The first days after childbirth can be demanding for new mothers. Alongside recovering from birth, mothers may be expected to care for their newborn around the clock, often while experiencing pain, fatigue, anxiety, and disrupted sleep.

One approach commonly used in hospitals is rooming-in, where mothers and newborns remain together continuously, including overnight. This model is intended to support breastfeeding and mother-infant bonding. However, being motivated to breastfeed does not necessarily mean that a mother feels ready to provide continuous care for her newborn.

A new study published in the Open Access Journal of Clinical Medicine (JCM) investigated this distinction by examining maternal readiness for alongside breastfeeding readiness and a range of psychological and physical factors.

The researchers found that breastfeeding readiness was strongly associated with readiness to care for a newborn during both the day and night. However, the two measures were not identical. Anxiety, sleep disturbance, and psychological flexibility were also associated with how ready mothers felt to care for their newborns.

The findings suggest that assessing whether a mother feels ready to breastfeed may not provide a complete picture of whether she feels prepared for the demands of continuous newborn care.

Defining ‘readiness’ for maternal care

Rooming-in is designed to keep mothers and newborns together for 24 hours a day. This can support breastfeeding by allowing mothers to respond to feeding cues and breastfeed frequently.

However, continuous newborn care can also be physically and psychologically demanding. Fatigue, pain, anxiety, and low mood may make it more difficult for a mother to feel capable of managing these demands, even when she remains motivated to breastfeed.

Dr Anna Prokopowicz, lead author of the study expands on this point:

Readiness to care for a newborn is not an assessment of a mother’s competence. It reflects her own perception of whether, considering her current physical and psychological condition, she feels capable of caring for her baby independently.

Importantly, the study distinguished what is meant between breastfeeding readiness and newborn self-care readiness:

• Breastfeeding readiness: Considered a motivational component which reflects a mother’s intention and willingness to breastfeed.
• Newborn self-care readiness: Represents the perceived ability to put this intention into practice through continuous caregiving.

This distinction is particularly important because a mother may want to breastfeed while simultaneously feeling that she needs help caring for her newborn, particularly through the night.

The researchers assessed readiness using three 0-10 self-report scales covering daytime newborn care, nighttime newborn care, and breastfeeding.

Linking breastfeeding readiness to newborn care readiness

The study included 200 women who were 48-72 hours postpartum at a university hospital in Poland. Participants had delivered healthy newborns and were receiving care in a rooming-in ward.

The women generally reported relatively high readiness. The median score was 8 out of 10 for daytime newborn care, nighttime newborn care, and breastfeeding. However, some women did report low or no readiness, highlighting differences between mothers even within the same hospital care system.

One of the clearest findings was the relationship between breastfeeding readiness and readiness for newborn care. Women who reported greater breastfeeding readiness were much more likely to report higher readiness to care for their newborn during both the day and night. However, the relationship was not completely linear, suggesting that increases in breastfeeding readiness did not correspond to an identical increase in newborn care readiness across the entire scale.

The strong relationship does support that the two forms of readiness are connected. However, differences in their other factors indicate that they should not necessarily be treated as the same construct.

Anxiety was associated with lower readiness for newborn care

While breastfeeding readiness was the strongest indicator of daytime and nighttime newborn care readiness, anxiety was consistently associated with lower readiness.

Women reporting higher anxiety on the second postpartum day had lower odds of reporting greater readiness for daytime care, with a similar trend being observed for nighttime readiness. Anxiety was also associated with breastfeeding readiness itself. Women with higher anxiety increasingly perceived themselves as not being as ready to breastfeed.

These findings suggest that a mother’s current emotional state may influence how prepared she feels to take on caregiving and breastfeeding responsibilities, as Prof. Izabella Uchmanowicz, corresponding author of the study, explains:

The most important finding of our study is that a woman’s readiness to care for her newborn is influenced more by her psychological condition than by purely physical factors. Anxiety proved to be a much stronger determinant than pain or normal postpartum physiological changes, which suggests that greater attention should be paid to the emotional well-being of new mothers.

Importantly, the study cannot establish that anxiety directly causes lower readiness. Because the research was cross-sectional, both factors were assessed at the same point in time. Therefore, the results represent associations rather than evidence of causation.

Daytime and nighttime newborn care may require different resources

Although daytime and nighttime readiness were strongly related, the researchers found differences in the factors associated with each.

For daytime care, sleep disturbance was associated with lower readiness. Meanwhile, the ability to maintain responsibilities despite feeling discouraged or low in mood was associated with higher daytime readiness. This measure reflects an aspect of psychological flexibility which describes an individual’s ability to maintain goal-directed behaviour despite difficult emotions.

Nighttime readiness showed a different pattern. Women who reported a greater ability to maintain concentration despite worry and emotional strain were more likely to report higher nighttime readiness.

Nighttime readiness was also lower among women reporting suicidal ideation, although the researchers emphasise that this represents an association with a specific depressive symptom rather than evidence of a causal relationship.

Together, these findings suggest that the demands of newborn care may differ depending on when that care takes place. Sleep and general behavioural functioning may be particularly relevant during the day, while maintaining concentration and managing emotional strain may become more important at night.

Previous breastfeeding experience may influence readiness for newborn care

The researchers also found that breastfeeding readiness was associated with current feeding behaviour and maternal experience.

Women who were already engaging more heavily in breastfeeding on the second postpartum day were more likely to report higher breastfeeding readiness. A similar trend was also observed for women with two children or more.

The researchers suggest that previous experience may contribute to greater confidence and adaptation to the parental role. However, these findings are associations and cannot establish that there is a direct correlation between the two.

Can the rooming-in method be optimised?

The findings raise an important question about how rooming-in is implemented. Keeping a mother and newborn together continuously can support breastfeeding, but the study suggests that a mother’s willingness to breastfeed should not automatically be interpreted as evidence that she feels ready for uninterrupted newborn care.

Some women may be highly motivated to breastfeed while simultaneously experiencing complications such as fatigue, anxiety, low mood, or difficulty coping with continuous caregiving demands.

This distinction could be particularly important at night. The researchers suggest that flexible care arrangements, including temporary relief or structured support, could allow mothers to receive assistance while maintaining their intention to breastfeed.

Rather than treating rooming-in as a goal, the authors argue that care should be aligned with the mothers’ current psychophysical resources.

Supporting mothers beyond breastfeeding

One of the study’s key contributions is its broader definition of maternal readiness.

Previous research has often examined specific aspects of newborn care or readiness for hospital discharge. In contrast, the study considered whether mothers felt prepared to care for their newborn during both the day and night, alongside their readiness to breastfeed.

The researchers suggest that simple self-report measures could eventually be developed into a brief clinical screening tool. This approach could help healthcare professionals identify mothers who may need additional support during the early postpartum period.

For example, a woman who reports high breastfeeding readiness but lower nighttime caregiving readiness may benefit from additional overnight support without necessarily requiring a change in her feeding intentions.

However, further research is needed. The study was conducted at a single hospital and included a relatively socioeconomically advantaged group of women. It also took place during the COVID-19 pandemic, when visitors were banned and informal support was limited.

Most importantly, readiness was assessed using self-report measures. The researchers measured how prepared mothers felt, rather than directly observing their caregiving behaviour. Future longitudinal studies could investigate whether readiness predicts actual caregiving behaviour, breastfeeding outcomes, or maternal wellbeing after discharge.

The study suggests that being ready to breastfeed and being ready for continuous newborn care are closely connected, but they are not necessarily the same thing.

By recognising the difference between wanting to provide care and feeling able to provide care, healthcare professionals may be better placed to offer support that reflects the individual needs of mothers during the first days after childbirth.

More research on maternal health, breastfeeding and newborn care can be found across MDPI’s Open Access journals JCM, Healthcare, and Women.

Alternatively, you can access the full MDPI journal list here.