Effect of behavioural-educational intervention on sleep for primiparous women and their infants in early postpartum: multisite randomised controlled trial

Abstract

The paper Abstract Objective —To evaluate the effectiveness of a behavioural-educational sleep intervention delivered in the early postpartum period in improving maternal and infant sleep. Design —Randomised controlled trial. Setting —Postpartum units of two university affiliated hospitals in Canada. Participants —246 primiparous women and their infants randomised while in hospital using an internet based randomisation service to intervention (n=123) or usual care (n=123) groups. Interventions —The behavioural-educational sleep intervention included a 45-60 minute meeting with a nurse to discuss information on sleep and strategies to promote maternal and infant sleep, a 20 page booklet with the content discussed, and phone contacts at one, two, and four weeks post partum to reinforce information, provide support, and solve problems. The usual care group received calls at weeks 1, 2, and 4 to maintain contact without provision of advice. Main outcome measures —Primary outcome was maternal nocturnal (9 pm to 9 am) sleep (minutes) and secondary outcome was longest stretch of infant nocturnal sleep (minutes) measured at six and 12 weeks post partum by actigraphy (sleep-wake cycles assessed by measuring body movement). Other outcomes measured at six and 12 weeks were number of maternal and infant night time awakenings measured by actigraphy, fatigue visual analogue scale, general sleep disturbance scale, and Edinburgh postnatal depression scale. Rates of exclusive breast feeding were measured at 12 weeks post partum only. Results —All women who completed any outcome measures at six or 12 weeks were included in analysis. Sleep outcomes were completed at one or both of six and 12 weeks post partum for 215 of 246 (87%) women (110/123 intervention and 105/123 usual care). Longitudinal mixed effects model analyses …