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. 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
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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
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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)
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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 ?
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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.
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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
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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
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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)
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10. results & discussion
Figure 1. Breastfeeding Assessment among groups
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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)
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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
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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
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14. CONCLUSION
The LATCH assessment tool identifies as a predictor
for the duration of breastfeeding
followed caesarean and vaginal delivery
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15. THE LATCH ASSESSMENT TOOL
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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
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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
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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)
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