Date of Award

12-21-2018

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Shih-Yu Lee, PhD, RN

Second Advisor

Patricia Clark, PhD, RN, FAHA, FAAN

Third Advisor

Joan Cranford, EdD, APRN, CNS

Fourth Advisor

Steven Lloyd, PhD

Abstract

ABSTRACT

POST-PARTUM SLEEP AND BREASTFEEDING OUTCOMES AMONG FIRST-

TIME MOTHERS OF FULL-TERM NEWBORNS

by

JOANNA K. CARREGA

Benefits of breastfeeding are well documented for both mother and infant. Most new mothers (81%) in the United States choose to breastfeed initially, but only 22% breastfeed exclusively through six months of age as recommended. Approximately 50% discontinue breastfeeding within three months. Perception of inadequate milk supply has been found to be an important factor associated with early breastfeeding cessation. Prolactin and oxytocin, the hormones responsible for production, maintenance, and release of human milk may contribute to low milk volume for some new mothers. Both are secreted in a diurnal manner paralleling the sleep-wake cycle.

A descriptive, correlational study design was used to examine impact of impaired sleep and its related health consequences (fatigue, hormone disruption, and mood changes) upon two breastfeeding outcomes: milk volume and discontinued breastfeeding among healthy postpartum mothers of healthy newborns at two weeks and one month postpartum. Factors that may have contributed to postpartum sleep disturbance (maternal characteristics and stress) were also examined.

A total of 29 primaparas, age 22-35, took part in this study. A home visit was conducted at two weeks’ postpartum to collect self-report data for sleep, stress, fatigue, depression, and anxiety. Test weights were performed to estimate breast milk volume by calculating the infant’s body weight before and after breastfeeding. Breastfeeding status was collected at one month via phone interview.

All mothers were exclusively breastfeeding at two weeks’ postpartum and most (90%) were breastfeeding exclusively one month postpartum. At two weeks postpartum, participants in this study were sleep disturbed (69.2%), fatigued (82.8%), reported symptoms of anxiety (27.6%), and had more clinically signficant depressive symptoms (27.6%) compared to postpartum women in the U.S. (12.8%). Age, education level, and perceived stress accounted for 43.2 % of the variance (R2 = .44, F (3, 25) = 6.35, p = .01) in sleep disturbance. Sleep disturbance was a significant predictor for lower breast milk production during the second postpartum week (Beta = -.70, p = .02).

Findings highlight a need to develop stress-reduction interventions that might lead to better sleep during the postpartum period and might have a positive impact upon breast milk production. Appropriate screening for depressive symptoms and anxiety are needed for early detection and assistance for postpartum women who develop mood disorders.

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