Barriers and Facilitators to Implementing Evidence-Based Breastfeeding Support in Miami-Dade County Maternity Wards.

OBJECTIVES: This qualitative study assessed the breastfeeding environment across all 12 maternity hospitals in Miami-Dade County, Florida, to identify institutional factors that influence breastfeeding support. METHODS: Interviews were conducted with lactation consultants and nurses and analyzed using the Consolidated Framework for Implementation Research (CFIR). RESULTS: Hospitals varied substantially in adherence to Baby-Friendly Hospital Initiative (BFHI) guidelines, regardless of official designation. Participants identified high cesarean rates, staffing shortages, cultural misconceptions, and inconsistent clinical protocols as key barriers to breastfeeding initiation and exclusivity. Despite these challenges, many hospitals employed innovative strategies, such as virtual lactation support and community partnerships, to promote breastfeeding. Notably, lack of prenatal education and limited physician involvement were seen as critical missed opportunities. CONCLUSIONS FOR PRACTICE: Results underscore the importance of coordinated, multilevel interventions that align clinical practice, staff training, and patient education. Recommendations from community partner BreastfeedMIAMI highlight the need for expanded lactation coverage, standardized staff training, culturally tailored education, and greater institutional investment. These insights can inform policy and programmatic efforts to foster more equitable, supportive breastfeeding environments in diverse hospital settings.