WHO/UNICEF Ten Steps to Successful Breastfeeding and Corresponding Indicators from the mPINC Survey

Ten Steps to Successful Breastfeeding* mPINC Indicator
1. Have a written breastfeeding policy that is routinely communicated to all health care staff Model breastfeeding policy: Hospital has a written breastfeeding policy that includes 10 model policy elements§
2. Train all health care staff in skills necessary to implement this policy Staff competency assessment: Nurses/birth attendants are assessed for competency in basic breastfeeding management and support at least once per year
3. Inform all pregnant women about the benefits and management of breastfeeding Prenatal breastfeeding education: Breastfeeding education is included as a routine element of prenatal classes
4. Help mothers initiate breastfeeding within an hour of birth Early initiation of breastfeeding: ≥90% of healthy full-term breastfed infants initiate breastfeeding within one hour of uncomplicated vaginal birth
5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants Teach breastfeeding techniques: ≥90% of mothers who are breastfeeding or intend to breastfeed are taught breastfeeding techniques (e.g. positioning, how to express milk, etc.) 
6. Give breastfeeding newborn infants no food or drink other than breastmilk unless medically indicated Limited use of breastfeeding supplements: <10% of healthy full-term breastfed infants are supplemented with formula, glucose water, or water
7. Practice rooming in - that is, allow mothers and infants to remain together 24 hours per day Rooming-in: ≥90% of healthy full-term infants, regardless of feeding method, remain with their mother for at least 23 hours per day during the hospital stay
8. Encourage breastfeeding on demand Teach feeding cues:  ≥90% of mothers are taught to recognize and respond to infant feeding cues instead of feeding on a set schedule
9. Give no artificial teats or pacifiers to breastfeeding infants Limited use of pacifiers: <10% of healthy full-term breastfed infants are given pacifiers by maternity care staff
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic Post-discharge support: Hospital routinely provides 3 modes of post-discharge support to breastfeeding mothers: physical contact, active reaching out, and referrals¶
*These are the Ten Steps to Successful Breastfeeding as implemented by Baby-Friendly USA.  In the U.S. these are the same as the WHO/UNICEF Ten Steps to Suceesful Breastfeeding except for step 4, which in the U.S. says mothers should initiate breastfeeding within one hour of birth, compared to thirty minutes elsewhere.
§Model policy elements are 1) in-service training, 2) prenatal breastfeeding classes, 3) asking about mothers' feeding plans, 4) initiating breastfeeding within one hour of uncomplicated vaginal birth, 5) initiating breastfeeding after recovery for uncomplicated c-sections and/or showing mothers how to express milk and maintain lactation if separated from infant, 6) giving only breast milk to breastfed infants, 7) rooming-in 24 hr/day, 8) breastfeeding on demand, 9) no pacifier use by breastfed infants, 10) referral of mothers with breastfeeding problems and/or referral of mothers to appropriate breastfeeding resources at discharge.
¶Physical contact: home visit, hospital postpartum follow-up visit; Active reaching out: follow-up phone call to patient after discharge; Referrals: hospital phone number to call, hospital-based support group, other breastfeeding support group, lactation consultant/specialist, WIC, outpatient clinic.