Latch assessment tool

THE LATCH ASSESSMENT TOOL AS A PREDICTOR OF BREASTFEEDING

PATTERNS FOLLOWING CAESAREAN AND VAGINAL DELIVERY

Wiyarni Pambudi

Department of Child HealthSumber Waras Hospital

Medical School, Tarumanagara UniversityJakarta – Indonesia

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)

INTRODUCTION

2THE LATCH ASSESSMENT TOOL

This study aimed to explore the LATCH scoring system in predicting breastfeeding patterns following caesarean and vaginal

delivery.

OBJECTIVE


introduction

Design : Prospective cohort studyInstrument : The LATCH Assessment ToolPeriod : August 2009 - July 2010Location : 2 private hospitals in West JakartaStatistical analysis: Kruskal-Wallis test

Mantel Haenzel chi-square testSpearman correlation coefficient Relative Risk & CI 95% p<0.05 ~ significant (SPSS ver 16.0)

METHODS


Participants : Convenience sampling of mother-

baby dyads who had caesareansection 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 deliver

y

Breastfeeding or not ?

LATCH score at hour-24

LATCH score at

day-7

LATCH score at week-6

methods

Assessment 0 1 2

Total

scores

L Latch on

Too sleepy or reluctant

No sustained latch or suck

achieved

Repeated attempts for sustained latch

or suckHold nipple in

mouthStimulate to suck

Grasps breastTongue downLips flangedRhythmical

sucking

AAudible swallowi

ngNone

A few with stimulation

Spontaneous and

intermittent/ frequent

T Type of nipple

Inverted Flat Averted

C Comfort

EngorgedCracked, bleed, large blisters or

bruisesSevere discomfort

FillingReddened/small

blisters or bruises

SoftNon tender

HHold

positioning

Full assist Minimal assist No assist6

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

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 newbo

rn

1011 primi mothe

rs

211 omitted

880 healthy singleto

ns

589 breastf

ed neonat

es

RESULTS & DISCUSSION

n=378


Vaginal delivery(n=117)

Elective c-

section (n=100

)

Emergency c-

section (n=162)

Maternal age, yrs (x SD) 240.6 240.2 250.4

Gestational age, wks (x SD) 390.3 390.5 390.7

Birth weight, g (x SD)

3,4900.4

3,5000.1

3,4750.7

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)* 10.1 30.3 20.2

8

Table 2.Characteristic of sample (n=378)

results & discussion

*p < 0.05


Six weeks was chosen because it is a vulnerable time when breastfeeding is being established (Riordan et al, 2001)

Vaginal deliver

y(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


*p < 0.05


10Figure 1. Breastfeeding Assessment among groups


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)



Mothers who had low score at day-7 were less likely to be breastfeeding at 6 weeks



Relative Risk (95% CI)

LATCH ScoreVaginal 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

LATCH score below 2 at day-7 was the most discriminate of the 3 time periods examinedLATCH 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 identifies as a predictor

for the duration of breastfeeding followed caesarean and vaginal delivery

CONCLUSION



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 breastfeedin

g

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



http://digitalcommons.uconn.edu/srhonors.theses/74

Assessment of breastfeeding effectiveness is most comprehensive when it includes :

Objective observations of maternal & infant factorsIndicators 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 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


Self Improvement

Latch assessment tool