THE LATCH ASSESSMENT TOOL
AS A PREDICTOR OF BREASTFEEDING PATTERNS
FOLLOWING CAESAREAN AND VAGINAL DELIVERY

Wiyarni Pambu...
INTRODUCTION
It is unquestionable that breast milk is the best source
of infant nutrition
Studies have suggested that mode...
introduction

OBJECTIVE

This study aimed to explore the LATCH scoring system
in predicting breastfeeding patterns followi...
METHODS
Design
:
Instrument
:
Period
:
Location
:
Statistical analysis :

Prospective cohort study
The LATCH Assessment To...
methods

Participants

: Convenience sampling of motherbaby dyads who had caesarean
section or vaginal delivery
Eligibilit...
methods
Table 1. The LATCH Breastfeeding Assessment Tool
Assessment

0

1

2

Repeated attempts for
sustained latch or suc...
RESULTS & DISCUSSION
3346
newborn

1011
primi
mothers

880
healthy
singletons

589
breastfed
neonates

211 omitted
n=378

...
results & discussion

Table 2.Characteristic of sample (n=378)
Vaginal
delivery
(n=117)

Elective
c-section
(n=100)

Emerg...
results & discussion
Table 3. Breastfeeding Assessment among groups
Vaginal
delivery
(n=117)

Elective
c-section
(n=100)

...
results & discussion

Figure 1. Breastfeeding Assessment among groups

10
results & discussion

Total LATCH score were higher among mother who
were still breastfeeding at 6 weeks (8.2±0.9 vs 5.3±0...
results & discussion
Table . Determinant fo breastfeeding duration
Relative Risk (95% CI)
Vaginal
delivery
(n=117)

Electi...
results & discussion

LATCH score below 2 at day-7 was the most
discriminate of the 3 time periods examined
LATCH scores p...
CONCLUSION

The LATCH assessment tool identifies as a predictor
for the duration of breastfeeding
followed caesarean and v...
THE LATCH ASSESSMENT TOOL

15
results & discussion
Table 5. Tools to measure breastfeeding
Aims

Tools

Study

Assess subjective
perspective of
the moth...
results & discussion

Assessment of breastfeeding effectiveness is most
comprehensive when it includes :
Objective observa...
results & discussion

The LATCH Assessment Tool measures 5 breastfeeding indicators (latch-on, audible swallowing, type
& ...
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Latch assessment tool

  1. 1. THE LATCH ASSESSMENT TOOL AS A PREDICTOR OF BREASTFEEDING PATTERNS FOLLOWING CAESAREAN AND VAGINAL DELIVERY Wiyarni Pambudi Department of Child Health Sumber Waras Hospital Medical School, Tarumanagara University Jakarta – Indonesia
  2. 2. INTRODUCTION It is unquestionable that breast milk is the best source of infant nutrition Studies have suggested that mode of delivery has influence on breastfeeding A practical & concrete tool to predict breastfeeding outcomes following different modes of delivery is needed The LATCH score provides a reliable, valid, and systematic method for gathering information about individual breastfeeding sessions (Riordan et al, 1997) THE LATCH ASSESSMENT TOOL 2
  3. 3. introduction OBJECTIVE This study aimed to explore the LATCH scoring system in predicting breastfeeding patterns following caesarean and vaginal delivery. THE LATCH ASSESSMENT TOOL 3
  4. 4. METHODS Design : Instrument : Period : Location : Statistical analysis : Prospective cohort study The LATCH Assessment Tool August 2009 - July 2010 2 private hospitals in West Jakarta Kruskal-Wallis test Mantel Haenzel chi-square test Spearman correlation coefficient Relative Risk & CI 95% p<0.05 ~ significant (SPSS ver 16.0) THE LATCH ASSESSMENT TOOL 4
  5. 5. methods Participants : Convenience sampling of motherbaby dyads who had caesarean section or vaginal delivery Eligibility criteria : First-time breastfeeding mother, 18 years or older, with healthy singletons LATCH score at hour-24 C-section or Vaginal delivery LATCH score at day-7 LATCH score at week-6 Breastfeeding or not ? THE LATCH ASSESSMENT TOOL 5
  6. 6. methods Table 1. The LATCH Breastfeeding Assessment Tool Assessment 0 1 2 Repeated attempts for sustained latch or suck Hold nipple in mouth Stimulate to suck Total scores Grasps breast Tongue down Lips flanged Rhythmical sucking L Latch on Too sleepy or reluctant No sustained latch or suck achieved A Audible swallowing None A few with stimulation Spontaneous and intermittent/ frequent T Type of nipple Inverted Flat Averted C Comfort Engorged Cracked, bleed, large blisters or bruises Severe discomfort Filling Reddened/small blisters or bruises Soft Non tender H Hold positioning Full assist Minimal assist No assist Jenson D, Wallace S, Kelsay P (1994). LATCH : A Breastfeeding charting system and documentation tool. JOGNN, 23(1):29. THE LATCH ASSESSMENT TOOL 6
  7. 7. RESULTS & DISCUSSION 3346 newborn 1011 primi mothers 880 healthy singletons 589 breastfed neonates 211 omitted n=378 A sample of 117 mother-baby dyads who had a normal vaginal delivery, 100 who with elective caesarean section and 162 with emergency caesarean section were recruited into this study THE LATCH ASSESSMENT TOOL 7
  8. 8. results & discussion Table 2.Characteristic of sample (n=378) Vaginal delivery (n=117) Elective c-section (n=100) Emergency c-section (n=162) Maternal age, yrs (x  SD) 240.6 240.2 250.4 Gestational age, wks (x  SD) 390.3 390.5 390.7 3,4900.4 3,5000.1 3,4750.7 Apgar score min-1(x ) 8.2 8.2 8.2 Apgar score min-5(x ) 8.9 8.9 8.9 10.1 30.3 20.2 Birth weight, g (x  SD) Length of stay, d (x  SD)* *p < 0.05 THE LATCH ASSESSMENT TOOL 8
  9. 9. results & discussion Table 3. Breastfeeding Assessment among groups Vaginal delivery (n=117) Elective c-section (n=100) Emergency c-section (n=162) Initiation (%)* 76.6 24.3 13.3 Breastfed at hour-24 (%)* 62.9 59.6 41.4 Breastfed at day-7 (%)* 59.1 46.5 51.4 Breastfed at week-6 (%)* 47.6 21.9 31.6 LATCH score at hour-24 (x)* 9.1 8.7 6.4 LATCH score at day-7 (x)* 8.7 6.8 7.5 LATCH score at week-6 (x)* 6.7 4.2 5.1 *p < 0.05 Six weeks was chosen because it is a vulnerable time when breastfeeding is being established (Riordan et al, 2001) THE LATCH ASSESSMENT TOOL 9
  10. 10. results & discussion Figure 1. Breastfeeding Assessment among groups 10
  11. 11. results & discussion Total LATCH score were higher among mother who were still breastfeeding at 6 weeks (8.2±0.9 vs 5.3±0.1, p=0.003) Total LATCH scores positively correlated with duration of breast-feeding (n=126, r=0.26, p=0.001) and mode of delivery (n=378, r=0.22, p=0.002) THE LATCH ASSESSMENT TOOL 11
  12. 12. results & discussion Table . Determinant fo breastfeeding duration Relative Risk (95% CI) Vaginal delivery (n=117) Elective c-section (n=100) Emergency c-section (n=162) At hour-24 3.8 (0.8-4.6) 2.6 (0.5-3.1) 3.2 (1.3-3.9) At day-7* 4.1 (1.6-4.9) 5.1 (2.0-6.1) 4.8 (1.9-5.7) At week-6 3.7 (1.6-4.5) 3.8 (1-5-4.6) 4.4 (0.8-5.3) 7-10 (low risk) 1.7 (0.7-2.1) 3.3 (0.8-3.9) 2.7 (0.6-3.2) 3-6 (medium risk) 2.6 (0.9-3.2) 4.7 (1.9-5.7) 4.0 (1.6-4.8) 0-2 (high risk)* 3.4 (1.4-4.1) 6.2 (2.5-7.6) 5.4 (2.2-6.5) LATCH Score *p < 0.05 Mothers who had low score at day-7 were less likely to be breastfeeding at 6 weeks THE LATCH ASSESSMENT TOOL 12
  13. 13. results & discussion LATCH score below 2 at day-7 was the most discriminate of the 3 time periods examined LATCH scores predict whether or not the mother would breastfed for up to 6 weeks  aid for health professionals in identifying those who potentially will stop breastfeeding prematurely & might need interventions to continue to breastfed THE LATCH ASSESSMENT TOOL 13
  14. 14. CONCLUSION The LATCH assessment tool identifies as a predictor for the duration of breastfeeding followed caesarean and vaginal delivery THE LATCH ASSESSMENT TOOL 14
  15. 15. THE LATCH ASSESSMENT TOOL 15
  16. 16. results & discussion Table 5. Tools to measure breastfeeding Aims Tools Study Assess subjective perspective of the mother Maternal Breastfeeding Evaluation Scale (56 item) Leff et al, 1994 Lactation Assessment Tool Blair et al, 2003 Assess objective factors of breastfeeding Systemic Assessment of the Infant at Breast (4 items) Breastfeeding Assessment Tool (3 items) The Potential Early Breastfeeding Problem Tool (23 items) Assess the risk of early weaning Bono, 1992 Kearney et al, 1990 Breastfeeding Attrition Prediction Tool Janke, 1944 Hill & Humenick Lactation Scale (30 items) Hill et al, 1996 Breastfeeding Self Efficacy Scale Breastfeeding Assessment Score (107 items) Assess effectiveness of breastfeeding Shrago, 1990 LATCH Assessment Tool (5 items) Infants Breastfeeding Assessment Tool (6 items) Dennis, 2002 Hall et al, 2002 Jensen et al, 1994 Matthews, 1988 Mother-Baby Assessment (5 items) Mulford, 1992 Via Christi Breastfeeding Assessment Tool (4 items) Riordan, 2005 Taha R (2009). Breastfeeding case study. http://digitalcommons.uconn.edu/srhonors.theses/74 THE LATCH ASSESSMENT TOOL 16
  17. 17. results & discussion Assessment of breastfeeding effectiveness is most comprehensive when it includes : Objective observations of maternal & infant factors Indicators of milk intake Subjective maternal evaluation BAS was shown to be highly significant in predicting breastfeeding cessation (Hall et al, 2002)  consisted of 107 detailed questionnaires about pregnancy, medication & experience with breastfeeding THE LATCH ASSESSMENT TOOL 17
  18. 18. results & discussion The LATCH Assessment Tool measures 5 breastfeeding indicators (latch-on, audible swallowing, type & shape of the nipple, comfort level, hold positioning); assigns a score of 0-1-2 for maximum total score of 10 (Jensen et al, 1994)  relationship was supported between higher scores & fewer breastfeeding problems (Schomer et al, 1999) LATCH 5 components of breastfeeding : Lack predictive capacity to breastfeeding outcomes (Hemelim et al, 2000) Correlates positively with breastfeeding duration (Riordan et al, 2001; Kumar et al, 2006) 18

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