“Persevering Toward Normalcy” after childbirth.

Purpose: To construct a theory of fatigue and sleep in nondepressed lower-income urban women in the 6 months after childbirth.
Design and Methods: We conducted this grounded theory study by recruiting participants from an inpatient postpartum unit in a Midwestern urban tertiary care facility. Sixteen participants, all of whom were negative for depressive symptoms, were interviewed at 1, 3, and 6 months postpartum.
Results: Participants engaged in "Persevering Toward Normalcy," in which they worked to minimize fatigue and maximize sleep by accessing flexible, dynamic social support networks, which enabled them to nap or sleep on weekends. The participants' fortitude, perseverance to "keep going" and push beyond exhaustion until their bodies "got used to" the lack of sleep and ongoing fatigue enabled them to continue working, pay rent, put food on the table, and keep children in school. At the onset of the study, participants firmly believed their fatigue would ease, and sleep would gradually improve as infant and family routines were established. Until such time, they simply needed to "deal with it."
Clinical Implications: In the early weeks postpartum, women can be taught how and when to access social support to promote sleep and prevent severe fatigue. Instruction on sleep hygiene and infant day/night entrainment may help women maximize sleep opportunities and infants establish a routine. To provide effective assistance, it is also necessary to understand the woman's individual sleep environment, as well as her socioeconomic and cultural contexts.