Generic placeholder image

Current Women`s Health Reviews

Editor-in-Chief

ISSN (Print): 1573-4048
ISSN (Online): 1875-6581

Systematic Review Article

Managing Maternal Fatigue During Childbirth: A Systematic Review

Author(s): Kunnikar Chaisitsanguan*, Puangpaka Kongwattananon and Dawn Hawthrone

Volume 19, Issue 4, 2023

Published on: 25 October, 2022

Article ID: e040822207296 Pages: 18

DOI: 10.2174/1573404819666220804163125

Price: $65

Abstract

Background: Fatigue is a complex phenomenon. It is a common problem that occurs at all periods of childbearing. Pregnancy and labor are recognized as a normal physiological process, and fatigue, a common symptom that occurs frequently throughout the childbearing experience, has the potential to negatively affect the woman’s prenatal and birth experience. Fatigue is often overlooked by health professionals.

Objective: The aim of this systematic review is to review the literature regarding the factors influencing maternal fatigue during childbirth and its management.

Methods: The Joanna Briggs Institute (JBI) systematic review was used to guide this study. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was performed to report this systematic review. The database was searched from CINALH, Pubmed, PsyInfo, ThaiJO, and other sources for grey literature from 1990-2021. The methodological quality process used the critical appraisal tool for RCT study and MINORS (Methodological Index for Non-randomized Studies). Nine published articles were selected for this study.

Results: The factors influencing maternal fatigue during childbirth were found to be physiological, psychological, and situational. The physiological factors were age, parity, uterine contractility, available energy substrate, nutrition adequacy, and prenatal exercise. The psychological factors were pain and anxiety. The situational factors were childbirth education, pain medication, prenatal employment, sleep, breathing technique, and pushing intervention. The strategies of managing fatigue during childbirth were 1) assessing maternal fatigue in early pregnancy; 2) childbirth preparation; 3) conservation of energy; 4) shortened duration of labor; and 5) reduced labor pain and anxiety.

Conclusion: Maternal fatigue during childbirth impacts the mother, the child, and the family. It is important for nurses to understand the deleterious effects of fatigue on childbearing women and to promote interventions that reduce or prevent fatigue during pregnancy and childbirth.

Keywords: fatigue during childbirth, managing fatigue, factors influencing fatigue, strategies of fatigue management, systematic review, women

Graphical Abstract

[1]
Warren JJ, Hoskins LM. The development of NANDA’s nursing diagnosis taxonomy. Int J Nurs Terminol Classif 1990; 1(4): 162-8.
[2]
Poole CJ. Fatigue during the first trimester of pregnancy. J Obstet Gynecol Neonatal Nurs 1986; 15(5): 375-9.
[http://dx.doi.org/10.1111/j.1552-6909.1986.tb01409.x] [PMID: 3639925]
[3]
Pugh LC, Milligan RA. Patterns of fatigue during childbearing. Appl Nurs Res 1995; 8(3): 140-3.
[http://dx.doi.org/10.1016/S0897-1897(95)80593-1] [PMID: 7668856]
[4]
Reeves N, Potempa K, Gallo A. Fatigue in early pregnancy. An exploratory study. J Nurse Midwifery 1991; 36(5): 303-9.
[http://dx.doi.org/10.1016/0091-2182(91)90045-Q] [PMID: 1757816]
[5]
Tulman L, Fawcett J. Return of functional ability after childbirth. Nurs Res 1988; 37(2): 77-81.
[http://dx.doi.org/10.1097/00006199-198803000-00004] [PMID: 3347523]
[6]
Pugh LC, Milligan R. A framework for the study of childbearing fatigue. ANS Adv Nurs Sci 1993; 15(4): 60-70.
[http://dx.doi.org/10.1097/00012272-199306000-00007] [PMID: 8512305]
[7]
Affonso DD, Lovett S, Paul SM, Sheptak S. A standardized interview that differentiates pregnancy and postpartum symptoms from perinatal clinical depression. Birth 1990; 17(3): 121-30.
[http://dx.doi.org/10.1111/j.1523-536X.1990.tb00716.x] [PMID: 2222637]
[8]
Beck CT. Teetering on the edge: A substantive theory of postpartum depression. Nurs Res 1993; 42(1): 42-8.
[http://dx.doi.org/10.1097/00006199-199301000-00008] [PMID: 8424067]
[9]
Milligan RA, Parks PL, Kitzman H, Lenz ER. Measuring women’s fatigue during the postpartum period. J Nurs Meas 1997; 5(1): 3-16.
[http://dx.doi.org/10.1891/1061-3749.5.1.3] [PMID: 9505466]
[10]
Rubin R. Maternity nursing stops too soon. Am J Nurs 1975; 75(10): 1680-4.
[PMID: 1099904]
[11]
Lee KA, Gay CL. Sleep in late pregnancy predicts length of labor and type of delivery. Am J Obstet Gynecol 2004; 191(6): 2041-6.
[http://dx.doi.org/10.1016/j.ajog.2004.05.086] [PMID: 15592289]
[12]
Tzeng YL, Chao YM, Kuo SY, Teng YK. Childbirth-related fatigue trajectories during labour. J Adv Nurs 2008; 63(3): 240-9.
[http://dx.doi.org/10.1111/j.1365-2648.2008.04732.x] [PMID: 18702771]
[13]
Cahill CA. Differential diagnosis of fatigue in women. J Obstet Gynecol Neonatal Nurs 1999; 28(1): 81-6.
[http://dx.doi.org/10.1111/j.1552-6909.1999.tb01968.x] [PMID: 9924868]
[14]
Cheng CY, Chou YH, Wang P, Tsai JM, Liou SR. Survey of trend and factors in perinatal maternal fatigue. Nurs Health Sci 2015; 17(1): 64-70.
[http://dx.doi.org/10.1111/nhs.12149] [PMID: 24835296]
[15]
Pugh LC, Milligan R, Parks PL, Lenz ER, Kitzman H. Clinical approaches in the assessment of childbearing fatigue. J Obstet Gynecol Neonatal Nurs 1999; 28(1): 74-80.
[http://dx.doi.org/10.1111/j.1552-6909.1999.tb01967.x] [PMID: 9924867]
[16]
Chien LY, Ko YL. Fatigue during pregnancy predicts caesarean deliveries. J Adv Nurs 2004; 45(5): 487-94.
[http://dx.doi.org/10.1046/j.1365-2648.2003.02931.x] [PMID: 15009351]
[17]
Siraprom T. Fatigue among pregnant women. Chiang Mai Chiang Mai 2006.
[18]
Theerakulchai J. Factors related to fatigue and fatigue management among Thai postpartum women. Chiang Mai Chiang Mai 2004.
[19]
Lenz ER, Pugh LC, Milligan RA, Gift A, Suppe F. The middle-range theory of unpleasant symptoms: An update. ANS Adv Nurs Sci 1997; 19(3): 14-27.
[http://dx.doi.org/10.1097/00012272-199703000-00003] [PMID: 9055027]
[20]
Lenz ER, Suppe F, Gift AG, Pugh LC, Milligan RA. Collaborative development of middle-range nursing theories: Toward a theory of unpleasant symptoms. ANS Adv Nurs Sci 1995; 17(3): 1-13.
[http://dx.doi.org/10.1097/00012272-199503000-00003] [PMID: 7778887]
[21]
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009; 6(7)e1000097
[http://dx.doi.org/10.1371/journal.pmed.1000097] [PMID: 19621072]
[22]
Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998; 52(6): 377-84.
[http://dx.doi.org/10.1136/jech.52.6.377] [PMID: 9764259]
[23]
Psychophysiological correlates of fatigue during childbirth 1990.
[24]
Dunemn K. Fatigue during labor. University of Illinois at Chicago, Health Sciences Center 1999.
[25]
Pugh LC, Milligan RA, Gray S, Strickland OL. First stage labor management: An examination of patterned breathing and fatigue. Birth 1998; 25(4): 241-5.
[http://dx.doi.org/10.1046/j.1523-536X.1998.00241.x] [PMID: 9892892]
[26]
Kelly M, Johnson E, Lee V, et al. Delayed versus immediate pushing in second stage of labor. MCN Am J Matern Child Nurs 2010; 35(2): 81-8.
[http://dx.doi.org/10.1097/NMC.0b013e3181cae7ad] [PMID: 20215948]
[27]
Chang SC, Chou MM, Lin KC, Lin LC, Lin YL, Kuo SC. Effects of a pushing intervention on pain, fatigue and birthing experiences among Taiwanese women during the second stage of labour. Midwifery 2011; 27(6): 825-31.
[http://dx.doi.org/10.1016/j.midw.2010.08.009] [PMID: 20952110]
[28]
Ebrahimzadeh S, Golmakani N, Kabirian M, Shakeri MT. Study of correlation between maternal fatigue and uterine contraction pattern in the active phase of labour. J Clin Nurs 2012; 21(11-12): 1563-9.
[http://dx.doi.org/10.1111/j.1365-2702.2012.04084.x] [PMID: 22519453]
[29]
Tzeng YL, Yang YL, Kuo PC, Lin YC, Chen SL. Pain, anxiety, and fatigue during labor: A prospective, repeated measures study. JNR 2017; 25(1): 59-67.
[http://dx.doi.org/10.1097/jnr.0000000000000165] [PMID: 28072678]
[30]
Yoshitake H. Relations between the symptoms and the feeling of fatigue. Ergonomics 1971; 14(1): 175-86.
[http://dx.doi.org/10.1080/00140137108931236] [PMID: 5117616]
[31]
Gardner DL. Fatigue in postpartum women. Appl Nurs Res 1991; 4(2): 57-62.
[http://dx.doi.org/10.1016/S0897-1897(05)80056-4] [PMID: 1741638]
[32]
Lee KA, Zaffke ME. Longitudinal changes in fatigue and energy during pregnancy and the postpartum period. J Obstet Gynecol Neonatal Nurs 1999; 28(2): 183-91.
[http://dx.doi.org/10.1111/j.1552-6909.1999.tb01983.x] [PMID: 10102546]
[33]
Nordström L, Achanna S, Naka K, Arulkumaran S. Fetal and maternal lactate increase during active second stage of labour. BJOG 2001; 108(3): 263-8.
[http://dx.doi.org/10.1111/j.1471-0528.2001.00034.x] [PMID: 11281466]
[34]
Srivastava RH. Fatigue in the renal patient. ANNA J 1986; 13(5): 246-9.
[PMID: 3640600]
[35]
Liu HE. Fatigue and associated factors in hemodialysis patients in Taiwan. Res Nurs Health 2006; 29(1): 40-50.
[http://dx.doi.org/10.1002/nur.20109] [PMID: 16404733]
[36]
Lee KA. Sleep and fatigue. Annu Rev Nurs Res 2001; 19: 249-73.
[http://dx.doi.org/10.1891/0739-6686.19.1.249] [PMID: 11439783]
[37]
Parks PL, Lenz ER, Milligan RA, Han HR. What happens when fatigue lingers for 18 months after delivery? J Obstet Gynecol Neonatal Nurs 1999; 28(1): 87-93.
[http://dx.doi.org/10.1111/j.1552-6909.1999.tb01969.x] [PMID: 9924869]
[38]
Eltzschig HK, Eckle T. Ischemia and reperfusion from mechanism to translation. Nat Med 2011; 17(11): 1391-401.
[http://dx.doi.org/10.1038/nm.2507] [PMID: 22064429]
[39]
Gourine AV, Llaudet E, Dale N, Spyer KM. Release of ATP in the ventral medulla during hypoxia in rats: Role in hypoxic ventilatory response. J Neurosci 2005; 25(5): 1211-8.
[http://dx.doi.org/10.1523/JNEUROSCI.3763-04.2005] [PMID: 15689558]
[40]
Luria O, Jaffa A, Farine D, et al. Effects of the individual uterine contraction on fetal head descent and cervical dilatation during the active stage of labor. Eur J Obstet Gynecol Reprod Biol 2009; 144 (Suppl. 1): S101-7.
[http://dx.doi.org/10.1016/j.ejogrb.2009.02.031] [PMID: 19278773]
[41]
Mayberry LJ, Gennaro S, Strange L, Williams M, De A. Maternal fatigue: Implications of second stage labor nursing care. J Obstet Gynecol Neonatal Nurs 1999; 28(2): 175-81.
[http://dx.doi.org/10.1111/j.1552-6909.1999.tb01982.x] [PMID: 10102545]
[42]
Lee KA, Lentz MJ, Taylor DL, Mitchell ES, Woods NF. Fatigue as a response to environmental demands in women’s lives. Image J Nurs Sch 1994; 26(2): 149-54.
[http://dx.doi.org/10.1111/j.1547-5069.1994.tb00935.x] [PMID: 8063323]
[43]
Fatigue MDK. Fatigue Philadephia. J.B. Lippincott Company 1985.
[44]
Ehsanipoor RM, Saccone G. Intravenous fluid rate for reduction of cesarean delivery rate in nulliparous women: A systematic review and meta-analysis. 2017; 97(7): 804-11.
[http://dx.doi.org/10.1111/aogs.13121]
[45]
Hutchinson MK, Baqi-Aziz M. Nursing care of the childbearing Muslim family. J Obstet Gynecol Neonatal Nurs 1994; 23(9): 767-71.
[http://dx.doi.org/10.1111/j.1552-6909.1994.tb01951.x] [PMID: 7853082]
[46]
Dodd MJ, Miaskowski C, Lee KA. Occurrence of symptom clusters. J Natl Cancer Inst Monogr 2004; (32): 76-8.
[http://dx.doi.org/10.1093/jncimonographs/lgh008] [PMID: 15263044]
[47]
Eidelman D. Fatigue: Towards an analysis and a unified definition. Med Hypotheses 1980; 6(5): 517-26.
[http://dx.doi.org/10.1016/0306-9877(80)90105-X] [PMID: 7412641]
[48]
Byrne J, Hauck Y, Fisher C, Bayes S, Schutze R. Effectiveness of a mindfulness-based childbirth education pilot study on maternal self-efficacy and fear of childbirth. J Midwifery Womens Health 2014; 59(2): 192-7.
[http://dx.doi.org/10.1111/jmwh.12075] [PMID: 24325752]
[49]
Ip WY, Tang CS, Goggins WB. An educational intervention to improve women’s ability to cope with childbirth. J Clin Nurs 2009; 18(15): 2125-35.
[http://dx.doi.org/10.1111/j.1365-2702.2008.02720.x] [PMID: 19583645]
[50]
Zlott DA, Byrne M. Mechanisms by which pharmacologic agents may contribute to fatigue. PM R 2010; 2(5): 451-5.
[http://dx.doi.org/10.1016/j.pmrj.2010.04.018] [PMID: 20656627]
[51]
Lhoten D. Fatigue and the postsurgical patient. Concept clarification in nursing. 1982.
[52]
Abboud TK, Sarkis F, Hung TT, et al. Effects of epidural anesthesia during labor on maternal plasma beta-endorphin levels. Anesthesiology 1983; 59(1): 1-5.
[http://dx.doi.org/10.1097/00000542-198307000-00001] [PMID: 6305238]
[53]
Gay CL, Lee KA, Lee SY. Sleep patterns and fatigue in new mothers and fathers. Biol Res Nurs 2004; 5(4): 311-8.
[http://dx.doi.org/10.1177/1099800403262142] [PMID: 15068660]
[54]
McDonald AD, McDonald JC, Armstrong B, Cherry NM, Nolin AD, Robert D. Prematurity and work in pregnancy. Br J Ind Med 1988; 45(1): 56-62.
[PMID: 3342188]
[55]
Troy NW, Dalgas-Pelish P. Development of a self-care guide for postpartum fatigue. Appl Nurs Res 1995; 8(2): 92-6.
[http://dx.doi.org/10.1016/S0897-1897(95)80550-8] [PMID: 7598523]
[56]
Barasinski C, Vendittelli F. Effect of the type of maternal pushing during the second stage of labour on obstetric and neonatal outcome: A multicentre randomised trial-the EOLE study protocol. BMJ Open 2016; 6(12)e012290
[http://dx.doi.org/10.1136/bmjopen-2016-012290] [PMID: 27998899]
[57]
Gupta JK, Sood A, Hofmeyr GJ, Vogel JP. Position in the second stage of labour for women without epidural anaesthesia. Cochrane database of systematic reviews 2017; 2017(5)
[http://dx.doi.org/10.1002/14651858.CD002006.pub4]
[58]
Potempa K, Lopez M, Reid C, Lawson L. Chronic fatigue. Image J Nurs Sch 1986; 18(4): 165-9.
[http://dx.doi.org/10.1111/j.1547-5069.1986.tb00569.x] [PMID: 3641780]
[59]
Ament W, Verkerke GJ. Exercise and fatigue. Sports Med 2009; 39(5): 389-422.
[http://dx.doi.org/10.2165/00007256-200939050-00005] [PMID: 19402743]
[60]
Cobb S. Presidential Address-1976. Social support as a moderator of life stress. Psychosom Med 1976; 38(5): 300-14.
[http://dx.doi.org/10.1097/00006842-197609000-00003] [PMID: 981490]
[61]
Hung S, Morrison DR, Whittington LA, Fein SB. Prepartum work, job characteristics, and risk of cesarean delivery. Birth 2002; 29(1): 10-7.
[http://dx.doi.org/10.1046/j.1523-536X.2002.00150.x] [PMID: 11843785]
[62]
Vatwani A, Margonis R. Energy conservation techniques to decrease fatigue. Arch Phys Med Rehabil 2019; 100(6): 1193-6.
[http://dx.doi.org/10.1016/j.apmr.2019.01.005] [PMID: 30955793]
[63]
ACOG Committee Opinion No. 766 Summary: Approaches to limit intervention during labor and birth. Obstet Gynecol 2019; 133(2): 406-8.
[http://dx.doi.org/10.1097/AOG.0000000000003081] [PMID: 30681540]
[64]
Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures: A report by the American Society of Anesthesiologist Task Force on Preoperative Fasting. Anesthesiology 1999; 90(3): 896-905.
[http://dx.doi.org/10.1097/00000542-199903000-00034] [PMID: 10078693]
[65]
Dalal KS, Rajwade D, Suchak R. “Nil per oral after midnight”: Is it necessary for clear fluids? Indian J Anaesth 2010; 54(5): 445-7.
[http://dx.doi.org/10.4103/0019-5049.71044] [PMID: 21189883]
[66]
Dawood F, Dowswell T, Quenby S. Intravenous fluids for reducing the duration of labour in low risk nulliparous women. Cochrane Database Syst Rev 2013; (6): CD007715.
[http://dx.doi.org/10.1002/14651858.CD007715.pub2] [PMID: 23780639]
[67]
Beebe KR, Lee KA. Sleep disturbance in late pregnancy and early labor. J Perinat Neonatal Nurs 2007; 21(2): 103-8.
[http://dx.doi.org/10.1097/01.JPN.0000270626.66369.26] [PMID: 17505229]
[68]
Shaliha F, Mozaffari M, Ramezani F, Hajnasiri H, Moafi F. Daytime napping and nighttime sleep during pregnancy and preterm birth in Iran. J Prev Med Public Health 2021; 54(3): 182-9.
[http://dx.doi.org/10.3961/jpmph.20.372] [PMID: 34092064]
[69]
Chaisitsanguan K, Kongvattananon P. Strategies of comfort management during childbirth: A qualitative. Syst Rev 2021; 17(1): 36-44.
[PMID: 33485392]
[70]
Velvovsky I, Platonov K, Ploticher V, Shugom E. Painless childbirth through psychoprophylaxis: lectures for obstetricians. Foreign Languages Publishing House 1960.
[71]
Busch V, Magerl W, Kern U, Haas J, Hajak G, Eichhammer P. The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing - An experimental study. Pain Med 2012; 13(2): 215-28.
[http://dx.doi.org/10.1111/j.1526-4637.2011.01243.x] [PMID: 21939499]
[72]
Klarer M, Arnold M, Günther L, Winter C, Langhans W, Meyer U. Gut vagal afferents differentially modulate innate anxiety and learned fear. J Neurosci 2014; 34(21): 7067-76.
[http://dx.doi.org/10.1523/JNEUROSCI.0252-14.2014] [PMID: 24849343]
[73]
Olson R, Olson C, Cox NS. Maternal birthing positions and perineal injury. J Fam Pract 1990; 30(5): 553-7.
[PMID: 2332746]
[74]
Shermer RH, Raines DA. Positioning during the second stage of labor: Moving back to basics. J Obstet Gynecol Neonatal Nurs 1997; 26(6): 727-34.
[http://dx.doi.org/10.1111/j.1552-6909.1997.tb02748.x] [PMID: 9395982]
[75]
Susan T, Blackburn D. Maternal, fetal, & neonatal physiology: A clinical perspective. Qual Health Res 2007; 11(6): 780-94.
[76]
De Jonge A, Lagro-Janssen AL. Birthing positions. A qualitative study into the views of women about various birthing positions. J Psychosom Obstet Gynaecol 2004; 25(1): 47-55.
[http://dx.doi.org/10.1080/01674820410001737432] [PMID: 15376404]
[77]
Lemos A, Amorim MM, Dornelas de Andrade A, de Souza AI, Cabral Filho JE, Correia JB. Pushing/bearing down methods for the second stage of labour. Cochrane Database Syst Rev 2017; 3(3): CD009124.
[http://dx.doi.org/10.1002/14651858.CD009124.pub3] [PMID: 28349526]
[78]
Roberts JE. A new understanding of the second stage of labor: Implications for nursing care. J Obstet Gynecol Neonatal Nurs 2003; 32(6): 794-801.
[http://dx.doi.org/10.1177/0884217503258497] [PMID: 14649600]
[79]
Abbasi Z, Abedian Z. Study of the effects of massage therapy on the intensity of labor fatigue 2007.
[80]
Fulton KB. Effects of music therapy on physiological measures, perceived pain, and perceived fatigue of women in early labor 2005.
[81]
Weil MH, Afifi AA. Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation 1970; 41(6): 989-1001.
[http://dx.doi.org/10.1161/01.CIR.41.6.989] [PMID: 5482913]
[82]
Harrison MJ. Postpartum concerns of mothers and their sources of help 1983; 325-8.
[83]
Milligan R, Lenz ER, Parks PL, Pugh LC, Kitzman H. Postpartum fatigue: Clarifying a concept. Sch Inq Nurs Pract 1996; 10(3): 279-91.
[PMID: 9009822]
[84]
Milligan RA, Flenniken PM, Pugh LC. Positioning intervention to minimize fatigue in breastfeeding women. Appl Nurs Res 1996; 9(2): 67-70.
[http://dx.doi.org/10.1016/S0897-1897(96)80435-6] [PMID: 8871433]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy