Crosswalk: Aligning mPINC and the Ten Steps
Note: This tool does not correspond to or replace Baby-Friendly USA’s on-site assessments or Baby-Friendly designation.
| Step 1: Hospital Policies* | ||
|---|---|---|
| Ten Steps Competency1 | mPINC Item | mPINC Data Element |
| Compliance with the Code: Acquisition of infant formula | Indicates how your hospital acquires infant formula. | G4_a1 |
| Compliance with the Code: 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): a) infant formula, b) feeding bottles/nipples, nipple shields, or pacifiers, or c) coupons, discounts, or educational materials from companies that make or sell infant formula or feeding products. |
G5_a1/G5_a2/ G5_a3 |
| Written infant feeding 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. |
G2_a1 |
| Written infant feeding policies | …formal assessment of staff’s clinical competency in breastfeeding support. | G2_a2 |
| Written infant feeding policies | …documentation of prenatal breastfeeding education. | G2_a4 |
| Written infant feeding policies | …staff to teach mothers breastfeeding techniques AND staff to show mothers how to express milk. | G2_a5/G2_a6 |
| Written infant feeding policies | …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. | G2_a8/G2_a12 |
| Written infant feeding policies | …staff to provide mothers with resources for support after discharge. | G2_a9 |
| Written infant feeding policies | …placement of all newborns skin-to-skin with their mother at birth or soon thereafter. | G2_a7 |
| Written infant feeding policies | …the option for mothers to room-in with their newborns. | G2_a11 |
| Monitoring and data-management systems | Indicates whether your hospital records/tracks exclusive breastfeeding throughout the entire hospitalization. | G1 |
| Step 2: Staff Competency* | ||
| Ten Steps Competency1 | mPINC Item | mPINC Data Element |
| Staff competency to support breastfeeding | Indicates which competency skills are required of nurses: – Placement and monitoring of the newborn skin-to-skin with the mother immediately following birth. – 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. |
F4_a1/F4_a2/ F4_a3/F4_a4/ F4_a5/F4_a6 |
| Assessment of staff competency to support breastfeeding | Assesses whether formal assessment of clinical competency in breastfeeding support and lactation management is required of nurses. | F3 |
| Step 3: Prenatal Care* | ||
| Ten Steps Competency1 | mPINC Item | mPINC Data Element |
| Prenatal breastfeeding education† | Indicates women who deliver at your hospital have the opportunity to receive prenatal breastfeeding education (in either group or individual settings) provided by your hospital and/or a hospital-affiliated clinic or service.† | A5 |
| Step 4: Care Right After Birth* | ||
| Ten Steps Competency1 | mPINC Item | mPINC Data Element |
| Immediate skin-to-skin contact after vaginal delivery | 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 |
| Immediate skin-to-skin contact after Cesarean-delivery | 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 after birth… …if breastfeeding, until the first breastfeeding is completed. …if not breastfeeding, for at least one hour. |
C2_a1/C2_a2 |
| Step 5: Support Mothers with Breastfeeding* | ||
| Ten Steps Competency1 | mPINC Item | mPINC Data Element |
| Practical support to initiate and maintain breastfeeding and manage common 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 |
| Step 6: Supplementing* | ||
| Ten Steps Competency1 | mPINC Item | mPINC Data Element |
| Non-medically indicated supplementation | Percent of healthy, term breastfed newborns who are fed infant formula. | D3_a1 |
| Counseling on the importance of exclusive breastfeeding | Frequency that staff counsel breastfeeding mothers who request infant formula about possible health consequences for their infant and the success of breastfeeding. | E3 |
| Instruction of formula feeding techniques and safe preparation and handling of formula | 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 |
| Step 7: Rooming-in* | ||
| Ten Steps Competency1 | mPINC Item | mPINC Data Element |
| Mother-infant separation after birth | Percent of vaginally-delivered newborns separated from their mothers before starting rooming-in. | C3 |
| Rooming-in for 24 hours/day | Percent of newborns who stay in the room with their mothers for 24 hours/day (not including separation for medical reasons). | C4_a1 |
| Mother-infant separation while rooming-in | 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 |
| Observation of mother-infant dyads to ensure 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 |
| Step 8: Responsive Feeding* | ||
| Ten Steps Competency1 | mPINC Item | mPINC Data Element |
| Support recognition and response to infant feeding cues | 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. |
E2_a1/E2_a5 |
| Step 9: Bottles, Teats (Nipples), and Pacifiers* | ||
| Ten Steps Competency1 | mPINC Item | mPINC Data Element |
| Counseling on the risks of artificial teats (nipples) and pacifiers | Percent of breastfeeding mothers who are taught or shown how to… …understand the use and risks of artificial nipples and pacifiers. |
E2_a7 |
| Step 10: Discharge* | ||
| Ten Steps Competency1 | mPINC Item | mPINC Data Element |
| Coordination of discharge to ensure appropriate follow-up care | Indicates whether your hospital’s discharge criteria for breastfeeding newborns requires scheduling of the first follow-up visit with a health care provider. | E5_a3 |
| Coordination of discharge to ensure ongoing breastfeeding support | Indicates whether your hospital’s routine discharge support to breastfeeding mothers includes: a) in-person follow-up visits/appointments for lactation support, b) personalized phone calls to mothers to ask about breastfeeding, or c) formalized, coordinated referrals to lactation providers in the community when additional support is needed. |
E6_a1/E6_a2/ E6_a3 |
*Although this tool assesses many aspects of each of the Ten Steps, it does not assess every aspect. Every aspect of each Step cannot be assessed using mPINC data alone.
†This item was not scored and therefore not included in mPINC Hospital Reports. Please use your knowledge of hospital practice to answer this question. If you have requested access to mPINC data from CDC, this item corresponds with mPINC Data Element A5.
References
- World Health Organization. Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services: implementing the revised Baby-friendly Hospital Initiative. Geneva: World Health Organization; 2018.
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