Latch assessment tool

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. It is unquestionable that breast milk is the best source of infant nutrition S tudies 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) INTRODUCTION 2 THE LATCH ASSESSMENT TOOL

3. This study aimed to explore the LATCH scoring system in predicting breastfeeding patterns following caesarean and vaginal delivery. OBJECTIVE 3 THE LATCH ASSESSMENT TOOL introduction

4. Design : Prospective cohort study Instrument : The LATCH Assessment Tool Period : August 200 9 - July 20 10 Location : 2 private hospitals in West Jakarta Statistical analysis : Kruskal-Wallis test Mantel Haenzel chi-square test Spearman correlation coefficient Relative Risk & CI 95% p<0.05 ~ significant (SPSS ver 16.0) METHODS 4 THE LATCH ASSESSMENT TOOL

5. Participants : Convenience sampling of mother- baby dyads who had caesarean section or vaginal delivery Eligibility criteria : First-time breastfeeding mother, 18 years or older, with healthy singletons THE LATCH ASSESSMENT TOOL 5 C-section or Vaginal delivery Breastfeeding or not ? LATCH score at hour-24 LATCH score at day-7 LATCH score at week-6 methods

6. Assessment 1 2 Total scores L Latch on Too sleepy or reluctant No sustained latch or suck achieved Repeated attempts for sustained latch or suck Hold nipple in mouth Stimulate to suck Grasps breast Tongue down Lips flanged Rhythmical sucking 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 6 methods Table 1. The LATCH Breastfeeding Assessment Tool Jenson D, Wallace S, Kelsay P (1994). LATCH : A Breastfeeding charting system and documentation tool. JOGNN, 23(1):29. THE LATCH ASSESSMENT TOOL

7.   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 3346 newborn 1011 primi mothers 211 omitted 880 healthy singletons 589 breastfed neonates RESULTS & DISCUSSION n=378 7 THE LATCH ASSESSMENT TOOL

8. 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 Birth weight, g ( x  SD) 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 Length of stay, d ( x  SD)* 1 0.1 3 0.3 2 0.2 8 Table 2.Characteristic of sample (n=378) r esults & discussion *p < 0.05 THE LATCH ASSESSMENT TOOL

9. Six weeks was chosen because it is a vulnerable time when breastfeeding is being established (Riordan et al, 2001) 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 9 Table 3. Breastfeeding Assessment among groups r esults & discussion *p < 0.05 THE LATCH ASSESSMENT TOOL

10. 10 Figure 1. Breastfeeding Assessment among groups r esults & discussion

11. 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 r esults & discussion

12. Mothers who had low score at day-7 were less likely to be breastfeeding at 6 weeks THE LATCH ASSESSMENT TOOL 12 r esults & discussion Relative Risk (95% CI) LATCH Score 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) Table . Determinant fo breastfeeding duration *p < 0.05

13. 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 r esults & discussion

14. The LATCH assessment tool identifies as a predictor for the duration of breastfeeding followed caesarean and vaginal delivery CONCLUSION 14 THE LATCH ASSESSMENT TOOL

15. THE LATCH ASSESSMENT TOOL 15 thank you

16. 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) Shrago , 1990 Breastfeeding Assessment Tool (3 items) Bono, 1992 Assess the risk of early weaning The Potential Early Breastfeeding Problem Tool (23 items) Kearney et al, 1990 Breastfeeding Attrition Prediction Tool Janke , 1944 Hill & Humenick Lactation Scale (30 items) Hill et al, 1996 Breastfeeding Self Efficacy Scale Dennis, 2002 Assess effectiveness of breastfeeding Breastfeeding Assessment Score (107 items) Hall et al, 2002 LATCH Assessment Tool (5 items) Jensen et al, 1994 Infants Breastfeeding Assessment Tool (6 items) Matthews, 1988 Mother-Baby Assessment (5 items) Mulford , 1992 Via Christi Breastfeeding Assessment Tool (4 items) Riordan, 2005 16 Table 5. Tools to measure breastfeeding Taha R (2009). Breastfeeding case study. http://digitalcommons.uconn.edu/srhonors.theses/74 r esults & discussion THE LATCH ASSESSMENT TOOL

17. 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 r esults & discussion

18. The LATCH Assessment Tool measures 5 breast-feeding 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 r esults & discussion