Scoring: Maternity Care Practices

Maternity Practices in Infant Nutrition and Care (mPINC)

CDC calculates a Total mPINC score for every participating hospital to indicate its overall level of maternity care practices and policies that support optimal infant feeding. A Total mPINC score is provided in the individual hospital reports. Subscores further categorize maternity care practice subdomains:

  • Immediate Postpartum Care
  • Rooming-In
  • Feeding Practices
  • Feeding Education & Support
  • Discharge Support
  • Institutional Management

Responses are scored using an algorithm that denotes the evidence and best practices to promote optimal infant feeding within the maternity care setting. Possible scores range from 0 to100, with higher scores indicating better maternity care practices and policies.

2018 mPINC Scoring Algorithm

Overall Maternity Practices Score (Total Score) Mean of 6

IMMEDIATE POSTPARTUM CARE
IMMEDIATE POSTPARTUM CARE
Measure Explanation Survey item Scoring
Immediate skin-to-skin contact After vaginal delivery, percent of newborns who remain in uninterrupted skin-to-skin contact with their mothers immediately after birth …
  • if breastfeeding, until the first breastfeeding is completed.
  • if not breastfeeding, for at least one hour.
  • C1_a1
  • C1_a2
  • 100 = Most
  • 70 = Many
  • 30 = Some
  • 0 = Few
    Items scored then averaged.
After Cesarean-delivery, percent of newborns who remain in uninterrupted skin-to-skin contact with their mothers as soon as the mother is responsive and alert …
  • if breastfeeding, until the first breastfeeding is completed.
  • if not breastfeeding, for at least one hour.
  • C2_a1
  • C2_a2
  • 100 = Most
  • 70 = Many
  • 30 = Some
  • 0 = Few
    Items scored then averaged.
Transition Percent of vaginally-delivered newborns separated from their mothers before starting rooming-in. C3
  • 100 = Few
  • 70 = Some
  • 30 = Many
  • 0 = Most OR Not an Option
Monitoring following birth Percent of newborns who receive continuous observed monitoring throughout the first two hours immediately following birth. C5
  • 100 = Most
  • 70 = Many
  • 30 = Some
  • 0 = Few
Immediate Postpartum Care Subscore Mean of the 4 item scores†
†The subscore for hospitals with a valid skip for immediate skin-to-skin after Cesarean delivery was the mean of 3 items scored.
ROOMING-IN CARE
ROOMING-IN
Measure Explanation Survey item Scoring
Rooming-In Percent of newborns who stay in the room with their mothers for 24 hours/day (not including separation for medical reasons). C4_a1
  • 100: 80%+
  • 70: 50-79%
  • 30: 20-49%
  • 0: <20%
Mother-infant separation Indicates usual location of newborns during…
  • pediatric exams/rounds.
  • hearing screening.
  • pulse oximetry screening.
  • routine labs/blood draws/injections.
  • newborn bath.
  • C6_a1
  • C6_a2
  • C6_a4
  • C6_a5
  • C6_a6
  • 100 = in mother’s room for all 5 situations
  • 70 = removed from mother’s room for 1-2 situations
  • 30 = removed from mother’s room for 3-4 situations
  • 0 = removed from mother’s room for all 5 situations
Rooming-in safety Indicates whether your hospital has a protocol requiring frequent observations of high-risk mother-infant dyads by nurses to ensure safety of the infant while they are together. C7
  • 100 = Yes
  • 0 = No
Rooming-In Subscore Mean of the 3 item scores
FEEDING PRACTICES
FEEDING PRACTICES
Measure Explanation Survey item Scoring
Formula- feeding of breastfed infants Percent of healthy, term breastfed newborns who are fed infant formula. D3_A1
  • 100=<20%
  • 70=20-49%
  • 30=50-79%
  • 0=80% +
Glucose monitoring Indicates whether your hospital performs routine blood glucose monitoring of full-term healthy newborns NOT at risk for hypoglycemia. D5
  • 100 = No
  • 0 = Yes
Formula counseling for breastfeeding mothers Frequency that staff counsel breastfeeding mothers who request infant formula about possible health consequences for their infant and the success of breastfeeding. E3
  • 100 = Almost always
  • 70 = Often
  • 30 = Sometimes
  • 0 = Rarely
Feeding Practices Subscore Mean of the 3 item scores
FEEDING EDUCATION & SUPPORT
FEEDING EDUCATION & SUPPORT
Measure Explanation Survey item Scoring
Formula preparation & feeding techniques Among mothers whose newborns are fed any formula, percent of mothers taught…
  • appropriate formula feeding techniques.
  • how to safely prepare and feed formula.
  • E4_A1
  • E4_A2
  • 100 = Most
  • 70 = Many
  • 30 = Some
  • 0 = Few
    Items scored then averaged.
Feeding cues & Pacifiers Percent of breastfeeding mothers who are taught or shown how to …
  • recognize and respond to their newborn’s feeding cues.
  • breastfeed as often and as long as their newborn wants.
  • understand the use and risks of artificial nipples and pacifiers.
  • E2_A1
  • E2_A5
  • E2_A7
  • 100 = Most
  • 70 = Many
  • 30 = Some
  • 0 = Few
    Items scored then averaged.
Identify/solve breastfeeding problems Percent of breastfeeding mothers who are taught or shown how to…
  • position and latch their newborn for breastfeeding.
  • assess effective breastfeeding by observing their newborn’s latch and the presence of audible swallowing.
  • assess effective breastfeeding by observing their newborn’s elimination patterns.
  • hand express breast milk.
  • E2_A2
  • E2_A3
  • E2_A4
  • E2_A6
  • 100 = Most
  • 70 = Many
  • 30 = Some
  • 0 = Few
    Items scored then averaged.
Feeding Education & Support Subscore Mean of the 3 item scores
DISCHARGE SUPPORT
DISCHARGE SUPPORT
Measure Explanation Survey item Scoring
Pre-discharge criteria Indicates whether your hospital’s discharge criteria for breastfeeding newborns requires …
  • direct observation of at least one effective feeding within the 8 hours prior to discharge.
E5_a2
  • 100 = Yes
  • 0 = No
Post-discharge follow-up visit
  • scheduling of the first follow-up visit with a health care provider.
E5_a3
  • 100 = Yes
  • 0 = No
Post-discharge breastfeeding support Indicates whether your hospital’s routine discharge support to breastfeeding mothers includes:
  1. in-person follow-up visits/appointments for lactation support,
  2. personalized phone calls to mothers to ask about breastfeeding, or
  3. formalized, coordinated referrals to lactation providers in the community when additional support is needed.
  • E6_a1
  • E6_a2
  • E6_a3
  • 100 = Yes to any
  • 0 = No to all 3
Distribution of infant formula or formula- related supplies/ coupons as gifts Indicates whether your hospital gives mothers any of these items free of charge (not including items prescribed as part of medical care):
  1. infant formula,
  2. feeding bottles/nipples, nipple shields, or pacifiers, or
  3. coupons, discounts, or educational materials from companies that make or sell infant formula or feeding products.
  • G5_A1
  • G5_A2
  • G5_A3
  • 100 = No to all 3
  • 0 = Yes to any item
Discharge Subscore Mean of the 4 item scores
INSTITUTIONAL MANAGEMENT
INSTITUTIONAL MANAGEMENT
Measure Explanation Survey item Scoring
Nurse skill competency Indicates which competency skills are required of nurses:
Placement and monitoring of the newborn skin-to-skin with the mother immediately following birth.
  • F4_a1
  • F4_a2
  • F4_a3
  • F4_a4
  • F4_a5
  • F4_a6
  • 100 = 6 skills
  • 80 = 5 skills
  • 65 = 4 skills
  • 50 = 3 skills
  • 35 = 2 skills
  • 20 = 1 skill
  • 0 = 0 skills
Assisting with effective newborn positioning and latch for breastfeeding.
Assessment of milk transfer during breastfeeding.
Assessment of maternal pain related to breastfeeding.
Teaching hand expression of breast milk.
Teaching safe formula preparation and feeding.
Nurse competency assessment Assesses whether formal assessment of clinical competency in breastfeeding support and lactation management is required of nurses. F3
  • 100 = Required at least once per year OR Less than once per year
  • 0 = Not required
Documentation of exclusive breastfeeding Indicated whether your hospital records/tracks exclusive breastfeeding throughout the entire hospitalization. G1
  • 100 = Yes
  • 0 = No
Acquisition of infant formula Indicates how your hospital acquires infant formula. G4_a1
  • 100 = Pays fair market price
  • 0 = Receives free OR
    Unknown/Unsure
Written policies Indicates whether your hospital has a policy requiring…
  • documentation of medical justification or informed consent for giving non-breast milk feedings to breastfed newborns.
  • formal assessment of staff’s clinical competency in breastfeeding support.
    documentation of prenatal breastfeeding education.
  • staff to teach mothers breastfeeding techniques AND staff to show mothers how to express milk.
  • purchase of infant formula and related breast milk substitutes by the hospital at fair market value AND a policy prohibiting distribution of free infant formula, infant feeding products, and infant formula coupons.
  • staff to provide mothers with resources for support after discharge.
  • placement of all newborns skin-to-skin with their mother at birth or soon thereafter.
  • the option for mothers to room-in with their newborns.
  • G2_a1
  • G2_a2
  • G2_a4
  • G2_a5 / G2_a6
  • G2_a8 / G2_a12
  • G2_a9
  • G2_a7
  • G2_a11
  • 100 = Yes
  • 0 = No
    Final score is an average of the 8 scores.‡
Institutional Management Subscore Mean of the 5 item scores
‡ G2_a5 and G2_a6 as well as G2_a8 and G2_a12 are combined. Responses of Yes/Yes received a score of 100, other responses received a score of 0. Note: Subscores are not provided if half or more of the items in the section do not have a score. Total score is not provided if any subscore is missing.