mPINC Ten Steps Assessment Tool
Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions. Have a written infant feeding policy that is routinely communicated to staff and parents. Establish ongoing monitoring and data-management systems*
Ten Steps Competency1 | mPINC Item | mPINC Domain | mPINC Data Element | Ideal Response† | Hospital Response | Did the Hospital Select the Ideal Response? |
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Compliance with the Code: Acquisition of infant formula | Indicates how your hospital acquires infant formula. | Institutional Management | G4_a1 |
Pays fair market price Not ideal: Receives Free or Unknown/Unsure |
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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. |
Discharge Support | G5_a1/G5_a2/ G5_a3 |
No to all three items Not ideal: |
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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. |
Institutional Management | G2_a1 |
Yes Not ideal: No |
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Written infant feeding policies | …formal assessment of staff’s clinical competency in breastfeeding support. | Institutional Management | G2_a2 |
Yes Not ideal: No |
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Written infant feeding policies | …documentation of prenatal breastfeeding education. | Institutional Management | G2_a4 |
Yes Not ideal: No |
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Written infant feeding policies | …staff to teach mothers breastfeeding techniques AND staff to show mothers how to express milk. | Institutional Management | G2_a5/G2_a6 |
Yes to both items Not ideal: No to either item |
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Written infant feeding policie | …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. | Institutional Management | G2_a8/G2_a12 |
Yes to both items Not ideal: No to either item |
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Written infant feeding policies | …staff to provide mothers with resources for support after discharge. | Institutional Management | G2_a9 |
Yes Not ideal: No |
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Written infant feeding policies | …placement of all newborns skin-to-skin with their mother at birth or soon thereafter. | Institutional Management | G2_a7 |
Yes Not ideal: No |
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Written infant feeding policies | …the option for mothers to room-in with their newborns. | Institutional Management | G2_a11 |
Yes Not ideal: No |
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Monitoring and data-management system | Indicates whether your hospital records/tracks exclusive breastfeeding throughout the entire hospitalization. | Institutional Management | G1 |
Yes Not ideal: No |
Ensure that staff have sufficient knowledge, competence and skills to support breastfeeding*
Ten Steps Competency1 | mPINC Item | mPINC Domain | mPINC Data Element | Ideal Response† | Hospital Response | Did the Hospital Select the Ideal Response? |
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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. |
Institutional Management | F4_a1/F4_a2/ F4_a3/F4_a4/ F4_a5/F4_a6 |
Required for all items Not ideal: Not required for any item |
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Assessment of staff competency to support breastfeeding | Assesses whether formal assessment of clinical competency in breastfeeding support and lactation management is required of nurses. | Institutional Management | F3 |
Required at least once per year OR Required less than once per year Not ideal: Not required |
Discuss the importance and management of breastfeeding with pregnant women and their families*
Ten Steps Competency1 | mPINC Item | mPINC Domain | mPINC Data Element | Ideal Response† | Hospital Response | Did the Hospital Select the Ideal Response? |
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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.§ | Not included in mPINC Hospital Report | A5 |
Yes Not ideal: No or Not Sure |
Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as soon as possible after birth*
Ten Steps Competency1 | mPINC Item | mPINC Domain |
mPINC Data Element | Ideal Response† | Hospital Response | Did the Hospital Select the Ideal Response? |
---|---|---|---|---|---|---|
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. |
Immediate Postpartum Care | C1_a1/C1_a2 |
Most to both items Not ideal: Many, Some, or Few to either item |
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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. |
Immediate Postpartum Care | C2_a1/C2_a2 |
Most to both items Not ideal: Many, Some, or Few to either item |
Support mothers to initiate and maintain breastfeeding and manage common difficulties*
Ten Steps Competency1 | mPINC Item | mPINC Domain | mPINC Data Element | Ideal Response† | Hospital Response | Did the Hospital Select the Ideal Response? |
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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. |
Feeding Education | E2_a2/E2_a3/ E2_a4/E2_a6 |
Most to all items Not ideal: Some, or Few to any item |
Do not provide breastfed newborns any food or fluids other than breast milk, unless medically indicated*
Ten Steps Competency1 | mPINC Item | mPINC Domain | mPINC Data Element | Ideal Response† | Hospital Response | Did the Hospital Select the Ideal Response? |
---|---|---|---|---|---|---|
Non-medically indicated supplementation | Percent of healthy, term breastfed newborns who are fed infant formula. | Feeding Practices | D3_a1 |
<20% Not ideal: ≥20% |
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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. | Feeding Practices | E3 |
Almost always Not ideal: Often, Sometimes, or Rarely |
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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. |
Feeding Education | E4_a1/E4_a2 |
Most to both items Not ideal: Many, Some, or Few to either item |
Enable mothers and their infants to remain together and to practice rooming-in 24 hours a day*
Ten Steps Competency1 | mPINC Item | mPINC Domain | mPINC Data Element | Ideal Response† | Hospital Response | Did the Hospital Select the Ideal Response? |
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Mother-infant separation after birth | Percent of vaginally-delivered newborns separated from their mothers before starting rooming-in. | Immediate Postpartum Care | C3 |
Few Not ideal: |
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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). | Rooming-in | C4_a1 |
80%+ Not ideal: <80% |
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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. |
Rooming-in | C6_a1/C6_a2/C6_a4/C6_a5/C6_a6 |
In mother’s room for all situations Not ideal: Not in a mother’s room for any situation |
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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. | Rooming-in | C7 |
Yes Not ideal: No |
Support mothers to recognize and respond to their infants’ cues for feeding*
Ten Steps Competency1 | mPINC Item | mPINC Domain | mPINC Data Element | Ideal Response† | Hospital Response | Did the Hospital Select the Ideal Response? |
---|---|---|---|---|---|---|
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. |
Feeding Education | E2_a1/E2_a5 |
Most to both items Not ideal: Many, Some, or Few to either item |
Counsel mothers on the use and risks of feeding bottles, teats (nipples), and pacifiers*
Ten Steps Competency1 | mPINC Item | mPINC Domain | mPINC Data Element | Ideal Response† | Hospital Response | Did the Hospital Select the Ideal Response? |
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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. |
Feeding Education | E2_a7 |
Most Not ideal: Many, Some or Few |
Coordinate discharge so that parents and their infants have timely access to ongoing support and care*
Ten Steps Competency1 | mPINC Item | mPINC Domain | mPINC Data Element | Ideal Response† | Hospital Response | Did the Hospital Select the Ideal Response? |
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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. | Discharge Support | E5_a3 |
Yes Not ideal: No |
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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. |
Discharge Support | E6_a1/E6_a2/ E6_a3 |
Yes to any item Not ideal: No to all items |
Note: This tool does not correspond to or replace Baby-Friendly USA’s on-site assessments or Baby-Friendly designation.
*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.
†Ideal responses are in bold.
§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.
- World Health Organization. Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services: implementing the revised Baby-friendly Hospital Initiative.external icon Geneva: World Health Organization; 2018.