Dysphoric milk ejection reflex among Japanese mothers: A self-administered questionnaire survey

Abstract Background The dysphoric milk ejection reflex (D-MER) is a reflexive symptom that causes temporary discomfort during milk ejection. D-MER is a symptom that develops due to the influence of hormones involved in lactation, and it has been reported that it is a physiological symptom different from postpartum depression, but the actual situation is often unknown even in Japan. Methods This study was conducted using a self-administered, anonymous questionnaire survey of mothers of children who had undergone health checkups at 3 years of age at five health centers in city A, and aimed to clarify the reality and perceptions of mothers regarding D-MER. The questionnaires were distributed to 389 mothers, and 216 (55.5% recovery rate) responses were received, of which 202 (valid response rate 93.5%) were included in the analysis. Results Regarding the experience of D-MER, mothers in the study population had given birth to a total of 403 children, and experienced D-MER when breastfeeding 62 (15.4%) of them. Among the 202 mothers included in the analysis, 47 (23.3%) answered that they had experienced D-MER at least once while breastfeeding. Sixty-six mothers (32.7%) knew about D-MER. Compared to those who had not experienced D-MER, those who had experienced D-MER had significantly higher scores on the items of having had trouble breastfeeding (odds ratio [OR]: 3.774, 95% confidence interval [CI]: 1.566–9.093, p = 0.003) and knowing about D-MER (OR: 2.409, 95% CI: 1.199–4.841, p = 0.014). Regarding symptoms, irritability (n = 24, 51.1%), anxiety (n = 22, 46.8%), and sadness (n = 18, 38.3%) ranked high. Coping strategies included distraction, focusing on the child, and in some cases cessation of breastfeeding. Thirty mothers (63.8%) answered that they did not consult anyone when they experienced D-MER, citing reasons such as no one would likely understand their symptoms and they could not sufficiently explain their symptoms. Conclusion The low level of awareness of D-MER suggests that it is necessary to inform and educate mothers and the public about the physiological symptoms of D-MER. Moreover, it is necessary to listen to the feelings of mothers with D-MER at the onset of symptoms and support them in coping with their symptoms.