Background <p>Breastfeeding is a critical component of neonatal nutrition and maternal-infant bonding. However, breastfeeding practices remain suboptimal in many resource-poor settings including Nigeria.</p> Objectives <p>To determine the prevalence of breastfeeding confidence and exclusive breastfeeding among postpartum women; and to identify hospital breastfeeding support practices associated with breastfeeding confidence and exclusive breastfeeding, adjusting for maternal age, educational level, parity, mode of delivery, breastfeeding confidence, early initiation of breastfeeding, skin-to-skin contact, rooming-in practice, postnatal breastfeeding counselling and formula supplementation.</p> Methods <p>This was a hospital-based cross-sectional study conducted among 114 postpartum women attending postnatal and immunization clinics at the Federal Medical Centre, Umuahia, Southeast Nigeria in April, 2026. Participants were recruited consecutively using interviewer-administered structured questionnaires. Data collected included sociodemographic characteristics, obstetric history, hospital breastfeeding support practices, breastfeeding confidence assessed using the Breastfeeding Self-Efficacy Scale-Short Form, and exclusive breastfeeding practices. Data were analyzed using descriptive statistics, chi-square tests and multivariable logistic regression.</p> Results <p>The mean age of the respondents was 30.9 ± 5.8 years. The mean Breastfeeding Self-Efficacy Scale Score was 52.4 ± 9.1. High breastfeeding confidence was observed among 47.4% of respondents while 43.9% practiced exclusive breastfeeding. Early initiation of breastfeeding occurred among 48.2% of respondents, skin-to-skin contact among 44.7% and postnatal breastfeeding counselling among 58.8%. High breastfeeding confidence was significantly associated with early initiation of breastfeeding (<i>p</i> &lt; 0.001), skin-to-skin contact (<i>p</i> &lt; 0.001) and postnatal breastfeeding counselling (<i>p</i> &lt; 0.001). Exclusive breastfeeding practice was significantly associated with high breastfeeding confidence (<i>p</i> &lt; 0.001), early initiation of breastfeeding (<i>p</i> &lt; 0.001) and postnatal counselling (<i>p</i> = 0.001). In exploratory adjusted analysis, high breastfeeding confidence (AOR = 4.2, 95% CI: 1.9–9.3), early initiation of breastfeeding (AOR = 2.5, 95% CI: 1.1–5.7) and postnatal breastfeeding counselling (AOR = 3.0, 95% CI: 1.3–6.8) were associated with maternal self-reported exclusive breastfeeding practice.</p> Conclusions <p>Breastfeeding confidence and exclusive breastfeeding practices among postpartum women were strongly associated with hospital breastfeeding support practices. Strengthening institutional breastfeeding support practices including early breastfeeding initiation, skin-to-skin contact, structured lactation counselling and reduction of unnecessary formula supplementation should be prioritized.</p>