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Background The dysphoric milk ejection reflex (D-MER) is a reflex that causes temporary discomfort during milk ejection. D-MER develops due to the effects of hormones involved in lactation, and it has been reported that it is a physiological symptom different from postpartum depression, but the actual situation is unknown in Japan. Methods This study was conducted using a self-administered, anonymous survey of mothers of children who had undergone health checkups at three years of age at five health centers in Kagoshima city and aimed to clarify the reality and perceptions of mothers regarding D-MER. The survey period was from May to September, 2022. The questionnaires were distributed to 389 mothers, and 216 (55.5% recovery rate) responses were received, of which 202 (valid response rate 93.5%) were included in the analysis. Results Regarding the experience of D-MER, 202 mothers in the study population had given birth to a total of 403 children and experienced D-MER when breastfeeding 62 children (15.4%). Of the 202 mothers included in the analysis, 47 (23.3%) answered that they had experienced D-MER with at least one child while breastfeeding. Sixty-six mothers (32.7%) knew about D-MER. Compared to those who had not experienced D-MER, those who had experienced D-MER had significantly higher scores on the items related to having had trouble breastfeeding (odds ratio (OR]: 3.78; 95% confidence interval (CI]: 1.57, 9.09) and knowing about D-MER (OR 2.41; 95% CI 1.20, 4.84). Regarding symptoms, irritability ( n  = 24, 51.1%), anxiety ( n  = 22, 46.8%), and sadness ( n  = 18, 38.3%) ranked high. Coping strategies included distraction, focusing on the child, and, in some cases, cessation of breastfeeding. Thirty mothers (63.8%) answered that they did not consult anyone, citing reasons such as a belief that no one would be likely to understand their symptoms, and that they could not sufficiently explain their symptoms. Conclusion The low level of awareness of D-MER suggests that it is necessary to inform and educate mothers and the public about the physiological symptoms of D-MER. Moreover, it is necessary to listen to the feelings of mothers with D-MER and support them in coping with their symptoms.

Objective: The objective of this study was to compare the effectiveness, efficiency, comfort and convenience of newly designed breast pump suction patterns (BPSPs) that mimic sucking patterns of the breastfeeding human infant during the initiation and maintenance of lactation. Study Design: In total, 105 mothers of premature infants ⩽34 weeks of gestation were randomly assigned to 1 of 3 groups within 24 h post-birth. Each group tested two BPSPs; an initiation BPSP was used until the onset of lactogenesis II (OOL-II) and a maintenance BPSP was used thereafter. Result: Mothers who used the experimental initiation and the standard 2.0 maintenance BPSPs (EXP-STD group) demonstrated significantly greater daily and cumulative milk output, and greater milk output per minute spent pumping. Conclusion: BPSPs that mimic the unique sucking patterns used by healthy-term breastfeeding infants during the initiation and maintenance of lactation are more effective, efficient, comfortable and convenient than other BPSPs.

In this Research Communication we report the results of a controlled study conducted under field conditions in which we analysed milk ejection curves in cows with chronic mastitis, and assessed the influence of antinflammatory treatment with ketoprofen. Total milking time was reduced in chronic mastitis cows, irrespective of ketoprofen treatment, and the proportion of bimodal flow curves was increased. This latter effect was partially reversed by ketoprofen. To our knowledge, this is the first study showing that chronic mastitis has a significant effect on the milk ejection curve. Antinflammatory treatment with ketoprofen was shown to be efficacious in reducing these negative effects, re-establishing a pattern close to the one observed in healthy cows.

Dysphoric milk ejection reflex is a condition that causes an abrupt emotional downturn during the initial moments of milk ejection in a breastfeeding mother. Depression, anxiety, hopelessness, anger, irritability, homesickness, and stomach hollowness are all possible symptoms. The exact cause of D-MER remains unknown. However, it is proposed that it is caused by an alteration in oxytocin signaling response where secretion of oxytocin upregulates the stress response instead of its downregulation. Activation of the defensive response of the mother by oxytocin during breastfeeding, disruption in dopamine levels, and activation of vasopressin-regulated pathways are other probable causes. Due to a lack of awareness, this phenomenon is easily misdiagnosed as postpartum depression and aversion by many healthcare professionals. Its prevalence in various populations of the world remains unknown due to the lack of research studies conducted in these populations. While no medically approved therapeutic strategy is available, supportive techniques such as maintaining a healthy diet, mental distraction, relaxation methods, and increasing skin-to-skin contact can help alleviate dysphoria during breastfeeding. However, due to a lack of D-MER research, specific challenges exist regarding early withdrawal from breastfeeding and women’s help-seeking attitude toward perinatal mental health.

Background Milk ejection characteristics remain consistent throughout 12 months of lactation in women who expressed breastmilk with an electric breast pump. In addition these characteristics appear to remain constant when women are breastfeeding or pumping suggesting that milk ejection is a robust physiological response. It is not known whether the stimulation of an infant at the breast in the early post partum period influences milk ejection patterns or whether this is a programmed event. However, as more data become available on the mechanisms involved in infant feeding, pumping patterns mimicking the infant more closely may provide enhanced results. The objective of this study was to compare milk ejection characteristics obtained when using a novel infant-derived pumping pattern with an established 2-phase pattern. Methods A convenience sample of ten lactating mothers, 1 to 40 weeks of lactation with normal milk production were recruited in 2015. Each participated in two pumping sessions in which either a 2-phase pattern or infant-derived pattern were randomly assigned. Milk volume and milk ejection characteristics were recorded and the percentage of available milk removed (PAMR) was calculated. Statistical analysis used linear mixed effects modeling to determine any differences between breasts and pump patterns with the consideration of individual variability as a random effect. Results The number of milk ejections and milk ejection characteristics did not differ between patterns. Milk volumes removed were 53.6 ± 28.5 ml (PAMR 58.2 ± 28.4) for the 2-phase pattern and and 54.2 ± 26.3 ml (PAMR 52.2 ± 22.3) for the infant derived pattern. Peak milk flow rates were positively associated with the available milk ( p  = 0.0003) and PAMR ( p  = 0.0001), as was the volume of milk removed during each milk ejection ( p  = 0.001 and p  = 0.0001). Conclusion An experimental pumping pattern designed to resemble infant sucking characteristics did not alter milk ejection characteristics or milk removal parameters compared with an established 2-phase pattern. Theses findings provide further evidence that milk ejection is a robust physiological response.

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.

Objective To compare the effects of metoclopramide and domperidone on the breast milk output of mothers with infants in neonatal intensive care. Design Double-blind randomised controlled trial. Setting Tertiary level neonatal intensive care unit (NICU). Sample Eighty mothers expressing breast milk for their infants (mean gestational age 28 weeks) based in NICU and the amounts expressed fell short of the prescribed target. Intervention Mothers were randomised to receive domperidone or metoclopramide for 10 days (10 mg three times a day). Outcome measures Total milk volume daily for up to 10 days before the medication, 10 days during the trial and up to 10 days after medication. Adverse side effects were also recorded. Results Mothers produced more milk in the domperidone group and achieved a mean of 96.3% increase in milk volume (mean increase/pretrial volume) compared with a 93.7% increase for metoclopramide. After adjusting for the amount of milk produced prior to medication, the mean amount of milk produced while taking medication for those on domperidone was 31.0 ml/24 h (95% CI −5.67 to 67.6) greater than the mean for those on metoclopramide. Seven mothers taking metoclopramide reported side effects and three taking domperidone; a further eight women (of 29) who had a follow-on prescription for metoclopramide also reported side effects. Conclusions Oral domperidone and metoclopramide increased the volume of milk produced by mothers who are expressing to feed their babies in NICU. There were small differences in milk output between the two medications and in the incidence of side effects, but the differences were non-significant.

The mother–infant relation is key to infant physical, cognitive and social development. Mutual regulation and cooperation are required to maintain the dyadic system, but the biological foundation of these responses remains to be clarified. In this study, we report the maternal calming responses to infant suckling during breastfeeding. Using behavioral measures and a Holter electrocardiogram as a readout of the maternal autonomic nervous system, the maternal activities during resting, sitting with her infant on her lap, and breastfeeding were assessed. We found that during breastfeeding, mothers talked less and maternal heart rate was lower than during sitting with the infant without breastfeeding. Congruently, maternal heart rate variability measurements indicated a higher parasympathetic activity during breastfeeding. Time-locked analyses suggested that this maternal calming response was initiated by the tactile stimulation at the breast by the infant face or mouth latch, which preceded the perceived milk ejection. These findings suggest that somatosensory stimuli of breastfeeding activate parasympathetic activity in mothers. Just as how the infant Transport Response facilitates the carrying of infants, the maternal calming responses during breastfeeding may promote efficient milk intake by inhibiting spontaneous maternal activities.

The camel dairy industry has gone through major development in the last decade. The world’s first large-scale camel dairy farm was established 10 years ago in Dubai, United Arab Emirates, and since then, several commercial and scientific projects have been started, and more studies have been published demonstrating increasing interest in camel milk. The aims of this paper are to summarize relevant published data on factors influencing milk production under intensive management, compare those with our own observations obtained from Emirates Industry for Camel Milk and Products (EICMP), and highlight areas of research that are indispensable for further development. As in other species, the most important factors influencing milk yield are genetic and individual variation, age, parity, stage of lactation, nutrition, management, season, photoperiod, etc. However, the precise role of the various factors has not been thoroughly studied in camels and based on our understanding of the basic physiological processes, endocrine control is minimal. In addition, machine milking of dromedaries is still at early stage and requires research for improvement of the technology and defining factors affecting and improving milk ejection. The role of environment (like photoperiod, nutrition) should also be investigated as there is significant annual variation both in milk quantity and quality that might influence the processing characteristics of raw camel milk. The large pool of animals and thoroughly recorded data at EICMP provide an excellent opportunity for increasing milk production and improving milk quality using various methods, like feeding, management, reproduction, selection, and breeding.

In both conventional and automatic milking systems (AMS), sensitive and reliable mastitis detection is important for profitable milk production. Mastitis detection parameters must be able to detect mastitis when the somatic cell count (SCC) is only slightly elevated. Owing to the pre-milking teat cleaning process in AMS, sampling cannot take place before the occurrence of alveolar milk ejection and importantly, this can affect the ability of parameters to detect mastitis. The aim of the present study was to examine the effect of alveolar milk ejection on l-lactate, lactate dehydrogenase (LDH), serum albumin (SA) and immunoglobulin G (IgG) compared with SCC, a commonly used indicator of mastitis. In this experiment, milk samples were collected every 20 s from one quarter during a 120-s manual teat stimulation in ten cows. Samples were analysed for SCC, l-lactate, LDH, SA and IgG. Quarters were grouped by low (<5·0 log10 cells/ml), mid (5·0–5·7 log10 cells/ml), and high (>5·7 log10 cells/ml) SCC using the sample at t=0 s. Neither l-lactate nor LDH could statistically differentiate between low and mid-SCC quarters, but there were a significant difference in levels between the high-SCC quarters and low and mid-SCC quarters. SA could not differentiate between the low and mid-SCC quarters, but the SA levels for the high SCC quarters remained statistically different compared with low and mid-SCC quarters throughout the experiment. IgG could statistically differentiate between low and mid-SCC, although the high-SCC quarters were not statistically different from the mid-SCC quarters after 60 s. In the high-SCC quarters, a decrease was shown in all parameters during milk ejection, after t=60 s. In conclusion, alveolar milk ejection reduces the effectiveness of detection parameters when compared with SCC. With the exception of IgG, the ability of other tested parameters was not satisfactory to differentiate between quarters with low to mid-SCC levels