3 Horrible Things You Didn’t Know About Breastfeeding

by Dr. Brooke Kalanick ND | Follow on Twitter

I was prepared for the sleepless nights, cracked nipples, and difficulty pumping, but the stuff no one warned me about was the worst of all.


I’ve personally been breastfeeding (or pregnant) for the better part of the last several years. The health benefits are clear, the bonding is amazing and despite the horrible parts I’m about to discuss, I actually loved it.

After delivering my first baby, I was prepared for many of the crazy things I was about to endure: being terrified to sneeze or use the bathroom for fear I’d rip my stitches out, having my hair fall out at a terrifying rate, sore and cracked nipples, pumping, and of course, no sleep and erratic emotions.

These were all things family and girlfriends had warned me about, so I had no fear about them – I was braced for the ride. The stuff no one warned me about though, was a lot worse.

1. DMER – Dysphoric Milk Ejection Reflex

Lola had been home for only a few days and I was exhausted like I’d never been before. I had just reconnected with my mom (after a year of not speaking) and my grandmother had just passed away, so when I was feeling intense emotions with nursing,  I didn’t think much of it.

Lola and I had a rough start to breastfeeding, but I was adamant that we figure out the latch and deal with my copious milk supply.  I had so much milk and it would spray so much and so fast that she was choking every time we fed. But that wasn’t the half of it.

Every time I fed her I got this overwhelming wave of sadness. It was sudden, intense and felt like total and utter doom.  After a minute or two it would pass and I’d feel pretty normal again.  I assumed it was part of being one big ball of hormones after giving birth, but months later it was still happening.

I mentioned it to Joe and we started calling it the “milk sads”. It was so intense that I started getting a little anxious before feedings knowing it was going to happen. In time, I got used to it but always wondered what the heck it was.

In my doctor head, I figured it had something to do with dopamine and prolactin (the hormones that makes us lactate, which lowers dopamine and vice versa) but I was too busy – and too tired –  to look into it beyond that.

When I had my second baby, it happened again. Right away I got that rush of gloom and doom every time I nursed Gigi. I decided to take a look and see if this was a “thing” – if it was, it certainly wasn’t anything anyone warned me about.

As I typed in “sadness with n…” into Google, before I even spelled out ” nursing”, it popped up. Clearly this is a thing!

It’s called Dysphoric Milk Ejection Reflex and it is exactly what I thought: dopamine plummeting as prolactin spikes to cause the milk let down.

Dopamine is one of our happy brain chemicals. It’s responsible for motivation, focus and a positive outlook. Even on a good day, I have low dopamine so perhaps this is why this happened for me. And while I couldn’t find any conclusive research, I was curious if this phenomenon happens more for women with PCOS.

In my practice, most women with PCOS have issues with either low dopamine and/or high prolactin. Curious, huh?

DMER is not the same as postpartum depression.

DMER is transient and a direct result of this temporary spike in prolactin before let down. After a few minutes things level out again. But it feels truly dreadful.

For me, I felt sadness and gloom, but for some women with DMER, they feel anxiety or agitation. Either way, there’s nothing you can do about it. There are great herbs and nutrients to boost dopamine, but those would all lower prolactin and that’s not good for your milk supply – nor are they nutrients/herbs that I’d recommend to a breastfeeding woman (too stimulating for baby).

But it certainly helps to know that’s what it is! I had thought I was going nuts. And while you can’t take something to fix it, you can keep in mind that it’s not all in your head and that it will pass. This helped me just let it be for a few moments. I looked down at my sweet baby and knew I’d feel better soon.

For more info on DMER click here.

2. It’s Beginning To Look A Lot Like Menopause

Bring on the hot flashes and vaginal atrophy.

Pregnancy is a time of high estrogen and high progesterone. The progesterone makes sure baby stays put and the estrogen is, amongst other things, responsible for the glow…. and all that hair!  (This high estrogen keeps our hair in its last growth phase before falling out, so we don’t shed much and have the thickest hair of our lives.)

During the weeks after giving birth our estrogen plummets and can cause a host of issues on it’s way down, I was prepared for a breakout or two, my glow to give way to dark under-eye circles and my hair to leave on mass at 5 weeks out. I was not however prepared for the other symptoms the low estrogen would cause… and hot flashes were not the worst of it.

After a vaginal birth, there’s a lot going on “down there” and I thought when the soreness and swelling were gone and the stitches healed, I’ll be good to go. Uh-uh.

After about a week out I was itching like mad. It was the most uncomfortable I’ve ever been. Scratching isn’t an option so you just have to sit there and try to survive it.  It was making it nearly impossible for me to sleep. Just thinking back on it makes me squirm. It was terrible.

This symptom sends women running back to their OB/GYN certain they have a yeast or other infection. I was convinced my latex allergy was to blame leading me to buy every “natural” maxi pad on the market – but no relief.

I had no infection, no allergy, thus no real treatment options.

I was in agony. What the heck was this?

Estrogen normally keeps the vaginal tissues healthy, plump and moist.  With the low estrogen during breastfeeding, just like in menopause, women can see atrophic changes to the vaginal tissue making it dry, thin, weak, easy to tear… and itchy like crazy.

Women experiencing this in menopause often  turn to topical or oral estrogen. Some breastfeeding women will reach for The Pill to resolve this. Others, like me, just tough it out – with ice and coconut oil offering a temporary reprieve.

Luckily in my case, it resolved to barely noticeable by around 3 months – some women aren’t so lucky.

If you have itching, be sure to see you OB/GYN and rule out infections or other issues, but know this may just be a consequence of prolactin keeping estrogen low and your hormone profile temporarily looking a bit like that of a post-menopausal woman.

And although it’s tough, watch the urge to scratch – the tissue is thinner, weaker and scratching is very likely to create small tears which can easily get infected.

3. Failing The Breastfeeding Diet

I had heard one of the fabulous advantages of breastfeeding is that the “weight just falls off you”.  I’d heard “the Breastfeeding Diet is the best!”

That couldn’t have been farther from the truth for me.

Not only was my waist extra wide from an unclosed diastsis but despite my efforts, I had a really hard time leaning up and dropping those last pounds especially from my belly – which I’d NEVER had a problem with before, always hips and thighs for me.

I struggled with fat loss all throughout breastfeeding. When I stopped breastfeeding Lola at 16 months, 7 pounds just fell off in about 2 weeks with no extra effort. What gives?

While some women do have a menstrual cycle while they breastfeed, others including myself, don’t.  The hormonal and fat loss trouble is true, especially for those women not cycling while breastfeeding: low estrogen and low progesterone.

Simply put: high prolactin from nursing will lower your estrogen, lack of ovulation will lower progesterone.

While estrogen dominance gets a bad rap for making us fat, the truth is we need enough estrogen to keep a lean and tight body (think less body fat, more lean muscle).  Without it we have a less forgiving metabolism largely due to lack of temperance of insulin and cortisol.

In addition to low estrogen, if we aren’t ovulating, we also aren’t making much progesterone.  Progesterone plays a role in hindering belly fat storage by moderating cortisol’s effect in these fat cells.

With this low estrogen/low progesterone state and we see much more sensitivity to carbohydrates and a much harder time dropping belly fat – and fat in general. Couple that with the lack of sleep and the mummy tummy can be very tough to lose.

When we’re running on empty from the middle of the night feedings and often highly stressful time of having a newborn, we’re typically in a high cortisol state – ingredient #1 for belly fat.  And when we’re exhausted from being up all night, our cravings for carbs and sweets are usually off the chart.  If we indulge them, then we’ve added ingredient #2 for belly fat: high insulin.

This scenario is the perfect storm for difficult fat loss and easy fat gain, just what a new mom needs huh?

And those cravings aren’t just from the lack of sleep. Estrogen normally helps us have more serotonin and dopamine, and progesterone keeps GABA up. Healthy levels of all these brain chemicals keep our cravings at bay. And making matters worse, estrogen normally aids the hormone leptin in regulating appetite.

Obviously, not all women experience difficult weight loss with breastfeeding.  Take my friend Leslie who was able to sit back, let the pounds fall off and enjoy her big bosoms. For those of us who found/find fat loss during breastfeeding a really tough struggle, hearing stories like Leslie’s just makes us want to cry. (But what doesn’t make us cry during those first few months??)

It’s important to remember, if your metabolism is stubborn before pregnancy, it likely will be afterwards as well.  This is certainly the case for me.  The low estrogen and progesterone make my metabolic issues even worse.

So is there just no hope for us?

Of course there is, but it helps to get clear on what we’re dealing with. Given the hormonal landscape of breastfeeding (low estrogen, low progesterone) and the likelihood of less sleep (high cortisol) and potential to be eating more carbs and sweets than we can tolerate (high insulin), you can see where the deck is stacked against us.

Here’s some advice that will help:

*Don’t give yourself a 500+calorie justification for eating not so good for you foods, like me and my chai lattes. Eat more good foods: more protein, more healthy fats instead of more muffins and ice cream.

*Your time is limited so work out smart: walking with baby napping in stroller, short metabolic circuits at home or your gym for optimal hormonal balancing fat loss. Skip the longer duration cardio and too much intense exercise. Low estrogen makes the long duration stuff less effective and the high cortisol can make the intense stuff back fire.

*Don’t focus on cutting calories or on eating less, your main job really is to nurture your baby – let’s not lose sight of that as we vie for more weight loss.  Instead focus on more support foods: vegetables and lean proteins; as well as more activity.  Move as much as you can.

*Do 10-20 body weight squats several times per day i.e. while you’re waiting for your tea water to boil, as baby sits there cooing at you, anytime you have 1 minute do a pelvic floor lift, tight abs and squat away. Squat while you pee instead of sitting down (seriously). Dance with your baby. Walk as much as possible instead of driving or park further way (10,000 steps a day is a great goal). Jaunt up and down your staircase quickly and frequently. Play at the park. Live the Dr Brooke Mommy mantra of “Do as much as you can, as often as you can.”

*Consider a lower carb, higher fat diet. The lower carb aspect will keep your insulin more managed while the higher fat intake will keep your calories up and keep you satiated. Overall you’ll likely feel more satisfied and won’t risk dropping calories so low your milk supply drops.

*Trust that it will likely gets easier after you stop nursing. I was pleasantly surprised that my fat loss got so much easier literally the week I stopped breastfeeding. This is a time to own your breastfeeding choice. Sure it may be easier if you weren’t breastfeeding, or hadn’t just had a baby, but these were our choices – for better or worse.

*And skip the guilt. So many women feel wracked with guilt that they are complaining about feeling chubby while they are also experiencing the joy of a beautiful baby. I’ve fallen prey to this as well, I mean how shallow am I to worry about my waistline when so many women can’t even ovulate well? Here I am with my adorable baby girls and I’m whining about being fat??

Both can be true: you can want to feel good about your body again and be insanely grateful for your baby. They aren’t mutually exclusive. But keep perspective and use the gratitude you feel for having your little bundle fuel you to make BETTER choices for yourself when it comes to food and exercise.

*Do do that hard, hard thing of making time for yourself.  If you’re exercising, eating better and finding a few moments for self care you will be much better able to care for yourself and your family. They need you, so you need to be in a good place.

*Finally, some of the lack of progress in your midsection has nothing to do with fat but rather a structural issue. During pregnancy your abs were stretched, your ribs began to flare out to the sides as your growing baby pressed up under your ribcage, and your pelvis likely tipped forward as your low back tried to deal with the big baby belly.

All of this postural mess will make your waist look wider – not to mention your core and pelvic floor much weaker. Although you weren’t prescribed physical therapy the day you left the hospital for all these significant issues, you should’ve been! We all should’ve been.

And above all else, don’t forget breastfeeding is temporary. Your body will be your own again some day and what you’re doing for the health of your baby is no small sacrifice. Find a balance between taking care of yourself, feeling good in your body again and whatever fat loss feel appropriate for you given your hormones and sanity. Most importantly, don’t lose sight of why you wanted to do this in the first place.

Our bodies are changed by our babies – for better and for worse. You can love your body again, but if you fight the realities of pregnancy and breastfeeding you’ll end up doing all the wrong things: over exercising, under-eating, and making yourself crazy.

Try the suggestions in this post, get some coaching from a qualified trainer on your exercise, heal your core and floor, and if necessary, get some help with your nutrition to both feed baby and move you closer to your WANT.

About the Author
Dr. Brooke Kalanick ND

A recognized expert and author in the field of natural medicine and fitness, Dr Brooke is a licensed naturopathic doctor devoted to helping women achieve a healthy weight and a happy state of well being through her integrative and holistic approach to health. Using tailored nutrition therapy, coaching and a comprehensive naturopathic and functional medicine approach, she helps women heal their metabolism and restore their hormonal balance. Her book, Ultimate You, co-authored with celebrity trainer Joe Dowdell, offers the latest in nutritional and exercise science to help women lose body fat by understanding their hormones.