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The Baby Friendly Health Initiative (BFHI) aims to improve breastfeeding initiation and continuation. Teaching antenatal colostrum expression (ACE] may also promote positive breastfeeding outcomes. However, there is concern that this may impact birth outcomes. This study was a retrospective audit of medical records from 294 women attending a general public hospital in Western Australia. The aim was to assess breastfeeding and birth outcomes before and after provision of ACE education and BFHI care as standard hospital practice. Breastfeeding, infant and obstetric outcomes were assessed across three time periods representing different situations: no routine ACE education or BFHI accreditation (n = 98); ACE education only (n = 100); and both ACE education and BFHI accreditation (n = 96). Results showed that mothers were more likely to see a lactation consultant after introduction of ACE education (p = 0.045) and with BFHI care (p = 0.053); and increased initiation of breastfeeding as the first feed was also observed (p = 0.049). ACE education was not associated with significantly increased rates of special care nursery admission, or lower gestational age at birth. No significant differences in infant formula use were detected. Further research is warranted to investigate the impact of antenatal education on rates of ACE performance, and explore both antenatal expressing and the BFHI care in relation to longer-term outcomes, including exclusive breastfeeding duration. [ABSTRACT FROM AUTHOR]