There is no disputing that human milk provides healthy, full-term infants the most optimal and complete form of nutrition available, and there is little reason that healthy infants cannot be breastfed (Ip et al., 2007). These facts, supported by volumes of research, have been well known for decades and are promoted by several organizations, including the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. Why is it, then, that in most of the hospitals across this country, exclusive breastfeeding of healthy newborns is not universal? Hospital postpartum units and birthing centers should be "formula free"-meaning that for healthy newborns, breastfeeding should be the gold standard for infant nutrition.

Providing new mothers with nursing practices that are evidence based is our goal, yet we condone and often promote the use of artificial substitutes for newborn nutrition when we know that evidence tells us otherwise. Infants who are breastfed exclusively have fewer and less serious illnesses than formula-fed infants. Some evidence indicates that maternal benefits include a decreased risk of ovarian cancer and premenopausal breast cancer, particularly if a mother chooses to exclusively breastfeed (Ip et al., 2007). Furthermore, the practice of breastfeeding makes good economic sense-it is far cheaper to breastfeed, and because breastfeeding decreases the incidence of many illnesses, the result is a savings in healthcare costs.

Hospitals have tremendous influence in communities and therefore have great responsibilities. Encouraging women to breastfeed should start there. If a hospital accepts free formula, passes out formula discharge packs, and uses materials from formula companies, it is essentially advertising for the formula company and promoting a practice that is not optimal for most mothers and their babies. In a Baby-Friendly hospital, where formula is purchased by the hospital, formula is used sparingly and usually only when "medically necessary" (Shealy, Li, Benton-Davis, & Grummer-Strawn, 2005).

There are many initiatives hospitals can undertake to create optimal environments for breastfeeding mothers and babies. Researchers have shown that new mothers are strongly influenced by the opinion of their obstetrical providers, who often are unaware of the magnitude of their influence and the opportunity they have to promote exclusive breastfeeding (Shealy et al., 2005).

For nurses to support breastfeeding among new mothers, they need access to quality continuing education about breastfeeding so they can integrate new information about breastfeeding into their practices. Optimally, lactation consultants should visit all new mothers during their hospital stays, provide educational and "how to" materials for mothers to take home with them, and be accessible to the moms for follow-up after discharge. Follow-up phone calls in the days after discharge also are an important component in supporting breastfeeding among new mothers. Providing consistent information to mothers by all nursing staff also helps to reduce the anxiety and misinformation that some mothers experience in the immediate postpartum period (Shealy et al., 2005).

Hospital-based breastfeeding classes taught by lactation consultants and attended by expecting parents and nursing staff from postpartum units and the nursery are essential. This education enables prospective parents to meet many of the special people who will reassure them that they and their babies will receive personalized care. These classes can be incorporated into other prenatal classes, thereby sending the message that breastfeeding is the "norm."

Finally, breastfeeding is an emotionally charged and subjective issue, which makes it difficult for healthcare workers to be objective. It often seems easier or more empathetic to give one's personal opinion rather than follow the best practices model. The prevailing feeling is that mothers should be able to choose among the options available for infant nutrition. The fundamental question is "What would her baby choose?" Breastfeeding is a natural process for babies, and breastfeeding is the standard of care that hospitals should promote and to which hospital staff should adhere.

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