How women manage fatigue after childbirth.

OBJECTIVE

to explore the strategies used by women to manage fatigue in the first six months following childbirth.

DESIGN

a qualitative study using an exploratory descriptive design. Data were collected using open-ended questions contained in surveys posted to participants six, 12 and 24 weeks after birth.

SETTING

Canberra, Australian Capital Territory, Australia.

PARTICIPANTS

59 well women, 27 primipara and 32 multipara, aged 20-40 years, who gave birth in the Australian Capital Territory.

FINDINGS

three themes emerged from the analysis:'Looking after me' or self-care practices; 'Managing the load' or balancing the work to be done with the aim of managing the woman's fatigue; and 'How it worked', describing how useful the strategies had been in managing fatigue. From six weeks to six months, the women used self-care strategies (sleep/rest, relaxing, conserving energy) more often than strategies designed to manage the load (getting help, planning, lowering expectations). Most multiparas (24/32) conserved energy to manage fatigue, in contrast to primiparas (13/27). Women experiencing high fatigue conserved energy more often than women who were experiencing less fatigue. No differences in strategy choice were found between women who experienced a vaginal birth and those who had experienced a caesarean birth, or between those women who scored 13 on the Edinburgh Postnatal Depression Scale (EPDS) as opposed to those who scored <13. Overall, women rated their chosen strategies as very useful or useful. Womens' comments also indicated that getting help from partners and family was sometimes difficult, reducing the usefulness of this strategy.

IMPLICATIONS FOR PRACTICE

preparing women and their partners to manage postnatal fatigue more effectively is essential. Midwives should encourage women to identify sources of help and what particular help that individual could provide. Scenarios should be used in parenting classes to encourage women and their partners to negotiate issues surrounding the sharing of responsibilities after birth. After birth, ongoing assessment of fatigue and the strategies used to manage it is essential beyond the first six weeks.