Introduction to mPINC

In the U.S., nearly all infants are born in a hospital or free-standing birth center. Their stay is typically very short, but events during this time have lasting effects. Many of the experiences of mothers and newborns in the hospital affect breastfeeding.

In most cases, these experiences reflect routine practices at the facility level, and patients rarely request care different from that offered them by health professionals. Experiences with breastfeeding in the first hours and days of life significantly influence an infant’s later feeding. Due to its inextricable relationship with the birth experience, breastfeeding must be established during the maternity hospital stay, not postponed until the infant goes home.

A Cochrane review¹ found that institutional changes in maternity care practices effectively increases breastfeeding initiation and duration rates. Birth facilities that have achieved designation as part of the World Health Organization/UNICEF Baby-Friendly Hospital Initiative (BFHI)² typically experience an increase in breastfeeding rates.³ In addition, DiGirolamo et al.⁴ found a relationship between the number of Baby-Friendly   steps (included in the Ten Steps to Successful Breastfeeding   of BFHI) in place at a birth facility and a mother’s breastfeeding success. The authors found that mothers experiencing none of the Ten Steps to Successful Breastfeeding   required for BFHI designation during their stay were eight times as likely to stop breastfeeding before 6 weeks as those experiencing six steps.

Key areas to intervene to improve breastfeeding outcomes. Formative research has revealed that although most hospital administrators and staff agree that breastfeeding provides optimal nutrition for most infants, breastfeeding is not as widely recognized as a significant public health issue that it needs to be, and many remain unaware of the specific characteristics of a supportive hospital environment. Additionally, despite recognizing the demand for evidence-based health care, many do not accurately identify current non-evidence-based routine hospital practices.

Supportive Hospital Practices
Birth facility policies and practices that create a supportive environment for breastfeeding begin prenatally and continue through discharge, and include:

• Skin-to-skin contact – Doctors and midwives place newborns skin-to-skin with their mothers immediately after birth, with no bedding or clothing between them, allowing enough uninterrupted time (at least 30 minutes) for mother and baby to start breastfeeding well.
• Teaching about breastfeeding – Hospital staff teach mothers and babies how to breastfeed and to recognize and respond to important feeding cues.
• Early and frequent breastfeeding – Hospital staff help mothers and babies start breastfeeding as soon as possible after birth, with many opportunities to practice throughout the hospital stay. Pacifiers are saved for medical procedures.
• Exclusive breastfeeding – Hospital staff only disrupt breastfeeding with supplementary feedings in cases of rare medical complications.
• Rooming-in – Hospital staff encourage mothers and babies to room together and teach families the benefits of this kind of close contact, including better quality and quantity of sleep for both and more opportunities to practice breastfeeding.
• Active follow-up after discharge – Hospital staff schedule in-person breastfeeding follow-up visits for mothers and babies after they go home to check-up on breastfeeding, help resolve any feeding problems, and connect families to community breastfeeding resources.

CDC’s mPINC Survey

In October, 2003, an expert panel of researchers with specific experience in surveillance and monitoring of hospital practices related to breastfeeding convened by CDC recommended establishment of an ongoing, national system to monitor and evaluate hospital practices related to breastfeeding among all facilities that routinely provide intrapartum care in the United States.

In 2007, CDC administered the first national survey of maternity care practices related to breastfeeding (OMB # 0920-0743) to every facility in the U.S. that routinely provides maternity care services. Known as the Maternity Practices in Infant Nutrition and Care (mPINC) Survey, this survey is a national census of facilities routinely providing maternity care. One individual completes the mPINC survey on behalf of his or her institution in their capacity as the person most knowledgeable about the relevant practices.

The initial survey established baseline measures of practices in place at intrapartum care facilities across the United States and Territories, and the extent to which practices vary by state. It has been administered every other year thereafter in order to monitor and examine changes in practices over time. Information from the surveys helps inform intrapartum care facilities, state public health departments, and CDC programs.

The mPINC Survey is a key element of CDC’s coordinated activities addressing maternity care practices and policies as they relate to breastfeeding outcomes. This multifaceted and collaborational approach also includes publication of scientific articles on the survey findings, presenting findings at national conferences, prioritizing interventions in the hospital setting as evidence-based strategies to improve breastfeeding in CDC funding opportunities, technical assistance on improving hospital practices, publication of resources highlighting the maternity care setting as an intervention area, and funding extramural projects to identify and evaluate specific new approaches to improve hospital practices related to breastfeeding. For more information, visit www.cdc.gov/mpinc

References

1. Fairbank L, O’Meara S. Renfrew MJ, Woolridge M, Snowden AJ, Lister-Sharp D. A systematic review to evaluate the effectiveness of interventions to promote the initiation of breastfeeding. Health Technology Assessment 2000;4(25):1-171.
2. World Health Organization/UNICEF. Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services. A joint WHO/UNICEF statement. Geneva: World Health Organization, 1989.
3. Philipp BL, Merewood A, Miller LW, et al. Baby Friendly Hospital Initiative improves breastfeeding initiation rates in a U.S. hospital setting. Pediatrics 2001;108(3):677-81.
4. DiGirolamo AM, Grummer-Strawn LM, Fein S. Effect of Maternity care practices on breastfeeding. Pediatrics 2008;122(Supp 2):543-49.

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