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.

Download PDF of Hospital Scoring Algorithm [PDF-467KB]

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.
Immediate skin-to-skin contact	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.

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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

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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

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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

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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: in-person follow-up visits/appointments for lactation support, personalized phone calls to mothers to ask about breastfeeding, or 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): infant formula, feeding bottles/nipples, nipple shields, or pacifiers, or 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

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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 every two years OR Less than every two years 0 = Not required
Documentation of exclusive breastfeeding	Indicated whether your hospital records/tracks exclusive breastfeeding throughout the entire hospitalization.	G1_a1	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.

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