New parents are taught to feed. But sleep is just as vital, for both of you
Occupational fatigue is acknowledged as a serious hazard for shift workers, with one notable exception: mothers.
So serious are the risks, which include “short-term cognitive and physical degradation” and, to a lesser extent, error, injury, and illness, that workplaces are required to manage fatigue by law.
Parents are often not educated about settling, soothing and sleep routines, nor supported when they experience “occupational fatigue”.
But, in the domestic workplace, occupational fatigue is not taken seriously, says Professor Jane Fisher, director of Global and Women’s Health at Monash University.
“When the home is the workplace it is often trivialised,” says Professor Fisher, co-supervisor on a Australian-first study exploring ways to alleviate psychological distress among new mothers.
The researchers, from Monash University's Turner Institute for Brain and Mental Health and the Monash School of Public Health and Preventive Medicine, noted that, while it is routine to screen for postpartum depression, severe fatigue and other forms of psychological distress are often overlooked. This is despite up to 60 per cent of new mothers experiencing elevated fatigue and insomnia in the months after giving birth.
Professor Fisher explains there is “a continuum” of fatigue for new parents and some, particularly those with unsettled babies, experience it to a “severe” degree.
Some fatigue is normal, but about 25 per cent of parents have “really unsettled” babies who wake up frequently (every hour or so between 7pm and 7am) and who cry a lot (for more than three hours over 24 hours, for more than three days consecutively).
“They are exhausted and exasperated,” she says. “These women are really demoralised and they often say they are desperate and at the end of their tether.”
They are also impaired from fatigue. Fisher hears “all the time” about saucepans burning dry, forgotten food left in the oven, near car accidents, falling asleep at traffic lights, and forgetting to put the sides of the cot up or the baby’s seatbelt on in the car.
As with occupational fatigue in other workplaces, it impacts our ability to perform “safety sensitive activity”. But, in this instance, it is putting both mothers and their babies in harm's way.
The study, being presented at the launch the Turner Institute for Brain and Mental Health on Tuesday, assessed 78 women with “unsettled” babies, in a five-day early parenting residential program in Melbourne.
The research, part of a larger ongoing study, found almost all (91 per cent) had severe fatigue on admission, about half were experiencing insomnia, a third had clinically relevant symptoms of depression, and a third had clinically relevant symptoms of anxiety.
Many of the 3600 mothers who attend early parenting residential programs in Victoria each year have developed a “huge repertoire” to try and settle their babies, including long drives, singing, rocking, walking and feeding, Professor Fisher says, but are rarely educated about what works.
“They feel incompetent," she says.
Over five nights, the mothers learned their babies' tiredness cues as well as soothing and settling techniques aimed at helping their babies, and themselves, get more sleep.
“When babies are well rested they are much easier to care for,” Professor Fisher says.
At the end of the program, the women’s symptoms had improved significantly, and, upon completing a computerised task, had faster reaction times, important for daily tasks including driving.
Professor Fisher says the results show the importance of recognising various forms of psychological distress in new parents and providing support, through general education and, where necessary, greater access to residential stays.
Terri Smith, CEO of PANDA (Perinatal Anxiety & Depression Australia), says sleep schools “can be great” but points out that unsettled babies are not always the cause for the mother's lack of sleep.
One in five new mums, and one in 10 new dads, experience anxiety which can prevent them from sleeping even when the baby does, she explains.
“We run a national helpline and every day we talk to mums about their lack of sleep,” Smith says. “If you can't get to sleep when the baby sleeps, that's a concern.”
In the case of anxiety, Smith says mindfulness exercises (such as the strategies provided by the free MindMum App), psychological support, and sometimes medication are helpful.
“Sleep is crucial. It's very difficult to function without it,” Smith says. “So it's about getting the right sort of help… Rather than just being empathetic, ask what's getting in the way?”
For Professor Fisher, the purpose of recognising sleep deprivation and its impact is not to pathologise fatigue, but to ensure new mums are “offered support and assistance”.
“The focus of early parenting education is feeding. We think they also need education around sleeping, soothing and settling.”
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