Skip to main content


Measure Set

This document lists the measures for the initiative.



CheckPoint delivers reliable reports designed to support health care decisions and assist Wisconsin hospitals with quality improvement activities. To access Exclusive Breast Milk Feeding rates, select “Birth” for the measure category.


Key Driver Diagram

The diagram provides the underlying approach for the initiative.

Measure Tracking Worksheet

This document is designed to assist tracking measures.

Project Assessment Scale

This scale will be used for assessing progress in the initiative.

Team Aims Worksheet

This document provides guidance on overall aims.

WisPQC Data Terms of Use

This document is required for sharing data.

Informational Webinar

Informational Webinar

Scheduled for April 26 from 12:00-1:00 p.m.

Click here to register

Setting the Foundation

The Family Voice

Voices of Impact
The Voices of Impact video series is available through the Council on Patient Safety in Women’s Health Care. The goal of the Voices of Impact video series is to elevate the voices of women and families who have experienced severe maternal events. Putting voices to the numbers can bring awareness to this critical issue and empower women and their care providers to make a positive impact.
Voices of Impact: Irving Family’s Story

Getting Started

Always Events Toolkit

Always Events(R) are defined as those aspects of the care experience that should always occur when patients, their family members or other care partners, and service users interact with health care professionals and the health care delivery system. A one page overview is also available.

Institute for Healthcare Improvement (IHI)

The Institute for Healthcare Improvement (IHI), an independent not-for-profit organization based in Boston, Massachusetts, is a leading innovator, convener, partner, and driver of results in health and health care improvement worldwide. At its core, IHI believes everyone should get the best care and health possible. IHI has a commitment to Person- and Family-Centered Care. This page lists resources for getting started.

PDSA Worksheet

This worksheet is a component of IHI’s QI Essential Toolkit. The Plan-Do-Study-Act (PDSA) cycle is a useful tool for documenting a test of change. Use this worksheet for each change you test.

QI Project Charter

The QI Project Charter provides a rationale and roadmap for team to clarify thinking about what needs to be done and why.


Walk-throughs enable providers to understand the experience of care from the patient’s and family’s points of view by going through the experience themselves.

Addressing Disparities

Improving Health Equity: Assessment Tool for Healthcare Organizations

A resource from IHI.

Bigman G, Wilkinson AV, Pérez A, Homedes N. Acculturation and Breastfeeding Among Hispanic American Women: A Systematic Review. Matern Child Health J. 2018 Sep 1;22(9):1260–77.

Higher acculturation is inversely related to breastfeeding rates, independently of income

Butler M, Allen JA, Hoskins-Wroten J, Sanders-Bey T, Venegas RN, Webb I, et al. Structural Racism and Barriers to Breastfeeding on Chicagoland’s South Side. Breastfeeding Medicine [Internet]. 2020 Dec 14 [cited 2021 Jan 11];

Funding is increasingly competitive for community health organizations and federally qualified health centers. Institutions and agencies that receive funding or adequately allocate funding to include lactation services cannot address breastfeeding barriers within socioeconomically marginalized communities. Inconsistencies persist between breastfeeding information provided by lactation providers and delivery team care received in the hospital.

Chiang KV, Li R, Anstey EH, Perrine CG. Racial and Ethnic Disparities in Breastfeeding Initiation ─ United States, 2019. MMWR Morb Mortal Wkly Rep [Internet]. 2021 [cited 2021 Jul 27];70.

The prevalence of breastfeeding initiation was 84.1% overall and varied by maternal race/ethnicity, ranging from 90.3% among infants of Asian mothers to 73.6% among infants of Black mothers. Across states, the magnitude of disparity between the highest and lowest breastfeeding rates by racial/ethnic groups varied, ranging from 6.6 percentage points in Vermont to 37.6 percentage points in North Dakota, as did the specific racial/ethnic groups with the highest and lowest rates.

Griggs KM, Waddill CB, Bice A, Ward N. Care During Pregnancy, Childbirth, Postpartum, and Human Milk Feeding for Individuals Who Identify as LGBTQ+. MCN: The American Journal of Maternal/Child Nursing. 2021 Feb;46(1):43–53.

To meet the needs of sexual and/or gender groups, it is important that nurses use strategies focused on promoting respectful, affirming care, reducing negative experiences, and eliminating marginalizing language and practices.

Mercier RJ, Burcher TA, Horowitz R, Wolf A. Differences in Breastfeeding Among Medicaid and Commercially Insured Patients: A Retrospective Cohort Study. Breastfeed Med. 2018 May;13(4):286–91.

Among patients delivering at an urban academic hospital, women on Medicaid were significantly less likely to breastfeed than those with private insurance.

Robinson K, Fial A, Hanson L. Racism, Bias, and Discrimination as Modifiable Barriers to Breastfeeding for African American Women: A Scoping Review of the Literature. Journal of Midwifery & Women’s Health. 2019;64(6):734–42.

Racism, bias, and discrimination are modifiable barriers that adversely affect breastfeeding among African American women. (The authors are from Marquette University, Milwaukee, WI.)

Safon CB, Heeren T, Kerr S, Corwin M, Colson ER, Moon R, et al. Racial and Ethnic Disparities in Breastfeeding Continuation Among U.S. Hispanic Mothers: Identification of Mechanisms. Breastfeed Med. 2023 Jan;18(1):3–13.

Breastfeeding continuation among U.S. Hispanic mothers varied by birth country, highlighting the heterogeneity of breastfeeding populations of Hispanic mothers in the United States. Tailored interventions should strengthen policies supportive of positive attitudes toward and subjective norms around breastfeeding.

Safon CB, Heeren TC, Kerr SM, Clermont D, Corwin MJ, Colson ER, et al. Disparities in Breastfeeding Among U.S. Black Mothers: Identification of Mechanisms. Breastfeeding Medicine. 2021 Feb 1;16(2):140–9.

Among Black mothers in the United States, breastfeeding continuation varied substantially by birth country. Promotion of interventions targeting positive attitudes, perceived control, and subjective norms may reduce disparities among Black and between Black and White mothers.

Stephen JM, Shrestha S, Jimenez EY, Williams SM, Ortega A, Cano S, et al. Disparities in breastfeeding outcomes among women with opioid use disorder. Acta Paediatrica [Internet]. [cited 2020 Apr 18];n/a(n/a).

This study indicates a persistent disparity in breastfeeding outcomes in women with OUD (81.6% initiate and 23% at 6 months) relative to controls (97% initiate and 53% at 6 months), consistent with prior reports.

Stevens-Watkins D, Hargons CN, Dogan J, Malone N, Jester JK, Thorpe S, et al. Social Health Care Determinants of Breastfeeding Black Women: A Multigenerational Study. Breastfeed Med. 2022 Aug;17(8):666–72.

Interpersonal and systemic barriers in health care related to access, quality, support, and resources hindered Black mother’s breastfeeding across generations. Mothers across each age and breastfeeding cohorts emphasized a need for culturally tailored pro-breastfeeding health care systems to meet their breastfeeding needs.

Promote and Support Infant/Parent Bonding

Bingham D, Boisvert ME, Webb A, Muri J. Feasibility of AWHONN’s Immediate and Continuous Skin-to-Skin Nursing Care Quality Measures. J Obstet Gynecol Neonatal Nurs. 2019 Sep;48(5):516–25.

AWHONN’s nursing care quality measures were feasible in hospitals in which medical records were configured to document the start and stop times of skin-to-skin contact.

Brimdyr K, Cadwell K, Svensson K, Takahashi Y, Nissen E, Widström A. The nine stages of skin‐to‐skin: practical guidelines and insights from four countries. Matern Child Nutr. 2020 Jun 16;16(4):e13042.

This paper reviews the newborn’s progression through Widström’s 9 observable stages.

Cadwell K, Brimdyr K, Phillips R. Mapping, Measuring, and Analyzing the Process of Skin-to-Skin Contact and Early Breastfeeding in the First Hour After Birth. Breastfeed Med. 2018 Sep 1;13(7):485–92.

Process mapping of optimal skin-to-skin contact in the first hour after birth produced an accurate and useful measurement, showing how work is conducted and providing patterns for analysis and opportunities for improvement. The algorithm used, is Figure 1 on page 488.

McRae MJ, Miraglia R. Social Interactions and Institutional Structures that Influence 24-Hour Rooming-in for New Mothers and Newborns in the Hospital Setting. MCN Am J Matern Child Nurs. 2023 Feb 1;48(1):36–42

The paper highlights specific social interactions and institutional structures that affect rooming-in and can be used by leadership and educators to develop targeted interventions to ensure consistent rooming-in.

Patyal N, Sheoran P, Sarin J, Singh J, Jesika K, Kumar J, et al. A Quality Improvement Initiative: Improving First-hour Breastfeeding Initiation Rate among Healthy Newborns. Pediatr Qual Saf. 2021;6(4):e433.

After three months, first-hour breastfeeding rates increased from 12% to 80% applying QI strategies. The article describes the process and PDSA cycles used.

Support and Education for Lactating Parents

French CD, Shafique MA, Bang H, Matias SL. Perinatal Hospital Practices Are Associated with Breastfeeding through 5 Months Postpartum among Women and Infants from Low-Income Households. J Nutr. 2023 Jan;153(1):322–30.

This study assessed the association between hospital practices and the odds of any or exclusive breastfeeding through 5 months among dyads enrolled in WIC. Rooming-in and strong hospital staff support were associated with greater likelihood of any breastfeeding at 1, 3, and 5 months postpartum.

Support and Education for Staff

Lyndon A, Simpson KR, Spetz J, Zhong J, Gay CL, Fletcher J, et al. Nurse-Reported Staffing Guidelines and Exclusive Breast Milk Feeding. Nurs Res. 2022 Dec 1;71(6):432–40.

Lyndon A, Simpson KR, Spetz J, Zhong J, Gay CL, Fletcher J, et al. Nurse-Reported Staffing Guidelines and Exclusive Breast Milk Feeding. Nurs Res. 2022 Dec 1;71(6):432–40.

System Support

Centers for Disease Control and Prevention. Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies. Atlanta, GA: US Department of Health and Human Services; 2013.

This document provides guidance for public health professionals and others on how to select

strategies to support breastfeeding mothers and increase breastfeeding rates. It offers the most relevant

information on each type of strategy. A strategy, as used in the document, describes an environmental change or activity intended to prevent disease or promote health in a group of people. Criteria for inclusion of a strategy are a rationale supporting the strategies and examples of implemented programs.

Support after Discharge

Bogulski CA, Payakachat N, Rhoads SJ, Jones RD, McCoy HC, Dawson LC, et al. A Comparison of Audio-Only and Audio-Visual Tele-Lactation Consultation Services: A Mixed Methods Approach. J Hum Lact. 2023 Feb;39(1):93–106.

The goal of this study was to identify facilitators and barriers to the use of two modes of telehealth, telephone only and audiovisual. The authors found that both modes were equally effective. Further, study participants reported positive experiences, emphasizing the convenience, accessibility, education, and support provided.