Women’s Perceptions of Postpartum Stress: A Narrative Analysis

The impact of stress on the health of postpartum mothers is poorly understood. Although the postpartum period increases risk for stress related diseases such as depression and autoimmune disorders, little qualitative research has focused on women’s perceptions of postpartum stressors. A constant comparative content analysis using Atlas.Ti was done on data collected by Groer (NIH R01 NR05000“Influence of Lactation on Postpartum Stress & Immunity) from 2001 to 2005. Women (n=127) answered the prompt, “Think of any one incident, thought, or feeling that stands out as very stressful to you and describe in as much detail as you choose.” Researcher triangulation was provided by independent coding of data by two qualitative researchers. The women were predominantly white (91%), married (72%), and not yet working following the baby’s birth (70%). Only 28% had family incomes greater than $40,000 per year. Vaginal births were experienced by 66%, 83% without complications. Forty-seven percent were breastfeeding exclusively with 43% bottle feeding. Slightly less than half (48%) were first time mothers. Eighty-nine percent claimed no recent major life event, such as a death in the family. Twenty-seven postpartum stressors were identified that were grouped into five themes: 1) environmental stressors, 2) symptoms of depression, 3) infant health and safety issues, 4) maternal role strain, and 5) lack of support. Seventeen women identified fatigue or lack of sleep as stressful and each questioned her ability to parent a newborn. Though these women would seem low risk for stress (having had an uncomplicated birth, being married and not yet back at work postpartum), 27 different postpartum stressors were identified. Stressors such as lack of sleep may be known by maternal-child nurses, but women are unprepared for them. Interventions need to be designed to provide anticipatory guidance for new mothers regarding postpartum stressors. Tools should be developed for use by clinicians to assess maternal stress in the postpartum period. Prenatal preparation anticipating stressors and postpartum vigilance in assessing stressors could ease the transition into motherhood