Naomi Skena is Certified Lactation Counselor and a Postpartum Doula providing evidence-based, nonjudgmental and compassionate postpartum and breastfeeding support to families in the DC metropolitan area. Formerly, she worked in the field of international public health on child survival projects, with a focus on newborn health. She lives in the Navy Yard neighborhood of Washington, D.C. with her husband and three young children. 


Breastfeeding can be a touchy subject. When I decided to work as a postpartum doula and Certified Lactation Counselor, I knew I would feel like I was picking sides in an oftentimes personal debate. But finally, after time, I could no longer stay neutral. There is one statistic in particular that fuels my passion: upon leaving the hospital, 81% of new mothers intend to breastfeed, but by six months, only 22% are still breastfeeding exclusively per the recommendation of the World Health Organization and the American Academy of Pediatrics.

This means fewer babies receive the benefits of breastfeeding…but it also means that there A LOT of new mothers dealing with disappointment, shame, feelings of inadequacy and even depression because of a perceived failure to follow through. What is happening to that group of moms, the 60% who planned to breastfeed but stopped or started supplementing before six months? The top reasons mothers say they stop breastfeeding include concerns about not having enough milk, baby’s latch, breast pain/soreness and work or school. In many of these circumstances, a compassionate and well-informed support person may have been able to help the mother and baby continue their breastfeeding relationship.

Let me be very clear.

Women are not failing their babies. A structurally flawed maternal health system is failing women.

Women receive little information or education on breastfeeding during the prenatal period. Many doctors receive no training on breastfeeding. The effects of high-intervention births (from cesarean sections, intravenous fluids and medications) can get breastfeeding off to a difficult start. Immediate skin-to-skin contact between mother and newborn is associated with longer breastfeeding, but it is not yet a universal best practice in hospitals.

A few days after birth, we send women home, typically with no contact with medical providers for at least another two weeks. These two weeks are the most intense and important weeks of establishing breastfeeding. Although breastfeeding is ‘natural’, it does not come easily to most women; it is a learned skill. The last few generations of women in our country have not grown up surrounded by breastfeeding mothers, and we’ve lost some of our collective wisdom and skills in this area. So, many new mothers are left on their own to struggle up the steep learning curve, often coping with great pain and little sleep.

As anyone with a basic understanding of milk production can tell you, ill-informed baby care practices which sabotage breastfeeding are everywhere. Newborns have small stomachs and must nurse frequently to fill them.  This frequency (yes, even at night) is important to set their mothers’ milk supplies at full capacity. Many popular ‘theories’ about infant sleep and ‘schedules’ do not take this biological imperative into consideration, and they can inadvertently derail a mother’s plans to breastfeed.

baby bottle falling out of bag doulas of capitol hill

Many women will also stop breastfeeding because they go back to work. Even if their job can accommodate a time-consuming pumping regimen, it is a very difficult task to provide pumped breastmilk for a baby away from his mother all day. The United States is the only developed nation that does not provide universal paid maternity leave; let us hope that will change soon.

For all these reasons and more, my heart breaks every time I see a mother struggling with breastfeeding. Although I think breastmilk is the ideal food for babies, I am not in this field because of a dogmatic insistence upon one feeding method over another. There are many varied, legitimate, and appropriate reasons why some women are unable to or choose not to breastfeed and we must absolutely respect their decisions without hesitation. I am passionate about this work because I cannot abide the thought that any new mother would be forced to stop breastfeeding before she wanted to because of a PREVENTABLE reason.

So what can a new mother do to advocate for herself in the face of an inadequate breastfeeding support system?

First, if you are struggling – please,reach out. If breastfeeding hurts, something needs to be adjusted. There are International Board Certified Lactation Consultants (IBCLCs), Certified Lactation Counselors (CLCs), La Leche League leaders, and other breastfeeding support persons who can help. Your pediatrician, your midwife/ OB/GYN  or your doula can refer you to a trusted source. Sometimes the solution is very simple! Sometimes it isn’t, and you will need the compassionate support of someone who can walk with you through the challenges.

Secondly, build your village. Sometimes what you’ll need most is another mom who can say – I’ve been there, it’s hard, it got better, you’re doing great. You can find a group of moms whose babies are approximately the same ages through a childbirth class, breastfeeding support groups like La Leche League or other organizations such as P.A.C.E. Your peers can affirm that some behaviors are a stage their baby is going through as well, which may not solve your problems, but will help you feel less alone in them. These moms may also have tips to share on learning to breastfeed in other positions, when baby is sick, in public and other solutions to real-life dilemmas.

Finally, settle in and get comfortable for the fourth trimester. Your baby is doing important work, growing rapidly and eating frequently, and your body is recovering from the extraordinary task of creating and birthing a human, whom you are now nourishing.

Try to give yourself lots of grace; it’s a messy time for everyone.

Stay home and get cozy, pick a series to work through on Netflix, listen to audiobooks or music, and nurse your baby. Say yes to everyone who offers to help and suggest they bring food. Cocoon yourself for as long as you can while you focus on feeding and resting with your little one and don’t apologize for it. Read this and this for encouragement.

The first and most important thing is to feed the baby, however you can. If your goal is to breastfeed, I want to help you fight for it. If you’re formula-feeding, I stand with you and am here to help with your questions, too. Either way, I see how you love your baby, and I want you to succeed.  

If you are interested in prenatal or postpartum breastfeeding support and plans please contact us at