What is breastfeeding aversion and how can you manage it?

While many women find breastfeeding an enjoyable bonding experience, some will have an involuntary and overwhelming urge to remove their child from the breast.

Intense negative feelings during breastfeeding can be caused by breastfeeding aversion response (BAR).

Women describe BAR as a "skin-crawling" feeling or like "fingernails on a chalkboard", as well as feeling angry or violated.

With little recognition and understanding of the experience, it can be unexpected and confusing for women, says Alexandra Shanks, lactation and breastfeeding information officer at the Australian Breastfeeding Association (ABA).

"Especially when a mum has had a comfortable and happy breastfeeding journey to a certain point and then starts to experience these negative feelings."

Ms Shanks says breastfeeding aversion can really conflict with a woman's desire to breastfeed.

"She wants to breastfeed, and is choosing to, but then experiencing these negative feelings which can be difficult to manage and navigate."

What is breastfeeding aversion and how common is it?

Breastfeeding aversion response is considered a common phenomenon but is not a diagnosable condition, says Nicole Highet, who has a background in clinical psychology and is the founder and executive director of the Centre of Perinatal Excellence (COPE).

"It's a physiological [experience] with mental health implications," she says.

"It's clinically recognisable, but it's not in a diagnostic manual around mental health issues."

Melissa Morns is a breastfeeding researcher and pioneer in this space who experienced BAR while tandem breastfeeding her toddler and newborn.

Tandem feeding is when siblings who are not twins are breastfed, either together or at different times.

Dr Morns established a support group for BAR in 2013 and has since dedicated much of her research to it.

A 2023 study led by Dr Morns involved more than 5,500 Australian breastfeeding women and found as many as one in five reported having experienced it.

She says a simple definition of BAR is a feeling of aversion while breastfeeding that conflicts with a woman's desire to breastfeed, and most of the time lasts throughout the whole feed.

Breastfeeding aversion is not the same as dysphoric milk ejection reflex (D-MER), Dr Morns explains, which is when a woman feels negative emotions seconds before and during their let-down reflex.

"The biggest different with D-MER and BAR is D-MER happens any time someone gets a let-down, for example while feeding or pumping, and BAR only happens with the baby on the boob" and lasts the entire feed.

Dr Highet says because the condition isn't widely recognised, including by some health professionals, it can make it difficult for women to seek support.

"GPs often misunderstand it as postnatal depression."

What does breastfeeding aversion feel like?

"In-the-moment" sensations of BAR were described by women in Dr Morn's research as "touched out, feeling violated, angry, sad, dread, anxiety, guilt, worry, and feeling a disconnect between wanting to breastfeed and having negative feelings".

Ms Shanks says the "intense negative feelings" of BAR can be physical and emotional.

"Mums often describe feeling quite irritated, agitated — they might say they feel trapped by feeding.

"Those feelings can be quite visceral, like fingernails down a chalkboard, of skin crawling, where they have a strong urge to remove the baby from the breast."

Dr Morns says BAR can have a negative effect on maternal mental health and identity, and lead to stress and anxiety.

Dr Highet says breastfeeding aversion conflicts with the "natural, easy and bonding experience" of breastfeeding that women are expecting.

"It can impact negatively on their maternal identity … their trust in their body … and on infant bonding because breastfeeding can be so powerful for that, and this is a major impediment."

Who is most likely to experience breastfeeding aversion?

Those who are more at risk of BAR are women feeding their first infant, tandem and pregnant breastfeeding mothers, and women breastfeeding around the time of ovulation and menstruation, explains Dr Morns.

When there is tandem nursing, Dr Morns says the feelings are almost always related to the older nursing child.

She says further research is needed to investigate the link between breastfeeding aversion and other issues such as nipple pain.

Can breastfeeding aversion be managed?

Remembering breastfeeding aversion is a condition and not a reflection of you as a person or a mother is important, says Dr Highet.

"That is the first thing."

In terms of managing the condition itself, she recommends distraction techniques and setting boundaries.

"Things like cognitive distraction, such as using a phone or watching TV or putting on relaxing music [while breastfeeding] can help manage overstimulation."

Dr Highet says changing nursing positions can also decrease specific sensations and provide relief.

For tandem feeders, Ms Shanks suggests setting boundaries with the older child. For example, putting a time limit on how long they are nursed for, or having someone take them out of the room while feeding the younger child.

In addition to those techniques, women surveyed for Dr Morns' research said they managed feelings of BAR with:

• Breathing and meditation
• Positive self-talk, for example reminding themselves of the benefits of breastfeeding and reassuring themselves they were doing a great job
• Support from a midwife or lactation consultant.

Support from partners and loved ones is important too, says Dr Morns.

"A lot of the time partners will say things like 'If it's uncomfortable, just stop' … these women don't want to be told to wean, they want help."

Dr Highet says some women may consider weaning their child, and "weighing up the benefits and risks" can be helpful in that decision-making process.

"Go gently on yourself and realise the impact.

"If it's causing a lot of stress and impacting on bonding, and you have tried everything … it's really up to the woman what they want to do."

Lack of awareness 

Dr Morns says some of the women in her research expressed feeling really alone and had a lot of self-blame.

Knowing there are other people out there experiencing this internal conflict can help.

"If you have [breastfeeding] aversion, it's not your fault," Dr Morns says.

She says a lot of the conversation around breastfeeding challenges focuses on latching or nipple pain, and BAR needs to be talked about more.

"We can't support people if we don't talk about the challenges."

Dr Morns says with helpful support and understanding, many women who experience breastfeeding aversion response can continue to breastfeed and go on to have an overall positive experience.

Women looking for support or to learn more about BAR can reach out to the ABA's free 24-hour hotline, and connect with the Breastfeeding Medicine Network.

They can also visit COPE, and seek support from peers via online groups such as those dedicated to BAR on Facebook.