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!). *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html