There is an interesting new article that talks about development of an
assessment tool to predict the dyads who need extra support and expert
lactation consultation in the first week postpartum to prevent untimely
weaning.

R Hall, et al:  A breast-feeding assessment score to evaluate the risk for
cessation of breast-feeding by 7 to 10 days of age, J Pediatr 2002;
141:659-64.

Interesting points:

"...an estimated 10%-30% of mothers who intiate breast-feeding [sic] fail to
continue by 2 weeks of age...Data strongly suggest that success of
breast-feeding is associated with events in the first 2 weeks of life, if
not the first 3 to 5 days.  This was borne out by results in the current
study in which the mean age of feeding cessation was 5.4 days (S.D, 2.2)  It
is widely held that expert consultation during this crucial period may be of
benefit to those having difficulty with breast-feeding...The results of this
study indicate that 5 variables present with all patients were hightly
significant, both independently and interactively, in predicting cessation
of breast-feeding in term infants by 7-10 days of age in the population
studied.  Three variables present in some patients added significant
additional risk for breastfeeding cessation."

The study details a way of totalling the scores of the identified risk
factors.  The scores were highly predictive of cessation of breastfeeding.
The 5 variables identified were:  Maternal age, previous breastfeeding
experience, frequency of latching difficulty, breastfeeding interval during
the hospital stay, number of bottles of formula given.  The additional 3
variables were:  previous breast surgery, maternal hypertension during
pregnancy, vacuum vaginal delivery.

Younger mothers were more at risk, previous breastfeeding failure was a
greater predictor of early cessation than was having no experience.  The
more feedings where latch difficulties occured, the higher the risk of
cessation. Long breastfeeding intervals and increasing number of bottles
given in hospital were predictive of cessation.  This makes sense with what
we all see.

I was particularly interested in the 3 additional variables.  I've often
observed delayed onset of copious milk production in hypertensive mothers.
These delays contributes to excessive infant weight loss, early
supplementation, and lack of confidence in milk supply.  If the mom isn't
instructed to pump to bring in the milk during the delay, the increasingly
disinterested baby generally gives up and the milk supply never establishes.
The issue of breast surgery has been previously identified in the work of
Neifert and Hurst, but it bears repeating that this issue should be on all
our assessment check lists.  There have been previous discussions on Lactnet
about our perceptions about vacuum assisted deliveries contributing to
lactation difficulties.  This article seems to confirm this observation.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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