Assessing the association between fatigue and functional status during postpartum☆,☆☆
Introduction
During postpartum, which extends six weeks after birth, there is an increased risk of an array of physical and psychological health concerns that include fatigue, sleep disturbances, anxiety, and depression that may adversely affect general health, roles, and responsibilities of mothers [1], [2], [3], [4], [5]. Despite several publications on fatigue [2], [3], [6], [7] and functional status [8], [9] during postpartum that were investigated separately, limited studies have measured these variables in a single study with samples from middle-income countries. Moreover, little is known about the association between fatigue and functional status during postpartum.
Fatigue, as one of the most common health concerns in postpartum, is defined as an overwhelming, sustained sense of exhaustion and decreased capacity for physical and mental work at a usual level [10]. Fatigue is a complex multifaceted phenomenon that entails physical, psychological and social dimensions, which may extend up to a year after birth [1], [3], [6], [7], [11]. Fatigue was found to be higher in women who had cesarean deliveries compared to vaginal births [4]. However, mixed results were found linking parity with postpartum fatigue. In a meta-analysis study, parity was not found to be a predictor of postpartum fatigue [2], while higher fatigue among primiparas was reported [12]. Furthermore, fatigue was found to adversely influence women’s functional status levels during postpartum [4], [7], [13].
Functional status was originally defined by Fawcett, Tulman, and Myers [14] as a multidimensional concept encompassing the mother’s readiness to assume infant-care responsibilities as well as self-care, household, social and community, and occupational activities. Fawcett and colleagues developed the Inventory of Functional Status After Childbirth (IFSAC) as a tool that specifically measures functional status of mothers during postpartum [8], [14], [15]. Studies on functional status revealed that full recovery of functional status after childbirth extends beyond the typical six-week postpartum period [9], [14], [15], [16], [17]. Moreover, researchers reported statistically significant differences between women in postpartum in terms of parity, in which primiparas had better functional status compared to multiparas [14], [15], [17]. Conversely, other researchers [9], [16] reported higher total functional status scores in multiparas compared to primiparas. No differences in functional status were found between women who had vaginal births compared to women who had cesarean deliveries [9], [14], [15]. However, researchers found that mothers who had vaginal births had higher total functional scores compared to women with cesarean deliveries [16].
Fatigue and decreased functional status influence a mother’s ability to take care of herself, her infant, and other responsibilities. Fatigue, as a dynamic phenomenon during postpartum, has been shown to be affected by new maternal roles and responsibilities [7], [15]. A new mother usually resumes her daily routine combined with childcare and daily life responsibilities in a relatively short period of time that leaves little room for rest and recuperation, thus leading to more fatigue. Furthermore, fatigue was found to be a very common problem for both mothers and fathers in postpartum, and has been linked to poor parenting, increased parenting stress, and reduced coping with daily tasks [7], [11].
Generally, there is a paucity of research studies examining both fatigue and functional status of women during postpartum in one study. Moreover, although fatigue and functional status during postpartum have been researched as separate variables for the past 30 years, inconsistencies in findings regarding the associations between demographic variables (e.g. parity, type of delivery), fatigue, and functional status warrant further investigation, since there are limited studies that have been published on this topic.
This study was based on Roy’s Adaptation Model [18]. Roy assumed that the person is a bio-psycho-social being that is continuously interacting with a changing environment, and that adaptation is the process in which thinking and feeling persons use conscious awareness and choice to create human and environmental integration. Roy proposed four interrelated adaptive modes, which include physiologic function, self-concept, interdependence and role function (Fig. 1). In this study, physiologic function mode was represented by fatigue and role function mode was represented by functional status. The association between these two adaptive modes (fatigue and functional status) was examined (Fig. 2). The aims of this study were to assess the levels of fatigue and functional status of Jordanian women during postpartum, assess the association between these two variables, and investigate the association between demographics variables, fatigue, and functional status.
Section snippets
Design and sample
A cross-sectional, descriptive correlational design was used with a convenience sample of women at various stages of postpartum. To insure an adequate sample size, an estimation to meet the criteria of a power of .80, α = .05 and a medium effect size of .50 yielded a required sample of 256 women [19]. The final sample consisted of 315 women. The inclusion criteria of the sample included being 18 years or older; having a healthy newborn; and being free of physical or mental illnesses.
Settings
Data
Results
In our study, 323 questionnaires were distributed and 315 questionnaires were used in final analysis, representing a response rate of 97.5%. The age of participants ranged from 18 to 45 (M = 27.8, SD = 5.7). In this study, there were 73 primiparas and 242 multiparas. Additionally, 216 women had vaginal births, and 99 had cesarean deliveries. The majority of women were multiparas (76.8%), had planned pregnancies (55.2%), had a full-term pregnancy (92.7%), had a vaginal birth (68.6%), had a male
Discussion
Fatigue and decreased functional status are common health concerns during postpartum. In our study, fatigue was measured using the FSC at one time among women during the first three months postpartum. Results showed that moderate fatigue levels can extend beyond the typical postpartum timeframe of six weeks, indicating the importance of screening and diagnosing fatigue among women up to a year after childbirth [1], [3], [11]. An issue pertaining to measuring postpartum fatigue was the lack of
Conflict of interest
The authors declare no conflict of interest in this study. The authors have made substantial contributions to the intellectual content of the paper including the study concept, design, data collection, analysis, and have approved the final version to be published.
Funding source
This study was funded by The Deanship of Scientific Research, The University of Jordan, Grant # 102/2012-2013.
Acknowledgement
The authors would like to thank the mothers who participated in this study and thank the Dean of Scientific Research for funding this study.
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This study was conducted in full accordance with the ethical principles of the World Medical Association Declaration of Helsinki (2008).
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This study was independently reviewed and ethical permissions were granted from the University of Jordan (Grant # 102/2012-2013) and the Jordanian Ministry of Health ethical boards (Ethics committee/12266 dated Aug. 5th, 2013).