Given the continued national emphasis on increasing exclusive breastfeeding rates, nurses face daily challenges in helping mother-baby couplets initiate and maintain breastfeeding. Problems include maternal lack of education, difficulty in latching the infant to the breast, delayed lactogenesis, and sore nipples. Vulnerable, preterm and late preterm infants pose unique physiologic breastfeeding dilemmas; as do mothers with medical complications such as diabetes or a history of bariatric surgery. Discussion of the latest research and best practice strategies and solutions will help the nurse improve management and support for breastfeeding women and their newborns and highlight how hospitals can make changes that support this national initiative.