Persevering through postpartum fatigue

In Their Own Words: A Qualitative Investigation of the Factors Influencing Maternal Postpartum Functioning in the United States

During the first twelve months postpartum, infants require intensive care and mothers are susceptible to physical and mental health concerns as they undergo a period of tremendous psychological and physiological adjustment. The mother’s level of postpartum functioning not only impacts her experience as a mother but also the infant and family unit. However, efforts to bolster functioning are lacking, and previous literature has identified a gap between what experts recommend and what mothers desire during the postpartum period. To address this, we conducted structured interviews with a diverse sample of 30 postpartum mothers to identify factors that mothers report are most influential to their postpartum functioning. In total, we identified 23 clinically actionable factors, all of which are backed by existing literature. In addition to an in-depth presentation of the qualitative findings, we also present a heat map to visualize the relevance of these factors to each of seven established domains of maternal functioning. Lastly, based on our findings, we offer a taxonomy of interventional strategies that could bolster maternal functioning during this critical period.

Using Levine's conservation model in postpartum care: a randomized controlled trial

This randomized controlled trial was conducted with 117 puerperae who were assigned into 2 groups: the intervention group and the control group. While the participants in the intervention group participated in a full program based on the module trainings, the participants in the control group received routine care. There was a significant difference between the women in the intervention and control groups in terms of the variables such as fatigue, sleep, and quality of life. The women in the intervention group experienced less fatigue, and their quality of sleep and quality of life improved considerably. Levine's conservation model enables the provision of the integrative care to women in their postpartum period.

What matters to women in the postnatal period: A meta-synthesis of qualitative studies

INTRODUCTION

The postnatal period is an underserved aspect of maternity care. Guidelines for postnatal care are not usually informed by what matters to the women who use it. This qualitative systematic review was undertaken to identify what matters to women in the postnatal period, to inform the scope of a new World Health Organization (WHO) postnatal guideline.

METHODS

We searched MEDLINE, CINAHL, PsycINFO, POPLINE, Global Index Medicus, EMBASE, LILACS, AJOL, and reference lists of eligible studies published January 2000-July 2019, reporting qualitative data on women's beliefs, expectations, and values relating to the postnatal period.

DATA COLLECTION AND ANALYSIS

Author findings were extracted, coded and synthesised using techniques derived from thematic synthesis. Confidence in the quality, coherence, relevance and adequacy of data underpinning the resulting findings was assessed using GRADE-CERQual.

RESULTS

We included 36 studies from 15 countries, representing the views of more than 800 women. Confidence in most results was moderate to high. What mattered to women was a positive postnatal experience where they were able to adapt to their new self-identity and develop a sense of confidence and competence as a mother; adjust to changes in their intimate and family relationships, including their relationship to their baby; navigate ordinary physical and emotional challenges; and experience the dynamic achievement of personal growth as they adjust to the 'new normal' of motherhood and parenting in their own cultural context.

CONCLUSION

This review provides evidence that what matters to women in the postnatal period is achieving positive motherhood (including maternal self-esteem, competence, and autonomy), as well as fulfilling adaptation to changed intimate and family relationships, and (re)gaining health and wellbeing for both their baby, and themselves. Where this process is optimal, it also results in joy, self-confidence, and an enhanced capacity to thrive in the new integrated identity of 'woman and mother'.

Chronic, but not acute, fatigue predicts self-reported attentional driving errors in mothers attending infant children

Mothers attending infant children usually experience high levels of fatigue, and fatigue has been shown to be related to car crashes through attentional errors, among other causes. The current study investigates the effects of fatigue on the attentional errors while driving of women attending infant children. A sample of 112 women-67 attending infant children and 45 not attending-filled out self-report questionnaires assessing acute fatigue, chronic fatigue, and attention-related driving errors. A mediational analysis showed that women attending infant children had higher levels of fatigue, and that chronic fatigue, but not acute fatigue, was related to attentional errors while driving.

"It's Hard Being a Mama": Validation of the Maternal Distress Concept in Becoming a Mother

New mothers actively adapt to new demands and challenges in the mothering role but some may find this adjustment difficult and distressing, depending on their perceptions and resources. Previous research on maternal distress is primarily concentrated on needs of mothers with depression but nonpathological approaches of viewing difficulties in early parenting should be explored. A secondary analysis of a descriptive, qualitative study was completed on new, low-income mothers in early parenthood to determine how maternal distress influences mothers' transition to becoming a mother and to validate the use of the Maternal Distress Concept in the clinical setting. Findings reveal new mothers experience maternal distress on various levels: stress, adaptation, functioning, and connecting. Implications for practice and education are discussed.

Related but different: distinguishing postpartum depression and fatigue among women seeking help for unsettled infant behaviours

BACKGROUND

A growing body of evidence in relatively healthy populations suggests that postpartum depression and fatigue are likely distinct but related experiences. However, differentiating depression and fatigue in clinical settings remains a challenge. This study aimed to assess if depression and fatigue are distinct constructs in women with relatively high fatigue and psychological distress symptoms attending a residential program that assists with unsettled infant behaviour.

METHODS

167 women (age: M = 34.26, SD = 4.23) attending a private residential early parenting program completed the Depression Anxiety Stress Scale (DASS21-D), Fatigue Severity Scale (FSS) and self-report sleep variables before program commencement. Confirmatory Factor Analysis examined the associations between depression and fatigue latent factors.

RESULTS

A two-factor model of separate but related depression and fatigue constructs provided a significantly better fit to the data than a one-factor model of combined depression and fatigue (p < .001). In the two-factor model, the depression and fatigue latent factors were moderately correlated (.41). Further predictive utility of this two-factor model was demonstrated as both depression and fatigue factors were independently predicted by worse self-reported sleep efficiency.

CONCLUSIONS

This study provides empirical evidence that for women attending a clinical service with relatively high fatigue and psychological distress, postpartum depression and fatigue remain separate but related experiences. These findings suggest that in women seeking clinical support in the postpartum period, both depression and fatigue need to be carefully assessed to ensure accurate diagnoses, and (b) whilst depression intervention may improve fatigue, targeted fatigue intervention may also be warranted.

The Relationships among Postpartum Fatigue, Depressive Mood, Self-care Agency, and Self-care Action of First-time Mothers in Bangladesh

PURPOSE

Postpartum fatigue can impact maternal well-being and has been associated with levels of perceived self-care. This study aimed to examine the relationship among fatigue, depressive mood, self-care agency, and self-care action among postpartum women in Bangladesh.

METHODS

A descriptive cross sectional survey was done with 124 first-time mothers from two tertiary hospitals in Dhaka, Bangladesh. The Modified Fatigue Symptoms checklist, Denyes' Self Care Instrument, the Edinburgh Postnatal Depression Scale, and items on sociodemographic and delivery-related characteristics, were used in Bengali via translation and back-translation process.

RESULTS

High fatigue levels were found in 18.5%(n=23) and 73.4% had possible depression (n=91). There was a significant negative relationship between fatigue and self-care agency (r=-.31, p < .001), and self-care action (r=-.21, p < .05). Fatigue differed by level of self-care agency (t=4.06, p < .001), self-care action (t=2.36, p=.023), newborn's APGAR score (t=-2.93, p=.004), parental preparation class participation (F=15.53, p < .001), and postpartum depressive mood (t=-4.64, p < .001).

CONCLUSION

Findings suggest that high level of self-care efficacy and behaviors can contribute to fatigue management, and highlight the need for practical interventions to better prepare mothers for postpartum self-care, which may, in turn, alleviate postpartum fatigue.

A Postpartum Sleep and Fatigue Intervention Feasibility Pilot Study

The purpose of this pilot study was to evaluate the feasibility, acceptability, and cost of a self-management intervention for postpartum fatigue and sleep in socioeconomically disadvantaged urban women. Helping U Get Sleep (HUGS) is a theory-guided intervention developed from the Individual and Family Self-Management Theory. Medicaid-enrolled participants in the United States were recruited from an inpatient postpartum unit. Treatment and attention control interventions were delivered (15 HUGS, 12 comparison) at a week 3 postpartum home visit and 4 follow-up phone calls. Over the 9-week protocol, the HUGS group demonstrated significant improvements in subjective fatigue and subjective sleep disturbance relative to the comparison group. The HUGS intervention was feasible and acceptable, delivered on average, in 100 min and costing US$79 per participant.

The Spanish version of the Fatigue Assessment Scale: reliability and validity assessment in postpartum women

Background

Fatigue is the most widely reported symptom by women during pregnancy, labour, the postpartum period, and early parenting. The objective was to translate the Fatigue Assessment Scale (FAS) into Spanish and assess its psychometric properties.

Methods

Instrumental Design. The FAS was translated into Spanish (FAS-e) using forward and back translation. A convenience sample was constituted with 870 postpartum women recruited at discharge from 17 public hospitals in Eastern Spain. Data was obtained from clinical records and self-administered questionnaires at discharge. Internal consistency, factor structure, comparisons between known groups and correlations with other variables were assessed.

Results

Cronbach’s alpha coefficient was .80. Findings on the dimensionality of the FAS-e scale indicated that it was sufficiently unidimensional. FAS-e scores were higher among women who had undergone caesarean births (p < .05), had a higher level of postpartum pain (p < .01), experienced difficulties during breastfeeding (p < .01) and had lower levels of self-efficacy for breastfeeding (p < .01).

Conclusions

An equivalent Spanish version of the FAS was obtained with good reliability and validity properties. FAS-e is an appropriate tool to measure postpartum fatigue.

Efficacy of Warm Showers on Postpartum Fatigue Among Vaginal-Birth Taiwanese Women: A Quasi-Experimental Design

BACKGROUND AND PURPOSE

Postpartum fatigue is one of the most common complaints among women following childbirth. As a postpartum ritual practice, Taiwanese women refrain from taking showers while "doing the month." However, warm showers are the systemic application of moist heat, and they maintain physical hygiene, stimulate blood circulation, mitigate discomfort, and provide relaxation. As Taiwanese society becomes increasingly receptive to scientific and contemporary health care practice, more and more women choose to take warm showers after childbirth. The purpose of this study was to evaluate the efficacy of warm showers on postpartum fatigue among vaginal-birth women in Taiwan.

METHODS

This was a two-group quasi-experimental design. Women took showers in warm water with temperatures ranging between 40 °C and 43 °C for approximately 20 minutes. Postpartum women's fatigue is measured using the 10-item Postpartum Fatigue Scale (PFS). The intervention effect was analyzed using a generalized estimating equation (GEE) model.

RESULTS

The study population consisted of 358 vaginal-birth postpartum Taiwanese women aged 20-43 years. Postpartum women who took warm showers showed improvements from their pretest to posttest mean scores of postpartum fatigue compared to postpartum women who did not take warm showers. Warm showers helped to reduce postpartum fatigue among vaginal-birth women during the study period.

IMPLICATIONS FOR PRACTICE

Nurses have the unique opportunity to provide the intervention to Taiwanese women who have vaginal birth to help them relieve postpartum fatigue with warm showers while "doing the month" without the taboo of no-showering customary practices in the early postpartum period.

How Postpartum Women With Depressive Symptoms Manage Sleep Disruption and Fatigue

Postpartum sleep and fatigue have bidirectional relationships with depressive symptoms and challenge women's everyday functioning. The everyday process of managing postpartum sleep and fatigue in the context of depressive symptoms remains unexplored. We conducted a grounded theory study with a sample of 19 women who screened positive on the Postpartum Depression Screening Scale (PDSS™) Short Form at 3 weeks postpartum. Women completed semi-structured in-home interviews and the full PDSS and Modified Fatigue Symptoms Checklist at 1, 3, and 6 months postpartum. The sample was on average 27 years old, with 2.8 children, and 63% were African-American. They described a basic social process of Finding a Routine Together, during which women's experiences with their infants progressed from Retreating at month 1 toward Finding a New Normal at month 6. In their work to Find a Routine Together, mothers' patterns of change over time were continuous, gradual, or prolonged. Their progress was influenced by depressive symptoms, social support, work and daycare, stability in social circumstances, and underlying stressors. This study's findings suggest the need to allocate resources and tailor interventions to meet the needs of women who are most vulnerable to the health effects of ongoing persistent severe fatigue, disordered sleep, and sub-clinical and clinical levels of depressive symptoms. © 2017 Wiley Periodicals, Inc.

Applications of and Barriers to Holistic Self-Care in a Low-Income, High-Risk Obstetric Population

OBJECTIVE

We examined 1) women's perceptions regarding self-care, 2) applications of self-care, and 3) barriers to practicing effective self-care.

METHODS

Four focus groups were conducted in a low-income, pregnant population. Focus group recruitment and discussions took place at a large medical center in a medically underserved area of central Georgia. Thirty-two adult pregnant women attending a high-risk obstetric clinic were included. Data related to holistic self-care were identified and grouped into one of three categories: women's valuations of self-care, applications of self-care, and barriers to self-care. The results were synthesized and compared to results from a study of postpartum women in which the same analytic framework for examining self-care practice was applied.

RESULTS

Although women tended to understand the importance of self-care, they had difficulty practicing all forms of self-care on a regular basis owing to financial constraints, limited family support, health complications due to their high-risk obstetric status, external commitments, and childcare and household responsibilities. Applications of self-care were typically inexpensive and mainly required time rather than money.

CONCLUSIONS

Socioeconomic status seems to influence the specific applications of and barriers to self-care. Health care providers should be aware of existing low-cost resources in the community that may assist prospective and new mothers in tending to their own emotional and physical needs. Providers should also discuss the importance of self-care with women during the perinatal period. Efforts should be made to educate school administrators regarding the impact of spontaneous requests for money for school activities, supplies, and field trips on the family budget.

Efficacy of a footbath for post-partum fatigue in South Korea: A quasi-experimental study

AIM

The purpose of this study was to identify the effects of a footbath on post-partum fatigue.

METHODS

This study used a quasi-experimental design by using an unequivalent control group, pre-post-test design. The participants were divided into experimental and control groups. Fifty post-partum women who were admitted to an obstetrics and gynecology ward of a general hospital were the experimental group and 50 post-partum women who were admitted to an obstetrics and gynecology ward of a women's hospital were the control group. Two hospitals were providing similar postnatal care to their patients and they were located in the same city. The experimental group received a footbath along with postnatal care at the hospital, while the control group received only postnatal care from the hospital. Each group completed the Fatigue Continuum Form at a specified time.

RESULTS

The general characteristics and pretest dependent variables were homogenous between the two groups. The hypothesis was supported post-test as the Fatigue Continuum Form scores differed significantly between the experimental and the control groups.

CONCLUSION

This study showed that a footbath helps to decrease fatigue among post-partum women. In addition, it is a good preventative strategy for post-partum women who should initiate it in the early post-partum period.

Effect of Pilates exercises on postpartum maternal fatigue

INTRODUCTION

Postpartum fatigue is a pervasive phenomenon and often affects mothers immediately after delivery. The present study aimed to assess the effect Pilates home exercises had on postpartum maternal fatigue.

METHODS

A total of 80 women participated in our clinical trial study. The women were randomly divided into two groups - the intervention group (n = 40) and the control group (n = 40). In the intervention group, the women performed Pilates exercises five times a week (30 min per session) for eight consecutive weeks. The first session was conducted 72 hours after delivery. The control group did not receive any intervention. Each woman's level of fatigue was evaluated at hospital discharge (as a baseline), and at four and eight weeks after delivery, using the standard Multidimensional Fatigue Inventory (MFI-20) questionnaire and repeated measures analysis.

RESULTS

During the eight weeks of follow-up, we found that the intervention group had lower mean MFI-20 scores than the control group with regard to general fatigue (7.80 ± 2.07 vs. 12.72 ± 1.79; p < 0.001), physical fatigue (7.12 ± 1.41 vs. 10.42 ± 2.02; p < 0.001), reduced activity (6.95 ± 1.35 vs. 11.27 ± 1.70; p < 0.001), reduced motivation (6.20 ± 1.01 vs. 9.80 ± 2.04; p < 0.001) and mental fatigue (6.85 ± 1.45 vs. 10.72 ± 1.98; p < 0.001).

CONCLUSION

The present study's findings show that physical exercise can significantly reduce postpartum maternal fatigue in all subscales.

Postpartum fatigue, baby-care activities, and maternal-infant attachment of vaginal and cesarean births following rooming-in

AIM

This study compares women's postpartum fatigue, baby-care activities, and maternal-infant attachment following vaginal and cesarean births in rooming-in settings.

BACKGROUND

Postpartum women admitted to baby-friendly hospitals are asked to stay with their babies 24 hours a day and to breastfeed on demand regardless of the type of childbirth.

METHODS

The study used a descriptive cross-sectional study design. A total of 120 postpartum women were recruited from two accredited baby-friendly hospitals in southern Taiwan. Three structured questionnaires were used to collect data, on which an analysis of covariance was conducted.

RESULTS

Women who experienced a cesarean birth had higher postpartum fatigue scores than women who had given birth vaginally. Higher postpartum fatigue scores were correlated with greater difficulty in baby-care activities, which in turn resulted in weaker maternal-infant attachment as measured in the first 2 to 3 days postpartum.

CONCLUSIONS

Hospitals should implement rooming-in in a more flexible way by taking women's postpartum fatigue and physical functioning into consideration.

The role of maternal self-care in new motherhood

OBJECTIVE

To examine the following: (1) women's perceptions regarding the role of maternal self-care, (2) specific applications of self-care in new motherhood and (3) barriers to practising effective self-care.

DESIGN

three focus groups were conducted in order to study women's perspectives regarding the key components of new motherhood.

SETTING

Recruitment took place in Allegheny County, surrounding Pittsburgh. The focus groups were held at the University of Pittsburgh's Medical School.

PARTICIPANTS

Thirty-one adult women who had given birth in the year prior to enrollment participated in the study.

METHODS

The focus group conversations were recorded and transcribed for purposes of qualitative analysis. Conversation related to maternal self-care, which was identified as a component of new motherhood, was grouped into one of three categories: (1) women's valuations of self-care, (2) effective applications of self-care and (3) barriers to good self-care practice.

FINDINGS

Two ideologies regarding the role of self-care emerged. In one conception of effective mothering, self-care was of primary importance. On the contrary, some women associated a sometimes extreme form of self-sacrifice with new motherhood. Effective applications of self-care included taking time to exercise, allowing the infant's father to care for the child for a period of time and going out to restaurants. Barriers to good self-care practice were time, other limited resources such as money and social support and difficulty accepting help and setting boundaries.

KEY CONCLUSIONS

Additional focus groups should be conducted with the purpose of studying maternal self-care exclusively. This work is an important first step in identifying ways to help new mothers better care for themselves.

Theoretical contributions to a program of research promoting postpartum health

There is a need for interventions that address postpartum fatigue and sleep problems. Of the women who experience this, few receive the needed nursing care during the weeks after childbirth when severe postpartum fatigue and poor sleep are most prevalent. These health problems are significant not only for the well-being of the new mother, but for her infant and other family members. This article outlines four steps in applying theory in research, using a "top-down and bottom-up" approach to develop a nursing intervention for self-management of postpartum fatigue and sleep.

The physical and social environment of sleep in socioeconomically disadvantaged postpartum women

OBJECTIVE

To describe the physical and social environment of sleep self-management in postpartum socioeconomically disadvantaged women.

DESIGN

Descriptive, exploratory design.

SETTING

Participants were recruited in the hospital after giving birth. Data were collected in participant homes after discharge.

PARTICIPANTS

Postpartum women on Medicaid with normal healthy infants.

METHODS

Participants completed a survey about features within their physical and social sleep environment at 2 weeks postpartum. Participants then completed 3 days and nights of sleep diaries at 4 and 8 weeks postpartum to document perceived awakenings, select sleep hygiene practices, bed sharing, and reasons for sleep disruption.

RESULTS

The sleep environments of participants were dynamic from night to night. Bed sharing was common with nearly one half of participants sharing with a partner, approximately 25% with the infant, and 20% with older children. Fifty-two percent of participants slept with the television on part (31%) or all (69%) of the night. Eighty-five percent of participants drank caffeine and 24% smoked.

CONCLUSIONS

These results inform theory-driven postpartum sleep interventions. Modifications to the physical and social sleep environment that attend specifically to how sleep hygiene and environmental factors are manifested in the postpartum period have the potential to improve sleep for socioeconomically disadvantaged women. Future research is needed to articulate which changes can be effectively self-managed by mothers through nursing interventions.

Demystifying self-transcendence for mental health nursing practice and research

Because human development is an integral aspect of life, pathways to mental health necessarily involve developmentally based issues or resources. This column provides an overview of self-transcendence as one developmentally based resource for mental health. The Self-Transcendence Scale is presented to encourage its use in mental health nursing practice and research.

Severe Fatigue and Depressive Symptoms in Lower-Income Urban Postpartum Women

The purpose of this study was to identify whether severe postpartum fatigue at 1 and 3 months postpartum was associated with depressive symptomatology at 6 months in lower-income urban women. A convenience sample of 43 lower-income postpartum women completed the Modified Fatigue Symptoms Checklist and Edinburgh Postpartum Depression scale at 1, 3, and 6 months postpartum. Participants who were severely fatigued at both 1 and 3 months postpartum were significantly more likely to exhibit depressive symptomatology at 6 months. Fatigue and depressive symptoms were moderately to strongly correlated at 1 ( r = .68), 3 ( r = .74), and 6 ( r = .70) months postpartum ( p = .001). Severe fatigue and depressive symptomatology often co-exist for months after childbirth. Future research should examine whether interventions to targeting severe postpartum fatigue in lower-income urban women may also effectively reduce depressive symptoms.

A depressive symptoms responsiveness model for differentiating fatigue from depression in the postpartum period

Fatigue is both a symptom and a predictor of depression in women after childbirth. At the same time, postpartum fatigue is experienced by most non-depressed women. Health care providers experientially know that not all women who experience postpartum fatigue will manifest depression. However, while researchers agree that fatigue and depression are distinct concepts, they have not yet identified a means for describing or measuring this distinctness. A new model proposing how fatigue may be differentiated from depression after childbirth is presented. The Depressive Symptoms Responsiveness Model proposes that depression-related postpartum fatigue may potentially be differentiated from non-depression-related postpartum fatigue on the basis of whether depressive symptoms abate when fatigue is relieved. The ability to differentiate between fatigue and depression in postpartum women has the potential to improve women's health through improvements in practice and resource utilization. Furthermore, differentiation may lead to a better understanding of the role of fatigue in postpartum depression.