Maternal Sleepiness and Risk of Infant Drops in the Postpartum Period

An increase in infant drops on a postpartum unit prompted a quality improvement project to examine causes and formulate risk reduction strategies. Review of health records revealed that infant drops occurred more frequently when mothers fell asleep holding infants.

A prospective descriptive study was conducted with a convenience sample of 101 postpartum mother-infant dyads. Hourly assessments of maternal sleepiness using the Stanford Sleepiness Scale (SSS) and surveillance of patient rooms were performed during hospitalizations (N = 4,550 observations).

Mothers slept on average 3.7 hours/day (median = 5.0). Sleepiness followed an expected nighttime routine on postpartum day 1 regardless of when mothers arrived on the unit. Peak sleepiness was observed at 04:00 (mean SSS score = 5.3; standard deviation [SD] = 2.6), and mothers were most awake until 18:00 (mean SSS score = 1.9; SD = 1.7). No infant drops occurred during the project; however, 50 participants required at least one intervention or corrective action to address unsafe sleep. Of 1,718 observations of mothers in bed with their infant, there were 35 instances (2.0%) where nurses observed mothers asleep holding their infant.

Frequent observations of maternal sleepiness and infant environments may prevent infant drops and provide opportunities for intervening with risk reduction strategies, including education on safe sleep for infants.