Background: Exclusive breastfeeding during the first six months of life, and then continued breastfeeding for two years or longer, with appropriate supplemental feeding, ensures optimal growth and development of children and protects against many diseases. Hence, the WHO and UNICEF began the 'Baby-Friendly Hospital Initiative' in 1991 to promote, protect and support breastfeeding in maternity facilities. This initiative is based on 'Ten steps to successful breastfeeding', of which the fourth step promotes skin-to-skin contact (SSC) between mothers and their newborn upon birth. Numerous studies have shown positive effects of SSC on exclusivity and duration of breastfeeding in comparison to infants who were swaddled and separated from their mothers. This study compares newborns placed in immediate SSC with those swaddled first before being placed in non-SSC contact with their mothers. Objective: To examine the effect of 'birth' SSC vs. non-SSC on breastfeeding practices in healthy, term infants. Patients and Methods: This was a prospective cohort descriptive study, conducted at the University Hospital and Medical Faculty in Split between February 2008 and July 2010. All eligible mother-baby pairs were consecutively recruited from the postnatal ward. Mothers were interviewed at discharge using the UNICEF “Questionnaire for Monitoring Baby-Friendly Hospitals” to determine (amongst other things): if newborns were placed in SSC at birth or swaddled; the duration of SSC and the timing of the first breastfeed. Infant feeding data were collected using „Every-feed observation‟ charts² in hospital and via telephone interviews at 3, 6 and 12 months. Results: Of the total number of mothers included in our analysis (n=771), 589 (76%) received their newborn at birth in SSC while 182/771 (24%) were given their child swaddled. Significantly more women who were given their infants swaddled, held their infants for more than 30 minutes (P<0,001). Most women (98%) who held their newborns in SSC had a vaginal delivery and received their infants immediately following birth versus 45% of women whose children were swaddled (P<0,001). As a result, 82% of mothers from the intervention group breastfed their newborn within 12 hours of birth versus 40,9% of control mothers (P<0,001). In this study, newborns placed in SSC at birth were exclusively breastfed, up until 6 months, more often than their swaddled counterparts, but this difference was not statistically significant. Breastfeeding rates at 3,6 and 12 months were not significantly higher in the group with SSC. Conclusion: This study showed a trend towards higher exclusive breastfeeding rates among mothers who experienced birth SSC. Even though this did not reach statistical significance, implementing Step 4 of the Baby-Friendly Hospital Initiative suggests a positive effect on breastfeeding and therefore should be routinely performed in all maternity hospitals.