Proposed domains of postpartum sleep: a concept elicitation study using qualitative interviews

Sleep as a construct in the postpartum period and its perceived importance to postpartum patients remain largely under explored. The aim of this concept elicitation study was to develop a conceptual framework for postpartum sleep based on the key themes (domains and subdomains) identified. Secondary aims were to determine the frequency of discussion of individual domains/subdomains among participants and provide exemplar patient quotes for the most frequently discussed subdomains.

This study received Institutional Review Board approval from Stanford Lucile Packard Children's Hospital and the University of Arkansas for Medical Sciences. Semi-structured interviews were conducted with patients, partners and multidisciplinary experts until thematic saturation was achieved. All interviews were audio recorded and professionally transcribed and de-identified. Thematic codes (domains and subdomains of postpartum sleep) were derived from review of interview transcripts. Iterative thematic analysis of transcripts with constant comparison across cases was conducted systematically by ≥2 analysts. All transcripts were coded in Nvivo software and qualitatively analyzed to report frequency of domain/subdomain discussion and to identify exemplar patient quotes for individual subdomains.

Interviews were conducted with 42 patients, 13 multidisciplinary experts, and 6 partners over a total of 20 h. Median interval between delivery and interview for the recruited postpartum women was 8 weeks (interquartile range 6-10 weeks, range 3-52 weeks). Analysis of all 61 participant interviews resulted in derivation of 10 domains (psychological, pharmacological, non-pharmacological, sleep interference, medical factors, feeding of neonate, sleep disruption, social factors, societal and cultural factors, and infant related factors) and 85 subdomains related to the construct of postpartum sleep. The three most frequently discussed domains were sleep disruption, non-pharmacological interventions to improve sleep, and medical factors related to sleep. The top 10 most frequently discussed subdomains were breast feeding/feeding, maternal awakenings, social support, childbirth experience, infant sleep routine, day time sleep, infant care (bottles, milk, diapers), sleep arrangements, chronotype, and nighttime sleep.

This study provides a conceptual framework based on 10 domains and 85 subdomains, which can be used to comprehensively describe and study the complex construct of postpartum sleep. These findings can be used to counsel patients regarding postpartum sleep experiences, facilitate patient discussion in the postnatal period when assessing postpartum sleep experiences, guide development of new measures, and assess content validity of existing sleep measures.