• breastfeeding initiation;
  • mother-baby nursing;
  • baby-friendly;
  • hospital policies


Objective: To assess the variation in breastfeeding knowledge and practices of registered nurses in hospital women and family-care units and the informal and formal hospital policies related to the initiation and support of breastfeeding.

Design: This qualitative study employed a focus group approach to solicit perceptions of hospital-based nurses regarding breastfeeding best practices.

Setting: Eight state hospitals stratified by socioeconomic status (SES) and size served as settings to recruit participants for this study.

Participants: Forty female registered nurses from labor and delivery (n=9), postpartum (n=13), labor and delivery/recovery/postpartum care (LDRP) (n=12) and neonatal intensive care unit (NICU) (n=6) constituted eight focus groups.

Results: The majority of nurses reported being knowledgeable of evidence-based best practices related to breastfeeding initiation. However, in non-Baby Friendly/Baby Friendly Intent (non-BF/BFI) settings, nurses' knowledge often was not in accordance with current best practices in breastfeeding initiation, and reported hospital policies were not based upon evidence-based practices. Barriers to best practices in breastfeeding initiation included hospital lactation policies (formal and informal), nurses' limited education in breastfeeding initiation best practices, high rates of surgical delivery, and lack of continuity of care with the transition of responsibility from one nurse to another from labor and delivery to transition care to postpartum care.

Conclusions: A significant disparity between nurses' intention to support breastfeeding and their knowledge suggests a need for education based on the World Health Organization Baby Friendly standards for nurses at non-BF/BFI hospitals. A significant barrier to supporting breastfeeding is lack of hospital policy and inappropriate or outdated policy.