Effect of Rooming-in on Postpartum Fatigue and Sleep Quality

• Main Authors: Mung-Jung Lee, 李孟蓉
• Other Authors: Meei-Ling Gau, PhD
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/91430979328178901133

碩士 === 國立臺北護理健康大學 === 護理助產研究所 === 102 === Background: The practice of rooming-in has been shown to help new mothers and their newborn infants adjust physically and mentally and to increase breastfeeding success. Although “24-hour rooming-in” is one of the 10 key objectives of baby-friendly hospitals promoted in Taiwan since 2000, this objective has fallen significantly short of expectations in terms of both the number and the success of hospital implementations. In general, hospitals are concerned that rooming-in may increase fatigue and decrease sleep quality in postpartum mothers. Findings in the literature related to the impact of rooming-in on these two variables are inconclusive. Purpose: This study examines the correlations between the practice of rooming-in and the levels of fatigue and sleep quality in postpartum mothers. Methodology: This descriptive correlational study collected data from April to July 2013. Convenience sampling recruited primipara women who delivered after 37 or more weeks of pregnancy; experienced no abnormalities or complications during pregnancy, labor, or the postpartum period; and had no clinical contraindications for rooming-in. New mothers who planned to release their child for adoption or who had experienced sexual abuse were excluded from consideration. A total of 121 postpartum mothers met the above criteria and were enrolled as participants. Research instruments included a self-designed questionnaire, the Modified Fatigue Symptoms Checklist (MFSC), the Chinese version of the Pittsburg Sleep Quality Index (CPSQI), and cardiopulmonary coupling (CPC) analysis. Participants had a CPC monitor affixed to their upper chest prior to going to sleep each day of their hospital stay. Further, each participant filled in an MFSC and CPSQI every morning of their hospital stay. Results: In terms of demographic variables, participants with an associate degree or lower level of education (χ2(1) = 11.08, p < .001), those who practiced early skin-to-skin contact (χ2(1) = 6.40, p < .05), and those who planned during their pregnancy to practice 24-hour rooming-in (χ2(3) = 24.17, p < .001) were all more likely to adopt nighttime rooming-in. In terms of OB/GYN variables, vaginal birth (χ2(1) = 4.81, p < .05), a relatively mild degree of perineal laceration (p < .05), relatively mild blood loss during birth (t(119) = 2.11, p < .05), and relatively high breastfeeding frequency (p < .001) were all correlated with a higher likelihood of practicing nighttime rooming-in. Analysis using the baseline-tracking model, time-lag model, and change model found that among participants who gave vaginal birth, those who roomed-in had better subjective sleep quality than those who did not (B = -1.97, p < .001), number of gestational weeks related positively to subjective sleep quality (B = -0.35, p < .01), degree of weariness related negatively to subjective sleep quality (B = 0.11, p < .001), higher breastfeeding frequency related negatively to subjective sleep quality (B = 0.33, p < .001), number of days postpartum related positively to subjective sleep quality (B = -0.42, p < .05), improvements in the degree of weariness improved subjective sleep quality (B = 0.11, p < .01), reductions in breastfeeding frequency improved subjective sleep quality (B = 0.39, p < .001). In terms of objective-sleep-quality predictive factors among vaginal-birth participants those who roomed-in earned higher overall objective sleep quality scores than those who did not (B = 34.49, p < .001), those who stayed in single-occupancy hospital rooms earned lower overall objective sleep quality scores than those who stayed in multiple-occupancy rooms (B = -20.40, p < .001), those who used analgesics had better objective sleep quality than those who did not (B = 8.59, p < .05), those with higher breastfeeding frequencies had lower objective sleep quality than their peers (B = -4.93, p < .001), reducing breastfeeding frequency improved objective sleep quality (B = -4.81, p < .001). Furthermore, this study found no relationship between current objective sleep quality and either degree of weariness or breastfeeding frequency as measured on the previous day. Finally, no relationship was found between changes in degree of weariness and changes in objective sleep quality. A similar analysis of predictive factors among cesarean-birth participants found degree of weariness related negatively to subjective sleep quality (B = 0.20, p < .001), reducing weariness improved subjective sleep quality (B = 0.28, p < .001), those who roomed-in earned better overall subjective sleep quality scores than those who did not (B = 23.47, p < .001), number of days postpartum related positively to subjective sleep quality (B = 3.06, p < .05), improvements in degree of fatigue related positively to improvements in objective sleep quality (B = -0.83, p < .05). Similar to vaginal-birth participants, this study found no relationship between current objective sleep quality and either degree of fatigue or breastfeeding frequency as measured on the previous day in cesarean-birth participants. Finally, changes in breastfeeding frequency did not impact objective sleep quality in this group. Conclusions / Application to Nursing: The present study assessed the impact of predictive factors related to quality of sleep and degree of fatigue in a sample of postpartum mothers who had either given vaginal or cesarean birth and either did or did not practice rooming-in. For vaginal-birth participants, rooming-in impacted subjective and objective sleep quality; degree of fatigue impacted subjective sleep quality but not objective sleep quality; and high breastfeeding frequencies degraded both subjective and objective sleep quality. For cesarean-birth participants, rooming-in improved sleep quality; degree of fatigue related negatively to subjective sleep quality; and breastfeeding frequency was not significantly related to sleep quality. Our findings contradict the widely held assumption that mothers who room-in with their infant sleep less and have a lower quality of sleep than their non-room-in peers. Conversely, the room-in participants in our study reported improvements in terms of both sleep duration and sleep quality attributable to their practice of rooming-in. Factors found to affect postpartum fatigue include breastfeeding and irregular sleep schedule. In light of the importance of helping new mothers, especially cesarean-birth mothers, quickly overcome postpartum fatigue, the author suggests that clinical nurses and midwives provide adequate support and assistance to patients through the birthing process in order to minimize postpartum fatigue and improve patient quality of sleep. Furthermore, prenatal patient education and nursing-care guidelines should be revised to promote rooming-in, underscore its importance to postnatal health and recovery, and raise the confidence of new mothers in their emotional and physical capacities to undertake rooming-in responsibilities. The results of this study provide a reference for clinical obstetrics and pediatrics care staffs. Key Words: mother-infant rooming in, quality of sleep, fatigue