Self Learning Interventions Don't Help Sleep Deprived First Time Moms

A behavioral-educational intervention is ineffective in improving maternal and infant sleep in the early postpartum stage.

Sleep, critically important for new moms, eludes them even after behavioral-educational interventions, according to a study published in BMJ.

Taking care of the newborn for the first time is indeed an overwhelming experience. Sleep strategies and support given to first time mothers failed to improve their sleep, and the baby's sleep. Early interventions, though appreciated by the participants of the new study, did not bring a marked increase in postpartum sleep.

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Sleep disturbance is profound in the first twelve weeks after giving birth, but for the first time mothers its worse. Postpartum sleep deprivation increases the risk of mood disorders, fatigue, cognitive function lapses, and decreased wellbeing. And it's not only the mother who is affected.

While maternal sleep is affected by their infant's sleep-wake activity, the activity of the newborns is also shaped by interaction with their mother. Unfortunately, infant sleep problems can persist into later childhood if not treated.

So, given the physical, emotional, and cognitive demands on postpartum women, Robyn Stremler, assistant professor at Lawrence S Bloomberg Faculty of Nursing, Toronto, Canada, and her colleagues, conducted a study to evaluate the effectiveness of a behavioral-educational sleep intervention in improving maternal and infant sleep at 6 to 12 weeks after birth (postpartum). The idea was to promote sleep rather than solve sleep problems that developed.

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The researchers enrolled 246 new moms for the study. The new moms were divided into two groups, where the control group did not receive the intervention. The experiment group received the behavioral-educational intervention from a nurse before they were discharged from hospital. Once at home, moms were given follow up support at one, two and four weeks and booklets regarding sleep related issues.

The topics covered in this intervention included –

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• maternal sleep hygiene,
• strategies for increasing opportunities for maternal sleep,
• maternal relaxation techniques,
• acknowledgement of the challenges of parenting and sleep deprivation,
• information on infant sleep structure and interpreting infant cues,
• strategies for infant sleep promotion, and
• strategies for promoting infant night-day entrainment and self-soothing.

At 6 and 12 weeks, both, moms and their babies wore an actigraph (moms on the wrist and babies around their ankles) for 4 days and nights. Actigraph is a device for non-invasive monitoring of activity and rest cycles. Sleep problems such as sleep disorders and insomnia can be effectively assessed with actigraphy data.

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Behavioral-educational interventions use participatory learning to develop knowledge and skills for change. 'We thought this would be most successful in hospital in the early postpartum with the infant's and mother's behavior and responses as exemplars,' says Stemler.

However, the study found no effect on sleep patterns in the mother or child with this intervention delivered during the early postpartum. Both groups averaged 6.5 hours of night time sleep. 'While the women who participated in our trial valued receiving information about sleep, felt positive about their participation, and reported using many of the suggested strategies, there were no differences between groups on the main outcomes' according to the researchers.

The study thus concluded that behavioral-educational interventions can be targeted after the first few months of postpartum since the intervention did not work for the early postpartum stage. This intervention program did not also have any effect on maternal depressive symptoms, fatigue or breastfeeding rates.

Reference: Stremler, R. et al. Effect of behavioural-educational intervention on sleep for primiparous women and their infants in early postpartum: multisite randomised controlled trial. BMJ 2013.

Source-Medindia