Posts in Ask Dr. Michelle
Answers to your Questions about Dysphoric Milk Ejection Reflex
Mother breastfeeding baby
 

By Erin Erenberg, Totum Founder


Hey breastfeeding mamas -- have you ever felt a rush of intense negative emotions just prior to your milk letdown? This feeling might have felt like a slight fog or perhaps it was a heavy, depressed feeling in your chest or pit of the stomach. You may have worried how you could possibly feel this during such a special and intimate moment with your child. If this has been your experience with breastfeeding, you already know the bad news (this sucks A LOT), so I’ll skip ahead to the good news. This is a real thing, with a name, and you are not alone.

Dysphoric Milk Ejection Reflex, also referred to as D-MER, is characterized by a wave of negative emotion just prior to milk letdown. Breastfeeding mothers may experience this rush of negative emotions around 30-90 seconds prior to milk release. These feelings usually dissipate, between several seconds to a couple minutes after letdown, but return prior to another milk letdown. Moms who have experienced D-MER have described it as sadness, dread, anxiety, hollow feelings, irritability, hopelessness or angst. The feelings differ and range in intensity. One mother with mild D-MER may experience slight worry or even a feeling of homesickness. Another with more severe symptoms may feel intense sadness, anger, dread, or fear leading to thoughts of self-harm or suicidal ideation. These feelings are usually brief, and it is rare that women act on their catastrophic thoughts.

Moms who have experienced D-MER have described it as sadness, dread, anxiety, hollow feelings, irritability, hopelessness or angst.

Experts believe that D-MER is related to the relationship between the three main hormones involved in milk production: oxytocin; prolactin; and dopamine. Oxytocin is released when nipples are stimulated, breasts are full, baby latches, or even at baby's scheduled feeding time. This helps trigger the production of prolactin, which peaks at the beginning of a feed. However, in order for prolactin to peak, dopamine must drop. Some women may be more sensitive to this sudden drop, or their dopamine may drop more than what is necessary to stimulate milk flow. According to D-MER.org, some mothers may experience this due to an environmental effect, a nutritional deficiency, a breakdown in normal hormonal activity with aging, increased sensitivity to a normal drop in dopamine, dopamine receptor mutation, a predisposition to abnormal dopamine activity, or some other unknown cause.

Many women find it helpful to know that these feelings are due to a natural dance of the hormones that make breastfeeding work.

Most mothers notice the onset of D-MER within the first couple weeks of breastfeeding, and for many it will subside by the time the baby is around three months old. For others D-MER remains until weaning. In contrast to a mother who is experiencing a postpartum mood or anxiety disorder, a mother with D-MER generally feels okay except just before her milk starts to flow. It is possible that a mother who experiences D-MER may also struggle with postpartum depression or anxiety, but they are separate issues. It is important to distinguish one from the other in order to receive proper and effective treatment. Some mothers with D-MER may need to consider professional support in order to more effectively manage their D-MER.

Many women find it helpful to know that these feelings are due to a natural dance of the hormones that make breastfeeding work. They can then practice positive visualization techniques to tolerate and work through the negative feelings. Mothers without this information might consider discontinuing breastfeeding because they are confused by and afraid of what they are experiencing. Of course, deciding whether or not to breastfeed is a personal decision, but it is best when that decision comes from a position of knowledge as opposed to a state of fear. Often, just knowing what D-MER is can provide the comfort and support that is needed and the reassurance that these feelings will pass shortly.

Hang in there, beauties, and for more information, please visit D-MER.org.  

 
Answers to Your Questions About Working From Home and Hysterectomies
 
Mom typing on computer on bed while child sleeps next to her
 
 
 
 

How does one navigate life being a stay at home mom of two and trying to pursue passion projects / a work from home job?

I’m a firm believer in the old cliché that you need to take care of yourself in order to take care of others. Self-care might have different meanings for you, whether it's pursuing a career or passion, exercising, meditation, reading, eating healthy, taking a much-needed afternoon snooze, or even just hiding in the closet for a couple minutes while you recover from a toddler temper tantrum (I’ve been there)...If you’re a happy and healthy mama, then chances are your kids will be as well.

In terms of the actual navigation of pursuing a stay at home job or passion with children, this would depend on several different factors.  These might include: age and number of kids, if they’re in school yet, how many hours of alone time you have, and whether or not you have childcare help, etc.

I’m not aware of your particular situation, but I can share from my personal experience as a working mom of two high-energy toddlers. I don’t usually work from home, but there are those occasional times when I will need to make a work call or do a phone session with a patient when I am home. I try my best to schedule those when the kids are napping or at school, but this doesn’t always work out. In the moments when we are all home together, I try to give my children as much notice as possible and let them know ahead of time so that they’re not caught off guard. I will usually say something to the effect of, “Mommy needs a little bit of alone time to do some work. I know it’s hard to wait, but when I’m finished we can read a book or do an art project together.” Through this, I am letting them know what to expect and conveying to them that I am sensitive to and understand their feelings. I am also empowering them with the choice of a “time-with-mommy” reward for when I'm finished. I do my best to set them up with a fun activity so they’re not knocking at the door and yelling for me. I try to choose times when our nanny or my husband are available to help corral The Littles away from my work space. (I’m not risking any toddler power struggles over who was using the the yellow hot wheels truck to crash the purple sports car first, while I’m trying to speak professionally with a colleague or client!).

Sometimes this works, and sometimes I’m scrambling to find new ways. When all else fails…there’s always screen time (Yes, I do… we've got to get by, right?)  

Remember that taking care of yourself is not only important for YOU, but you are also modeling the importance of self-care and happiness for your children.

It’s also important for me to try and schedule my week ahead of time so I can communicate and plan logistics with my husband and our nanny. I will update the white-board calendar on the wall at the start of every week to make sure I have given myself enough time to do what I need to do, while also prioritizing my children’s needs and activities. I use my nights after I have put the kids down to bed for paperwork, while also trying not to stay up too late. If I need to revisit something the next day, then so be it. (All this talk of self-care and here I am writing this blog entry at 4am because I kept waking up thinking about it).

I’m not going to lie, it can be really difficult, both emotionally and physically. There are times when I feel like I’m spread so thin and that I’m not doing anything well enough. I consistently need to remind myself that I am doing my best and to remain mindful of when I need to slow down and take a break.   Balancing it all can be tough, so please be gentle with yourself Mama! Remember that taking care of yourself is not only important for YOU, but you are also modeling the importance of self-care and happiness for your children. 


I'm 36 and about to have a hysterectomy. What can I expect as far as emotions and aftermath?

A woman may choose to have a hysterectomy for elective reasons or for a number of medical issues, and the emotional effects can have varying implications for different women. For example, the removal of one’s uterus may represent a significant loss for a woman. This loss may trigger feelings that she is no longer a "real" or "whole" woman due to the removal of some of her female organs. With a hysterectomy, women are also experiencing the end of their childbearing years. Even though these women may not even desire to have more children, they may nonetheless feel saddened by this loss. 

Remember that despite these feelings and the difficulties you are encountering, you are still an incredible and whole woman. This medical procedure does not, in any way, make you any less. On the contrary, you are living and persevering through this difficult time, which makes you an even stronger and resilient woman. It is completely normal and expected that you would feel a degree of anxiety, fear, or uncertainty around this major surgery.

Remember that despite these feelings and the difficulties you are encountering, you are still an incredible and whole woman.

If you find that these feelings get in the way of daily functioning, it might be important to seek support. A trusted therapist can assist you in exploring your associated thoughts and beliefs, as well as the meaning and significance of this for you. He or she can then help you work through and process the associated emotions. Regardless of whether or not you experience any significant negative emotional effects, it may be beneficial for you to speak with a mental health professional during this stressful time. Find and accept support through friends and family, and don’t be afraid to reach out when you need some extra love, care, and attention. You deserve it!

Some additional helpful information about hysterectomies can be found here.

Wishing you all the best along with a safe and speedy recovery!

 
Answers to Your Questions About Checking on Your Baby at Night
 
Baby sleeping
 
 
 

This week and over the past few weeks, there have been a lot of questions about repeatedly checking in on your baby at night. One of you shared that you wake up at night panicking after dreaming that your baby is falling or lost in the covers of your bed. Dr. Michelle answers here, and we will be following up with a video on Instagram with some suggestions for self care when you're plagued by these and other symptoms of postpartum anxiety.

"I've been waking up in the middle of the night in a panic about the baby. I am either dreaming she is falling or lost in the covers in our bed. I wake up and frantically search for her or jump out of bed "to catch her." I eventually realize that she is safe and sound in her crib in our room, but for a few seconds I am terrified. I've had other friends tell me this happens to them. What causes this? How do I stop or ease it? Will it go away?"

It sounds as if you might be experiencing some symptoms of postpartum anxiety, but to be able to more clearly speak to your concern, I would need to clarify a few things.  First off, how old is your baby now?   While some anxiety and mood fluctuations are normal post-birth (up to 2 weeks), if they are too debilitating or last too long, you might consider seeking professional assistance.  I am also curious to hear if you are having any symptoms of anxiety during the day such as intrusive thoughts, difficulty concentrating etc?  How often are you waking up in the middle of the night feeling panicked and having these experiences? From your brief description, it sounds as if you might have some fears surrounding the potential loss of your baby. If you are not troubled by these thoughts or feeling anxious during the day, then I wonder if you are somehow repressing your anxiety and fears. As a result, your mind is still active during the night and while you are sleeping, forcing you to confront your fears.  Lucky for us, our brains are smart, but they’re crafty and don’t let us get away with much.  If we’re not allowing ourselves to acknowledge and confront our fears while awake, our brains are going to make sure we are doing it when we sleep (or at least when we are trying to sleep). The transition to parenthood is the most common and likely time for old traumas, conflicts, and fears that had been previously hidden away, to rise to the surface. With the help and support of a mental health professional, I would explore your fears in depth to understand how underlying conflicts might be contributing to your current symptoms. Hang in there, mama.  I know this is hard, but it might also be that your little one is providing you with an opportunity to grow through something.  It's amazing how these tiny babies can be our teachers.

 
"Will I Be Good Enough?" from Totum's Resident Psychologist
 
Woman holding baby
 
 

By Dr. Michelle Glantz, Ph.D.


Will I be good enough?

Like many women, I found this concern repeatedly running through my mind as I looked towards my transition to motherhood. I knew what type of mother I wanted to be, but I wondered if I would ever be good enough (also known in my mind as “perfect”) to raise a happy, healthy, kind, and compassionate human?

Can I actually be responsible for another person?

I can barely keep my houseplants alive for longer than 3 months, how the &^%$ am I going to raise a child?

Would I inadvertently falter to childhood experiences of tough love and criticism or would I be kind, nurturing, sensitive, and patient?

Will I be consumed by my own life and career or will I leave enough time for my children?   

Will my baby even like me?

The questions went on and on…

D.W. Winnicott, a British pediatrician and psychoanalyst first coined the term, “good enough mother” in 1953. Through extensive observation of mothers and babies, Winnicott believed that it is actually beneficial when mothers “fail” their babies in manageable ways. At first, a mother is entirely devoted to her infant’s needs. The mother gradually allows her baby to experience small amounts of frustration, according to the infant's increased ability to deal with failure. The mother is not perfect, but she is good enough. She is caring, empathic, and compassionate, but may not respond immediately to her baby’s every cry. Winnicott believed that parenting through these tolerable failures is essential in teaching children how to live independently in a flawed world with imperfect people.

Winnicott believed that parenting through these tolerable failures is essential in teaching children how to live independently in a flawed world with imperfect people.

I understood this theoretical concept from my education and training as a clinical psychologist and discussed its value and implications with my patients. Nonetheless, I wasn’t spared from the anxieties around my own pregnancy and becoming a mother. After eating my way through all the bakeries on the west side of Los Angeles, I received a call halfway through pregnancy from my OB alerting me that my gestational diabetes (GD) test had come back positive. He assured me that this had absolutely nothing to do with my diet (yeah right, I thought). The doctor continued to explain that in some women, placental hormones are responsible for causing a rise in blood sugar to levels that may affect the growth of the baby. It was almost impossible for me to believe that my eating habits had not been the culprit behind the development of my diagnosis.

Throughout the rest of pregnancy, I was forced to avoid sugar and maintain a low carbohydrate diet. I was also required to prick my finger four times daily to check that my food intake had not increased my sugar levels beyond a certain level. I was informed of the dangers that GD can impose on a newborn including the possibility of macrosomia, a condition where the baby can grow too large. These babies can become wedged in the birth canal or undergo birth injuries if they are not delivered via C-section.  Additionally, GD can increase the likelihood of preterm birth, respiratory distress syndrome, or hypoglycemia and seizures. As a result, my doctor recommended that I be induced at 38.5 weeks to make sure that my baby would not have difficulty coming out the birth canal.

When induction day arrived, my husband and I packed our hospital bags and headed to the hospital. Despite the ease of this scenario, this was NOT the labor I had envisioned. The fantasy in which my water would break unexpectedly forcing my husband and I to rush frantically through LA traffic to the hospital was gone.

Shortly after arriving at the hospital, I was hooked up to IV’s and started on Pitocin to initiate contractions. The anesthesiologist arrived shortly after to give me an epidural, my OB broke my water and when I was fully dilated I began to push. After about a half hour of pushing, my son’s head was visible. After more pushing and no further progress, my doctor realized that his umbilical cord was wrapped around his neck.  He didn’t seem overly concerned and proceeded to free him so that he could make his way completely out the birth canal.

When my baby was lifted out and brought into the world, it was the most beautiful experience I had ever witnessed in my lifetime. Unfortunately, it was cut short soon after because he wasn’t crying. The doctors placed him on me for a brief moment while they began to suction his airway, but quickly moved him to the table where they could begin extra stimulation. Naturally, I was terrified. As my doctor continued to stitch my episiotomy, the nurses continued to work with my baby. I asked if he was going to be okay and was reassured numerous times that he would be fine. My baby boy eventually began to cry and was placed on me again to try nursing for the first time.

Over the next several hours, my son’s blood sugar dropped to dangerously low levels, an effect of my gestational diabetes. Nurses entered my hospital room in the middle of the night to warn me that if they did not provide him formula to quickly raise his blood sugar, he could be at risk of having a seizure.  Scared and confused, with no one else to consult, my husband and I obviously agreed to give formula immediately, even though I had planned to breastfeed exclusively. Eventually, my son’s blood sugar raised and stabilized, and we were able to leave the hospital two days later.

The next several weeks were full of ups and downs. Breastfeeding was not going well, to say the least. My baby had difficulty latching and nursing felt like someone was scraping razor blades against my breasts. Countless lactation consultants visited us, with the last one advising us that if it was too difficult, then we should just quit. Despite this, I continued to nurse my baby for close to forty minutes per feeding, which did not satisfy him as he wasn’t able to suck adequately. This was then followed by twenty minutes of pumping, and finally giving a bottle of breast milk with additional formula. By the time this entire routine was over, it was time to start feeding him all over again. I was exhausted, anxious, and terrified that I was somehow inadequate. No one could explain to me why my baby was not latching or sucking effectively and I felt completely alone. Several weeks into my son’s life, I began to accept that I would not breast feed the way I had planned and my panic eventually subsided. I began to settle into motherhood as well as our never-ending feeding routine.   

After a couple months, we began a Mommy and Me group. The class was wonderful and I had the pleasure of spending time with other amazing moms and their babies. As the months progressed, however, I watched as the other babies reached milestones and mine did not. Rolling over, sitting up, crawling...my baby was as happy as a clam laying on his back, smiling at me, and gazing up at the world. I was too embarrassed and afraid to ask for advice in group.  Fearing that the other moms would think I wasn’t doing a good enough job with my baby or that worse, I would be told something could be terribly wrong, I chose to remain silent. After all, they were all with their babies during the day, and I had already returned to work. I thought that perhaps my baby was missing out on something he could have received from me, leading him to these delays. Unfortunately, these fears and concerns led to my early discontinuation in the group and I never felt courageous enough to share how I was feeling with the group leader or the other moms. 

And here it was again.  That self-doubting, critical voice I had become so familiar with insidiously repeating itself in my mind…Am I not good enough?

My pediatrician eventually referred us for evaluations with a neurologist, physical therapist, and developmental pediatrician. After numerous months of nerve-wracking testing, doctors and specialists finally determined that there was no specific or critical underlying cause for my son’s delays. I came to understand that my son had just been born this way and that he would meet his milestones on his own time. Additionally, it was not because of anything I did or didn’t do for him.

And here it was again. That self-doubting, critical voice I had become so familiar with insidiously repeating itself in my mind…Am I not good enough?

My son is now a happy, healthy 3.5-year-old boy who is just about caught up developmentally to his same age peers. It has been a long road of early intervention for us, with numerous physical, occupational, and speech therapy sessions per week. Looking back, I wouldn’t change a thing except for the way in which I was so harsh and critical of myself and so quick to believe that there had been something I had done wrong.   

Becoming a mother was one of the first major lessons I received in acceptance, losing control, and appreciating the beauty of imperfection. Although my initiation to parenting is just one of countless other experiences, I understand how terrifying it feels to be a new mother and to fear that you are now responsible for another living, completely dependent human. I know how distressing and shameful it feels to admit that you are uncertain about your new role as mother and how this leads many women to stay quiet about their experiences.

Becoming a mother was one of the first major lessons I received in acceptance, losing control, and appreciating the beauty of imperfection.

My goal in sharing my story is to help destigmatize the thoughts and fears around pregnancy, childbirth, and parenting. It is time that we embrace our imperfections as parents and human beings and to remember that not only is this okay, but it is what our growing babies need. We, as mothers, are essential in modeling for our babies that perfection is not only impossible, but it is not and should not be our goal. We, as mothers, are human and we make mistakes.  It is time that we finally receive and welcome the idea of imperfection and allow ourselves to just be…good enough.


Dr. Michelle Glantz is a Los Angeles based mother of two and Clinical Psychologist. She works in private practice specializing in the treatment of life transitions and perinatal mental health disorders. Dr. Glantz works to help expecting or new mothers and fathers work through underlying conflicts that surface around their transitions to parenthood. As a mother herself, she combines a professional and personal approach to her practice and understands first-hand the struggles and difficulties around assuming a new role as a parent. Dr. Glantz also works with children and adolescents struggling with anxiety and/or mood disorders. In doing so, she believes that including parents in the therapeutic process is vital in helping them to better understand the complexities of development and to improve communication with their children.