Comparison of LATCH scores at the second day postpartum between - - PowerPoint PPT Presentation

Comparison of LATCH scores at the second day postpartum between mother with cesarean sections and those with normal deliveries.

Supree Buranawongtrakoon, MD Pawin Puapornpong, MD Department of Obstetrics & Gynecology, Faculty of Medicine Srinakarinwirot University

Introduction

Breast feeding

• Gold standard for infant feeding.
• LATCH scores: tool for prediction of success
• Routinely evaluated and recorded at HRH Princess

Maha Chakri Sirindhorn Medical Center(MSMC).

LATCH scores

Reference: Jensen D, Wallace S, Kelsey P. LATCH: a breastfeeding charting system and documentation tool. J Ob stet Gynecol Neonatal Nurs 1994;23:27-32.

LATCH scores

• Kumar et al study
• LATCH scores can predict the success rate of

breastfeeding at sixth week of postpartum

• May be affected by route of delivery
• No previous study in Thailand

Objectives

• Primary objective
• Comparison of the LATCH scores between cesarean

section and normal delivery at the 2nd day postpartum

• Secondary objective
• Comparison of sixth week exclusive breastfeeding rate

between cesarean section and normal delivery

Materials and methods

• Retrospective cohort study
• Evaluation the patient’s notes of women who delivered

at the MSMC during January 2010 to April, 2013

• Route of delivery
• LATCH scores
• Exclusive breastfeeding rate(Telephone conversation)
• Institutional ethics committee approval

• Inclusion criteria
• Primiparous women who delivered a singleton born without

any complications

• Neonatal birth weight > 2500 grams without complication.
• Exclusion criteria
• Had contraindication for breast feeding
• galactosemia baby

Sample size calculation

α error 0.05, power 0.95, effect size 0.3 N= 651 for each group. add 10 % for data lost

Total N = 1316

Statistical analysis

• Presented as either mean or median for numerical
• data. Categorial data was shown as percentage.
• Student t-test or Mann-Whitney U test; Chi-square for

numerical and categorial data, respectively

• Logistic regression analysis for adjusted odds ratio of

LATCH scores > 8

• p-value< 0.05 was considered significant.
• SPSS IBM Singapore Pte Ltd (Registration No.1975-

01566-C).

Result

Table 1: Demographic data

Mother and newborn’s data Cesarean section group (n=658) Mean ± SD Normal delivery group (n=658) Mean ± SD p-value Mother’s age (years) 28.2 ± 7.3 26.3 ± 6.4 <0.001 Gestational age (week) 38.6 ± 1.4 38.8 ± 1.7 0.981 Body mass index (kg/m2) 26.8 ± 4.9 24.1 ± 2.8 0.863 Nipple length (cm.) 0.7 ± 0.3 0.7 ± 0.3 0.198 Birth weight (gram) 3085 ± 473 3050 ± 483 0.57 Pain scores (cm) 4.3 ± 1.0 3.0 ± 0.9 <0.001

Table 2: Comparison of LATCH scores, exclusive breastfeeding rates between normal delivery and cesarean section group.

Parameters Cesarean section group (n=658) Normal delivery group (n=658) p-value LATCH scores at the second day postpartum (points) 7 8 0.037 Exclusive breastfeeding rate at six week (%) 369(56.1) 388(59.0) 0.048

Table 3: Odds ratio of LATCH scores > 8 between cesarean section group compared with normal delivery group

LATCH scores > 8 Crude Odds ratio 95%CI Adjusted Odds ratio 95%CI p-value cesarean section: normal delivery group 0.67 0.42-0.94 0.82 0.69-0.97 <0.05

Table 4 - Cause of breastfeeding cessation at sixth week postpartum in cesarean section and normal delivery groups.

Cause of breastfeeding cessation at sixth week postpartum Cesarean section group (n=289) Normal delivery group (n=270) Insufficient milk (%) 133(46.0) 118(43.7) Return to work (%) 93(32.2) 98(36.3) Mother’s or infant’s illness (%) 42(14.5) 35(13.0) Mother exhaustion (%) 11(3.8) 14(5.2) Infant crying concern (%) 10(3.5) 5(1.9)

Discussion

• In this study, lower LATCH scores at the second day

postpartum in those with cesarean sections than in the normal delivery group.

• It is postulated that pelvic and wound pain are the major

maternal concerns in cesarean section patients in order to starting their breastfeeding.

• Delay initiation process of breastfeeding

Discussion

• Confirmed by
• Lower rate of exclusive breastfeeding
• Correspond to lower rate of LATCH Scores>8 on

cesarean section group

Discussion

• Compare to Kumar et al study
• Similar finding that the LATCH scores predicting the

success of breastfeeding at the sixth week postpartum Able to predict breastfeeding at 6 weeks postpartum using LATCH scores!

Discussion

• The limitation of this study ;
• Recall bias for data of exclusive breastfeeding at sixth

week due to telephone follow-up method

• Did not explain exclusive breastfeeding definition to the

mothers before being discharged.

Conclusion

• Lower LATCH scores at the second day postpartum in

cesarean group than the mothers with normal deliveries.

• Lower exclusive breastfeeding rates on the sixth week

postpartum in cesarean group than in normal delivery group

Acknowledgement

References

1. Kumar SP, Mooney R, Wieser LJ, Havstad S. The LATCH scoring system and prediction of breastfeeding duration. J Hum Lact 2006;22:391-7. 2. Phadungkiatwattana P, Tongsakul N. Analyzing the impact of private service on the cesarean section rate in public hospital Thailand. Arch Gynecol Obstet 2011;284:1375-9. 3. Charoenboon C, Srisupundit K, Tongsong T. Rise in cesarean section rate over a 20-year period in a public sector hospital in northern Thailand. Arch Gynecol Obstet 2013;287:47-52. 4. Jensen D, Wallace S, Kelsey P. LATCH: a breastfeeding charting system and documentation tool. J Obstet Gynecol Neonatal Nurs 1994;23:27-32.