Morns et al 2019

This pioneering national online study of 5,511 Australian breastfeeding women found that Breastfeeding Aversion Response (or BAR) may be common than previously thought. Just over one in five women reported having experienced it. This study also found that most women experienced some breastfeeding challenges, with only 4.5% (n=247) having no breastfeeding complications. Despite this extremely high level of breastfeeding challenge, 86.9% of the women in the study rated their overall breastfeeding experience as good (n=2052). Here are other key elements of this study's findings.

• Women described the feelings of BAR as overwhelming, uncontrollable, and confusing. For some mothers it was visceral, like “fingernails down a chalkboard”. One woman described BAR as “intense”:It was both a mental and physical feeling like you want to throw your child off. You just can’t feel this feeling like you’ve got something crawling underneath your entire skin, that’s why this felt like you wanted to rip your skin off and just, you know, escape it.

• BAR is most likely to occur in women feeding their first infant, tandem and pregnant breastfeeding mothers, and women breastfeeding around the time of ovulation and menstruation

• Women who are breastfeeding for the first time are more likely to encounter difficulties with breastfeeding such as BAR

• Significantly, 82.5% of those who experienced BAR also described their breastfeeding experience overall as good or very good, by the end. Mothers who experiencde breastfeeding aversion but were supported to continue to breastfeed and achieve their personal breastfeeding goals reported an overall positive breastfeeding experience.

• BAR reporting was decreased by women in higher education and income groups

• Many health professionals are not familiar with complex breastfeeding challenges and so those who are experiencing breastfeeding aversion sometimes felt isolated.

• It's not known what causes BAR. Morne et al suggest it may be linked to hormones, or evolutionary and genetic factors. Although nutritional factors were also suggested as causative by the authors of this study, there are many reasons why nutritional factors seem to be an unlikely explanation.

• Further research is needed to investigate if some mothers describe feeling breastfeeding aversion with their newborn as a result of other breastfeeding issues such as nipple pain.

What helped?

With support and understanding, Morns et al found that many women who experienced BAR could continue to breastfeed and go on to have an overall positive breastfeeding experience.

Those who experienced BAR were mostly unsure if there was any way to help or reduce the negative feelings. Some used breathing, meditation and positive self-talk to continue feeding, that is, reminding themselves of the benefits of breastfeeding and reassuring themselves that they were doing a great job.

Each of the following strategies were applied by about one fifth or more of the cohort, resulting in self-reported reduction of BAR

• Distracting self while breastfeeding

• Having breastfeeding boundaries with an older nursing child

• Getting past the first few months of breastfeeding

• Breathing, meditation and positive self-talk.

Sahin 2025

Aim

This study aimed to evaluate the frequency of BAR and affecting factors in mothers with breastfeeding experience in Turkiye.

Methods

The survey was conducted online using Google Forms. A total of 1,046 mothers were included in the research.

Findings

A total of 9.8% of mothers stated they experienced BAR. The most frequently reported risk factors for BAR were

• Fatigue

• Breastfeeding a toddler

• Breast pain.

The BAR rate was higher among working mothers, those lacking spousal support, mothers diagnosed with postpartum depression, and those encountering breastfeeding problems.

Middleton et al 2025

Definitions

Breastfeeding aversion response (BER) and DMER are two examples of breastfeeding phenomena which present as negative emotional experiences of breastfeeding and lactation, but which are considered physiological in origin.

• DMER is the sudden onset of dysphoria prior to and during milk ejection.

• BAR is unpleasant feelings and physical sensations during breastfeeding.

Background

Many women self-diagnose with DMER and BAR and seek online support. Being believed helps women cope. Self-care alleviates both DMER and BAR. DMER and BAR are associated with range of negative emotions which impact breastfeeding. Much remains unknown about both.

Health professionals may reach inaccurate conclusions especially if women have pre-existing mental health conditions. Health professionals commonly misdiagnose DMER or BAR as postnatal depression or anxiety.

Both phenomena are distinct from perinatal mood disorders. Some suggest hormonal shifts as the causes.

A patient is quoted as follows: "I wanted to keep on breastfeeding, but ... I also ... didn't want to ... it is a ... fight inside me every time."

Methods

This study is a scoping review 116 academic and grey literature records.

Findings

DMER

The rate of DMER estimates varied from 6-28% of women.

Participants with DMER reported a hollow feeling ranging through anxiety, sadness, and anger to rage and suicidal ideation. Some women with DMER describe nipple pain during milk ejection, nausea, food revulsion, extreme thirst.

There are two dominant hypotheses concerning the aetiology of DMER.

1. DMER results from a brief drop in dopamine which occurs during milk ejection triggers DMER

2. DMER results from the release of oxytocin prior to milk ejection.

Mindfulness, relaxation and skin-to-skin contact with the baby helped alleviate the intensity of DMER.

BAR

• BAR was found in 23% of participants.

• BAR most commonly affects pregnant women, women breastfeeding older infants, and women who tandem feed.

• BAR manifests as feelings of agitation, disgust, irritability and tingling and skin crawling, which only occur during breastfeeding. Some women with BAR describe skin-crawling, tingling, prickling, throat tightening, and gut-wrenching sensations. Intrusive thoughts affect some women postnatally but BAR relates specifically to the breastfeeding act, which distinguishes from perinatal mood disorders.

• BAR has been framed by some as “an evolutionary mechanism to protect parental resources and increase the chance of further ... reproduction”.

Recommended resources

Do you have Breastfeeding Aversion Response?

Do you have Dysphoric Milk Ejection Reflex?

What does the research say about Dysphoric Milk Ejection Reflex?

What the research DOESN'T tell us about Dysphoric Milk Ejection Reflex and the risks associated with unnecessary use of this diagnosis

Selected references

Middleton C, Lee E, McFadden A. Negative emotional experiences of breastfeeding and the milk ejection reflex: a scoping review. International Breastfeeding Journal. 2025;20(13):https://doi.org/10.1186/s13006-13024-00692-13003.

Morns MA, Burns E, McIntyre E, Stell AE. The prevalence of breastfeeding aversion response in Australia: a national cross-sectional survey. Maternal and Child Nutrition. 2023;19:e13536 DOI: 13510.11111/mcn.13536.

Sahin BM. Factors associated with the Breastfeeding Aversion Response. Breastfeeding Medicine. 2025;20(2):118-125.