mPINC™ Survey Scoring

At a glance

  • CDC's Maternity Practices in Infant Nutrition and Care (mPINC™) Survey assesses policies and practices that support infant feeding in maternity care hospitals.
  • CDC calculates a Total mPINC™ score and six subscores for participating hospitals.
  • Learn how the mPINC™ Survey is scored.
A nurse takes personal data from a mother and talks to her while she holds her newborn baby.

How mPINC™ scoring works

CDC calculates a Total mPINC™ score for every participating hospital. The score indicates a hospital's 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 and Support
  • Discharge Support
  • Institutional Management

Responses are scored using an algorithm that denotes evidence and best practices to promote optimal infant feeding within the maternity-care setting. Possible scores range from 0 to 100. Higher scores indicate better maternity care practices and policies.

Download Hospital Scoring Algorithm

mPINC™ scoring algorithm

Overall maternity practices score (total score) average of six sub-scores

Immediate postpartum care
Measure Explanation 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 (Survey item C1_a1).
  • If not breastfeeding, for at least one hour (Survey item 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 (Survey item C2_a1).
  • If not breastfeeding, for at least one hour (Survey item 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 (Survey item 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 (Survey item C5).
  • 100 = Most
  • 70 = Many
  • 30 = Some
  • 0 = Few
Immediate postpartum care sub-score is the mean of the 4 item scores. The sub-score for hospitals with a valid skip for immediate skin-to-skin after Cesarean delivery was the mean of 3 items scored.
Rooming-in
Measure Explanation Scoring
Rooming-In Percent of newborns who stay in the room with their mothers for 24 hours/day (not including separation for medical reasons) (Survey item C4_a1).
  • 100: 80%+
  • 70: 50-79%
  • 30: 20-49%
  • 0: <20%
Mother-infant separation Indicates usual location of newborns during:
  • Pediatric exams/rounds (Survey item C6_a1).
  • Hearing screening (Survey item C6_a2).
  • Pulse oximetry screening (Survey item C6_a4).
  • Routine labs/blood draws/injections (Survey item C6_a5).
  • Newborn bath (Survey item 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 (Survey item C7).
  • 100 = Yes
  • 0 = No
Rooming-In sub-score is the mean of the 3 item scores.
Feeding practices
Measure Explanation Scoring
Formula- feeding of breastfed infants Percent of healthy, term breastfed newborns who are fed infant formula (Survey item 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. (Survey item 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 (Survey item E3).
  • 100 = Almost always
  • 70 = Often
  • 30 = Sometimes
  • 0 = Rarely
Feeding practices sub-score is the mean of the 3 item scores.
Feeding education and support
Measure Explanation Scoring
Formula preparation & feeding techniques Among mothers whose newborns are fed any formula, percent of mothers taught:
  • Appropriate formula feeding techniques (Survey item E4_a1).
  • How to safely prepare and feed formula (Survey item 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(Survey item E2_a1).
  • Breastfeed as often and as long as their newborn wants (Survey item E2_a5).
  • Understand the use and risks of artificial nipples and pacifiers (Survey item 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 (Survey item E2_a2).
  • Assess effective breastfeeding by observing their newborn’s latch and the presence of audible swallowing (Survey item E2_a3).
  • Assess effective breastfeeding by observing their newborn’s elimination patterns(Survey item E2_a4).
  • Hand express breast milk (Survey item E2_a6).
  • 100 = Most
  • 70 = Many
  • 30 = Some
  • 0 = Few Items scored then averaged.
Feeding education and support sub-score is the mean of the 3 item scores.
Discharge support
Measure Explanation 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 (Survey item E5_a2).
  • 100 = Yes
  • 0 = No
Post-discharge follow-up visit Scheduling of the first follow-up visit with a health care provider (Survey item 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 (Survey item E6_a1),
  • Personalized phone calls to mothers to ask about breastfeeding (Survey item E6_a2), or
  • Formalized, coordinated referrals to lactation providers in the community when additional support is needed (Survey item 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 (Survey item G5_a1),
  • Feeding bottles/nipples, nipple shields, or pacifiers (Survey item G5_a2), or
  • Coupons, discounts, or educational materials from companies that make or sell infant formula or feeding products (Survey item G5_a3).
  • 100 = No to all 3
  • 0 = Yes to any item
Discharge support sub-score is the mean of the 4 item scores.
Institutional management
Measure Explanation 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 (Survey item F4_a1).
  • Assisting with effective newborn positioning and latch for breastfeeding (Survey item F4_a2).
  • Assessment of milk transfer during breastfeeding (Survey item F4_a3).
  • Assessment of maternal pain related to breastfeeding (Survey item F4_a4).
  • Teaching hand expression of breast milk (Survey item F4_a5).
  • Teaching safe formula preparation and feeding (Survey item F4_a6).
  • 100 = 6 skills
  • 80 = 5 skills
  • 65 = 4 skills
  • 50 = 3 skills
  • 35 = 2 skills
  • 20 = 1 skill
  • 0 = 0 skills
Nurse competency assessment Assesses whether formal assessment of clinical competency in breastfeeding support and lactation management is required of nurses (Survey item 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 (Survey item G1_a1).
  • 100 = Yes
  • 0 = No
Acquisition of infant formula Indicates how your hospital acquires infant formula (Survey item 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 (Survey item G2_a1).
  • Formal assessment of staff’s clinical competency in breastfeeding support (Survey item G2_a2).
  • Documentation of prenatal breastfeeding education (Survey item G2_a4).
  • Staff to teach mothers breastfeeding techniques AND staff to show mothers how to express milk (Survey item G2_a5 / G2_a6)..
  • 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 (Survey item G2_a8 / G2_a12).
  • Staff to provide mothers with resources for support after discharge (Survey item G2_a9).
  • Placement of all newborns skin-to-skin with their mother at birth or soon thereafter (Survey item G2_a7).
  • The option for mothers to room-in with their newborns (Survey item G2_a11).
  • 100 = Yes
  • 0 = No Final score is an average of the 8 scores.‡
Institutional management sub-score is the 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: Sub-scores 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 sub-score is missing.
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Content Source:
National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP)