeding, I should probably know about it. So I opened up this thread and then there was this woman and who, I mean, it was a post from months and months ago and she described, she described EMER without a name.

She said, every time my milk lets down, I have this. Drop in my stomach and I feel hopeless and depressed and like everything has gone wrong in the world. And then within a few minutes it's gone. I had such a robust milk supply and had so many spontaneous letdowns that I had yet to connect it to letdown.

And so as soon as I read that and the emotional experience was perfectly described. I paid attention to my body for the next three hours. And within those three hours, I knew that it was connected to the milk release. 

[00:32:27] Emma Pickett: So you had the aha moment. Um, and what, what did you do next? I mean, so this, this post is presumably dead and no one's really posting on it.

What, what do you do next? 

[00:32:37] Alia Macrina Heise: So fortunately, you know, I, since I was already part of the lactation community, I went ahead and started reaching out to other lactation professionals. I was part of what is now a long dead. Uh, message board for lactation professionals and I started searching. I also started searching on other parenting forums and what I was finding is I was finding a lot of moms who were describing this, this experience and nobody was replying.

And I found a lot of breastfeeding professionals reaching out to other professionals describing this experience because they were working with mothers who were having it and nobody was replying. But I came across one post. On that LACnet page for professionals where one LC lactation consultant had posted and one lactation consultant had replied.

She had no answers, but she showed curiosity. She asked questions. She supposed about things. And it just so happens that it was a lactation professional that was not only a published author and international speaker, but also lived within an hour of where I live in New York State. Uh, so I reached out to her and she has a Che League background, which means that she has spent 25 years listening to mothers, um, and not just sitting in lecture halls with doctors and nurses.

Um, and she listened to me and because she is. She's a leading force of the lactation community around the world, Diane Wiesinger. She had clout and pull and standing and connections that I didn't have and she teamed up with me. And we just started working and we haven't stopped working. We're still working on another paper together now.

She keeps trying to retire and 

[00:34:30] Emma Pickett: I feel not going to allow that to happen now. I don't think I would say that even from the UK. I know Diane's work and some of her really powerful. I mean, she's made a difference to the whole culture of lactation support in the world. And she's an extraordinary person. And that was meant to be that you did not live in Malaysia and speak a different language.

You were in the UK. In the US, near her, that was definitely meant to be.

A little advert, just to say that you can buy my four books online. You've Got It In You, a positive guide to breastfeeding, is 99p as an e book, and that's aimed at expectant and new parents. The Breast Book, published by Pinter and Martin, is a guide for 9 to 14 year olds, and it's a puberty book that puts the emphasis on breasts, which I think is very much needed.

And my last two books are about supporting breastfeeding beyond six months. and supporting the transition from breastfeeding. For a 10 percent discount on the last two, go to Jessica Kingsley Press, that's uk. jkp. com and use the code MMPE10. Makes milk, pick it Emma, 10. Thanks. I'm interested to what you're saying about how it was only with your third that you experienced it because I had a misunderstanding that it would have to be every time anybody lactated in the same way that sounds like that was Jen's story that it was something that happened every time but you did not have the experience with your first two?

[00:36:01] Alia Macrina Heise: No, and you can find plenty that go both ways. The one thing you usually don't find is a mom who had it with. A first or second baby and then did not have it with a subsequent baby. What we see is once you experience it, a near guarantee, um, that you will experience it with subsequent babies. And this points to some kind of biological breakdown in the body.

Um, you know, clearly DMER is a, not an ideal situation and I don't think we can really call it normal. Um, it doesn't, it doesn't promote. Infant feeding, and we know that biologically, uh, that we are designed to want to feed and nurture our babies. There's no evolutionary, biological reason why a mother would have such a disturbing emotional experience that she would feel loathe to feed her baby.

So in that sense, it seems like there is something that's going wrong in the body. You know, lactation is a new science, so it's certainly not surprising that we should be learning new things about lactation. And we lost A millennia of verbal wisdom passed down between mothers to mothers to mothers and women to women with the industrial revolution and the onset of rampant formula use.

But you would still think that if this was something that was as common as we are seeing it to be now, in the 1600s, that there would be a snippet in a medical text somewhere. Um, even if it was labeled as hysteria, it would probably have been described. So I don't think that it's something that hadn't been happening, and since the beginning of time, I think it's something that's probably always been able to happen to lactating women, but I think that something that we're doing in our modern lifestyle and living, um, is probably putting mothers at greater risk, and there's something that's affecting our chemistry that causes it to happen, and once that change in your chemistry has happened, um, Unless we find a way to pinpoint what that is and how to fix it.

That's why we see that once you have it with one baby, you have it with another. 

[00:38:15] Emma Pickett: Okay. Thank you. So, so Jen, you, you very bravely explained that when you were pregnant, you were frightened of the idea of breastfeeding for your third child, which I think is, is really important to touch on. And, you know, even though you have this underlying desire to want to make breastfeeding work, it was scary to imagine that you might go through this again.

Did you for a moment think maybe I don't want to put myself through this? How close were you to not breastfeeding? 

[00:38:38] Jen Hall: Um, yeah, probably, I think before I was pregnant, I can remember one time when I was speaking to the health visitor about my second baby, and we sort of laughed and I said, if I ever have another baby, do not let me breastfeed again, because I always had like a really fast letdown, um, which I think probably didn't help by using one of those little silicone pumps.

Um, I thought it was just collecting the milk and I definitely wasn't. And I don't know if that has been part of the problem. Um, the way that my milk does come in is so rapid and abrupt. So when I was pregnant, I definitely sort of thought, do I really want to do this again? Um, but then as I got more pregnant, the birth got closer.

I knew that I did. I probably wanted to breastfeed my third baby even more than the other children for some reason, I just knew I really wanted to do it, but I was also quite desperate to kind of not have the same experience too, so. Just trying to figure it out more this third time round. 

[00:39:54] Emma Pickett: Yeah, I mean, you mentioned your letdown being quite forceful and, and Alia, you touched on that for your experience as well.

Is, does there seem to be a correlation between overactive letdown and DMER? 

[00:40:04] Alia Macrina Heise: So judging milk supply, um, is a very subjective experience for a mother. Um, especially, again, I don't, I don't, I'm not sure of the cultural differences between countries, but in the U. S. there's kind of this. Overwrought paranoia of not having enough milk.

Probably just a good place to project all of our, our American perfectionistic mothering anxiety. But, um, so when you ask a mother to judge her milk supply, it's very much going to be her opinion. I had oversupply with all three. Um, with my first though, when I didn't know anything, I had succumbed to all of this literature of, you know, Make sure you feed this often for this long and You know failure to thrive and your baby and milk and weight gain and all this pressure To the point where I finally went to an LC and we did a pre pre way and post way after a feed and she was Getting four ounces inside three minutes and I was trying to make this poor little three week old baby nurse for 20 minutes Um, so if, if you had asked me at that time as a new mother and I, you know, do you have oversupply?

I would have been like, no, no, like my baby's not feeding, but I, I couldn't have even judged my own milk supply. But it does seem that when you dig down and ask more specific questions, when it comes to how long does the baby feed? Is there gulping? Is there, you know, Popping off the breast, spraying milk, things like that, that mothers with DMER do lean to having healthier or more robust milk supplies.

And that would make sense considering the inverse relationship of prolactin and dopamine. 

[00:41:49] Jen Hall: Yeah, okay. That's um, really interesting what you've described there earlier because it sounds very similar to me, the first baby and even for a while of my second baby I had no idea, didn't know anything about breastfeeding and had never heard of an oversupply or not having enough milk.

But then this third time round I had heard of it online and whenever I would pump, I would get a large volume of milk in three, four minutes, you know, the bottle would be full. Um, and again, I sort of felt pressure in the UK there's a tick sheet that People have to fill in that says the baby's feeding eight to 12 times.

Um, my babies have never done that in 24 hours. But then by day five, they've always gained weight. So it's sort of that made me feel even on day five, I was going to the midwife concerned that the baby was only feeding for four minutes and only on one side. And then gradually, as my third baby got older, the poos were green and foamy and, you know, like all the classic things now if I hear anything about oversupply, I think, oh, like, I should have tackled that.

With my first baby, with my second and third earlier on, but you live and learn, don't you? 

[00:43:11] Emma Pickett: Yeah. Yeah. Did you find, by the way, that you got the same experience when you were pumping? Is it so, it's not whether you're breastfeeding or pumping that makes a difference? It's, it's the let down reflex that's making a difference.

[00:43:21] Jen Hall: Yeah. I felt like if I was to pump and say, use a double electric pump, like The DMER feeling would sort of cripple me almost like it was really, um, that would be the worst thing to do to say, have full breasts and then use a double electric pump. That would be like the heavier, the letdown, the worst the DMER seems.

So now Leo is at like 11 and a half months and my milk supply is probably reduced an awful lot. barely feel it and I don't make anywhere near as much milk and I stay as clear as a can of a pump because I, I know for me that that increases my supply too much. It's like hypersensitive, and I think because my middle child only ever fed for a few minutes, she never fed to sleep, um, so that added the feeling for me that maybe she didn't like breastfeeding because I was having the DMER symptoms, but I think she didn't like breastfeeding because the milk was too fast and it wasn't a soothing or relaxing experience for her.

[00:44:35] Emma Pickett: Yeah, that makes sense. I'm guessing, Ali, what just what Jen was just saying about the pumping, she wouldn't have been getting the oxytocin release from the pump experience. Is that is that maybe what was going on there? Is that why maybe the DMR symptoms were particularly poor? 

[00:44:49] Alia Macrina Heise: Yeah, she touched on some really, some really good stuff.

Um, so that the stronger the letdown, the worse the DMER is. So, um, you know, if you have, if you have severe DMER, which basically just is severe. determining the strength of the emotions and the duration of DMER throughout the time of lactation, um, then you're going to probably feel a, a version of DMER throughout every letdown, even throughout a single feed.

So with my daughter, Ellie, My DMER baby, I had severe DMER that lasted, um, for a good two, two and a half years to a differing extent. It was much milder the older that she got. Uh, but in the beginning, I would have the worst DMER feeling for the first letdown. And then I would feel the other letdowns and have further DMER experiences for the other letdowns during the feed.

But the emotional experience lessened for each one. And then a spontaneous letdown, and Jen could probably attest to this as well, when your breasts are over full and you do not have a chance to get the baby there or the pump there, that'll double you over with a DMER feeling because that's basically at the fullest that your breasts are and they are releasing spontaneously because they're saying, we cannot hold anymore.

Um, and that, that's, that's a very disruptive emotional experience. Um, mothers with mild DMER, though, may only feel DMER for the first letdown of a feed. They may not even feel it when they pump, simply because pumping is not Triggering as strong of a letdown as the baby does. Okay. So there are going to be a lot of different factors at play.

[00:46:38] Emma Pickett: Right. So even though there might be less oxytocin because you're not in contact with the baby, your letdown may not be as forceful, so that might, that might balance that out. Okay. Mm hmm. Thank you. That's helpful. So, so we've talked about how it feels. We've talked about, you know, when it may be worse.

Through your research, Alia, have you found that there are things that can help people? Let's talk about what we can do about it. So I think one of the most important things is knowing it exists and resolving that feeling of isolation and am I crazy and do I hate breastfeeding and what the hell's going on?

That's so powerful. Tell us about some of the experiences that people have shared with you about that experience of having a diagnosis. You've spoken to lots of women that have DMER through your research. What are some of the stories that have stuck with you over time? 

[00:47:24] Alia Macrina Heise: So yes, being able to have a name, um, and then hear from other mothers that are experiencing exactly what you are.

And, um, DMER is, is so unique in its presentation that when you kind of hear the description of it or hear another mother describe it, it's a very strong aha moment. It's not just like, yeah, that kind of sounds like maybe what could be going on. It's like, Oh my goodness, you took words out of my mouth. And so that understanding and education and connection, um, are, are very powerful and very helpful.

Um, we can't stop there. Unfortunately, a lot of the research papers that are coming out about DMER these days are becoming redundant with researchers using it to simply re describe, re define. And call for more research, re describe, re define, call for more research. Which is doing a disservice to women right now because, uh, it's been described, it's been defined.

We know we need more research, we want research that is going to provide mothers with better solutions and understanding of the mechanism and therefore what can we do about it. Unfortunately, Diane and I are not, we're, we're lactation professionals, we're not medical professionals, we're not associated with universities or hospitals.

So despite our passion, we're limited in what we can do. Um, but, uh, actually Diane and I spent a lot of time talking to Jen online over the past couple of years because Diane and I decided that what we could do is we could turn to the mothers online. There are over 6, 000 now in the DMER Facebook group because they had been working on finding their own solutions of what makes it better.

Even if we can make it a little better, let's do that. What do you find makes it better? And we wanted to talk to these moms and encourage them, uh, about their own solutions. And Jen, I don't know if you want to talk about that experience at all and what you ended up finding that helped ease your experience of DMER.

[00:49:27] Jen Hall: Yeah, so I, I really enjoyed being part of that group that were trialing different things to see if it helped ease symptoms. I think some of the things were like trying dark chocolate just before pumping or breastfeeding to see if that would help. Um, the thing that I remember that helped me a lot was drinking really cold water, like ice cold water.

Um, and another thing we tried was mint, like a menthol, a really strong mint. And I sort of found for me that having the mint and the cold water made me have a really cold mouth. And for some reason that changed the DMER symptoms. I could still feel it, but nowhere near as bad with the, the cold mouth worked wonders.

[00:50:19] Alia Macrina Heise: Yes, and so what Diane and I did when we found that the most Frequently suggested solution for easing your DMER symptoms, uh, online, um, was cold water. We worked with a smaller group of moms specifically in that arena. To dig more deeply into their experience. And then we turned to other areas of research and we found that researchers are using mouth cooling techniques to cool the mouth of top performing athletes.

In order to bring up their dopamine levels. Dopamine is hard to measure. And so what they do is they measure prolactin. And they found that by cooling your mouth, you lower prolactin just enough that you get that inverse reaction with dopamine. And it brings up the dopamine level. Um, and so where we lack answers in lactation, we've been able to find, uh, answers in other areas of science.

[00:51:25] Emma Pickett: Wow. That's so cool, but I'm also aware that there isn't some expensive thing that you can necessarily get some company to produce and no one's going to make a lot of money out of, let's have a drink of cold water, but how great that something so simple. 

[00:51:41] Alia Macrina Heise: We spent a lot of time looking for carbonated mint water because carbonation also helps and we cannot find carbonated mint water anywhere.

So if anybody can, can find some really good mentholated carbonated water, then that's, that's what we really want to try. 

[00:52:00] Emma Pickett: Yeah. I mean, I guess the, I don't know if anyone has a soda stream these days. That was a thing of the eighties where you could make your own, but I don't think we should be encouraging moms to buy their own soda streams, but so literally just a drink of ice water, it seems to do something to the dopamine and prolactin relationship.

Which then reduces the symptoms. 

[00:52:18] Alia Macrina Heise: We even came across this, this woman who lived in, uh, Scandinavia, which I just found funny because it's just so associated with cold. She would expose herself to cold on a regular basis throughout the day, just in her own environment. And she'd go for a brisk walk outside with her face uncovered.

And then she'd come home and she'd nurse the baby. So face and mouth cooling is also covered in the same research from, um, these researchers with athletes. So even a cold compress on your face is something that can be beneficial. 

[00:52:49] Emma Pickett: Wow. Now I'm wondering whether maybe the reason you didn't find it in texts from the 1600s and 1700s is because everybody was colder.

So people who lived in, obviously there were parts of the world that were warm, but those guys weren't necessarily writing books and recording their history through text. And the people who were writing stuff down were living in colder places and not necessarily, I don't know, I'm just wondering what was going on there.

Yeah. 

[00:53:13] Alia Macrina Heise: We also treated a lot of students. stuff with warmth back then as well. We did think that, you know, keeping people warm was the solution to a lot of things. 

[00:53:21] Emma Pickett: Okay. So this particular group that you're talking about, um, the Facebook group that's, that's operating today. If someone listening to this recognizes themselves in these descriptions and wants to look for a community, that Facebook group is still the place to go.

[00:53:35] Alia Macrina Heise: For sure. 

[00:53:36] Emma Pickett: Yeah. And is there any, anything else that has helped people that you're happy to share? I mean, I realise, you know, this is all going to be very individual, but is there anything else that has helped you, Jen, or you've come across other people who've found techniques? 

[00:53:48] Jen Hall: Um, so when my third baby was born, he had a tongue tie and I was struggling to get him to latch.

And a lovely lady called Bex from the infant feeding team came out. And she must have said something like every breastfeeding journey is different. And I just burst into tears and then told her I had DMER. And, um, she was really honest, said, I don't know a lot about it, but would you like me to refer you to Stacy, the infant feeding lead in my local area?

Um, and seeing Stacy was probably the big turning point for me. Um, she did. Again, she was quite honest and said, I don't know that much about it, but kind of leave it with me. I'll do some research. And I think she looked at your resources, Alia. And, um, she came back to me and sort of suggested taking probiotics, taking magnesium, vitamin D, vitamin B12, um, But probably the most, like, the best part of that support from Stacey was speaking to her and going through all my breastfeeding history and kind of the baggage that that had brought along with this third journey.

Um, and she was just like a wonderful person who she really listened to me. I felt like she understood the impact it was having on me and she really wanted to try and help me find solutions that could help manage the DMER on a day to day, um, business. So talking through my experience as well as taking those supplements.

Was really, really useful and helpful. 

[00:55:39] Emma Pickett: Yeah, I mean, being validated just sounds like it's such an important part of this experience. And, and your work earlier has meant that that's happened because so many professionals are now aware of it and are able to help validate. What's your journey been like trying to get the sort of medical community and the lactation support community to recognize it?

Have you had any full on resistance? Like, nah, that's not a thing, you're making it up? Or has everyone been pretty much receptive to it? 

[00:56:04] Alia Macrina Heise: In the beginning, I had resistance in the beginning, but that's when I was the most bull headed, so that worked out okay. Um, there were people who wanted to say that it was, you know, uh, repressed sexual trauma, but if that was the case, I would have had it with my first two lactations, so I kind of ended up being like, the perfect first, like, guinea pig purchase proof of DMER.

Um, because then it was like, well, birth intervention, separation of mother of baby, and I was like, Nope, sorry, you can't tag that on me. And then, uh, maybe a couple years in, um, I had been working on writing articles for, you know, like small online, uh, magazines and trying to get information out there and mothering.

com. I don't know if they still do their magazine or not. Um, but I wrote something for them and they specifically turned it down because it makes breastfeeding look bad and they didn't want to make breastfeeding look bad. And so therefore they didn't publish the information, but that time of denial and resistance is fortunately over because you just can't anymore.

Uh, so really since then, for me, it's been slow and steady. I mean, you Google it, you get it. You can, you can put in, you can put in all sorts of variety of search terms of like uneasy while breastfeeding sad when milk lets down. Um, And, and you're going to be able to find a name for what you're experiencing and then very quickly find community as well.

Um, and that in itself is impactful because then if a mother goes to a care provider and the care provider tries to dismiss her, she's at this point got the force of like 20 research papers behind her saying, Nope, this is a real thing. And that that's important. So I. You know, this is my, DMER is my passion project and my side hustle, and it always will be in any way that I remain useful and helpful.

Um, but I don't have the same kind of sense of urgency that I had before because other people are now stepping in and picking up various pieces and reigns. I'm trying to kind of sometimes Make sure that, that, that, that stays together as well as possible, but it's so much bigger than I am now. And, you know, that's, it's, it was supposed to be.

So that's the sign that you've done 

[00:58:34] Emma Pickett: your job when other other people are running with it. I mean, there's obviously, you've mentioned all these papers that keep saying more research is needed, more research is needed. Is there an obvious gap? I mean, what paper do we need to have, needs to happen? Do we need a really big randomized controlled trial?

What, what needs to happen, do you think? 

[00:58:51] Alia Macrina Heise: Well, so Diane and I are publishing this paper on what we're basically calling mother sought solutions. So in the absence of the medical community stepping in to give mothers answers, they found their own. And we're, we're going to go ahead and talk about that because that's a starting place.

And if we can point to these other places of research, like The research done inside athletics and sports, then that may give some other researcher a ha moment and make them feel like they could, they could do something with that, that we can't, because you're right. The good, the good thing about DMER is that you can trigger it.

You can make it happen. You can. Therefore, then measure what's going on in the body when you trigger it, it's not a vague thing you sit around and wait for and see if the levels in a mother's brain or body changes. They know how to measure prolactin levels and therefore inversely measure dopamine levels.

We have the technology. But that is the hard work sitting and writing the papers about defining and describing is easy, but they're doing it because DMER is new and cool and we want our name on that kind of paper. Um, but somebody is going to have to get their hands dirty and do the hard work of finding out what is the mechanism and therefore, what can we do to more successfully treat the problem?

[01:00:14] Emma Pickett: Yeah, thank you. So if someone's listening to this and they're in the world of lactation support and they want to learn more. Can they join the Facebook group as well? Um, and I know you wrote a book. Tell us a bit a bit about your book. 

[01:00:25] Alia Macrina Heise: Yeah, so I self published a book a long time ago and then just within the last year I went ahead and self published a second edition because there was so much updated information Uh, mostly coming from the mothers themselves, which was what the first book consisted of but they are the most reliable source of information We have so it's good information.

Um, and it's linked. So so everything stems out from the website d hyphen Dot org and you can find the Facebook page there. Um, it links to a lot of podcasts that have been done on DMER. All of the research papers that have been done on DMER, it links to my book. Um, basically it's a big hub that sends everybody out into the world of DMER and the Facebook group page is for, uh, people who work with breastfeeding women.

For the breastfeeding women themselves that have DMER. 

[01:01:16] Emma Pickett: Okay. Okay. Jen, what do you feel we need to do, particularly in the uk? Where do you think the, the, the gaps are? What support do you think is missing? 

[01:01:24] Jen Hall: Um, I think it would obviously be a lot. better if like lactation specialists knew about DMER if anyone working with breastfeeding mums is able to kind of even just saying how does that feel you know when you're breastfeeding and um So more people, much more awareness in terms of helping people get diagnosed, if you like, but then also the support for people that have got it too, and making sure that they're okay if they have got DMER.

[01:02:01] Emma Pickett: Yeah, I mean, so we need it to be covered in health visiting training, particularly we need it to be in any, any breastfeeding supporter, peer supporter course that needs to be included in there. It just needs to be a standard part of all the curriculums, doesn't it? So everyone's aware of it and also knows, knows where to signpost people to because that community sounds so important.

[01:02:19] Alia Macrina Heise: Well, and it's looking like the prevalence rate of DMER is higher than the prevalence rate of mastitis. There have been three different prevalence studies. If you average them together, then you get a prevalence rate around 9 percent and, um, mastitis is about the same as well. I have the exact number somewhere.

And what mother going into breastfeeding hasn't ever heard of mastitis and what medical professional working with lactating and breastfeeding and postpartum women hasn't heard of mastitis? And yet DMER happening at the same rate as mastitis. And people don't have the awareness or knowledge. 

[01:02:59] Emma Pickett: Yeah, and mastitis may only happen once, and that's that.

It's a rough few days, but there you go. Whereas you're talking about DMER day after day, hour after hour. I'm just trying to imagine, Jen, what it must have been like to have two other children. Well, for both of you to have two other children while you're breastfeeding. Having a, do you call them episodes?

What do you, how would you refer to it? A DMER event? What language would you use to describe that moment? A wave, I think for me, or yeah. 

[01:03:31] Alia Macrina Heise: Yeah. You describe the, I think there was a lot of it, it's it. 

[01:03:37] Emma Pickett: So you've got it happening when you've got two other children with you in that same space. That must be a really difficult parenting moment to kind of keep yourself regulated enough to be able to parent.

Did they see what was happening? If you had, I don't know how old your children were earlier, did you, did they notice what was happening to you? 

[01:03:55] Alia Macrina Heise: Uh, they were, they were three and six. Um, and I think I talked about it. I don't know if they saw, but I brought words to it so that they could have understanding that there were times where, you know, like mom feels really sad.

It will be over soon. Um, you know, a lot of affirming of, no, it's not you. It's, it's just my body. It's because I'm breastfeeding. It will be okay in a minute. Um, because, because there is so much patience needed, the only times that moms will ever talk about the DMER experience being projected outward is usually if, if their emotional experience is being interrupted by outside pressure.

So if their husband is trying to get their attention in a way that could be unwelcome or aggressive or their kids are just ramping up in volume while they're experiencing DMER, that's more likely when a mom might, you know, yell or snip or snap versus being very insular and introspective to just try to get through it.

Um, and so if you can, if you can use any language possible with toddlers and older children. to let them know that you need a moment, you'll be okay, they're okay. And then that since you get that fast rebound, unlike postpartum depression, you do have the energy to then turn towards your older children again, because you have come back into yourself.

[01:05:21] Emma Pickett: Yeah, where did you cut? Do you remember any of those moments being difficult for you, Jen? 

[01:05:25] Jen Hall: Um, well, my, I've had three children quite close together, so I feel like they're probably a bit too young to be aware. And I probably just, I've never really projected or snapped when I've been in that moment. I'm probably just focusing on myself and sort of that these feelings will pass.

If, like, the older two children are around and playing, that might also help to sort of ground me as well. It kind of reminds me that this feeling's gonna pass and then I can go and play with them or, um, What I found the hardest was probably the random letdowns and like going and watching my daughter dance on a Saturday.

I know that, you know, there's a couple of songs that I know will be played and for whatever reason that will just always trigger a letdown with me. be sitting there really enjoying the experience but I, and now I know it's going to happen, have a little sip of my cold water so no one notices but um, that like wave comes and goes and it, it's just any time a letdown's triggered.

So I find those random ones so much harder than say if I'm feeding the baby on the sofa and the older two children are playing, that's fine, I'm in control of that letdown, whereas if it's happening when I'm doing something else, it sort of takes you a bit by surprise sometimes. 

[01:06:56] Emma Pickett: Yeah, that makes sense.

That feeling of control. I can appreciate feels important. So if someone listening to this episode has had their aha moment while they've been listening to this episode, is there a sort of final message you'd like to leave them with earlier? 

[01:07:11] Alia Macrina Heise: My go to is you're not alone. Like if you've been feeling alone, that totally makes sense to me.

And And of course you have been feeling alone, but you're not, there's information support connection out there and your experience is real and valid. And with understanding you can move forward, feeling more empowered and able to make better choices. 

[01:07:35] Emma Pickett: Thank you. Jen, 

[01:07:35] Jen Hall: anything you'd like to leave them with?

Um, I'd probably first of all say I'm really sorry that breastfeeding is like this for you. It probably isn't what you've hoped when you've been pregnant and when you've initially started breastfeeding. Yeah, hopefully people will get some comfort from listening to other people's stories. Knowing that the feeling will pass, and I guess like research is being done, so things are moving forward in the right direction.

[01:08:07] Emma Pickett: Yeah, go and fill your ice trays right now. See if the cold water thing helps you as a starting point, but getting to the, um, d m e r. org website and finding the Facebook group as well. Thank you so much to both of you, Alia and Jen, I'm so grateful for your time today and all the work that you've been doing.

You've both been doing in this area and supporting other people and, uh, thank you for your time. 

[01:08:29] Jen Hall: Thank you. Happy to be here.

[01:08:35] Emma Pickett: Thank you for joining me today. You can find me on Instagram at emmapicketibclc and on Twitter at makesmilk. It would be lovely if you subscribed because that helps other people to know I exist and leaving a review would be great as well. Get in touch if you would like to join me to share your feeding or weaning journey, or if you have any ideas for topics to include in the podcast.

This podcast is produced by the lovely Emily Crosby Media.