Postpartum smoking contributes to child health problems and is a barrier to breastfeeding, which promotes child health. There is a risk of postpartum smoking relapse for smokers and they are less likely to breastfeed. Understanding of smoking-breastfeeding associations must be improved. Enhancing smoking cessation advice simultaneously with breastfeeding counseling could increase smoking abstinence and breastfeeding rates. A low income sample of 31 volunteer maternal smokers and ex-smokers were recruited for this pilot intervention in an urban hospital's postpartum unit. Following pre-intervention interview, participants received either smoking relapse prevention plus breastfeeding counseling, or smoking relapse prevention only counseling. At one-month follow-up, we hypothesized that breastfeeding duration would positively relate to 7-day point prevalence abstinence rates and days to relapse and explored prenatal care and pregnancy smoking behavior associations with postpartum smoking and breastfeeding. Of the mothers, 75% completed follow-up. Days to relapse was related to duration of breastfeeding (r = 0.92, p = 0.08); however, counseling group differences in one-month smoking status were not significant. Earlier prenatal care initiation was associated with smoking abstinences at one month postpartum (chi(2) = 4.87, p <or= 0.05). Early prenatal care and breastfeeding is associated with postpartum smoking abstinence.