OK, OK, well I guess I have to finally come out of lurkdom...
I am Jan DeCoopman, now CNM in practice in Milwaukee, WI, formerly
lactation consultant/educator in Detroit, MI. I am the offer of the
BREASTS scale described by my good friend, Pat Young, in a post on 1/27:
>>Date: Sat, 27 Jan 2001 14:58:15 -0500
>>From: Patrica Young <[log in to unmask]>
>>Subject: LATCH(long)
>>Jan DeCoopman did one on BREASTS (Mom does the scoring.)
* B- Baby awake
* R- baby Rooting
* E- baby takes in Enough of areola
* A- Active suckling
* S- Swallowing heard
* T- Time- actively swallowing for 10-40 minutes
* S- Satisfaction, baby Settles down
Each letter gets one point
Score 5-6-7: mom and baby doing OK
Score 3-4: mom ask for help if not better at next feeding
Score 0-1-2: mom ask for help NOW
>>Jan suggests that this be printed on a 3x5 card and given to mom
prenatally, at first feeding, when she is getting help with >>latch-on and
positioning. At discharge mom can be given card again. My idea would be to
put community #s, warm line #s, > >>class info, etc. on back.
I would like to explain it further and respond to the excellent comments on
it.
This was developed in about 1994. My goal was to find something that the
Mom could do for several reasons: 1) I felt it was critical for the Mom to
know whether or not they needed help, both in the hospital AND later, since
I had seen babies go home and deteriorate because of jaundice, etc. 2) to
improve maternal confidence; 3) because the nurse's strongly resisted doing
another assessment.
I chose BREASTS to make it easy to remember. The "B" actually was written
out as "Baby wakes and shows interest in feeding" because of my concern
about placid, non-demanding newborns. R for Rooting reinforced the need
for following feeding cues and for a wide open latch.
It was tough to think of an E, but I settled on Enough of the
nipple/areolar complex to assure pain-free BF. Please keep in mind that
the scale was explained to the Mom as she was being taught how to BF; it
wasn't just handed to her. It was used to help her recognize a correct latch.
A for Active Suckling explains itself. The baby shouldn't just sit there
or fall asleep.
S was for Swallowing originated from my strong belief that yes, you can and
should be able to hear swallowing. I am pretty significantly
hard-of-hearing, but even I can hear and recognize it. Of all of the
criteria, this is the one that I believe matters most. I never found it
hard to teach Moms to recognize it either, but maybe they were just
humoring me.
T for Time has always been controversial, but keep in mind that I was a
real pioneer, and I had to deal with physicians and nurses who just
couldn't give up on the idea. This was a major compromise--they wanted
some sort of guideline, so I used the extremes of 10 and 40
minutes. Remember, I was dealing with newborns, and it would be highly
unusual to see one polish off a breast in 5 minutes and actually have done
well; more likely a babe who fed for 5 minutes and stopped was not doing
well. As for the 40 minutes, it seemed like a reasonable number to
pick. To suggest that feeding for an hour was normal would have never be
acceptable to the nurses, and may have deterred some women from BF.
And yes, I agree with Heather's comments about timing; we have come to a
point where time limits play no role in BF, but we weren't there yet in
1993-94.
>>Date: Sun, 28 Jan 2001 11:29:22 +0000
>>From: heather <[log in to unmask]>
>>Subject: Re: LATCH(long)
>>Potential problems here - haven't we been discussing the importance of
getting away from *timing* a feed?
And I really, really like Pat Young's tummy-to-tummy suggestions!
>>Date: Sun, 28 Jan 2001 08:39:58 -0500
>>From: Patrica Young <[log in to unmask]>
>>Subject: Re: LATCH(long)
>>Dear Heather, This acronym BREASTS is about 10 + years old. Can we think
up something better for T than Time ? Tummy >>to tummy ???
Or this one from T. Pitman:
>>Date: Sun, 28 Jan 2001 12:18:54 -0500
>>From: T Pitman <[log in to unmask]>
>>Subject: Re: LATCH, BREASTS, etc.
>>baby not just tummy to tummy but wrapped around the mother's body.
Without the "wrap" it's more likely that the baby will >>come to breast
"nose-first."
Last but not least is the second S. Originally it stood for Settled, but
any Satiated word would do: Stuffed, Sleepy, Satisfied, etc.
I did a pilot study of the instrument with about 35 Moms, and found a close
relationship of the scores to the baby's voiding & stooling patterns. I
would have like to compare the scores to initial weight loss, but some
babies weren't there long enough to lose weight, and since they were all
weighed at 2AM, I couldn't get exact 24 hour, 48 hour numbers, etc.
The Moms were asked to rate the tool for ease of use. All 35 said it was
somewhat or very easy to use. All 35 women also reported that they were
either somewhat or were much more confident after filling out the scale.
I hope this explains it for you. Anyone is free to use it, change it, study
it, do whatever you want. I have always wanted to establish its validity
and reliability. If any member of the collective wisdom out there has
ideas on how I might do so, please email me privately.
Hello to all my friends in the Great Lake State and across the country (Go
Blue!).
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