Small survey finds that new mothers use self-care approaches to manage fatigue more often than other strategies such as seeking help from others
- Deputy Director and Coordinator of International Programmes Centre for Women's Health, Gender and Society
- Correspondence to Associate Professor Jane Fisher
Centre for Women's Health, Gender and Society, Melbourne School of Population Health, University of Melbourne, Victoria 3010, Australia;
Fatigue in mothers of newborns is widespread and especially problematic for those whose domestic workload is not shared and who have unsettled infants. Maternal exhaustion can be persistent and disabling. In the absence of a clear evidence based to management, it is often normalised, or responded to with advice that might be unproven, ineffective and difficult to implement including ‘sleep when the baby sleeps’. Taylor and Johnstone argue that it is relevant to know what fatigue self-management strategies mothers of young infants use.
The purposive sample of 59 women was drawn by a non-systematic process from a larger (undescribed) study. Data were collected by surveys containing three open-ended questions about fatigue-management strategies posted to participants at 6, 12 and 24 weeks after they had given birth. It appears that the investigators also had access to psychometric data collected in the primary study which were used to categorise participants into groups on the basis of severity of fatigue and depressive symptoms.
Participants were sleeping and resting more commonly than ‘getting help’ or ‘lowering expectations’. The authors concluded that women need to learn ‘how to ask for assistance’. There is no reference to the management of infant behaviour. They are perplexed, however, that 3–6-month postpartum maternal fatigue remains problematic for many and acknowledge that wider consideration of the context of women's lives is needed.
Occupational fatigue and the work of mothering
Work-related fatigue is the subject of substantial scholarly research, most focused on the military, manufacturing, transport, media and health sectors. Severe occupational fatigue is associated with prolonged or irregular working hours, particularly with early starting times and overnight work. Any work taking place between 1:00 and 6:00 increases risk of fatigue because of circadian rhythm disruption. It is especially problematic in highly mentally and emotionally demanding work in which there are inadequate rest breaks. Occupational fatigue has adverse effects on emotional, cognitive and physical domains of functioning.1 It is an aspect of the workplace which employers have an obligation to manage.
The domestic setting is not, however, conceptualised or named as a workplace and consequently does not benefit from considerations of occupational safety, including responsibility for managing worker fatigue. Infant care is far more time consuming than can be imagined, and all other household activities are slower and more difficult to complete when caring simultaneously for a baby. It is not accurate to define the times when an infant is asleep as spare time, not only because there are invariably other household tasks to complete but also because there is no true freedom either to rest or to pursue leisure activities because of the essential primary responsibility for the baby. The tasks do not remit on weekends and, in general, women have much less leisure than had been anticipated. Together, the repetitive work of managing a household and caring for an infant cannot be completed by one person. Nevertheless, the prevailing stereotype is that paid employment is defined as work and mothering responsibilities as ‘not work’. Many women seek, therefore, to assume this workload singlehanded and to spare their partners who ‘are working’.2 The notion that a man should ‘help’ his partner perpetuates the stereotype that it is her work, which he is assisting, rather than their work which needs to be shared fairly.
Unsettled infant behaviour and occupational fatigue
Unsettled behaviours including prolonged inconsolable crying; resistance to soothing; difficulties settling to sleep; waking after short sleeps and frequent overnight waking are common in infants. One of the main contributing factors to maternal fatigue is unsettled infant behaviour which leads to extended periods of interrupted and insufficient sleep, especially if overnight infant care is not shared between partners. Hiscock and Wake3 found that 46% of mothers of 6–12-month-old infants attending community clinics for routine health checks described a sleep problem including co-sleeping, being dependent on suckling to go to sleep, prolonged time to settle, frequent overnight waking, intense crying associated with night-time waking and short daytime sleeps. Maternal fatigue diminishes when infant behaviour management strategies are implemented. These lead to fewer overnight wakings, increased daytime sleep and reduced crying and fussing in the infant and improved mood and functional efficiency in the mother.4
Too little research about maternal health, including this study, is gender-informed. Although Taylor and Johnstone proposed some relevant risks for maternal fatigue, the opportunity to apply a gender-informed conceptualisation of the work of mothering to the collection and interpretation of data was not taken. Consequently the main recommendation, to encourage women to ask for help, provides only a modest advance. It is possible that if couples are assisted early in the postpartum period to challenge gender stereotypes and view the work of infant care and household tasks as an obligation to be shared fairly, and that they are given advanced skills in infant settling that occupational fatigue in mothers of newborns might be less prevalent and disabling.