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Mississippi has the lowest rates of breastfeeding in the United States at 6 and 12 months. There is growing evidence that the rates and duration of infant breastfeeding improve after hospitals implement the Ten Steps to Successful Breastfeeding; moreover, the Ten Steps approach is considered the standard model for evaluation of breastfeeding practices in birthplaces.This study aimed to examine the implementation level of the Ten Steps and identify barriers to implementing the Ten Steps in Mississippi hospitals.A cross-sectional self-report survey was used to answer the research aim. Nurse managers of the birthing and maternity units of all 43 Mississippi hospitals that provided birthing and maternity care were recruited. A response rate of 72% (N = 31) was obtained. Implementation of the Ten Steps in these hospitals was categorized as low, partial, moderate, or high.The researcher classified implementation in 29% of hospitals as moderate and in 71% as partial. The hospital level of implementation was significantly positively associated with the hospital delivery rate along with the hospital cesarean section rate per year. The main barriers for the implementation process of the Ten Steps reported were resistance to new policies, limited financial and human resources, and lack of support from national and state governments.Breastfeeding practices in Mississippi hospitals need to be improved. New policies need to be established in Mississippi to encourage hospitals to adopt the Ten Steps policies and practice in the maternity and birthing units.