Form 0920-0743 mPINC Hospital Survey- English

mPINC 2026

Form Pending Approval

OMB #0920-0743

Exp. Date: MM/DD/YYYY

2026

System use notification:

This warning banner provides privacy and security notices consistent with applicable federal laws, directives, and other federal guidance for accessing this Government system, which includes all devices/storage media attached to this system. This system is provided for Government-authorized use only. Unauthorized or improper use of this system is prohibited and may result in disciplinary action and/or civil and criminal penalties. At any time, and for any lawful Government purpose, the government may monitor, record, and audit your system usage and/or intercept, search and seize any communication or data transiting or stored on this system. Therefore, you have no reasonable expectation of privacy. Any communication or data transiting or stored on this system may be disclosed or used for any lawful Government purpose.

Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing burden to CDC, Reports Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30329, ATTN: PRA (0920-0743). Do not send the completed form to this address.

About the Maternity Practices in Infant Nutrition and Care (mPINC)™ trademark: The mPINC trademark (word and logo) are owned by the U.S. Department of Health and Human Services in the United States. An organization’s participation in CDC’s mPINC survey does not imply endorsement by the U.S. Department of Health and Human Services or the Centers for Disease Control and Prevention.

About the mPINC survey:

The Centers for Disease Control and Prevention (CDC) invites you to participate in a national survey of infant feeding practices at hospitals in the United States and Territories that provided maternity care in the past year. Your participation helps to provide a more complete picture of maternity care practices in the United States and Territories. If your hospital provided maternity care at multiple locations, only report data for the specific physical location listed in your email invitation.

Your participation in the survey is completely voluntary.

Prior to submitting the survey, you will have the opportunity to provide your business contact information and business contact information for others at your hospital to receive an electronic copy of your hospital’s results. Providing contact information is voluntary.

How long will this survey take to complete?

The survey will take about 30 minutes to complete.

How will this information be used?

The purpose of this survey is to learn about specific maternity care practices that affect how babies are fed at hospitals in the United States and Territories. After data collection is complete and data analysis has ended, your hospital will receive a private individualized report containing a summary of survey results. Data from all participating hospitals will be used to generate state, regional, and national reports. Information from this survey will assist CDC with program planning.

Are our survey responses kept private?

CDC will keep the information that you provide private and secure to the extent permitted by law.

Upon request, data with hospital identifiers (i.e., hospital name and address) may be shared under a data use agreement with applicable state, tribal, local, and territorial health departments for the development of public health programs. Data without hospital identifiers may be released under data use agreements for additional approved purposes such as answering research questions.

Your business contact information is collected to provide your hospital’s survey answers and private individualized report, as well as to invite your participation in future mPINC surveys or other related opportunities. Your name, hospital name, and any other personal identifiers will not be included in either oral or written presentation of survey results. Responses will only be reported in summary form (≥5 hospitals) so individual responses cannot be identified. Business contact information (i.e., name and email address) will not be shared with health departments or other data requesters.

Survey Instructions:

Thank you for participating in this survey. You have been identified as the survey recipient for your hospital, which means that you have been given a unique link to submit the 2026 mPINC survey for your hospital. No single person may be best able to answer all the survey questions, so we encourage the person completing the survey to share this survey link and obtain input from other key personnel, as needed.

We are asking you to fill out the survey with data from the 2025 calendar year (January 1, 2025 – December 31, 2025) or your hospital’s fiscal year 2025. Unless otherwise specified, questions on the survey are asking about healthy newborns who are discharged to home (i.e., not transferred or admitted to the Special Care Nursery (SCN) or Neonatal Intensive Care Unit (NICU)).

This survey contains 6 core sections and an additional section for hospitals with an SCN or NICU. Each section should be completed by the most knowledgeable and appropriate staff. An email has been sent to [screened_email] with unique links to each section of the 2026 mPINC survey. You may wish to distribute these links to the staff member who is the most knowledgeable and appropriate to complete the section of the survey. For example, the Mother-Baby Unit supervisor may be better able to answer one section, while the Lactation Services coordinator or NICU nurse manager may be better able to complete another section. See the list below for a list of people who may be helpful with completing different sections of the survey.

Titles of staff who may be appropriate to fill out sections of the survey include:

Mother-Baby Unit Manager / Supervisor

Labor and Delivery Unit Manager / Supervisor

Lactation Services Coordinator / Lactation Specialist

NICU Nurse Manager

Staff Nurse

Database Manager / Coordinator

Maternal and Child Health Physician Leaders

Some questions ask you to enter exact percentages; however, if your hospital does not formally track this information, please provide your best estimate.

Click here to download a blank copy of the survey. This version should only be used as a worksheet to record responses prior to entering and submitting them online. No paper copies of the survey will be accepted.

You may wish to work on this survey over a period of time, particularly if it will be completed by multiple staff. Your responses will only be saved after you have clicked Save and Return Later or Complete Section at the bottom of the page. If you cannot complete the survey all at one time, click Save and Return Later. To protect the privacy of your hospital’s information, please use only official hospital email addresses. Note that if you and another person at your hospital are simultaneously responding to the same section of the survey, the last person to save the section will overwrite the responses of the other person. For this reason, we recommend clearly delineating who will respond to each section(s). You may return and edit each section until you affirm that you are finished at the end of the survey and click Submit.

Survey Tips:

• Move between sections of the survey by clicking the Survey Queue at the upper right of the page and clicking Begin survey on the section of your choosing.

• After completing a section, move to the next one by clicking Complete Section.

• Do not click on your browser's back or forward button while taking the survey.

• Click here to download/print a blank copy of the survey.

What to do if you have questions:

If you have any questions about the survey, please contact [email protected].

What to do when you have completed the survey:

When you are ready to submit, please affirm that you are finished in Section H and click Submit. You will be directed to a screen thanking you for your submission. This action will send the survey to a secure database. Once you have submitted the survey, you will not be able to return to it. It is important to remember to click Submit at the end of the last survey section to complete the submission process and ensure you receive a hospital report.

Once you have submitted the survey, you will be sent a copy of your responses to the email address you provide. Once data analysis has ended, your hospital will receive a private individualized report containing a summary of survey results.

Thank you for your contribution!

SURVEY ITEMS

Hovers, skip patterns, & notes

SECTION A: Hospital Data

This section is about deliveries and general hospital information.

A1

What type of facility is your hospital? (select 1 option only)

• government (public, non-military) hospital

• non-profit, private hospital

• for profit, private hospital

• military hospital

Programming note: This should be a drop-down menu

A3

Is your hospital currently designated as “Baby-Friendly” by the Baby-Friendly Hospital Initiative (BFHI)?

YES
NO

A5

YES
NO
Not Sure

Do 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_0

Does the prenatal breastfeeding education provided by your hospital and/or a hospital-affiliated clinic or service…

	Yes	No	Not sure
Describe the health benefits of breastfeeding for women and their infants as compared with the outcomes experienced by those using infant formula?
Use electronic medical record prompts to improve the consistency of the support and education provided?
Integrate lactation consultants and clinicians skilled in breastfeeding into prenatal care?

Programming note: A5_0 will only be asked of hospitals who respond “Yes” to A5.

Complete the following item using data from the past calendar or fiscal year:

A6

[Total live births]: ____________

Total number of live births includes vaginal and Cesarean (C-Section) deliveries. For multiples, count each newborn as a separate live birth.

A8_0a

What percent of all newborns receive [vitamin K prophylaxis]?

	Enter %	Select one
Intramuscular administration of vitamin K	_____ %	Actual Estimate
[Oral administration] of vitamin K	_____ %	Actual Estimate
No vitamin K administered	_____ %	Actual Estimate
Total sums to 100%	100%

Vitamin K prophylaxis: Per the American Academy of Pediatrics (AAP), vitamin K should be administered to all newborn infants weighing >1500 g as a single, intramuscular dose of 1 mg within 6 hours of birth. Preterm infants weighing ≤1500 g should receive a vitamin K dose of 0.3 mg/kg to 0.5 mg/kg as a single, intramuscular dose.

Oral administration: Per the AAP, parents who refuse IM vitamin K prophylaxis and request an oral dosing regimen should be aware of the increased risks of late-onset Vitamin K Deficiency Bleeding.

Programming notes: allow for two decimal places.

If the respondent enters values that do not total to 100%, the screen will say, “Total should equal 100%.”

A8_0b

If parents/caregivers refuse vitamin K prophylaxis, how often do staff [counsel] them about the risks of Vitamin K Deficiency Bleeding?

No parents/ caregivers have refused	Rarely or never	Sometimes	Often	Almost always

Counsel: Because Vitamin K Deficiency Bleeding remains a relatively rare occurrence, most families are unaware of the serious consequences of the disease and must be counseled on the risk of refusal. The American Academy of Pediatrics (AAP) has a Vitamin K Information Sheet that may be useful to providers in their discussions with families.

A9

Throughout their hospital stay, what percent of healthy newborns are fed the following?

	Enter %	Select one
[ONLY breast milk]	_____ %	Actual Estimate
Breast milk AND any formula, water, or glucose water	_____ %	Actual Estimate
No breast milk	_____ %	Actual Estimate
Total sums to 100%	100%

[ONLY breast milk]:

• no water or formula at any time during hospitalization

• no glucose water or sucrose solution except for during painful procedures

• can include donor human milk

Programming note: If the respondent enters values that do not total to 100%, the screen will say, “Total should equal 100%.”

A10

Did your hospital provide [pasteurized donor human milk] to newborns in Level I care (not in a special care nursery or neonatal intensive care unit)?

Yes	No, available in hospital but not provided in Level I	No, not available at our hospital

Pasteurized donor human milk: breast milk that was donated to a milk bank. This refers to base milk regardless of fortifier; this does not include mother’s own milk, even that which is fortified with a human milk-based fortifier

Although most of the survey is about early postpartum care practices for healthy mother-baby dyads, the following items address a special population of newborns.

A11_0a

In the past year, has your hospital cared for ANY newborns diagnosed with [Neonatal Abstinence Syndrome (NAS)] sometimes referred to as Neonatal Opioid Withdrawal Syndrome (NOWS)? Check one.

• No, we did not have any newborns born in our hospital who were diagnosed with NAS/NOWS (skip to B1)

• No, all newborns with NAS/NOWS born in our hospital were transferred to another facility (skip to B1)

• Yes (proceed to A11_0b)

Neonatal Abstinence Syndrome (NAS): A newborn with confirmed or suspected in utero exposure to opioids, benzodiazepines, or barbiturates. Please see the “CSTE Neonatal Abstinence Syndrome Standardized Case Definition.”

A11_0b

In the past year, our hospital cared for approximately the following number of newborns diagnosed with NAS/NOWS:

1-25	26-50	51-100	101-200	>200

Neonatal Abstinence Syndrome (NAS): A newborn with confirmed or suspected in utero exposure to opioids, benzodiazepines, or barbiturates. Please see the “CSTE Neonatal Abstinence Syndrome Standardized Case Definition.”

A11

How many newborns diagnosed with NAS/NOWS. . .

					Not Applicable (no NICU/[PICU] at our hospital)
. . .are breastfed or provided with expressed mother’s own milk, if not [contraindicated]?
. . .are fed [as often and as long] as the newborn wants, [without restrictions]?
. . .are [rooming-in]?
. . .are cared for in your hospital’s Intensive Care Unit (NICU or [PICU])?
. . .practice [skin-to-skin contact] or [Kangaroo Care] outside of the immediate postpartum period?

Contraindicated: See Academy of Breastfeeding Medicine protocols (e.g., Protocol #21)

As often and as long: Also known as 'cue-based' or 'on-demand' feeding.

Without restrictions: Without setting a schedule for how long or how much baby should be fed and/or the amount of time that should pass between feeds.

Rooming-in is a practice where mother and newborn are in close proximity.

PICU: Pediatric intensive care unit

Skin-to-skin contact: The naked newborn is placed directly on the mother’s bare chest or abdomen (with or without a diaper).

Kangaroo Care refers to skin-to-skin care where a newborn, often premature, is placed prone directly on the mother’s, father’s, or other’s bare chest or abdomen. The caregiver is then wrapped in a blanket or other cloth to secure the newborn against his or her chest.

A12

Are the following included in a written policy/protocol about management of NAS/NOWS at your hospital?

	Yes	No
Verbal screening for maternal substance use (e.g., asking in the medical history)
Neonatal toxicology screening for maternal substance use (e.g., urine, meconium, blood, hair)
Maternal toxicology screening for maternal substance use (e.g., urine, blood, hair)
Use of a standardized assessment to evaluate NAS/NOWS (e.g., Eat, Sleep, Console (ESC), modified Finnegan’s)
Breastfeeding or provision of expressed mother’s own milk as a recommended nonpharmacological treatment of NAS/NOWS, if not [contraindicated]
[Rooming-in] as a recommended nonpharmacological treatment of NAS/NOWS
[Skin-to-skin contact] or [Kangaroo Care] outside of the immediate postpartum period as a recommended nonpharmacological treatment of NAS/NOWS
Pharmacologic treatment of NAS/NOWS

Contraindicated: See Academy of Breastfeeding Medicine protocols (e.g., Protocol #21)

Rooming-in is a practice where mother and newborn are in close proximity.

Skin-to-skin contact: The naked newborn is placed directly on the mother’s bare chest or abdomen (with or without a diaper).

Kangaroo Care refers to skin-to-skin care where a newborn, often premature, is placed prone directly on the mother’s, father’s, or other’s bare chest or abdomen. The caregiver is then wrapped in a blanket or other cloth to secure the newborn against his or her chest.

A13
Which NAS/NOWS scoring/assessment system does your hospital primarily use? Check one.

Finnegan’s
Modified Finnegan’s
Neonatal Withdrawal Inventory (NWI)
Eat, Sleep, Console (ESC) Approach
ESC NOWS Care Tool
None
Other: ____________
Unknown (not specified)

Programming note: Only one option can be selected; “Other” should have an open text field for write-ins

SECTION B: SPECIAL CARE NURSERY (SCN) AND / OR NEONATAL INTENSIVE CARE UNIT (NICU)

This section is about practices in your hospital’s SCN and / or NICU. The primary contact should consult with an SCN or NICU colleague before answering these questions.

B1

What is the highest [level of neonatal care] provided at your hospital?

The remaining questions in Section B only apply if your hospital has Level II-Level IV neonatal care.

Level I: Care for low-risk newborns, which can include a wellborn nursery
Level II: Special care nursery
Level III: Neonatal Intensive Care Unit
Level IV: Regional Neonatal Intensive Care Unit

Level of neonatal care: classification of neonatal care as defined by the American Academy of Pediatrics (AAP). Please see AAP’s policy statement, “Levels of Neonatal Care.”

This section is only available to those who have a Level 2-4 SCN or NICU from item B1. If Level 1 is selected for B1, the remaining items in Section B are skipped.

B2

How many mothers with infants in your hospital’s SCN or NICU . . .

. . .are advised to provide human milk as a component of their infant’s medical care?
. . .are advised to breastfeed or express their milk 8 or more times every 24 hours to establish and maintain their milk supply?
. . .have access to their infants whenever they want?

B2_0

How many breastfeeding mothers with infants in your hospital’s SCN or NICU . . .

. . .are provided guidance and support with expressing their milk within the first 6 hours after birth?
. . .are shown techniques or are given written instruction for using breast pump equipment?
. . .are shown techniques or are given written instruction for cleaning breast pump equipment?

Within the first 6 hours, but preferably within 1-2 hours after birth and completion of initial skin-to-skin contact—if safe and medically feasible.

B3

Among SCN/NICU infants eligible for [Kangaroo Care], how many practice Kangaroo Care?

Not offered at our hospital	Few (0-19%)	Some (20-49%)	Many (50-79%)	Most (80% +)

Kangaroo Care refers to skin-to-skin care where an infant, often premature, is placed prone directly on the mother's, father's, or other's bare chest or abdomen. The caregiver is then wrapped in a blanket or other cloth to secure the infant against his or her chest.

B4

What percent of infants are receiving their mother’s own breast milk at any time in the SCN/NICU?

Few (0-19%)	Some (20-49%)	Many (50-79%)	Most (80% +)

B5

Did your hospital provide any [pasteurized donor human milk] to infants while they were cared for in your hospital’s SCN/NICU?

	Yes	No, available but not provided	No, not available at our hospital
Infants <1500 grams at birth
Infants ≥ 1500 grams at birth

Pasteurized donor human milk: breast milk that was donated to a milk bank. This refers to base milk regardless of fortifier; this does not include mother’s own milk, even that which is fortified with a human milk-based fortifier.

B5_0

What barriers exist in providing [pasteurized donor human milk], when [medically indicated], to infants whose birth weight is < 1500 grams and are cared for in your hospital’s SCN/NICU?

1. _________________________

2. _________________________

3. _________________________

• There are no barriers.

Pasteurized donor human milk: breast milk that was donated to a milk bank. This refers to base milk regardless of fortifier; this does not include mother’s own milk, even that which is fortified with a human milk-based fortifier.

Medically indicated: when mother’s own milk is not available, insufficiently available, or contraindicated.

SECTION C: CARE PRACTICES

A7

Does your hospital perform deliveries by Cesarean section?

YES
NO

Programming note: Those who enter “no” will not see any future cesarean-related items (A7a & C2)

This question is only asked of those who report “Yes” for item A7.

Complete the following item using data from the past calendar or fiscal year:

A7a

[Total live births delivered by Cesarean section]: ____________

Total number of live birth Cesarean (C-Section) deliveries that were performed at your hospital, including in the perinatal services area, an operating room, or any other location within the hospital.

This section is about early postpartum care practices for all healthy mother-baby dyads, REGARDLESS OF FEEDING METHOD. More information/supporting evidence is available here.

C2

After Cesarean-delivery, how many newborns 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?

Skin-to-skin contact: The naked newborn is placed directly on the mother’s bare chest or abdomen (with or without a diaper).

Programming note: This item is skipped if no cesareans (A7 = no)

C1

After vaginal delivery, how many newborns remain in uninterrupted [skin-to-skin contact] with their mothers beginning immediately after birth . . .

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

Skin-to-skin contact: The naked newborn is placed directly on the mother’s bare chest or abdomen (with or without a diaper).

C3

How many vaginally-delivered newborns are separated from their mothers [before] starting [rooming-in]?

Few (0-19%)	Some (20-49%)	Many (50-79%)	Most (80% +)	Rooming-in is not an option at our hospital

Before: Prior to or during transfer from Labor / Delivery care to Postpartum / Nursery care.

Rooming-in is a practice where mother and newborn are in close proximity.

C4

What percent of newborns stay in the room with their mothers for 24 hours per day (not including those separated for medical reasons)?

Enter %	Select one
_________%	Actual Estimate

C5

How many newborns receive continuous [observed monitoring] throughout the first two hours immediately following birth?

Observed monitoring includes for positioning, color, and breathing.

C6

Where are newborns usually located during each of the following situations? Click one location per situation. For situations addressed in multiple locations in your hospital, choose the most frequently used location.

	Mother's Room	Nursery, procedure room, or newborn observation unit
Pediatric exams/rounds
Hearing screening
Pulse oximetry screening (congenital heart defect screening)
Routine labs/blood draws/injections
Newborn bath

C7

Does your hospital have a protocol that requires frequent observations of [high-risk] mother-infant dyads by nurses to ensure safety of the infant while they are together?

YES
NO

Examples of high-risk include: low Apgar scores, late preterm, infants who required resuscitation, difficult delivery, or medications given to the mother that may make her drowsy or sedated or affect the newborn.

SECTION D: FEEDING PRACTICES

This section is about infant feeding practices for healthy BREASTFED newborns.

D3

What percent of healthy, [term] breastfed newborns are fed any of the following?

	Enter %	Select one
Infant formula	_____ %	Actual Estimate
Water or glucose water Do not include the use of glucose water for painful procedures – e.g. circumcision – in your response.	_____ %	Actual Estimate
Not expected to sum to 100%

Term: 37 0/7 to 41 6/7 weeks gestation

D4_a

Among healthy breastfed newborns who are supplemented with formula during the hospital stay, what percent are medically indicated?

	Enter %	Select one
[Medically indicated]	_____ %	☐ Actual ☐ Estimate
[Not medically indicated]	_____ %

Percentages should add to 100%.

Medically indicated: see Table 1 of ABM Clinical Protocol #3: Supplementary Feeding in the Healthy Term Breastfed Neonate for possible indications for supplementation.

Not medically indicated includes patient/parent requests for formula.

Programming note: Autopopulate the not-medically indicated section

D5

Does your hospital perform routine blood glucose monitoring of [full-term] healthy newborns who are NOT at risk for hypoglycemia?  

YES
NO

Full-term: 39 0/7 to 40 6/7 weeks gestation

SECTION E: EDUCATION AND SUPPORT OF MOTHERS

This section is about information taught to mothers and caregivers about feeding and caring for their newborn and support provided to mothers by staff.

E1

To prevent newborn adverse events (e.g., infant falls, accidental suffocation) associated with maternal sleep in the hospital, how many mothers are shown by staff how to place their newborn on a separate, [safe sleep] surface or with another caregiver when the mother becomes sleepy/drowsy?

Safe sleep: infants are placed on their backs on a firm, flat, non-inclined sleep surface to reduce the risk of suffocation or wedging/entrapment and will prevent infant falls.

E2

How many breastfeeding mothers are taught or shown how to . . .

. . .recognize and respond to their newborn’s [feeding cues]?
. . .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 (i.e., urine and stool output and stool character)?
. . .breastfeed [as often and as long] as their newborn wants, [without restrictions]?
. . .hand express their breast milk?
. . .understand the [use and risks of artificial nipples and pacifiers], including delaying pacifier use until breastfeeding is well-established?

Feeding cues: Signs the baby is ready to feed, including increased alertness, flexion of the extremities, mouth and tongue movements, cooing sounds, rooting, bringing fist toward the mouth, or sucking on fingers / hand.

As often and as long: Also known as 'cue-based' or 'on-demand' feeding.

Without restrictions: Without setting a schedule for how long baby should be at the breast and/or the amount of time that should pass between feeds.

Use and risks of artificial nipples and pacifiers: hygiene, oral formation, and recognition of feeding cues.

E3

When breastfeeding mothers request infant formula, how often do staff counsel them about the possible consequences to the health of their infant and the success of breastfeeding?

RARELY	SOMETIMES	OFTEN	ALMOST ALWAYS
(0-19%)	(20-49%)	(50-79%)	(80% +)

E4

Among mothers whose newborns are fed any formula, how many are taught . . .

. . .appropriate [formula feeding techniques]?
. . .how to [safely prepare and feed] formula?

Formula feeding techniques: Feeding in response to hunger cues and holding the baby closely during the feed, allowing for eye-to-eye contact.

Safely prepare and feed: Instructions for mixing, handling, and storing infant formula.

E5

Do your discharge criteria for breastfeeding newborns require. . .

	YES	NO
. . . direct observation of at least one effective feeding at the breast within the 8 hours prior to discharge?
. . . scheduling of the first follow-up visit with a health care provider?

E6

What discharge support does your hospital routinely provide to breastfeeding mothers?

	Yes	No
[In-person follow-up visits/appointments for lactation support]
Personalized phone calls to mothers to ask about breastfeeding (not automated calls)
[Formalized, coordinated referrals to lactation support providers in the community when additional support or follow-up is needed]
Virtual breastfeeding support consultations (e.g., telehealth consults)

In-person follow-up visits:

Breastfeeding assessments, support, and weight checks at a post-discharge home, hospital, clinic, or office visit; breastfeeding-specific support group in a hospital wellness center

Formalized, coordinated referrals:

Scheduling an appointment on the mother’s behalf with a lactation support provider, WIC peer counselor, or home visiting program; providing a referral for insurance coverage; providing access to lactation support via interactive smartphone app or other online/remote support; writing a prescription for lactation support.

SECTION F: STAFFING

This section is about maternity-care staff and providers who work in your maternity-care unit, as well as staff and provider responsibilities and training.

F3

How often are nurses [formally assessed] for clinical competency in breastfeeding support and lactation management?

At least every 2 years
Less frequently than every 2 years
Not required

Formally assessed: Systematic evaluation of staff’s hands-on ability to support breastfeeding mothers, and may include demonstration of competency at an annual skills lab or observation by a lactation specialist.

F4

Are nurses required to demonstrate competency in the following skills?

	Yes	No
Placement and monitoring of the newborn in [skin-to-skin contact] 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
Counseling the parents/caregivers on [safe sleep] practices for their newborn while [rooming in] at the hospital
Counseling the mother on the importance of exclusive breastfeeding

Skin-to-skin contact: The naked newborn is placed directly on the mother’s bare chest or abdomen (with or without a diaper).

Safe sleep: infants are placed on their backs on a firm, flat, non-inclined sleep surface to reduce the risk of suffocation or wedging/entrapment and prevent infant falls.

Rooming-in: a practice where mother and newborn are in close proximity.

F7

How often does your hospital require that maternity staff and providers complete [continuing education or in-service training] on breastfeeding support and lactation management?

	Staff Nurses (e.g., Registered Nurses)	Physicians*	Nurse Practitioners / Advance Practice Registered Nurses	Certified Nurse Midwives	Medical Residents
At least every 2 years
Less frequently than every 2 years
Not required
We don't have this type of provider

 *Physicians: Obstetricians, Pediatricians, Family Practice Physicians

Participation in educational and training activities that improve the care that is provided to mothers and infants.

SECTION G: POLICIES AND PROCEDURES

This section is about hospital policies and procedures.

G1

Does your hospital…

	YES	NO
…record (keep track of) [exclusive breastfeeding] throughout the entire hospitalization?
…have an ongoing monitoring and data-management system that is used for quality improvement related to practices that support breastfeeding?

Exclusive breastfeeding is defined as ONLY breast milk:

• no water or formula at any time during hospitalization

• no glucose water or sucrose solution except for during painful procedures

• can include donor human milk

G2

Which of the following are included in a written policy (or policies) at your hospital?

		Yes	No
Policy requiring…	documentation of medical justification and/or informed parental consent for giving [non breast milk feedings] to breastfed newborns
	formal assessment of staff’s clinical competency in breastfeeding support
	formal, in-service, breastfeeding-related staff training
	documentation of prenatal breastfeeding education
	staff to teach mothers breastfeeding techniques, including how to manage common difficulties
	staff to show mothers how to express breast milk
	placement of newborns in [skin-to-skin contact] with their mother at birth or soon thereafter
	purchase of infant formula and related breast milk substitutes by the hospital at fair market value
	staff to provide mothers with resources for breastfeeding support after discharge
	staff to teach parents/caregivers about strategies for [safe sleep] while [rooming-in] at the hospital
	the option for mothers to room-in with their newborns
	staff to teach mothers to breastfeed [as often and as long] as their newborn wants, [without restrictions]
	staff to counsel parents/caregivers on the use and risks of feeding bottles, nipples, and pacifiers, including delaying pacifier use until breastfeeding is well-established
	staff to counsel parents/caregivers on the risks of Vitamin K Deficiency Bleeding for families who decline the intramuscular vitamin K prophylaxis?
Policy prohibiting…	distribution of marketing/education materials, samples, or gift packs by the facility that include or promote breast milk substitutes (infant formula), infant feeding supplies, or infant formula coupons

Non breast milk feedings: formula, water, glucose water.

Skin-to-skin contact: The naked newborn is placed directly on the mother’s bare chest or abdomen (with or without a diaper).

Safe sleep: infants are placed on their backs on a firm, flat, non-inclined sleep surface to reduce the risk of suffocation or wedging/entrapment and will prevent infant falls.

Rooming-in is a practice where mother and newborn are in close proximity.

As often and as long: Also known as ‘cue-based’ or ‘on-demand’ feeding.

Without restrictions: Without setting a schedule for how long baby should be at the breast and/or the amount of time that should pass between feeds.

Counsel: Because Vitamin K Deficiency Bleeding remains a relatively rare occurrence, most families are unaware of the serious consequences of the disease and must be counseled on the risk of refusal. The American Academy of Pediatrics (AAP) has a Vitamin K Information Sheet that may be useful to providers in their discussions with families.

G3

How many health care providers who have any contact with pregnant women, mothers, and/or newborns have been oriented on the hospital’s infant feeding policies?

Our hospital does not have written policies related to infant feeding practices.	Few (0-19%)	Some (20-49%)	Many (50-79%)	Most (80% +)

G4

How does your hospital acquire each of the following:

	HOSPITAL PURCHASES at [fair market price]	HOSPITAL RECEIVES below fair market price or free of charge
Infant formula
Bottles, nipples, pacifiers

Fair market price: Consistent with hospital-wide vendor policy.

G5

Does your hospital give mothers any of the following items free of charge, as gifts or free samples (not including items prescribed as part of medical care)?

	Yes	No
Infant formula (including formula discharge packs)
Feeding bottles, bottle nipples, nipple shields, or pacifiers
Coupons, discounts, or educational materials from companies that make or sell infant formulas or feeding products.

G6

How does your hospital certify compliance with Centers for Medicaid & Medicare Services (CMS) health and safety standards? Check one.

ACCREDITATION by a national accreditation organization	Accreditation Commission for Health Care (ACHC)
	Center for Improvement in Healthcare Quality (CIHQ)
	Det Norske Veritas Healthcare (DNV Healthcare)
	The Joint Commission (TJC)
CERTIFICATION by a State Survey Agency
NOT APPLICABLE (not approved as a CMS Provider)
DON’T KNOW

SECTION H: EXIT / COMPLETION

H1

Select the positions or titles of the people who have participated in completing this survey, including your own. Click all that apply.

Mother-Baby Unit Manager / Supervisor
Labor and Delivery Unit Manager / Supervisor
Maternity Care Services Director / Manager
Lactation Services Coordinator
Lactation Care Provider (i.e., IBCLC, CLC, CBC)
Clinical Nurse Specialist
Director of Obstetrics and Gynecology
Director of Perinatal Care
Director of Pediatrics
Medical Director
NICU Nurse Manager
Staff physician
Staff midwife
Staff nurse
Database Manager / Coordinator
Other: _____________
I prefer not to answer

Programming note: Write in option for “other”

H2

Business contact information for mPINC reports

We would like to email you a copy of your hospital’s survey answers and, once data analysis has ended, a private individualized hospital report containing a summary of survey results. Please enter the name, hospital position, and official hospital email address of up to three people at your hospital so that we may email these items to you. To protect the privacy of your hospital’s information, please do not provide personal email addresses (e.g., Yahoo, Gmail, Hotmail). Business contact information is collected to provide your hospital’s survey answers and individualized report, as well as to invite your participation in future surveys.

Survey Recipient Name	Position	Email

H3

Comments

Free text

Thank you for your time!

5