Navigating D-MER waves

: a classic grounded theory of women’s experiences of Dysphoric Milk Ejection Reflex (D-MER)

Abstract

Background
Dysphoric Milk Ejection Reflex (D-MER) is a little-recognised phenomenon characterised by sudden, brief episodes of negative emotions that occur just before and during milk ejection. While typically fleeting, D-MER episodes can recur multiple times daily throughout lactation, with consequences for women’s health and wellbeing. Despite increasing visibility online, D-MER remains under-acknowledged in clinical practice and research.

Aim
This study aimed to generate a classic grounded theory that explains the main concern of women who experience D-MER and how this concern is processed and resolved.

My research questions were therefore:
What it the main concern of women who experience D-MER?
How is this concern processed and resolved?

Methods
Using Classic Grounded Theory via a pragmatist approach, I conducted in-depth online interviews with n=22 women who had experienced D-MER within the past five years. Data were analysed using constant comparison, theoretical sampling, memoing and abductive reasoning.

Findings
The resulting theory, navigating D-MER waves, conceptualises how women work to make sense of and live with D-MER. This staged and cyclical process comprises three stages of assimilating, adjusting and reconciling which women move through via an iterative micro-cycle of meaning making, adapting and integrating. The theory positions D-MER as a liminal phenomenon with physiological, emotional, and sociocultural dimensions, shaped by sociocultural expectations of breastfeeding and motherhood, and digital peer-to-peer knowledge exchange.

Conclusion
Navigating D-MER waves contributes to maternal health knowledge by conceptualising D-MER as a problem in living which women navigate with limited support, as a self-directed process. The theory offers practical insights for women, health professionals, and other individuals who support women during the postnatal period and aims to raise awareness of D-MER and the importance of its recognition and validation.

Date of Award	2026
Original language	English
Awarding Institution	University of Dundee
Supervisor	Alison McFadden (Supervisor), Elaine Lee (Supervisor) & Jenna Breckenridge (Supervisor)