AN INTERPRETATIVE PHENOMENOLOGICAL STUDY EXPLORING THE ATTITUDES OF FIRST-TIME MOTHERS TOWARDS SLEEP DEPRIVATION IN THE POSTPARTUM PERIOD JOANNE CHWALKO 2019 1 An interpretative phenomenological study exploring the attitudes of first time mothers towards sleep deprivation in the postpartum period Joanne Chwalko A thesis submitted in partial fulfilment of the requirements of Manchester Metropolitan University for the degree of Professional Doctorate Department of Health Professions Manchester Metropolitan University 2019 2 ABSTRACT Background This study set out to explore first-time mother’s attitudes to sleep deprivation. During the transition to motherhood sleep deprivation is considered a ‘normal’ adjustment to motherhood. However, there is no evidence to suggest that new mothers are able to cope better with sleep deprivation or the detrimental impact on physical or psychological health compared to the population as a whole. Women often feel they should be able to manage the effects and are often unprepared for the reality when experiencing the effects. Methodology Guided by the philosophical assumptions of interpretative phenomenological analysis (IPA), this study explores the experience of maternal sleep deprivation through the voices of six first-time mothers. Testimonies were collected through face-to-face, semi-structured interviews during the postnatal period. Each testimony was analysed using Smith et al.’s (2009) IPA model. Findings Four main themes emerged: power of the professional, relationship with child, transition of self and idealism vs reality. Women’s attitudes were influenced by their sense of identity defined through their relationships with professionals, their child and previous role. Attitudes are influenced by relational care: the ability of professionals and mothers to connect, be compassionate and explore sleep deprivation in collaboration. Training professionals and mothers in mindfulness, particularly ‘being present’, may have a positive impact on women’s attitudes to sleep deprivation including their ability to develop appropriate coping strategies. 3 ACKNOWLEDGEMENTS I would like to begin by expressing my sincerest thanks to the women who participated in this study. I will be forever thankful for the trust placed in me to share their experiences with others. I would like to thank Dr Carol Taylor who created the opportunity for me to pursue my research study, and Professor Duncan Mitchell for his encouraging words during the early stages. Special thanks are given to my supervisors, Dr Kirsten Jack and Dr Christopher Wibberley who joined me on this journey at a crucial time personally. Their expertise, encouragement and support were invaluable. The study would not have been possible without the support of Wirral Community Trust and particular thanks goes to Viv Harrison who started out on this journey with me and is still offering words of encouragement as the study comes to an end. My thanks are extended to the Queens Nurse Institute, Florence Nightingale Fund, Worshipful Barbers Company and the Institute of Health Visiting, as without their support and inspiration I would not have been able to complete this research. I hope that there is an opportunity to use this thesis to promote the fantastic work they do. I also hope that nurses read this and feel motivated to undertake research themselves. Finally, and most importantly, I would like to acknowledge the unequivocal support from my husband Gary and children Adam and Sarah. DEDICATION ‘In memoriam’ Evie 4 CONTENTS ABSTRACT ......................................................................................................... 3 ACKNOWLEDGEMENTS ................................................................................... 4 LIST OF TABLES ................................................................................................ 9 LIST OF FIGURES ............................................................................................. 9 DECLARATION ................................................................................................ 10 CHAPTER 1 – DEVELOPING THE RESEARCH QUESTION .......................... 11 Introduction.................................................................................................... 11 Exploring my professional role ...................................................................... 13 Aims and objectives ...................................................................................... 22 Thesis structure ............................................................................................. 22 CHAPTER 2 – REVIEW OF THE LITERATURE .............................................. 24 Introduction.................................................................................................... 24 Searching the Literature…………………………………………………………..23 Sleep ............................................................................................................. 26 Effects of sleep deprivation ........................................................................... 28 Physical effects of sleep ............................................................................ 30 Behavioural effects of sleep ....................................................................... 30 Performance and cognitive effects of sleep ............................................... 31 Maternal mental health and effects of sleep .............................................. 33 Attitudes to maternal sleep deprivation ......................................................... 36 Attitudes and norms ...................................................................................... 37 Professional support for sleep deprivation .................................................... 41 CHAPTER 3 – METHODOLOGY ...................................................................... 44 Research strategy/methodology .................................................................... 44 Epistemological position ................................................................................ 44 Credibility....................................................................................................... 47 5 Interpretative phenomenological analysis (IPA) ............................................ 49 IPA as a methodology ................................................................................ 51 IPA and hermeneutics ............................................................................... 53 CHAPTER 4 – DATA COLLECTION ................................................................ 56 Ethical considerations ................................................................................... 56 Confidentiality ................................................................................................ 57 Consent ......................................................................................................... 57 Participants and recruitment method ............................................................. 59 Participant eligibility and recruitment ............................................................. 60 Recruitment process ..................................................................................... 60 Participant demographics .............................................................................. 61 Interview schedule ......................................................................................... 63 Questions ................................................................................................... 64 Conducting the interviews .......................................................................... 65 Pre-interview feedback .................................................................................. 66 Protection and storage of data ...................................................................... 69 CHAPTER 5 – IPA ANALYSIS .......................................................................... 70 Introduction.................................................................................................... 70 IPA iterative and inductive analytical cycle .................................................... 71 Developing emergent themes ........................................................................ 76 Developing themes – individual transcript ................................................. 78 Searching for connections across emergent themes ................................. 83 Moving to the next testimonial ................................................................... 85 Looking for patterns across testimonials .................................................... 85 Generating the master themes ...................................................................... 88 CHAPTER 6 – FINDINGS ................................................................................. 90 Introduction.................................................................................................... 90 Power of the professional .............................................................................. 92 6 As a navigator of emotion .......................................................................... 92 As an expert pre and post birth .................................................................. 97 Relationship with baby ................................................................................ 100 Routines and planning ............................................................................