Scoring Algorithm

mPINC Scoring Algorithm
Mean of 6
subscores

Overall Maternity Practices Score (Total Score)
IMMEDIATE POSTPARTUM CARE
Measure

Explanation

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.

Survey item

C1_a1
C1_a2

C2_a1
C2_a2

. . .if breastfeeding, until the first breastfeeding is completed.
. . .if not breastfeeding, for at least one hour.

Transition

Monitoring
following birth

Percent of vaginally-delivered newborns separated from their mothers
before starting rooming-in.

Percent of newborns who receive continuous observed monitoring
throughout the first two hours immediately following birth.

100 = Most
70 = Many
30 = Some
0 = Few
Items scored then
averaged.

C3

100 = Few
70 = Some
30 = Many
0 = Most OR Not
an Option

C5

100 = Most
70 = Many
30 = Some
0 = Few

Immediate Postpartum Care Subscore
†The

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 . . .

Scoring

subscore for hospitals with a valid skip for immediate skin-to-skin after Cesarean delivery was the mean of 3 items scored.

Mean of the 4
item scores†

ROOMING-IN
Measure

Rooming-In

Explanation

Percent of newborns who stay in the room with their mothers for 24
hours/day (not including separation for medical reasons).

Survey item

Scoring

C4_a1

100: 80%+
70: 50-79%
30: 20-49%
0: <20%

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

C7

100 = Yes
0 = No

Indicates usual location of newborns during. . .
Mother-infant
separation

Rooming-in
safety

. . .pediatric exams/rounds.
. . .hearing screening.
. . . pulse oximetry screening.
. . .routine labs/blood draws/injections.
. . .newborn bath.

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.

Mean of the 3
item scores

Rooming-In Subscore

FEEDING PRACTICES
Measure

Explanation

Formulafeeding of
breastfed
infants

Percent of healthy, term breastfed newborns who are fed infant formula.

Glucose
monitoring

Indicates whether your hospital performs routine blood glucose monitoring
of full-term healthy newborns NOT at risk for hypoglycemia.

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.

Feeding Practices Subscore

Survey item

Scoring

D3_A1

100=<20%
70=20-49%
30=50-79%
0=80% +

D5

100 = No
0 = Yes

E3

100 = Almost
always
70 = Often
30 = Sometimes
0 = Rarely

Mean of the 3
item scores

FEEDING EDUCATION & SUPPORT
Measure

Formula
preparation &
feeding
techniques

Explanation

Among mothers whose newborns are fed any formula, percent of mothers
taught. . .
. . .appropriate formula feeding techniques.
. . .how to safely prepare and feed formula.

Survey item

E4_A1
E4_A2

. . .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

. . .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 & Support Subscore

100 = Most
70 = Many
30 = Some
0 = Few
Items scored then
averaged.

Percent of breastfeeding mothers who are taught or shown how to. . .
Identify/solve
breastfeeding
problems

100 = Most
70 = Many
30 = Some
0 = Few
Items scored then
averaged.

Percent of breastfeeding mothers who are taught or shown how to . . .
Feeding cues &
Pacifiers

Scoring

E2_A2
E2_A3
E2_A4
E2_A6

100 = Most
70 = Many
30 = Some
0 = Few
Items scored then
averaged.

Mean of the 3
item scores

DISCHARGE SUPPORT
Measure

Pre-discharge
criteria

Explanation

Indicates whether your hospital's discharge criteria for breastfeeding
newborns requires . . .

Survey item

Scoring

E5_a2

100 = Yes
0 = No

E5_a3

100 = Yes
0 = No

E6_a1
E6_a2
E6_a3

100 = Yes to any
0 = No to all 3

G5_A1
G5_A2
G5_A3

100 = No to all 3
0 = Yes to any item

. . . direct observation of at least one effective feeding within the 8 hours
prior to discharge.
Post-discharge
follow-up visit

. . . scheduling of the first follow-up visit with a health care provider.

Indicates whether your hospital's routine discharge support to breastfeeding
mothers includes:
Post-discharge
breastfeeding
support

Distribution of
infant formula
or formularelated
supplies/
coupons as
gifts

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.
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 Subscore

Mean of the 4
item scores

INSTITUTIONAL MANAGEMENT
Measure

Explanation

Survey item

Scoring

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

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

Indicated whether your hospital records/tracks exclusive breastfeeding
throughout the entire hospitalization.

G1_a1

Indicates which competency skills are required of nurses:
Placement and monitoring of the newborn skin-to-skin with the mother
immediately following birth.
Nurse skill
competency

Nurse
competency
assessment
Documentation
of exclusive
breastfeeding

Acquisition of
infant formula

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.

Indicates how your hospital acquires infant formula.

100 = Yes
0 = No

G4_a1

100 = Pays fair
market price
0 = Receives free
OR
Unknown/Unsure

G2_a1
G2_a2
G2_a4

100 = Yes
0 = No

Indicates whether your hospital has a policy requiring. . .

Written
policies

. . .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.

Institutional Management Subscore
‡

G2_a5 / G2_a6
G2_a8 / G2_a12

G2_a9
G2_a7
G2_a11

Final score is an
average of the 8
scores.‡

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.