INTRODUCTION Exclusive breastfeeding (EB) is globally recommended due to health benefits for women and their infants. Home-based postnatal midwifery care (HBPMC) is a model of care where midwives give in-home care during the first postnatal week. The study objectives were to investigate breastfeeding outcomes at two months after birth, in women and newborns receiving HBPMC, and to identify risk factors and describe women's reported reasons associated with EB cessation. METHODS A prospective cohort study including 219 women in Sweden, conducted between November 2023 and March 2024. Background and breastfeeding variables were collected from medical records. Telephone interviews two months after birth contained open-ended questions about breastfeeding duration and reasons for EB cessation. Multivariable logistic regression was used to calculate adjusted odds ratios (AORs) with 95% confidence intervals (CIs). RESULTS In total, 211 women (96%) completed the follow-up. The prevalence of exclusive breastfeeding was 86% at discharge from HBPMC, and 84% at two months after birth. Factors associated with EB cessation included early formula supplementation (AOR=5.89; 95% CI: 2.31–15.02), a pre-pregnancy body mass index ≥ 30 kg/m² (AOR=3.55; 95% CI: 1.27–9.94), and being born in another country (AOR=2.39; 95% CI: 1.01–5.67). The most frequently reported reasons for EB cessation were perceived breastfeeding barriers and insufficient milk supply. CONCLUSIONS A high continuation of exclusive breastfeeding was reported at two months after receiving HBPMC, suggesting that in-home breastfeeding support during the first week after birth may play an important role. Future interventions with in-home breastfeeding support targeting women with identified risk factors may further improve breastfeeding duration.