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Poor Letdown

Why Don't I Have Good Milk Let-Down?

There's no single reason why a postnatal patient might experience poor milk let-down or even DMER, but emotional, mental, and physical factors can all play a role.

When it comes to the emotions, some women experience a range of negative emotions while trying to breastfeed, which usually have a mental aspect, as well, though this isn't always immediately clear or obvious.

Stress from other aspects of your life can affect let-down, as can anxiety about something or other.

That can include stress and anxiety thinking about feeding the baby and producing sufficient milk, in fact. Or, anything else, really.

Stress and anxiety can also be a longstanding aspect of your lived experience and may even deeper origins in your past, and have little to do with what life is like now for you.

Feeling bodily discomfort, like being too hot or cold, feeling like you're not getting enough fresh air like in a packed railway car, experiencing pain of some sort somewhere in your body like your leg or arm, for example, or even being fatigued or tired can contribute to poor let-down.

If the pain condition is longstanding, then this may even lead to DMER, a situation where letdown ceases completely, or slows down substantially.

What is Dysphoria Milk Ejection Reflex (DMER)?

Dysphoric Milk Ejection Reflex (D-MER) is a condition that affects milk let-down in a postnatal person, whereby they experience strong negative emotions like deep sadness, depression, panic, self-loathing, a "pit in the stomach" sensation, anxiety and nervousness, or a feeling of extreme distress just as the milk begins flowing from the nipple, resulting in an abrupt stoppage of the flow of milk from the breast.

Poor Letdown does not necessarily mean that you have DMER, but of course, having DMER necessitates that you are experiencing poor letdown.

What's the Physiological Cause of Dysphoria Milk Ejection Reflex (DMER)?

DMER has been linked to a sudden drop in dopamine while the baby is at the breast, and is not the same as sustained low dopamine, as is often the case in postpartum depression.

What's The Connection Between Polycycstic Ovary Disease (PCOS) And Poor Milk Let-Down?

Research studies show a strong link between having a nervous or anxious personality and Polycystic Ovary Syndrome (PCOS), with women diagnosed with PCOS being significantly more likely to experience anxiety symptoms compared with the general population.

This is usually attributed to hormonal imbalances and physical symptoms associated with PCOS that cause self-consciousness, which can contribute to feelings of stress. However, we challenge this view as many PCOS-sufferers have no outward indications that might make them feel uncomfortable among others, such as thinning hair on the scalp, yet they suffer from nervousness and anxiety, all the same.

However, it's also possible that anxiety has created a run-away cycle of adrenaline, which lowers oxytocin and serotonin. This then creates an imbalanced hormone profile, and the person now has a higher propensity for nervousness and anxiety. Nervousness and anxiety affect milk letdown. Can anxiety and nervousness cause PCOS in the long-term? There isn't sufficient evidence yet, but it seems possible.

Can I Have Poor Milk Let-Down Without Having DMER?

You can have Poor Letdown without the condition qualifying as DMER, if you're not experiencing the strong emotional difficulties at the time of sudden milk ejection from the nipple, yet still have difficulties with slow or poor let-down.

It may just be a matter of degree of severity, as most milk letdown issues in the postnatal population are caused by stress and anxiety, while physical factors also play a smaller role.

While it's fair to say that many, if not most, postnatal people experiencing poor letdown without qualifying as DMER are stressed and anxious, the key difference is that with DMER, the emotions triggered are strong, and dealing with these emotions becomes a challenge of its own.

Have You Worked With Other Postnatal Women With Poor Let Down and DMER?

If you're having issues with milk let-down being nonexistent or severely insufficient, know that you're not alone and we're helped many breastfeeding women to successfully overcome this fairly common condition.

We appreciate the significance of being able to help you breastfeed your baby with greater ease.

What's the Standard Treatment For Dysphoric Milk Ejection Reflex (DMER)?

There is no FDA-approved medical drug or at this time for DMER, however the standard approach employed today, which is effective, is to manage the symptoms of DMER through coping mechanisms, Breast Massage, Pelvic Floor Therapy, and a few other things.

Postnatal Breast Massage For Poor Let-Down And DMER

Firstly, there's postnatal Breast Massage sessions with the specific, focused goal of helping you overcome issues of mental and emotional tension during let-down.

A qualified Perinatal LMT can help you become more comfortable with your breasts and with the feelings associated with let-down.

Of all the types of help you might seek, Postnatal Breast Massage is probably most effective, as the therapist is literally working with your breasts and nipples, hands-on, as well as going through the experiencing with you in real-time as it's happening.

Having someone alongside you as you experience DMER can be cathartic, in and of itself.

Add guided meditation to the session of Breast Massage For Letdown, including deep breathing and visualization, and Postnatal Breast Massage can be among the most effective strategies for dealing with Dysphoric Milk Ejection Reflex.

Pelvic Floor Therapy To Help With Poor Let-Down And DMER

Pelvic Floor Therapy can help to get rid of a "frozen core," and the associated emotional stagnation. Working on the Pelvic Floor helps letdown significantly.

Self-Soothing and Sexual Relations For Poor Let-Down And DMER

Self-touch and sexual relations with your loved one can help with milk let down, too. Be aware that when you're lactating, your vagina will not produce as much lubrication, and your vaginal tissues will be thinner from hormones.

Proceed with care. You or your partner can touch your clitoris, instead, and avoid the issues of sex during the postpartum time. For many men, sex during the postpartum time is not sought, and many postpartum women feel more comfortable with self-touch at this time when relying on clitoral stimulation to aid let-down.

Sex and Breastfeeding: An Educational Perspective https://pmc.ncbi.nlm.nih.gov/articles/PMC3431754/ Polomeno V. Sex and Breastfeeding: An Educational Perspective. J Perinat Educ. 1999 Winter;8(1):30–40. doi: 10.1624/105812499X86962. PMCID: PMC3431754.

Distraction During Letdown For DMER and Poor Letdown

Some women can only experience letdown when they're distracted. In reality, when our minds don't get involved, the process of letdown is automatic when there's proper nipple stimulation.

So, how do you distract your mind and feelings? That's different for everyone.

Some things women have done whom we've worked with that worked for them:

Sit in a rocking chair
read a book
watch TV
watch YouTube
have a conversation
do a puzzle
read about breastfeeding
get some (non-group) work done during maternity leave
use a hand squeeze exerciser squishy
shop on-line
write a journal entry
knit or crochet
plan a vacation
plan a meal

Relaxation Techniques For DMER and Poor Letdown

Our Postnatal Milk Letdown Massage focuses on relaxation. But you can relax anywhere, all by yourself.

Some techniques you can try include one-pointedness meditation, mindfulness meditation, stillness meditation, pranayama or deep breathing, visualization meditations, guided meditations, and chi kung meditations.

Seeking Support For DMER and Poor Letdown

Most people benefit from encountering others dealing with similar issues. When it comes to Slow Letdown and DMER, it's no different.

You can check out Reddit threads and Quora questions to find what people have said in public, regarding this subject.

You can even join a group on Facebook or a dedicated postnatal women's website where you can ask questions in the forums.

You can find women in real life in your local community going through the same thing as you, by local meet-ups, which again, are usually found, and arranged, via the Internet.

Seeking support from a health care professional can also help.

Our on-staff Perinatal LMTs who are also Lactation Counselors can fill this role, as we are uniquely qualified to make the most difference.

Increased Skin-To-Skin Contact With The Baby For DMER and Poor Letdown

You may want to increase you skin-to-skin time, if letdown is difficult, or you're having issues that seem to meet the criteria for DMER.

Skin-to-skin has been proven, in numerous research studies, to be of benefit.

There is no time limit. You can hold the baby skin-to-skin for as long as you choose. Few babies will protest!

If you've never held the baby skin-to-skin, seek help from a qualified Lactation Professional, or seek the information on how this works on-line.

LifeStyle Changes For DMER

Managing stress, long-term, is important. Find time to meditate and do postnatal Hatha yoga and take walks, once you're leaving the house again.

Eating a balanced diet is best, and traditional women's wisdom suggests a full-fat diet and ample protein.

You may need to understand that you need more space from certain people right now, yet you don't want to offend anyone. It's a difficult balance.

Even Just Learning About Poor Letdown and DMER Can Help

Understanding this condition can help to make the patient feel better-prepared to deal with it. Hopefully, dear reader, you've leaned something here today.

But chances are, you've heard some of this all before.

Imagine a person who's trying to breastfeed and has poor letdown or DMER and knows NONE of this, and has no support?

Knowledge can change everything, or at least help us begin the journey toward healing.

Find A Safe Spot and Pump or Feed There When you Can

This is true whether you're at home or at work. Feel out your environment and learn what works best with you.

When you go to that spot, you may even start leaking, as your body knows it's time to pump and letdown is happening automatically.

Poor Letdown With An Obvious Cause

If poor let-down only happens when you're trying to breastfeed in public, then you may feel like you don't have enough privacy and experience thoughts of self-consciousness and shame.

These are emotional and mental causes, and you have every right to feel your feelings.

The answer? Find a better spot to feed your baby.

There are always safe, yet darker corners of the seating areas at shopping malls with tons of planters all around and frothy exotic palm trees to block the view, and the security office might even accommodate by letting you feed or pump in an empty office at the security center at the mall, if you were to ask.

Most people like helping pregnant and postnatal women when they can and will do all they can to help you.

Why Might I Experience Poor Letdown At Only One Location?

If poor letdown only happens at a certain relative's house or at the Nature Center, then know there's something happening in that space that makes you feel uneasy, especially if you're not having issues anywhere else.

Trust your feelings and don't try pumping or breastfeeding there. You don't have to understand why, just trust that the vibe is somehow off and you're sensing it.

It's the easiest way of dealing with this sort of situation.

What if Poor Letdown Only Happens At my Job?

Understandably, if you're pumping at at the office, you need to have the process work effectively and efficiently and not waste any valuable time.

That pressure, alone, can make things difficult, and create poor letdown, as can managers making faces and giving dirty looks every time you get up to pump.

In this case, though, you need to pump and remove milk, as you really can't go elsewhere, and long hours at the office mean you have to pump during the workday.

Some things you can do to help might be to find a different spot to breastfeed.

We've worked with women who were relegated to the broom closet janitor chemicals and all. Of course, there was a chair.

That is not a good spot. Do not accept such "accommodations."

Your Right To Pump In Peace and Safety Is Established By Law

In New Jersey, by law, your employer must provide you with a safe space to pump.

That is nonnegotiable.

Maybe you can find an office way down the hall? Turn on your baby's favorite song on your phone to drown out noise of the office? Close the door of the office and sit in the dark and pump. Try putting in earplugs.

Bring your baby's onesie and hold it close to your face and focus on your baby's energy and send good, loving vibes, thoughts, feelings, and prayers of health and joy to them.

Slip out to the "other" lounge only five employees know about.

Do something. And, keep trying.

Don't give up.

One office may make you feel comfortable, in particular, because it's the office of a woman you feel has taken care of you at the company and now you feel safe in her space.

It all makes sense, just work with your life story and understand what you need to change, and keep looking until you find a safe and comfy spot.

One woman found a specious company bathroom with a single toilet and a chair, and most importantly, a lock no the door.

The locked door was what she needed to feel secure while pumping and letdown happened as soon as she sat down.

What if Poor Letdown Only Happens With my In-Laws Present?

Poor letdown sometimes happens when in-laws are in the room, or even over the house for a short visit.

There are all sorts of spoken, and unspoken, demands, and rules, in dealing with in-laws, and navigating this confusing reality can be especially difficult after childbirth, especially if your mother-in-law tends to be a perfectionist, demanding, judgmental, or just a bit harsh.

Even with the sweetest of in-laws, you may have issues with letdown. There are just so many expectations, and the idea of being a good mother for in-laws to witness may be tied in your own mind with having ample flowing milk for the baby.

You're suffering from performance anxiety, in this case.

What if Poor Letdown Only Happens One Person in Particular?

If poor letdown only happens when your cousin visits, know that she somehow make you feel uncomfortable and guarded.

Oh, wait. Didn't you guys have a fight in seventh grade? Isn't she a mite cold for no reason, even still?

In this case, just wait until she leases or excuse yourself to feed or pump where she isn't. Rude? No way. It's your right.

Sometimes there is no story or cause. It's just a vibe you feel. Trust your intuition. Pump later, elsewhere.

Don't feel like not pumping in front of someone in your family or friend circle means you're showing them you don't see them as close or trustworthy.

Everyone knows breastfeeding can be difficult and most are usually understanding.

Misperceived Sensations and Oxytocin: Sensual Is NOT The Same As Sexual

Sometimes women misperceive nonsexual feelings in their bodies as sexual, such as might be produced when breastfeeding, and this may stress-out the mother, and even lead to DMER (dysphoria milk ejection reflex) from emotional discomfort having to do with how they're framing the experience of breastfeeding. Some people, especially women raised in strongly Conservative families, feel ashamed that they feel what they incorrectly label as "sexual feelings" during breastfeeding.

This can be addressed, and the pattern of little or no milk let-down due to dysphoric milk ejection reflex can be altered. A session of Breast Massage focusing on this, perhaps with guided meditation, can change the situation for the better. Why? Stress causes adrenaline to rise in the blood., and adrenaline lowers the amount of oxytocin. This can happen slowly, or it can happen in an instant. It's an emotional and mental block, and not physiological.

Remember, oxytocin is the love hormone, and it makes us feel good. And, that's what's released during breastfeeding. Feeling love while you breastfeed your baby makes good sense. The same is true of the feelings you may begin to become aware of associated with your pelvic floor. Those feelings and sensations are just your own body doing its thing. That's just you feeling yourself as a living person. Feeling "in your body," on "sensual," has nothing to do with sex, and everything to do with being present and responsive to the moment and life's demands.

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