In survival mode: mothers and fathers’ experiences of fatigue in the early parenting period

Trajectories of interparental conflict and children's emotional-behavioural functioning at 10-11 years: an Australian population-based study

Interparental conflict (IPC) has the potential to adversely affect children's social, emotional, and behavioural functioning. The overall objective of this study was to investigate the relationship between both the severity and chronicity of IPC across early and middle childhood and children's emotional-behavioural functioning at 10-11 years. Specifically, we aimed to: (1) identify distinct trajectories of IPC spanning 10-11 years since birth of the study child as reported by mothers, and (2) examine the emotional-behavioural functioning of children exposed to the identified IPC trajectories. Drawing from a nationally representative longitudinal study of Australian families (N = 4875), four distinct trajectories of IPC were identified: (1) consistently low exposure to IPC over time, (2) persistently elevated exposure to IPC, (3) increasing IPC exposure over time, and (4) decreasing IPC exposure over time. Children exposed to trajectories with high IPC at any point during the study period were reported by their mothers to be experiencing more emotional-behavioural difficulties than children exposed to low IPC over time. Based on teacher report, there were no differences in emotional-behavioural functioning of children exposed to the different patterns of IPC. Our findings reinforce that high parental conflict at any point in a child's life is a form of adversity that can have adverse consequences for their mental health, and that early interventions for parents and caregivers experiencing high IPC are critical.

Children's sleep and fathers' health and wellbeing: A systematic review

Night-waking is typical across infancy and early childhood, inevitably disrupting family sleep. For some children, sleep problems develop and endure throughout childhood. This systematic review focused on fathers, and synthesised the evidence pertaining to the effects of children's sleep (from birth to 12 years) on fathers' health and wellbeing. A total of 29 studies were included. Key outcomes reported for fathers were: sleep and fatigue; mental and general health; and family functioning. An association between child sleep and father's sleep was observed when child's sleep was measured via actigraphy or paternal report, but not when measured via maternal report, suggesting that mothers may not always be aware of disruptions that awaken fathers. Findings showed poorer child sleep was associated with poorer general health and wellbeing among fathers, however, associations of poor child sleep with depression were fewer, and less frequent than those reported for mothers in the same households. Poor child sleep was negatively associated with the quality of family relationships, both within the couple and between parent and child. Future studies seeking to understand the interplay of child sleep and family wellbeing should apply objective measurement of sleep and integrate formal measures of family dynamics into the study design.

Perinatal Mental Health Support and Early Childhood Home Visitation During COVID-19

COVID-19 has disrupted many of the preventive service sectors designed to serve mothers at-risk for developing postpartum depression, forcing a rapid transition to telehealth-based modes of delivery. The purpose of this study was to explore differences in early childhood home visitation service provision (enrollment and depression screening) among mothers receiving home visitation services prior to and after the onset of the COVID-19 pandemic. Additional factors related to receipt of virtual home visitation services, family risk factors, and the maternal depressive symptoms were examined. Linear and logistic regression were utilized to examine whether there were differences in family risk factors, the percentage of mothers being screened for depression and maternal depressive symptoms, and associations between risk factors and positive depression screenings, while accounting for clustering by site. Samples compared outcomes for families enrolled during the pre-pandemic period (defined as March 16th to July 27th, 2019, n = 4,743) and the post-pandemic period (defined as March 16th to July 27th, 2020, n = 2,049). Families enrolled after the onset of the pandemic were significantly less likely to be impacted by housing instability, have a child with a disability, or be involved with the military, but more likely to have a history of child abuse or neglect. Fewer mothers were screened for depression during the pandemic and maternal report of depressive symptoms decreased. Virtual home visitation is currently attracting some groups of mothers who are experiencing fewer stressors, which may place them at decreased risk for exhibiting depressive symptoms. There may be aspects of the virtual depression screening experience that make detection more difficult. As a result, many mothers at risk for maternal depression may not receive adequate prevention services.

The Relationship between Fatigue in Mothers and the Age of Their Less-Than-24-Month-Old Newborns

The birth of a child marks the beginning of a new developmental period for the parents. These changes have positive but also negative aspects, such as the increase in fatigue experienced by mothers during this period of time, which can be very limiting and lead them to postpone other life or work goals. However, despite the widespread nature of this problem, there is a lack of information about the duration of this fatigue, with estimates ranging from three months to six years; this prevents mothers from planning this period of their lives adequately. The current study evaluated fatigue in a Spanish sample of 67 women with infants less than two years old and drew a comparison with another sample of 46 women with similar characteristics who were not caring for an infant at that time in order to determine the differences between them and how fatigue in the former group evolves depending on the age of the infant. The results show that fatigue is effectively maintained until at least two years after the birth of the infant.

The effect of nurse support and social support on fatigue experienced by mothers whose children are hospitalized

The authors' aim in this study was carried out to determine the effect of social support and nurse support on fatigue experienced by mothers whose children were hospitalized. This is a descriptive, analytical and cross-sectional research study. Our study population consisted of all the mothers (n = 198) who had children hospitalized in the pediatric services of the public and training and research hospitals. Data were collected using a questionnaire, Nurse Parent Support Tool, Multidimensional Scale of Perceived Social Support and Brief Fatigue Inventory. Our finding the mothers accompanying their hospitalized children who received adequate nurse support were found to have less maternal fatigue.

Changes in quality of life and sleep across the perinatal period in women with mood disorders

INTRODUCTION

The perinatal period represents a time of significant life changes associated with increases in sleep difficulties, depression, and potentially impaired quality of life (QoL). Associations between QoL and sleep among women with perinatal depression are poorly understood, and changes in QoL across the perinatal period have received little attention.

METHODS

Participants were the treatment-as-usual group (n = 23) from a clinical trial testing an intervention for perinatal mood disorders. They completed the WHOQOL-Bref, had depression assessed with the HAM-D-17, and wore wrist actigraphs to estimate sleep for 1 week during third trimester and at 6 weeks postpartum.

RESULTS

Higher education level was associated with better environmental QoL during pregnancy (p = .044) and presence of older children was associated with worse social QoL postpartum (p = .045). Psychological health QoL worsened (p = .014) across the perinatal period. Total sleep time (p = .001) and sleep efficiency (p = .008) decreased from third trimester to postpartum week 6, but sleep measures were not associated with QoL at either time point. Depressive symptoms decreased from pregnancy to postpartum week 6 and were inversely associated with postpartum physical and social QoL (p = .031 and .048).

DISCUSSION

Factors contributing to self-rated QoL are variable across multiple domains during the perinatal period. QoL among our participants was lower than population norms. In our sample of women with depression and/or anxiety, QoL was related to postpartum depressive symptoms, but not to objectively measured sleep quality, quantity, or timing. Links between QoL and sleep may be inherently complex in perinatal women.

"Being relieved and puzzled": A qualitative study of first time fathers' experiences postpartum in Jordan

BACKGROUND

Although the transition to fatherhood is a point of attention for researchers, little is known about the first time father's postpartum experience. This study aims to explore the first time fathers postpartum experience in the country of Jordan.

METHODS

An exploratory qualitative design was used. Semi-structured interviews were conducted with a purposive sample consisting of twelve first time fathers. The study was conducted in a public university in Jordan. The data was collected in 2017 and was thematically analysed using the colour and file index method.

RESULTS

The analysis revealed two main themes. The first theme centred around a feeling of relief which can be further divided into two sub-themes of self-actualisation and continuation of the family line. The second theme centred around the feeling of puzzlement, and this can also be further divided into two sub-themes of feeling unable to deal with a newborn baby and struggling to care for a recovering wife. The study identified fathers as willing to engage in the private care of their new babies and recovering wives but at a limited level of engagement. The fathers verbalised the lack of knowledge and exhibited sociocultural stereotypes related to masculinity and the role of the man in the family.

CONCLUSIONS

The first time fathers' experiences ranged from feelings of relief to puzzlement. The fathers experiences were shaped by religion, culture, and masculinity which suggests education during antepartum may enhance the experience.

The consequences of having an excessively crying infant in the family: an integrative literature review

BACKGROUND

The consequences of having an excessively crying infant in the family are acknowledged in research, yet to our knowledge, no literature review has been made regarding the overall consequences to the family and infant. This integrative review fills the gap with the aim to review and synthesise current research.

AIMS

To identify, describe and synthesise previous studies on the consequences of having an excessively crying infant in the family.

DESIGN

An integrative review of literature published between January 2008 and April 2018. The search was conducted in the following databases: MEDLINE, CINAHL, PsycINFO, Medic and Journals@Ovid. Empirical literature reporting the consequences of having an excessively crying infant in the family was eligible for inclusion. Quality appraisal was performed using CASP tools and JBI checklists. The extracted data were analysed using thematic analysis.

FINDINGS

Thirty-one articles were included in the review. Ten themes were identified: The consequences of having an excessively crying infant in the family create desperation. It ruins everyday life, impairs breastfeeding, isolates and casts parents into loneliness, strains and breaks family relationships with feelings of failure as a parent. The excessively crying infant in the family brings a struggle that can lead to physical and mental exhaustion. The infant may have problems later in childhood. Parents are actively trying to solve the problem and to adjust. Time allows survival with traces of negative symptoms, feelings and memories.

CONCLUSIONS

The consequences of having an excessively crying infant in the family are harmful to relationships and health. Caring for the crying infant can lead to exhaustion, which might escalate into abuse. These findings help professionals understand this complex phenomenon and encourage actions for concrete support. Further research is required to explore evidence-based interventions that can help excessively crying infants and their families.

Parenting Stress, Sleep, and Psychological Adjustment in Parents of Infants and Toddlers With Congenital Heart Disease

Objective

Parents of children with chronic medical needs report increased parenting challenges, poor sleep, and maladjustment. The impact of parenting stress on both sleep and adjustment has yet to be evaluated for parents of infants and young children with congenital heart disease (CHD). We studied the relations among parenting stress, sleep, and adjustment in parents of infants and toddlers with CHD. We expected that sleep quality would mediate the relationship between parenting stress and adjustment.

Methods

Sixty-nine parents of infants and toddlers with CHD were evaluated on self-report measures of illness-related parenting stress (Pediatric Inventory for Parents), sleep (Pittsburgh Sleep Quality Index), and psychological adjustment (Brief Symptom Index-18).

Results

The parents of infants and toddlers with CHD reported elevated levels of parenting stress, sleep problems, and maladjustment. The positive relationship between parenting stress and parent maladjustment was mediated by sleep quality.

Conclusions

Findings suggest that parents of infants and toddlers with CHD report high parenting stress, poor sleep, and maladjustment. Analyses indicate the stress-adjustment relationship is mediated by quality of sleep. Given the multiple demands on parents of infants and children with CHD, it is important to attend to parents’ overall functioning and mental health. Our findings highlight targets for intervention to improve the well-being of parents of young children with CHD.

Postpartum fatigue and depression: A systematic review and meta-analysis

BACKGROUND

New parents are vulnerable to fatigue and depressive symptoms. Many studies have reported significant positive correlations between the two in postpartum parents, but the size of correlations varies considerably between studies. The relationship between postpartum fatigue and depression is yet to be systematically synthesized and meta-analyzed.

METHODS

A PROSPERO registered systematic review and meta-analysis (CRD42017065240) was conducted on the correlation between fatigue and depression within the first two years postpartum in parents. Moderation analysis was used to examine the influence of demographic and measurement factors on the effect sizes.

RESULTS

Thirty-five eligible papers were identified (34 on mothers, 1 on fathers). The meta-analytic summary effect size for simultaneously measured fatigue and depressive symptoms among women in the postpartum period was r = 0.52, 95% CI [0.45, 0.59], p < .001. There was a high degree of heterogeneity in the strength of the correlation between studies. This heterogeneity was not accounted for by demographic (e.g., infant age, maternal age, population type) or methodology (e.g., measurement) related moderators.

LIMITATIONS

Studies not reporting or providing correlation between fatigue and depression were not included. Unable to assess some moderators due to limited sample size.

CONCLUSIONS

There is a strong correlation between fatigue and depressive symptoms among women in the first two years after child-birth, but a high degree of heterogeneity in correlation strength exists between studies. Careful assessment of both fatigue and depression when either symptom is reported could facilitate accurate differential diagnosis and prioritizing treatment in postpartum women. Further implications for assessment, treatment, and future research are discussed.

Parents' experiences with sleep problems in children aged 1-3 years: a qualitative study from a health promotion perspective

Purpose: The aim of this study was to explore the experiences of parents whose children aged 1–3 years have sleep problems, from a health promotion perspective.

Methods: This was a qualitative study, based on semi-structured interviews with 12 mothers in Norway. The material was analysed by qualitative content analysis.

Results: Parents experienced problems with getting their children to bed, getting them to fall asleep, and episodes of awakening at night. Parents expressed that it was time-consuming and difficult to teach their children sleep regulation. Parents handled the sleep problems through the following coping strategies: acknowledging challenges, clarifying one’s self-understanding, implementing change measures, and safeguarding family well-being. These coping strategies resulted in this main theme: the health-promoting regulation of interactions, including parents’ strengthening of sleep regulation in their small children and the safeguarding of well-being in the family.

Conclusions: Early, individually customized guidance for parents, with a focus on revealing and acknowledging their experiences with sleep problems in children, is essential for parents to find opportunities to cope with such challenges. Appropriate goals seem to be important for them to succeed in strengthening sleep regulation in their children in a more satisfactory way.

Sleep and its relationship to health in parents of preterm infants: a scoping review

BACKGROUND

Sleep is essential for human health and functioning. Parents of preterm infants are susceptible to sleep disturbances because of stress related to the preterm birth. Poor sleep has the potential to affect parental health and well-being. The aim of this study was to identify and map evidence on sleep and its relationship to health in parents of preterm infants. No review has summarized the evidence on this topic.

METHODS

A scoping review was conducted. Seven health and medical electronic research databases were searched for relevant quantitative and qualitative primary studies, including grey literature. The search was performed March 2-7, 2017.

RESULTS

Ten American studies and one Australian study were included in the review. Most research was quantitative and focused on maternal sleep and mental health within the first two weeks after the childbirth. Both objective and subjective sleep measures were used to study sleep at the hospital; actigraphs were not used after discharge. Maternal sleep was poor early postpartum, and this was associated with negative health outcomes. Two cohort studies compared sleep in mothers of preterm and term infants, but the results were conflicting. In one qualitative study, fathers described their inability to catch up on sleep after homecoming with a preterm baby.

CONCLUSIONS

Quantitative studies reporting on maternal sleep early postpartum was most frequently occurring in the results. Qualitative research on the topic was identified as a knowledge gap. More cultural and geographical breadth, including research on fathers' sleep, is recommended in future research.

Transition to parenthood: consequences on health and well-being. A qualitative study

OBJECTIVE

Parenthood is one of the most dramatic developmental transitions in the family life cycle. It requires profound changes in lifestyle, roles and relationships, can increase stress levels and affects both men and women's quality of life. This study aimed to explore the effects on the health and well-being of parents during the first six months of transition to the parental role.

METHOD

A qualitative study using the grounded theory approach. Data collection was from semi-structured interviews (total of 60 interviews). The constant comparative method was used and theoretical sampling in the process of data collection and analysis, and the study was undertaken in a simultaneous and cyclical way. Five fathers and five mothers (couples) participated.

RESULTS

The category "living on the edge of one's capacities" was described, which is composed of the subcategories "feeling exhaustion", "perceiving exhaustion in the mother", "overflowing emotions" and "feeling less exhaustion", to explain the impact that the birth of a child had on the parents' lives, when taking on all the tasks and responsibilities of parenthood.

CONCLUSIONS

Adapting to parenthood is not easy, linear or fast. It involves numerous situations that generate stress and emotional disturbance, linked to tiredness, sleep disturbance, work overload and readjustments of the dynamics of life, which especially affect the mother. Antenatal and postnatal preparation for this impact should, therefore, be encouraged and effective, as a focus of nursing intervention.

Maternal burn-out: an exploratory study

INTRODUCTION

Maternal burn-out is a psychological, emotional and physiological condition resulting from the accumulation of various stressors characterised by a moderate but also a chronic and repetitive dimension. Little research has focused on this syndrome.

OBJECTIVE

The current study aims to assess maternal burn-out rate and to identify factors associated with this state of exhaustion.

METHOD

263 French mothers aged between 20 and 49 years answered five scales quantifying maternal burn-out, perceived social support, parental stress, depression and anxiety symptoms and history of postnatal depression.

RESULTS

About 20% of mothers were affected by maternal burn-out. The main factors related to maternal burn-out were having a child perceived as difficult, history of postnatal depression, anxiety, satisfaction of a balance between professional and personal life and parental stress.

CONCLUSION

This research shows the need for further work on maternal burn-out to better understand and prevent this syndrome.

Course of maternal fatigue and its associated factors during the first 6 months postpartum: a prospective cohort study

Aims

To identify the course of maternal fatigue during the first 6 months postpartum and to determine factors associated with it.

Design

A prospective cohort study.

Methods

Women (N = 2,697) in 13 Japanese hospitals provided longitudinal data using self‐report questionnaires at five time points. Maternal fatigue was assessed using the Postnatal Accumulated Fatigue Scale. We focused on the effect of maternal age and parity on the course of maternal fatigue and used a mixed between/within‐subjects analysis of variance. Factors associated with maternal fatigue were analysed using stepwise multiple regression.

Results

In the 6‐month postpartum period, the level of fatigue was highest at 1 month and significantly decreased from 1–4 months postpartum. Primiparas showed a significantly higher level of fatigue than multiparas during hospital stay and their levels of fatigue more closely approximated the 1‐month peak. Multiparas showed significantly higher levels of fatigue than younger primiparas at 6‐month postpartum. Factors associated with maternal fatigue included satisfaction with sleep, concerns about child‐rearing, satisfaction with social support, financial burden and meal times per day.

Cross-sectional and longitudinal validation of a 13-item fatigue scale among Japanese postpartum mothers

This study examined the psychometric properties of a 13-item fatigue scale for postpartum mothers. Japanese mothers (n = 2026) from a cohort study completed questionnaires (e.g. fatigue scale, Japanese version of the Edinburgh Postnatal Depression Scale, demographics) during their hospital stay after childbirth (baseline) and at 1, 2, 4 and 6 months postpartum. Initial factor analysis of baseline data revealed that the fatigue scale had three factors or subscales (physical, emotional and cognitive). Within-group analysis across each measurement time revealed the same three-factor structure with acceptable fit. Between-group analysis also showed longitudinal factorial invariance across time. The fatigue subscales had acceptable divergent and convergent validities with the depression scale. The subscale scores differed significantly based on participant background. The Japanese Fatigue Scale is a concise and informative tool for assessing aspects of fatigue in clinical settings and in the community.

Factors influencing fatigue among mothers with hospitalized children: A structural equation model

PURPOSE

The aim of this study was to identify the physiological, psychological, and situational factors affecting fatigue among mothers of hospitalized children.

DESIGN AND METHODS

This study used a cross-sectional descriptive design with a self-report questionnaire. Participants were 211 mothers with children younger than 6 years old who were admitted to general hospitals. Based on the theory of unpleasant symptoms, the physiological, psychological, and situational factors were tested using structural equation modeling.

RESULTS

Mothers' fatigue was influenced by physiological (β = .24), situational, and psychological factors (β = .17), and situational (β = .37) factors such as the mother's sleeping hours, the child's adaptation to hospitalization, anxiety and having support with their housework. These three factors explained 31.34% of the variance in fatigue. In particular, it was found that the psychological factors exacerbate the negative influence of the situational factors on fatigue. Moreover, the situational factors were most strongly related to mothers' fatigue, and they had an indirect effect via the psychological factors as a mediator.

PRACTICE IMPLICATIONS

It is necessary to implement a nursing intervention that targets the controllable factors such as anxiety and children's adaptation to hospitalization that were identified in this study. Pediatric nursing care should not be limited to treating children's illnesses, but should be extended to providing family-centered care.

Perinatal Education and Support Program: Baystate's New Beginnings

Parent education traditionally focuses on childbirth, whereas the perinatal period gets little attention despite parents' reports of feeling unprepared. Lack of education surrounding newborn behavior leads to decreased maternal confidence and ineffective responsiveness to infant cues for feeding, crying, and sleep. This can cause overfeeding, lowered breastfeeding success, and contributes to parental stress which can impact maternal-infant bonding. Lack of postpartum maternal support adds to fatigue and stress which contributes to poor maternal well-being. This article describes an innovative perinatal program, Baystate's New Beginnings, modeled after the education from the 2011 California Baby Behavior Campaign and The Secrets of Baby Behavior that combines newborn behavior education and maternal support in the first 3 months postpartum to improve maternal role transition.

"I didn't know it was possible to feel that tired": exploring the complex bidirectional associations between maternal depressive symptoms and fatigue in a prospective pregnancy cohort study

Depressive and fatigue symptoms are common health concerns for women in the postnatal period. Few studies have sought to investigate the role of fatigue in the development and maintenance of depressive symptoms. The aim of this paper was to examine the relationship between depressive symptoms and fatigue over the course of the first 4 years postpartum, in particular focusing on the extent to which fatigue at earlier time points predicted later depressive symptoms and vice versa. Data from over 1000 women participating in a longitudinal study of Australian women's physical and psychological health and recovery after childbirth were used. An autoregressive cross-lagged panel model was tested to assess the mutual influences of fatigue and depressive symptoms across five time points at 3, 6, 12 and 18 months postpartum, and at 4 years postpartum. A complex bidirectional relationship between fatigue and depressive symptoms from 3 months to 4 years postpartum was observed, where fatigue at earlier time points predicted depressive symptoms at later time points, and vice versa. The findings of this study suggest interventions targeting the prevention and management of fatigue may also confer some benefit in improving or preventing the development of depression symptoms in the early parenting period.

The relationship between parental fatigue, parenting self-efficacy and behaviour: implications for supporting parents in the early parenting period

BACKGROUND

Emerging evidence indicates that parental fatigue is associated with low warmth and increased hostility in parent-child interactions. One possible pathway by which fatigue may impact on parenting behaviour is via parental self-efficacy (PSE), whereby high fatigue may undermine PSE, which is often associated with suboptimal parenting behaviour. The current study sought to explore a model of the relationships between parental fatigue, parenting warmth and hostility, where PSE mediates these relationships and whether the nature of these relationships differ by social or family context.

METHODS

The current sample was drawn from a larger Australian community sample survey on parent well-being and parenting. It consisted of 1143 parents (mothers, n = 1003; fathers, n = 140) of children aged 0-4 years.

RESULTS

Path analysis revealed that the relationship between fatigue and parenting warmth and hostility was fully mediated by PSE.

CONCLUSIONS

These results indicate that fatigue has the potential to negatively influence parenting behaviours that are important for their children's well-being and development, and that fatigue plays a mediating role in this relationship. Implications of the study for psycho-education and interventions targeting the management of parental fatigue are discussed.

Age-specific determinants of post-partum fatigue in primiparous women

AIM

Post-partum fatigue is a serious concern for mothers worldwide. The aim of this study was to identify age-specific determinants of self-perceived fatigue after childbirth among Japanese primiparous women.

METHODS

A multicenter prospective cohort study was conducted in Japan. The degree of fatigue was assessed using the Postnatal Accumulated Fatigue Scale during the hospital stay after childbirth. Associated factors were stratified into two age groups (<35 or ≥35 years old); data were analyzed using stepwise multiple regression.

RESULTS

In the younger group, significant determinants of post-partum fatigue included: anticipated difficulties in child-rearing after discharge; perception of inadequate sleep conditions; dissatisfaction with childbirth; shorter sleep and meal times; longer duration between feeding and infant bedtime; unemployment; and having hyperemesis gravidarum. In the older group, significant determinants of post-partum fatigue included: anticipated difficulties in child-rearing after discharge; perception of inadequate sleep conditions; shorter meal times; formula feeding; and dissatisfaction with childbirth.

CONCLUSION

Primiparous mothers who anticipated new life with their infants to be difficult and who had an irregular lifestyle tended to report higher levels of fatigue during the post-partum hospital stay. Nurses and midwives should assess maternal sleep and eating conditions, providing support to ensure adequate maternal rest. Special efforts should be made to reduce anxiety about new life with infants among younger primiparous women who had experienced hyperemesis gravidarum.

Differentiating maternal fatigue and depressive symptoms at six months and four years post partum: Considerations for assessment, diagnosis and intervention

OBJECTIVE

fatigue and depressive symptoms are common among women in the postpartum period, and it has been proposed that fatigue is a risk factor for later depression. To progress this research, there is a need to clarify the conceptual and measurement issue of whether these two sets of symptoms are distinct constructs. There is also a need to determine whether they are distinct constructs beyond the postnatal period. The aim of the study was to assess the construct and discriminant validity of fatigue and depressive symptoms as measured by the SF-36 Vitality subscale (SF-36) and the Edinburgh Postnatal Depression Scale (EPDS) at six months and at four years post partum.

DESIGN, SETTING AND PARTICIPANTS

data from over 1000 women participating in the Maternal Health Study, a longitudinal study of women׳s physical and psychological health and recovery after childbirth were used.

FINDINGS

confirmatory factor analysis revealed a two-factor model of fatigue and depressive symptoms represented as distinct but related constructs was a better fit to the data than a one-factor model of fatigue and depression sharing the same underlying construct at both six months and four years post partum.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

this study provides empirical evidence that maternal fatigue and depression in the first year after having a baby and at four years post partum are best understood as separate psychological constructs or experiences. The findings have important implications for clinical practice, in particular underlining the importance of differentiating tiredness from depression.

Hindering and buffering factors for parental sleep in neonatal care. A phenomenographic study

AIMS AND OBJECTIVES

To explore and describe how parents of preterm and/or sick infants in neonatal care perceive their sleep.

BACKGROUND

Parents experience many stressful situations when their newborn infant is preterm and/or sick. This affects bonding. By developing more family-centred care units with single-family rooms, parents are given the opportunity to stay and care for their newborn infant(s) 24 hours a day. Lack of sleep may affect new parents' ability to cope with the many challenges they face on a daily basis.

DESIGN

A phenomenographic study with an inductive and exploratory design.

METHODS

Semi-structured interviews were conducted with twelve parents of infants in neonatal care between January-March 2012. To describe variations in perception of the phenomenon, data were analysed using phenomenography.

FINDINGS

Four descriptive categories were identified within the phenomenon sleep in parents of preterm and/or sick infants in neonatal care: impact of stress on sleep; how the environment affects sleep; keeping the family together improves sleep; and, how parents manage and prevent tiredness.

CONCLUSION

Anxiety, uncertainty and powerlessness have a negative influence on sleep. This can be decreased by continuous information, guidance and practical support. Skin-to-skin care was perceived as a stress-reducing factor that improved relaxation and sleep and should be encouraged by the nurse. The parents also mentioned the importance of being together. Having a private place where they could relax and take care of themselves and their newborn infant improved sleep. It was also desirable to involve older siblings in order to decrease feelings of loneliness, sadness and isolation.

RELEVANCE FOR CLINICAL PRACTICE

Improved parental sleep in neonatal care may help the families cope with the situation and facilitate problem-solving, emotional regulation and the transition to parenthood.

Wide Awake Parenting: study protocol for a randomised controlled trial of a parenting program for the management of post-partum fatigue

BACKGROUND

Exhaustion and fatigue are commonly experienced by parents during the post-partum period, and can have implications for daily functioning, mental health and parenting practices. There is a need for the development of effective interventions to assist parents with the management of fatigue. This paper outlines the procedure for a randomised controlled study which aims to test the efficacy of Wide Awake Parenting, a program for the management of fatigue in the postnatal period.

METHODS/DESIGN

Parents with an infant less than 6 months of age, and from seven Local Government Areas in Melbourne, Australia were invited to participate in this study. Parents were randomised to receive the Wide Awake Parenting program (intervention groups) or usual care (control group) offered by health services. The Wide Awake Parenting program provides parents with psycho-education and information about fatigue, and strategies to reduce its effects either via a self-directed method, or professionally led with a home visit and telephone support. Baseline data will be collected prior to randomisation, and further data will be collected at 2- and 6-weeks post intervention.

DISCUSSION

To our knowledge this is the first randomised controlled trial of a program which compares the efficacy of a self-management approach and health professional assistance for the management of fatigue in the early post-partum period. If effective, it could offer an important, universal public health management approach to this common health concern.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry, ACTRN12611000133932.