Postpartum Fatigue Research Articles

Development and evaluation of ‘Sleep, Baby & You’—An approach to supporting parental well-being and responsive infant caregiving

Disrupted parental sleep, presenting as post-partum fatigue and perceived as problematic infant sleep, is related to increased symptoms of depression and anxiety among new mothers and fathers. Previous research indicates that UK parents would value an approach that facilitates meeting their infants' needs while supporting their own sleep-related well-being throughout their infant's first year. Six initial stakeholder meetings were held with 15 practitioners and 6 parents with an interest in supporting parent-infant sleep needs, to explore existing service provision and identify gaps. The Possums Sleep Program developed and delivered in Brisbane, Australia in a GP clinic setting, was chosen as an appropriate approach. Working collaboratively with a stakeholder group, we translated the Possums Sleep Program into an intervention that could be universally delivered in the UK via NHS antenatal and postnatal practitioners. Parent and practitioner views of the initial materials were obtained via feedback questionnaires and the tool was revised. The intervention was then field-tested by 164 practitioners who delivered it to at least 535 new parents and babies over 5 UK locations, to capture anonymous parent and practitioner views of the intervention concept, the materials, and their experiences with both. The intervention helps parents recalibrate their expectations of infant sleep development, encourages responsive parenting and experimentation to meet their infant's needs, offers parents strategies for supporting the development of their babies' biological sleep regulators and promote their own well-being, and teaches parents to manage negative thinking and anxiety that can impede sleep using the principles of Acceptance and Commitment Therapy. The 'Sleep, Baby & You' discussion tool, a 14 page illustrated booklet for parents, was field-tested and evaluated by practitioners and parents who offered enthusiastic feedback. Practitioners reported the 'Sleep, Baby & You' materials were easy for them to explain and for parents to understand, and were a good fit with the responsive parenting approaches they employed in other areas of their work. Parents who received the intervention postnatally understood the material and found the suggestions easy to follow. All parents who provided feedback had implemented one or more of the suggested changes, with the majority of changes (70%) being sustained for at least two weeks. Practitioners recommended development of digital and antenatal versions and offered feedback on circumstances that might challenge effective uptake of the intervention. 'Sleep, Baby & You' is a promising tool for promoting parental attitude and behaviour-change, that aims to adjust parental expectations and reduce negative thinking around infant sleep, promote responsive infant care in the face of infant-related sleep disruption and fatigue, and support parental well-being during the first year of parenthood. Initial field-testing provided insights useful for further development and subsequent testing via a randomised trial. Support exists for incorporating 'Sleep, Baby & You' into an anticipatory, universal intervention to support parents who may experience post-partum fatigue and infant sleep disruption.

Analysis of status quo and research progress in nursing of postpartum fatigue: a literature review

Abstract Postpartum fatigue is an important issue that threatens women’s health. The incidence of postpartum fatigue is high. Failure to intervene in time may lead to adverse outcomes such as postpartum depression, premature termination of breastfeeding, child abuse, and low infant development. This article reviews the concepts, characteristics, related factors, adverse effects, and interventions of postpartum fatigue. The aim is to improve doctors’ and nurses’ awareness of on postpartum fatigue in pregnant women, enrich the research content and methods, stimulate the interest of nurses, and actively carry out targeted intervention research to prevent or reduce the occurrence of adverse outcomes.

A randomized controlled pilot study of the effectiveness of magnolia tea on alleviating depression in postnatal women.

The magnolia tea has been used in traditional oriental medicine for multiple purposes including sleep aid. Postpartum depression is a mental illness that adversely affects the health and well‐being of many families with newborns. Given the known effectiveness and relative safety, herein we aimed to investigate whether magnolia tea has a palliative effect on postpartum depression. The qualified participants were randomly assigned to the intervention group or the control group. The participants in the intervention group drunk magnolia tea, while the control group received regular postpartum care only. The outcome variables including Postpartum Sleep Quality Scale (PSQS), Edinburgh Postnatal Depression Scale (EPDS), and Postpartum Fatigue Scale (PFS) were assessed and compared. In comparison with the control group, the intervention group demonstrated significant difference for physical‐symptom‐related sleep inefficiency (PSQS Factor 2) at 3 weeks post‐test (t = −2.10, p = .03). The comparison results also revealed significant differences for PFS at both 3 weeks post‐test (t = −2.02, p = .04) and 6 weeks post‐test (t = −1.99, p = .04). Further, magnolia tea intervention significantly alleviated the symptoms of depression, reflected by the EPDS scores at 3 weeks post‐test (t = −2.38, p = .02) and 6 weeks post‐test (t = −2.13, p = .02). Our trial results suggested that drinking single‐ingredient magnolia tea for a 3‐week duration has positive effects on postpartum women. Magnolia tea is recommended as a supplementary approach to ameliorate sleep quality of postpartum women, while alleviating their symptoms of depression.

The Effect of Postpartum Fatigue on Exclusive Breastfeeding Rates at Discharge: A Comparison of Birth Methods

Exclusive breastfeeding is recommended for the first six months of life due to the benefits it offers to both baby and mother. Although breastfeeding initiation rates are high, breastfeeding continuation rates at six and twelve months and exclusive breastfeeding rates remain lower than Healthy People recommendations. The purpose of this study was to determine if postpartum fatigue had any impact on the success of exclusive breastfeeding when comparing birth methods. Although postpartum fatigue has been reported as a common occurrence, less is known about its effect on exclusive breastfeeding rates. A quasi-experimental study with 157 participants was completed to evaluate the effect of postpartum fatigue on exclusive breastfeeding rates at discharge using the Visual Analog Scale to Evaluate Fatigue (VAS-F). Both mothers who delivered vaginally and by cesarean section took part in this study at no less than one day after delivery. One hundred percent of mothers in the study reported varying levels of fatigue postpartum, with 47% breastfeeding exclusively. An independent samples T-test compared fatigue levels in vaginal and cesarean births. Statistical significance was noted in that cesarean section mothers were more fatigued than those who gave birth vaginally (p=0.015). Findings from a chi squared test showed exclusive breastfeeding rates in women who gave birth vaginally higher than cesarean section (χ2=12.47,p<.01) suggesting exclusive breastfeeding rates were dependent on birth type. Further research needs to be completed to determine what education or strategies relative to postpartum fatigue need to be identified to diminish the effects of postpartum fatigue which could lead to improved exclusive breastfeeding rates.

The effect of mother-infant skin-to-skin contact on the involution process and maternal postpartum fatigue during the early postpartum period

ABSTRACT Evidence has been limited on the effect of mother-infant skin-to-skin contact on the involution process and maternal postpartum fatigue. This study aimed to determine such effects in a randomized controlled trial conducted in a hospital in Sivas, Turkey. Seventy-five women were randomized into one of two groups. The Mother-Infant Information Form, Involution Process Evaluation Form and Visual Analogue Scale for Fatigue were used to collect data between October 1, 2015 and May 1, 2016. Repeated Measures ANOVAs were used for data analyzes. In the intervention group, routine care and mother-to-infant skin-to-skin contact were provided for 30 minutes in first postnatal hour. In the control group, routine care was provided. At the postnatal second, fourth and 24th hours, fundus heights were 13.4 ± 0.3, 12.9 ± 0.3 and 11.8 ± 0.3 cm, respectively, in the intervention group, and 14.4 ± 0.4, 13.8 ± 0.3 and 12.9 ± 0.3 cm in the control group (p < .05). At the 24th hour, women in the intervention group had higher mean energy levels (29.8 ± 10.1) than the control group (25.1 ± 10.0) (p < .05), and fatigue score, amount of lochia and number of pads were statistically similar between the groups (p > .05). Mothers expressed satisfaction with skin-to-skin practice. Thus, mother-to-infant skin-to-skin contact can be used as a care practice in the postpartum period.

HOT BATH THERAPY FOR POSTPARTUM MOTHERS: THE ETHNOCARING PRACTICE IN THE MUNA TRIBE, SOUTHEAST SULAWESI, INDONESIA

Background: Postpartum mothers are vulnerable to postpartum fatigue, delivery process fatigue, and role transition. The unknown fatigue can trigger stress and anxiety that will lead to postpartum blues and postpartum depression. The ethnocaring of the Muna tribe has a series of care that can prevent postpartum fatigue, including a hot bath. Objective: To explore the ethnocaring practice on the postpartum care method in the Muna tribe using hot bath and analyze it scientifically. Methods: This study was a qualitative study with an ethnographic approach. The participants were 15 Muna’s indigenous midwives and 4 Muna’s mothers. Snowball sampling was employed to select the samples. The data were collected through in-depth interviews, focus group discussion and participatory observation. The data validity was made by completing the trustworthiness criteria process.Results: The results of the study were described into 3 themes, namely equipment, treatment, and prohibition. The equipment theme describes tools and materials. Conclusion: The ethnocaring therapy of a hot bath in Muna’s postpartum mothers has healthy benefits namely for relaxation, increasing the oxygen uptake, increasing concentration and revitalizing the reproductive organs.

Changes in salivary oxytocin levels and bonding disorder in women from late pregnancy to early postpartum: A pilot study.

ObjectivesThis pilot study aimed to 1) follow the longitudinal changes in the salivary oxytocin level of pregnant women from late pregnancy to early postpartum, 2) examine the factors related to these changes, and 3) clarify the association of these changes with mother-infant bonding.MethodsThis study used a longitudinal observational design and questionnaires to obtain objective and subjective data. For oxytocin evaluation, saliva samples were collected and their oxytocin levels were measured at 4-time points [i.e., 1) 36–37 gestation weeks, 2) 38–39 gestation weeks, 3) 1–2 days postpartum, 4) 4–5 days postpartum]. The oxytocin level was assayed in duplicates by enzyme-linked immunosorbent assay. Baseline data were evaluated using the Parental Bonding Instrument (25 items), State Trait Anxiety Inventory (20 items), and Center for Epidemiologic Studies Depression Scale. Postpartum data were evaluated using the Mother to Infant Bonding Scale Japanese Version (10 items), Maternity Blues Scale (13 items), and ‘Fatigue after Childbirth’ using the Visual Analogue Scale (VAS: 0–100 mm).ResultsThe participants were 13 primiparas with a mean age of 33 years. They had no depression or anxiety at the baseline. Their mean salivary oxytocin levels significantly increased from late pregnancy (36–39 gestation weeks) up to 1 day postpartum and then decreased until 5 days postpartum. There was a negligible correlation between the bonding disorder and the salivary oxytocin level on the 5th day after childbirth. A moderate correlation was observed between the maternity blues score and the salivary oxytocin level. There was a significant negative correlation between the postpartum fatigue and the salivary oxytocin level 1 day and 5 days after childbirth.ConclusionThe mean salivary oxytocin levels significantly increased from the baseline up to 1 day postpartum and then decreased until 5 days postpartum. The salivary oxytocin level was moderately associated with maternity blues and significantly with postpartum fatigue.

Factors associated with maternal postpartum fatigue: an observationalstudy

ObjectivesTo assess the prevalence of postpartum fatigue at 10 days, 1 month and 3 months, and to describe the sociodemographic and clinical characteristics of women with fatigue and the associations...

Postpartum fatigue, daytime sleepiness, and psychomotor vigilance are modifiable through a brief residential early parenting program

Objective/BackgroundIn the months after childbirth, women are vulnerable to sleep disturbances and sleep-related deficits in functioning, such as fatigue, daytime sleepiness, and attentional lapses. Currently there is limited evidence that these deficits are modifiable. Using both self-report and objective measures, this study examined changes in sleep-related daytime functioning among women attending a residential early parenting program for assistance with unsettled infant behavior and mild to moderate postpartum distress. MethodsParticipants were 78 women (age M = 34.16, SD = 4.16 years) attending a five-day program with their infants (age M = 8.67, SD = 4.82 months). Sleep was assessed via self-report. Sleep-related daytime functioning was operationalized as fatigue, sleepiness, and sustained attention, and measured using validated questionnaires (all women) and the 10-min visual Psychomotor Vigilance Test (PVT; subgroup of 47 women). All measures were administered on both admission (baseline) and discharge. ResultsOn admission, participants reported elevated sleep disturbance (94%), fatigue (91%), as well as trait (54%) and state (67%) sleepiness. From admission to discharge, there were medium effect size reductions in fatigue and sleepiness, and large effect size improvements in sleep quality related domains such as increased sleep efficiency and reduced nighttime awakenings (all p < 0.001); changes in total sleep time were nonsignificant (p = 0.22). PVT reciprocal mean reaction times were also significantly faster (p = 0.001; medium effect size). ConclusionsThis study demonstrated that among women attending a brief residential early parenting program, fatigue, daytime sleepiness, and objectively measured psychomotor vigilance can be improved. Implications for further research and potential treatments are discussed.

The effect of maternal fatigue on breastfeeding.

Postpartum fatigue means tiredness, sense of suffocation, and decreased physical and mental capacity. Fatigue reduces postpartum women's ability of concentrate, which may increase the frequency of postpartum depression, and their babies and cause babies' weaning off breastmilk earlier. Postpartum fatigue reduces the ability of mothers to concentrate and has a negative effect on communication between mothers and their babies. This study was performed to determine the effect of fatigue on breastfeeding and breastfeeding behaviors in postpartum women. The study had a descriptive desing and was carreid out in a postpartum clinic of a maternal, obstetric, and pediatric diseases hospital. It included 374 women giving normal vaginal birth. Data were gathered with a socio-demographic features form and Visual Analogue Scale for Fatigue. The mean score was 6,91 ± 2,25 for the subscale fatigue and 2,38 ± 0,91 for the subscale energy. The women reporting that it was not difficult to give birth and that they had little or some fatigue had significantly higher scores for energy (P = 0.001). The women starting to breastfeed in the hour of giving birth (P = 0.003) and the women breastfeeding at 1-hour intervals (P = 0.100) had a lower score for fatigue. The women not needing help while breastfeeding had a significantly lower score for fatigue (P = 0.001), while those reporting to give additional food had a significantly higher score for fatigue (P = 0.014). Women feel tired in the early postpartum period due to giving birth and their tiredness is increased by breastfeeding and infant care.

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

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

Factors Influencing Postpartum Fatigue in Vaginal-Birth Women: Testing a Path Model.

Postpartum fatigue is a very common complaint among postpartum women. Although current evidence indicates that several factors (e.g., parity, epidural analgesia, perineal trauma, perineal pain, and longer second stage of labor) are associated with postpartum, not enough is known about the relationships among these physical factors simultaneously and how they contribute to the development of postpartum fatigue. Increased awareness of the complex relationships among these factors will help nurses assess, prevent, and alleviate postpartum fatigue. The aims of this study were to test a model of factors that influence postpartum fatigue and to estimate the direct and indirect effects of these factors on postpartum fatigue in vaginal-birth women. The hypothesized model of the factors that influence postpartum fatigue after vaginal birth was developed based on previous studies. This study used a cross-sectional correlational design and convenience sampling. The Visual Analog Scale for Pain was used to measure postpartum perineal pain, and the Postpartum Fatigue Scale was used to assess postpartum fatigue via a structured, self-report questionnaire. Data analysis included descriptive statistics, Pearson's correlation coefficients, and path analysis. This study evaluated 326 healthy postpartum women within the first day after vaginal birth. Participants ranged from 20 to 43 years old, and 50.9% were primiparous. The model of the factors influencing postpartum fatigue after vaginal birth showed a good fit with the empirical data. Parity and the use of epidural analgesia predicted the duration of the second stage of labor, and the degree of perineal trauma predicted perineal pain. Participants who had experienced longer durations of the second stage of labor and more perineal pain reported higher levels of early postpartum fatigue. It is suggested that maternal nurses should better understand postpartum fatigue, take precautions to decrease perineal pain, and pay more attention to the longer duration of the second stage of labor to minimize postpartum fatigue, increase patient comfort, and improve the quality of perinatal care.

Postpartum fatigue: assessing and improving the psychometric properties of the Fatigue Severity Scale.

A brief, reliable, and valid measure of postpartum fatigue in both clinical and research settings is much needed. This study assessed the psychometric properties of the Fatigue Severity Scale (FSS) among women with unsettled infants and fatigue. Rasch analysis identified an overall ceiling effect for the original FSS, as well as disordered response categories and/or poor fit for 4 items. A modified 5-item version of the FSS (FSS-5R) had improved psychometric properties.

UPAYA PEMENUHAN KEBUTUHAN ISTIRAHAT TIDUR PADA IBU POSTPARTUM DENGAN PREEKLAMPSIA

All new-born mothers suffer from postpartum fatigue on average, especially in the early period, as a result the mother lacks sleep plus the responsibility that must be given to her baby. The first three days after giving birth are usually difficult for the mother to rest. Attempts to fulfill sleep restriction have created a comfortable atmosphere, reduced environmental distraction and sleep disturbances, limited visitors during client breaks, assessed fatigue, duration and type of labor, examined factors affecting rest, provided information about the need to sleep or rest after returning to home, study the home environment, help at home and other family members. The purpose of this study is to fulfill and maintain sleep rest in postpartum mothers who can provide enough energy to undergo daily activities. The method used by the author is observation, interview, measurement, and documentation. The subjects in this case study were two postpartum patients with normal second-day postpartum criteria, postpartum with preeclampsia, postpartum mothers with healthy infants. The results of the analysis conducted by the authors found problems with sleep patterns. The results of the study show that the nursing problems of sleep pattern disorders have not been resolved because the results of the PSQI questionnaire in the sleep quality of the two respondents were still poor. Recommendations need to continue to provide support and motivation to get enough rest, and encourage to increase the intensity of rest and sleep.

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

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. 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. 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). 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.

The relationship between fatigue and breastfeeding self-efficacy.

Postpartum fatigue appears in the early weeks and after childbirth has a clear impact on maternal functioning and breastfeeding. This study aimed to examine the relationship between fatigue and breastfeeding self-efficacy. This descriptive study was conducted at three family health centers (FHCs) in Izmir, Turkey, between June 2013 and March 2014. We used the Self-Description Form for Mothers, the Breastfeeding Self-Efficacy Scale Short Form (BSES-SF), and the Brief Fatigue Inventory (BFI) to collect data from 184 breastfeeding women during the postpartum period. At week 1 postpartum, 98.9% of the mothers in this study experienced fatigue; of those, 12.6% had minor fatigue, 48.3% had moderate fatigue, 36.8% had excessive fatigue, and 0.7% had the highest level of fatigue. At week 8 postpartum, 46.7% of the mothers experienced fatigue, 50.0% of whom experienced fatigue on a minor level, 16.2% on a moderate level, and 2.5% on an excessive level. The present study found that 55.4% and 1.1% of the mothers had BSES-SF mean scores below 50 at weeks 1 and 8 postpartum, respectively. The mean BSES-SF score was 51.21 ± 6.95 (min-max = 19.00-70.00) at week 1 postpartum, which increased to 64.54 ± 9.65 (min-max = 15.00-70.00) at week 8 postpartum. The statistical results indicated that there were no significant relationships between the BSES-SF and the BFI at week 1 postpartum (r = 0.007, P > 0.05) and week 8 postpartum (r = 0.111, P > 0.05). In this study, the mothers' fatigue during the postpartum period was not associated with breastfeeding self-efficacy. Many of the variables identified may be considered modifiable and amenable to interventions. Targeted interventions should be directed toward improved breastfeeding outcomes among Turkish women.

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

BackgroundFatigue 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.MethodsInstrumental 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.ResultsCronbach’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).ConclusionsAn equivalent Spanish version of the FAS was obtained with good reliability and validity properties. FAS-e is an appropriate tool to measure postpartum fatigue.

Effectiveness of aerobic gymnastic exercise on stress, fatigue, and sleep quality during postpartum: A pilot randomized controlled trial

BackgroundGymnastics is a preferable safe exercise for postnatal women performing regularly. ObjectiveThe aim of this pilot randomized controlled trial was to determine whether the aerobic gymnastic exercise improves stress, fatigue, sleep quality and depression in postpartum women. DesignSingle-blinded, randomized controlled trial held from December 2014 until September 2015. Setting: Postnatal clinic of a medical center in southern Taiwan. Participants140 eligible postnatal women were systematically assigned, with a random start to experimental (n=70) or a control (n=70) group. InterventionsEngage in aerobic gymnastic exercise at least three times (15min per section) a week for three months using compact disc in the home. Outcome measuresPerceived Stress Scale, Postpartum Fatigue Scale, Postpartum Sleep Quality Scale, and Edinburgh Postnatal Depression Scale. ResultsIn a two-way ANOVA with repeated measures, the aerobic gymnastic exercise group showed significant decrease in fatigue after practicing exercise 4 weeks and the positive effects extended to the 12-week posttests. Paired t-tests revealed that aerobic gymnastic exercise participants had improved significantly in perceived stress and fatigue after 4 weeks gymnastic exercise; these positive effects extended to the 12-week posttests. In addition, the changes in physical symptoms-related sleep inefficiency after 12 weeks gymnastic exercise were significantly decreased in the experimental group compared with the control group. Relevance to clinical practiceThe findings can be used to encourage postnatal women to perform moderate-intensity gymnastic exercise in their daily life to reduce their stress, fatigue and improve sleep quality.

Meta-analysis of the predictive factors of postpartum fatigue

PurposeNearly 64% of new mothers are affected by fatigue during the postpartum period, making it the most common problem that a woman faces as she adapts to motherhood. Postpartum fatigue can lead to serious negative effects on the mother's health and the newborn's development and interfere with mother-infant interaction. The aim of this meta-analysis was to identify predictive factors of postpartum fatigue and to document the magnitude of their effects using effect sizes. MethodWe used two search engines, PubMed and Google Scholar, to identify studies that met three inclusion criteria: (a) the article was written in English, (b) the article studied the predictive factors of postpartum fatigue, and (c) the article included information about the validity and reliability of the instruments used in the research. Nine articles met these inclusion criteria. The direction and strength of correlation coefficients between predictive factors and postpartum fatigue were examined across the studies to determine their effect sizes. ResultsMeasurement of predictor variables occurred from 3days to 6months postpartum. Correlations reported between predictive factors and postpartum fatigue were as follows: small effect size (rrange=0.10 to 0.29) for education level, age, postpartum hemorrhage, infection, and child care difficulties; medium effect size (rrange=0.30 to 0.49) for physiological illness, low ferritin level, low hemoglobin level, sleeping problems, stress and anxiety, and breastfeeding problems; and large effect size (rrange=0.50+) for depression. ConclusionPostpartum fatigue is a common condition that can lead to serious health problems for a new mother and her newborn. Therefore, increased knowledge concerning factors that influence the onset of postpartum fatigue is needed for early identification of new mothers who may be at risk. Appropriate treatments, interventions, information, and support can then be initiated to prevent or minimize the postpartum fatigue.

Clinical profile of persistent genito-pelvic postpartum pain

Objective*the primary aim was to describe the pain characteristics of persistent genito-pelvic postpartum pain (PPP) and compare these characteristics by mode of delivery. The secondary aim was to incorporate psychosocial variables into the conceptualization of PPP by exploring the relationship among postpartum depressive symptoms, fatigue, and PPP. Designcross-sectional study design. Settingonline survey. Participants106 women recruited from the community who gave birth within twelve months prior to completing the survey. Measurements and findingsquestionnaire regarding sociodemographic information, pregnancy and childbirth variables, depressive symptoms (Edinburgh Postnatal Depression Scale), and fatigue (Fatigue Symptom Checklist). Women who were ≥3 months postpartum and indicated they were still experiencing any genito-pelvic pain from childbirth were provided questions about their current pain experience. Twenty-seven (25.5%) women were between 3–12 months postpartum and currently experiencing PPP. The intensity of pain was mild, and had multiple locations and triggers. Compared to women whose acute pain resolved after childbirth, women with PPP were more likely to have had a Caesarean section (15.2% versus 33.3%). Other birth-related (i.e., epidural/spinal anesthesia use during vaginal birth) and psychosocial variables (income) also differentiated women with PPP from women whose gentio-pelvic pain resolved. Postpartum fatigue independently predicted PPP (Odds ratio = 4.7), while postpartum depressive symptoms did not. Key conclusionsPPP was quite prevalent in this sample, and while the intensity of pain was on average, mild, the pain was widespread in terms of location and triggers. Multiple biopsychosocial factors differentiated women with persistent postpartum pain from those women whose pain resolved. Implications for practicePPP is a common health concern for new mothers in the first year postpartum, and may be best addressed by health care professionals using a multidimensional approach, which focuses on the psychosocial aspects of pain.