Table 5 Perceived barriers and facilitators to progress on the ten steps

• Older nurses and physicians

• Ready availability of in-hospital breastfeeding rates

• Staffing constraints: Need more LCs

• Rounding on progress/statistics

• Interference in mothers’ choices

• Opportunities for staff to discuss and consider

• Increasing C/S rate

• Advocacy for breastfeeding at multiple levels within the facility

• Assumptions re: Hispanic culture

• Strong management support for Ten Steps

• Lack of self-efficacy among nurses

• Creating an atmosphere of openness to changing practices

• Perception negative to rooming-in

• Emphasizing and demonstrating benefits of breastfeeding to nurses

• Perception physicians will oppose policy changes

Including breastfeeding support in personnel evaluations

• Expense of baby-friendly designation and budget constraints

• Seeing mothers utilizing lactation services

• Nights: Staff practices

• Hands-on training

• Perception that the LC alone is responsible

• Too many visitors in L&D

• Pacifiers are needed for “fussy” babies and for the transition periods

• Rooming –in will create patient dissatisfaction