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 2 nd 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 J anuary 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 Cesarean Normal p-value data section group delivery (n=658) group Mean ± SD (n=658) Mean ± SD 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/m 2 ) 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 Normal p-value section group delivery (n=658) group (n=658) LATCH scores at the second day 7 8 0.037 postpartum (points) 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 95%CI Adjusted 95%CI p-value ratio Odds ratio cesarean section: 0.67 0.42-0.94 0.82 0.69-0.97 <0.05 normal delivery group

Table 4 - Cause of breastfeeding cessation at sixth week postpartum in cesarean section and normal delivery groups. Cause of breastfeeding cessation Cesarean section Normal at sixth week postpartum group delivery group (n=289) (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.