Negative emotional experiences of breastfeeding and the milk ejection reflex: a scoping review.

Background: Breastfeeding aversion response (BAR)and dysphoric milk ejection reflex (D-MER) are two examples of breastfeeding phenomena which present as negative emotional experiences of breastfeeding and lactation but are considered physiological in origin. D-MER presents as a sudden onset of dysphoria prior to and during milk ejection. BAR refers to unpleasant feelings and physical sensations during breastfeeding. Research suggests both phenomena are distinct from perinatal mood disorders. As awareness of D-MER and BAR is limited, this scoping review extended beyond the terms D-MER and BAR to describe the nature, extent and range of literature relating to negative emotional experiences of breastfeeding and the milk ejection reflex. The aim of this scoping review was to capture concepts, knowledge and experiences relating to D-MER and BAR.

Methods: This review followed standard scoping review methodology. Medline, CINAHL, MIDIRS, British Nursing Index, PsychInfo, EBSCO, EMBASE, Cochrane Database of Systematic Reviews, Web of Science, Google, Google Scholar, Open Grey, EThOS and PROSPERO were originally searched between March and July 2020 and April 2024, using predetermined keywords. After removing duplicates, records were screened for eligibility. Data were charted, then summarised and synthesised using numerical and thematic analysis.

Results: In total, 116 academic and grey literature records were included in the scoping review and five main themes were identified. D-MER and BAR are associated with a range of negative emotions which impact breastfeeding. Awareness of D-MER and BAR is limited, thus, understanding the phenomena better is important for helping women achieve their personal breastfeeding goals.

Conclusion: This review identified a wide range of literature which described the nature of D-MER and BAR episodes, suggested causes for both phenomena, the impact of D-MER and BAR on women's lives, strategies women use to cope and possible prevalence rates. Many health professionals remain unaware of D-MER and BAR, and so support provided may be inappropriate or inadequate. Much remains unknown about D-MER and BAR and further research is indicated.