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actigraphy, cesarean delivery, fatigue, postpartum, sleep disturbance



  1. Lee, Shih-Yu PhD, RNC
  2. Lee, Kathryn A. PhD, RN, FAAN


Objective: The purpose of this study was to describe sleep and fatigue during the first week of postpartum recovery, and compare women after cesarean delivery with women after vaginal delivery while their infants were hospitalized in the intensive care unit (ICU).


Methods: This cross-sectional descriptive exploratory study involved 21 postpartum Chinese American mothers (6 after cesarean delivery and 15 after vaginal delivery). Three types of data were collected: (1) mothers' demographic data; (2) objective sleep that included total sleep time (TST) and wake after sleep onset (WASO) measured using wrist actigraphy, and (3) subjective sleep quality (General Sleep Disturbance Scale) and fatigue severity (Numerical Rating Scale-Fatigue).


Results: All of the mothers experienced poor sleep while their 3- to 5-day-old infants were in the ICU. After cesarean birth, mothers averaged only about 4 hours TST with 34% WASO while still hospitalized, compared with 6.5 hours TST with 14% WASO for mothers after vaginal birth monitored in their home after hospital discharge.


Conclusion: Sleep disturbances and fatigue need to be further investigated to better understand the relationship between type of delivery and maternal health outcomes. Despite infant care provided in ICUs, these new mothers could benefit from interventions to promote their own sleep, particularly when also recovering from cesarean delivery.