Exclusive breastfeeding for the first 6 months, followed by continued breastfeeding for a year or more is the gold standard to ensure an infant's optimal health, growth, and neurodevelopmental outcomes (American Academy of Pediatrics, 2012). Yet, women are often not well supported even from the birth of their child to meet breastfeeding recommendations. Since 2007, the Centers for Disease Control and Prevention (CDC, 2016) has collected data from administrators who oversee maternity care in birth hospitals nationwide about breastfeeding practices using the mPINC (Maternity Practices in Infant Nutrition and Care) survey every other year (2007, 2009, 2011, 2013, and 2015). Participating hospitals receive copies of their facility's benchmark; copies are sent to the administrator/chief executive officer, obstetric and pediatric medical directors, mother-baby unit nurse manager, and chief quality improvement officer (CDC).

The survey assesses infant feeding care processes, policies, and staffing expectations in maternity care settings (CDC, 2016) by covering seven major aspects of birth hospital practices: (1) labor and birth care, (2) feeding of breastfed infants, (3) breastfeeding assistance, (4) contact between mother and infant, (5) facility discharge care, (6) staff training, and (7) structural and organization aspects of care delivery. Survey scores are available on the CDC Web site with data aggregated by state; however, individual hospital scores are not made publically available. As a speaker, who presents extensively, a question I often pose to participants in the United States is "do you know your hospital's mPINC score?" Few hands are raised and many participants often never had heard of such a survey. What if these data were publically available by hospital? Would it spur facilities to improve their practices? What if individual institutions just made the data publically available to their staff as a metric for quality improvement?

The most current scores available on the CDC Web site are from 2013; the national score is only 75 out of 100 possible points. Nationally, the two domains with the highest score are breastfeeding assistance (86/100) and feeding of breastfed infant (84/100). The labor and birth domain has a score of 80/100 and the other four areas have scores of under 80/100: mother infant contact (79/100), structural and organizational aspects (74/100), discharge care (62/100), and staff training (62/100). Clearly there is much room for improvement in birth hospital breastfeeding practices.

I am often asked "how do we know the survey data are accurate?" which is indeed a valid question, as the results are only as good as those answering the survey. Despite any potential limitations, my call to action is that hospital administrators first find out if they participated and completed the past five surveys from the CDC, then examine trends in their mPINC scores over the past 10 years and share these data with the nurses. Nurses play a critical role in lactation support and care. If nurses were informed of current practices in their institution, they could be change agents and catalysts for ensuring women receive evidence-based lactation support and care throughout the birth hospital stay.

Hospital administrators may feel overwhelmed at the amount of change that needs to occur to improve breastfeeding practices; however, quality improvement can be done over time. Focus on one of the seven areas and work with nurses to develop quality initiatives related to metrics in that area. Nurses are the key in improving birth hospital practices. Quality improvement projects are imperative so that all women can reach their personal breastfeeding goals. What is your mPINC score? What changes need to be made to improve your score?

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