Infant sleep problems: a qualitative analysis of first-time mothers' coping experience

Tsai, S., Hu, W., Lee, Y., & Wu, C. (2014). Infant sleep problems: A qualitative analysis of first-time mothers' coping experience. Midwifery, 30(6), 750-755.

Objective:                  

Discover  how individuals, interpersonal networks, and informal and formal help sources interact, and together influence maternal perceptions and coping with infant sleep patterns and problems.

Hypotheses: Not Provided.

Design: Qualitative, Data Collection

Variables Measured, Instruments Used:

In-depth face-to-face interviews with mother participants. During home visits, each woman completed an antenatal, birth, and postpartum health questionnaire, and participated in a 30–45 minute audio- taped interview.

Participants

• N= 12

• Participant ages: 23-40 years old

• Location: Northern Taiwan

• Eligibility: A convenience sample of healthy, first-time mothers of full-term infants (within three months of postpartum). Women were eligible if they were at least 18 years of age, and had no medical complications during pregnancy. Only women who spoke Mandarin fluently were included in this study. Women were excluded if they had been diagnosed with a medical or psychiatric condition either before or during pregnancy. Those diagnosed with depression in the postpartum period were excluded.    

• SES: Not Provided.

Limitations:

1. Subjective variables measured/ instruments used

2. Results  may only be representative of coping experiences in early postpartum women with healthy full-term infants.

3. Findings must be verified in mothers of infants of older ages to examine whether underestimation of the severity of sleep problems may characterize perceptions of mothers toward infant sleep concerns.

4. This study did not address the issue of barriers to seeking medical advice, which may be a future direction of research​

Finding(s):

1. Self-Help     

   1. Interpreting infant sleep patterns and defining sleep problems : Most mothers considered their infant sleep patterns a problem. The following infant sleep behaviours were perceived as problematic by the mothers: (a) difficulty initiating sleep including bedtime resistance, inability to self-soothe, or irregular nighttime sleep schedule and sleep onset time; and (b) difficulty maintaining sleep including easily awakening from sleep, frequent night awakenings, waking with intense and persistent crying, or unstable nighttime sleep–wake cycles. The women expressed not knowing whether the infant sleep was a problem due to reasons such as the infant was their first child and they did not have another child with which to compare sleep patterns.

   2. Reception and acceptance of suggestions: Staying positive towards infant sleep problems and keeping faith in normalising such sleep patterns were part of some mothers' coping strategies. Being persistent was a factor considered to be critical for successful change.         

   3. Changing behaviour: Mothers reported receiving suggestions to take various steps to manage infant sleep patterns and problems, such as providing a pacifier, patting the crying infant or playing music to induce sleep.         

     2. Seek-Help

1. Informal help-seeking: Family members, mainly the maternal grandmother, provided most assistance to the mothers. However, advice from family members was not necessarily implemented by the mothers particularly when negative comments and attitudes adversely affected the mother's decisions, such as conflicting views on breast feeding. Friends, colleagues, or local community breastfeeding support groups were sources of support and information. These informal help sources were identified as most prevalent among those who perceived their infants as having sleep problems     

2. Formal help-seeking: Medical services were an alternative and a less frequently mentioned resource from which mothers sought help. Medical advice was not sought right after infant sleep patterns were considered problematic by the mother. A few mothers waited until they went to the clinic for regular infant check-ups, but most mothers chose to seek help from informal resources rather than from the paediatricians. It is worth noting that several mothers who considered their infant sleep a problem did not seek medical advice even during infant medical check-ups. After seeking professional help, some mothers perceived infant sleep patterns that were previously perceived problematic such as night waking or decreasing total sleep time at night, as normal.