Continuous uninterrupted skin-to-skin contact is known to facilitate newborn transition to extrauterine life, the ability to actively find the nipple and establishment of effective breastfeeding but is not promoted consistently in practice. The Newborn Feeding Ability Questionnaire (NFAQ) was developed to measure midwives' knowledge and practice in supporting the first breastfeed. The NFAQ was administered to 3 500 midwives in Australia through a mailed survey. A response rate of 31.6% (n=1 105) was achieved and the sample was representative of the national midwifery population for age, sex, education and experience. Mean total score for knowledge was 85.94 (range 40-110 out of 110, SD=10.55) and mean practice score was 95.89 (range 57-117 out of 120, SD=9.19). Knowledge of newborn feeding ability was consistently associated with best practice in managing the first breastfeed. Almost all midwives reported that skin-to-skin contact for newborn infants immediately after birth was important, but few understood the significance of 'continuous uninterrupted' skin-to-skin contact to facilitate correct attachment and effective suckling. One-third reported separating mother and baby for routine interventions before allowing the opportunity to demonstrate pre-feeding behaviour or actually breastfeed. Although midwives attempt to ensure the first breastfeed is facilitated soon after birth, the practice of continuous uninterrupted skin-to-skin contact seems poorly understood and not uniformly practised. Further research is needed to investigate how midwives teach mothers' positioning and attachment for the first breastfeed. Education of midwives so they can optimally facilitate the first breastfeed is required to improve breastfeeding initiation rates.