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Mothers' Sleep and Fatigue: Some Preliminary Findings

Kathleen Kendall-Tackett, Ph.D., IBCLC and Thomas W. Hale, Ph.D.
From: Leaven, Vol. 45 No. 2-3, 2009, pp. 4-14

In July 2008 we launched our online Survey of Mothers' Sleep and Fatigue, and we asked for your help in recruiting mothers. All three Divisions of La Leche League responded to our request. Our study is timely. Co-sleeping is once again in the news this week in the U.S., as results from a new paper warn that co-sleeping increases the risk of accidental strangulation (Shapiro-Mendoza et al., Pediatrics, 2009). We decided to conduct our study because we were concerned that many of the policies around co-sleeping were made with limited empirical data about how the majority of mothers and babies actually sleep. Indeed, many of the cautions about co-sleeping come from studies of infants who have died of SIDS. These cases are tragic, but in terms of policymaking, the samples are not necessarily representative of the practices of families around the world. They also often include a broad range of safe and unsafe practices grouped together. In order to make wise policy decisions, policymakers must know more about what average families are doing -- and may or may not be telling their doctors.

Another concern we wanted to address in this study was whether nighttime breastfeeding increased the risk of postpartum depression. There is an increasing number of books that tell mothers not to breastfeed at night in order to prevent depression. While this advice is well-intended, no one knows if it even works. We wanted to examine if there was a relationship between nighttime feedings, sleep deprivation, and depression, while accounting for other depression risk factors, such as trauma history, postpartum pain, and lack of support. All of these other factors can compromise sleep quality and increase daytime fatigue.

At the beginning of this study, we optimistically hoped that we would have a final sample of 1,500 mothers after a year of data collection. Instead, 6,418 mothers have completed our survey in the past six months -- dramatically exceeding our wildest expectations. We know that La Leche League Leaders have been key in the success of this study. We have had responses from all over the world, and are we both quite grateful for your help. Below is a first look at the findings. We will present a vastly larger review at the Hartmann-Hale Conference, and at ILCA (International Lactation Consultant Association) this summer.

Study Participants

The sample was 6,418 mothers of infants ages 0-12 months (Mean age=6.96 months), from 60 countries (see Table 2). The largest group was from the U.S. (N=4,725), followed by Canada (N=416), European countries (N=544), Australia and New Zealand (N=182), the Middle East (N=53), Central and South America (N=32), Asia (N=30), and Africa (N=12). The average current age of the mothers was 31.2. They were primarily in their 20s and 30s: less than 1% were teens, 36% were 20-29, 59% were 30-39, 4% were 40-49, and one mother was 50. When asked about their age at their first births, the ages were younger, with a mean of 28.2: 4.2% were teens, 56.3% were 20-29, 38.3% were 30-39, and 1.3% were 40-49.

The sample was predominantly Caucasian (89.7% in the U.S. sample, 100% in Australia, 84% in New Zealand, 75% in Great Britain), 91% were married, and 97% were living with a partner. The sample was quite well educated, with 70% having a bachelor's degree or higher. We collected income data for the U.S. sample, and there was reasonable distribution across categories: 2.6% (<$15K), 4.7% ($15-$25K), 18% ($26-50K), 21.3% ($51-$75K), 20% ($76-$100K), 17.5% ($101-$150K), 10.2% (>$150K), and 5.5% (declined to state).

Regarding feeding, 78.5% breastfeed, 18.6% combine breast and bottle feeding, and 2.9% formula-feed only. The high percentage of breastfeeding mothers is not surprising given the channels by which we recruited mothers. But we still have enough of a sample of formula-feeding mothers to allow some comparison (N=171).

Initial Analysis

Our preliminary analyses were in three topic areas: where babies sleep, mothers' self-reported fatigue, and mothers' history of psychological trauma.

Where Babies Sleep

Table 1
Location Percentage
Crib in another room 44.6%
Crib, bassinet in mother's bedroom 16.6%
Co-sleeper 4.8%
In my bed 32.6%
Someplace else 1.3%

Interestingly, even with a predominantly breastfeeding sample, the respondents were not uniform in their belief that babies should share a bed or even be in the same room as the mother: 44.6% indicated that their babies are in a crib in another room, 16.6% had babies in a crib or bassinet in their room, 4.8% in a co-sleeper [a bassinet attached to the parents bed, allowing the baby to sleep beside the mother], and 32.6% indicated that their babies were in their beds. In the U.S. sample, the percentage of co-sleeping among African Americans (52%) and Mexican Americans (51%) was higher than the percentage of Caucasian Americans (42%), consistent with other studies. Even comparing U.S. and Canadian mothers found slightly more babies in bed among the American vs. Canadian mothers. Our data has a lot more detail about babies' sleep arrangements, how they change over the night, and how mothers feel about them, and we will be analyzing the data in the next month or so. We cannot reveal details before we publish our findings. But what we have found so far is amazing. Stay tuned.

Mothers' Fatigue

Mothers' self-rated fatigue levels were spread evenly from "very fatigued" to "not at all fatigued." We found that fatigue varied by feeding method. When asked to rate their energy on most days, 28.7% of breastfeeding mothers rated their energy as excellent or very good, compared to 19.4% of formula feeding mothers, and 19.1% of women who combined methods. At the other end of the scale, 23.4% of breastfeeding women described their energy level as fair or poor, compared with 39% of women who formula fed, and 35.4% of women who combined methods. Women's friends were twice as likely to think the women would get more rest if they formula fed than the women thought themselves.

Mothers' Trauma History

Have you ever been depressed?

Trauma history can be an important predictor of fatigue since it often compromises sleep quality. An astonishing 51.6% had experienced at least one type of traumatic event, and approximately one third had been exposed to parental substance abuse, mental illness, or intimate partner violence. Moreover, 13% reported rape or sexual assault. Not surprisingly, there were repercussions of these events. In our sample, 58.4% had been depressed, with 34.8% of those mothers having 3 or more episodes of depression. The good news is that almost all of the mothers reported happy, stable and safe relationships with their current partners.

We are very pleased with the amazing data set you have entrusted to our care. Our pledge to you is that we will get this research out in the field as soon as possible. Thanks again for your help with this study. We'll keep you posted on our progress.

Adapted from an article in Medications & More, February, 2009. Used with permission.

Table 2
United States 4,725
Canada 416
European Union/Eastern Europe 544
Czech Republic1
Russian Federation7
United Kingdom159
Australia and New Zealand 182
New Zealand138
Middle East 53
United Arab Emirates2
Mexico/Central and South America/Caribbean 32
Dominican Republic7
St. Kitts1
Asia 30
Africa 12
South Africa7

Numbers in final total differ slightly.

Editor's note: Some incidental errors have been corrected for the web version of this article.

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