Review Article
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Pensar Enfermagem / v.30 n.01 / Jan-Dec 2026 / DOI: 10.71861/pensarenf.v30i1.515 / e00515
Parental confidence in newborn care: a scoping review
Rita Martins1*, Sandra Risso2 Maria Helena Presado3
1 Master’s degree. Arrábida Local Health Unit, Setúbal, Portugal; orcid.org/0009-0005-0095-7683
2 Master’s degree. PhD candidate in Nursing. Department of Maternal Health Nursing, School of Nursing of the University of Lisbon (ESEUL),
Lisbon; Nursing Research Innovation and Development Centre of Lisbon (CIDNUR), School of Nursing, Universidade de Lisboa. Lisbon. Portugal;
orcid.org/0000-0002-7169-5570
3 PhD. Department of Maternal Health Nursing, School of Nursing of the University of Lisbon (ESEUL), Lisbon; Nursing Research Innovation
and Development Centre of Lisbon (CIDNUR), School of Nursing, Universidade de Lisboa. Lisbon. Portugal; orcid.org/0000-0002-6852-7875
* Corresponding author: rtavares@campus.enfermagem.ulisboa.pt
Received: 09.04.2026
Revised: 25.06.2026
Accepted: 14.08.2026
Editor: Florinda Galinha
How to cite this article: Martins R, Risso S, Presado MH. Parental confidence in newborn care: a scoping review. Pensar Enf [Internet]. 2026; 30 (1):
e00515. Available from: https://doi.org/10.71861/pensarenf.v30i1.515.
Abstract
Introduction
When a child is born, parents must provide care essential to the newborn’s development. This responsibility is
integral to the transition to parenthood, which begins during pregnancy and becomes tangible with the
newborn’s arrival. Identifying barriers to and facilitators of parental confidence in newborn care may help assess
couples’ needs and plan interventions centered on the mother–father–newborn triad, thereby supporting a
healthy transition and a positive experience of parenthood. We therefore conducted a scoping review to identify
the available evidence and related knowledge gaps.
Objective
To map the evidence on barriers to and facilitators of parental confidence in newborn care.
Methods
The review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews. We searched
MEDLINE Ultimate, CINAHL Ultimate, MedicLatina, the Cochrane Database of Systematic Reviews, Web
of Science, and PubMed. Eligible studies addressed barriers to and facilitators of parental confidence in
newborn care among parents of healthy newborns in any care setting. We considered studies published in
Spanish, French, English, or Portuguese from January 2018 through September 2025. Two reviewers assessed
the studies for eligibility.
Results
Sixteen studies were included. The findings were organized into five categories: technological facilitators; social,
physiological, and educational barriers and facilitators; and professional and gender-related barriers and
facilitators. Key facilitators included online programs, in-person and online support groups, continuity of care
from the prenatal to the postnatal period, skin-to-skin contact, and rooming-in. Major barriers included limited
attention to the postnatal period, insufficient postnatal support and education, conflicting advice from family
members, primiparity, and limited parental leave.
Conclusion
The findings highlight the importance of strengthening postnatal care, fostering reliable, informed support
networks, and including fathers in newborn care.
Keywords
Father; Mother; Parental Confidence; Parenthood; Newborn Care.
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Pensar Enfermagem / v.30 n.01 / Jan-Dec 2026 / DOI: 10.71861/pensarenf.v30i1.515 / e00515
Introduction
Parenthood is considered a period of change and instability for couples and involves assuming and transitioning
into new roles. The International Council of Nurses (ICN)1 defines parenthood as fulfilling the responsibility
of being a mother or father. During the first months of life, newborns are entirely dependent on their parents.
Maintaining and promoting newborn health requires the informed and motivated involvement of both mothers
and fathers.2 During the postnatal period, mothers and fathers undergo major changes as they transition to
parenthood and adapt to a new way of life.3 This transition encompasses attitudes that influence adaptation to
pregnancy and preparation for the role of mother or father.1
Changes in life circumstances and behavior give rise to transitions and require adaptation to new routines and
circumstances associated with these events.4 The transition to parenthood begins during pregnancy and
continues until both parents have developed confidence in performing their new role.5 The ICN1 defines
confidence as a sense of security and a belief that others are reliable and well-intentioned. The aim is therefore
to foster parental confidence, a dynamic, subjective, and individualized attribute6 that enables individuals to
cope with challenges.7 In turn, parental confidence supports a safe and positive postnatal transition.
The transition to parenthood is framed within Meleis’ Transition Theory; this middle-range theory describes
transition as a passage from one stable state to another equally stable state through a dynamic process of change,
adaptation, and acquisition of new knowledge and skills.8 According to this theory, transition begins when
change is anticipated and continues until the individual achieves stability and mastery of the new role.8,9
This process may involve a variety of events that influence how individuals experience the transition and adapt
to the new parenting role8; these events are often described in the literature as barriers and facilitators.
The development of confidence is a key indicator of both the process and the outcome of a healthy transition.10
Parental confidence is therefore an important indicator of the quality of the transition to parenthood, reflecting
the degree of adaptation and mastery parents have achieved in newborn care.10 Strategies that help couples
manage their interactions more effectively can increase their confidence.10 Confidence develops progressively,
enabling parents to master the new skills required to navigate a healthy transition.
Developing parenting skills is essential for providing safe newborn care and is a priority during the transition
to parenthood.11 Parenting competence encompasses the knowledge, skills, and attitudes that enable mastery
of the parenting role and support the child’s full potential for growth and development.12 Building parents’
capacity is fundamental to this process, which requires effective health promotion strategies and an appropriate,
individualized education plan.13
Historically, childcare and household responsibilities were largely assigned to women, whereas men were
expected to be the economic providers.14 This pattern has been changing, with fathers increasingly participating
in health services, particularly during childbirth.15 Fathers have also assumed a more prominent role in newborn
care12, a shift reflected in men’s uptake of shared parental leave. The percentage of men taking shared parental
leave rose from 27.5% in 2015 to 45.7% in 2021.16 Today, women also invest in their careers and incorporate
their professional aspirations into their plans for parenthood rather than devoting themselves exclusively to
this transition.12 Some couples live independently rather than with extended family, often away from their social
support networks, a living arrangement that affects family reorganization.12
Mothers receive greater attention in this process. However, both parents experience the transition to
parenthood. Coparenting describes the relationship between parents and occurs when mothers and fathers
share responsibility for raising their children through mutual support and coordination.17 The concept does
not, in itself, imply that the parenting role is shared equally.17 However, the collaborative involvement of both
parents, increasingly common today, can support effective coparenting. Effective coparenting requires mutual
coordination and teamwork, whereas competitive and conflictual coparenting can adversely affect the transition
to the parenting role and, subsequently, newborn behavior.18
It is important to understand the contribution of the nurse specialist in maternal and obstetric health
(EEESMO) to the care of the mother–father–newborn triad. This perspective is supported by the Quality
Standards for Specialized Nursing Care in Maternal and Obstetric Health issued by the Portuguese Order of
Nurses19, which recognize the newborn and the father as care recipients during the postnatal period. Fathers
should be recognized as individuals with their own values, beliefs, and wishes from pregnancy through the
postnatal period. Therefore, mothers and fathers should be recognized as individuals with their own needs and
as partners who complement one another through inclusive, supportive coparenting in newborn care.18,19
In Portugal, the scope of EEESMO practice encompasses the entire transition to parenthood, including
pregnancy, childbirth, and the postnatal period. During the days and weeks after birth, postnatal care addresses
the needs of the mother–father–newborn triad by supporting the early detection of complications and fostering
parents’ confidence in adjusting to their new circumstances and in caring for their newborn.3
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Pensar Enfermagem / v.30 n.01 / Jan-Dec 2026 / DOI: 10.71861/pensarenf.v30i1.515 / e00515
We therefore conducted a scoping review to examine the barriers to and facilitators of parental confidence in
newborn care. This approach enables a broad examination of a topic20 and can generate evidence to inform
EEESMO decision-making and couples’ needs assessment. Few studies have focused on the continuity of
interventions designed to build parental confidence and to support newborn care during the postnatal period.21
Assessing couples’ needs is a prerequisite for planning individualized interventions that strengthen parental
confidence and parenting skills and promote a positive experience of parenthood. “Providing care for women
within their families and communities during the postnatal period”22 is one of the specific competencies of
EEESMOs. These professionals should design, plan, implement, and evaluate interventions that promote and
support adaptation during the postnatal period; identify and monitor changes in transition processes; and foster
responsible parenthood. Expanding their professional knowledge is also essential for EEESMOs to optimize
care and contribute to improved health outcomes.
A preliminary search of the Cochrane Database of Systematic Reviews and JBI Evidence Synthesis identified
no systematic reviews or scoping review protocols on this topic published during the 5-year period examined.
Accordingly, this scoping review aimed to map the evidence on barriers to and facilitators of parental
confidence in newborn care.
Methods
We conducted a scoping review in accordance with the Joanna Briggs Institute (JBI) methodology for scoping
reviews20 and reported it using the PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist.23 We
developed a scoping review protocol that specified the objectives, methods, and planned data management
procedures24 and registered it on the Open Science Framework (https://osf.io/9nr8d/overview). The review
question was: “What are the barriers to and facilitators of parental confidence in newborn care?”
Eligibility criteria were defined using the Population, Concept, and Context (PCC) framework.24 The population
comprised mothers, fathers, and couples; the concept encompassed barriers to and facilitators of parental
confidence in newborn care; and the context included any setting in which care was provided to healthy
newborns. We excluded studies of parents whose newborns required specialized care or follow-up, including
admission to a neonatal unit, or had congenital or genetic malformations or respiratory, neurological, metabolic,
or gastrointestinal diseases. We also excluded study protocols and studies involving maternal conditions that
precluded rooming-in, including illnesses or complications requiring care in other units, severe psychiatric
disorders, or drug abuse.
We used a three-step search strategy.20 In April 2024, we conducted an initial search of MEDLINE Ultimate
and CINAHL Ultimate via EBSCOhost using topic-related terms. We examined the text words in the titles and
abstracts of the retrieved records, as well as the index terms used to describe them, to inform the full search
strategy. In the second step, also conducted in April 2024, we developed a full search strategy and adapted it
for each information source: MEDLINE Ultimate, CINAHL Ultimate, MedicLatina, and the Cochrane
Database of Systematic Reviews via EBSCOhost, as well as Web of Science and PubMed. The search strategies
are presented in Box 1.
In the third step, we screened the reference lists of the included reports to identify additional relevant sources
of evidence. We also searched organizational websites for gray literature. We updated the search in September
2025 to identify newly published sources relevant to the review.
We included all types of published and unpublished sources of evidence, including experimental and quasi-
experimental studies; descriptive and correlational studies; qualitative and quantitative studies; systematic
reviews; case studies; opinion articles; and conference abstracts. We considered sources published in Spanish,
French, English, or Portuguese from January 2018 through September 2025.
Box 1. Search strategies by database
Database
Search strategy
MEDLINE Ultimate
(Father* OR Mother* OR Parents* OR MH Fathers OR MH Mothers OR MH Parents) AND
(“Self-confidence” OR confidence OR MH Trust OR MH “Self-Assessment”) AND (Barrier*
OR Obstacle* OR Difficult* OR Facilitator* OR Enabl*) AND ((MH “Infant, newborn” OR
Newborn) AND (Care))
CINAHL Ultimate
(Father* OR Mother* OR Parents* OR MH Fathers OR MH Mothers OR MH Parents) AND
(“Self-confidence” OR confidence OR MH Trust OR MH “Self-Assessment”) AND (Barrier*
OR Obstacle* OR Difficult* OR Facilitator* OR Enabl*) AND ((MH “Infant, newborn" OR
Newborn”) AND (Care))
Mediclatina
(Father* OR Mother* OR Parents*) AND (“Self-confidence” OR confidence OR Trust OR “Self-
Assessment”) AND (Barrier* OR Obstacle* OR Difficult* OR Facilitator* OR Enabl*) AND
(Newborn AND Care)
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Cochrane of Systematic Reviews
(Father* OR Mother* OR Parents*) AND (“Self-confidence” OR confidence OR Trust OR “Self-
Assessment”) AND (Barrier* OR Obstacle* OR Difficult* OR Facilitator* OR Enabl*) AND
(Newborn AND Care)
Web of science
(Father* OR Mother* OR Parents*) AND (“Self-confidence” OR confidence OR Trust OR “Self-
Assessment”) AND (Barrier* OR Obstacle* OR Difficult* OR Facilitator* OR Enabl*) AND
(Newborn AND Care)
PubMed
(Father* OR Mother* OR Parents*) AND (“Self-confidence” OR confidence OR Trust OR “Self-
Assessment”) AND (Barrier* OR Obstacle* OR Difficult* OR Facilitator* OR Enabl*) AND
(Newborn AND Care)
The search results were imported into Covidence25, which automatically removed duplicate records.
Two reviewers independently screened the remaining records by title and abstract against the eligibility criteria.
They subsequently assessed the full-text reports and excluded those that did not meet the eligibility criteria.
A third reviewer resolved disagreements.
Two reviewers independently charted data from the studies included in the scoping review using a form
developed for this purpose. The form included the title, authors, year, country, study design, sample size,
objectives, methods, findings, reported barriers and/or facilitators, and secondary conclusions.
We summarized the relevant charted data in a table containing the following information: authors, year, country,
methods, objectives, sample, and findings, including barriers and facilitators. Analysis of the included studies
identified barriers to and facilitators of parental confidence in newborn care.
Results
The updated search identified 1,099 records: 205 from MEDLINE Ultimate, 124 from CINAHL Ultimate, 0
from MedicLatina, 3 from the Cochrane Database of Systematic Reviews, 446 from PubMed, and 321 from
Web of Science. After the records were imported into Covidence25, the software automatically removed 391
duplicate records. Two reviewers excluded 668 records during title and abstract screening. In the next stage,
40 full-text reports were assessed for eligibility. Of these, 25 were excluded because they involved parents of
newborns admitted to a neonatal intensive care unit; were study protocols or abstract-only publications;
described interventions or outcomes unrelated to parental confidence; or included mothers with complications
or drug abuse.
The database searches identified 15 eligible studies. Reference list screening, the third step in the search strategy,
identified one additional study. The review therefore included 16 studies. The search results and study selection
process are presented in the PRISMA 2020 flow diagram26 (Figure 1).
Figure 1. PRISMA 2020 flow diagram.
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Pensar Enfermagem / v.30 n.01 / Jan-Dec 2026 / DOI: 10.71861/pensarenf.v30i1.515 / e00515
The 16 included studies were published between 2018 and September 2025. Study designs included
5 descriptive qualitative studies, 2 longitudinal qualitative studies, 2 cross-sectional qualitative studies,
1 hermeneutic phenomenological study, 1 qualitative evidence synthesis, 1 prospective cohort study,
1 randomized controlled trial, 1 qualitative study, 1 cross-sectional mixed-methods study, and 1 exploratory
mixed-methods study. The studies were conducted in the United Kingdom (n = 3), the United States (n = 3),
Canada (n = 2), Singapore (n = 2), India (n = 1), Australia (n = 1), Italy (n = 1), South Korea (n = 1), the
Netherlands (n = 1), and Tanzania (n = 1). Study populations included couples, mothers, and health
professionals. Data collection and analysis methods included semistructured and structured interviews, focus
groups, and statistical analyses.
Table 1 summarizes the relevant data charted from the included studies: authors, publication year, country,
study design and methods, study population and sample, objectives, and findings, including barriers and
facilitators. Analysis of the included studies identified barriers to and facilitators of parental confidence in
newborn care.
Table 1. Findings from the included studies.
A1.
Authors, year, and country
Machold, C., Rinn, S., Mckellin, W., Ballabtyne, G. & Barrett, J. (2021) Canada
Study design and methods
Hermeneutic phenomenologic study; semistructured telephone interviews conducted 1–19 months
after delivery
Population/sample
10 women who had previously undergone a planned or unplanned cesarean delivery and were
scheduled for a repeat cesarean delivery
Objective
To describe women’s experiences of cesarean birth with and without skin-to-skin contact
Findings
Barriers
Participants reported feelings of shame or guilt about having had a cesarean birth.
Facilitators
Skin-to-skin contact
Participants reported that breastfeeding after a skin-to-skin cesarean birth differed substantially from
their previous experiences, with greater breastfeeding confidence and a longer duration of
breastfeeding. Skin-to-skin contact also helped alleviate feelings of guilt and shame and strengthened
their confidence during the transition to parenthood.
A2.
Authors, year, and country
Finlayson, K., Sacks, E., Brizuela, V., Crossland, N., Cordey, S. Ziegler, D., Langlois, E., Javadi, D.,
Thomson, L., Downe, S. & Bonet, M. (2023) United Kingdom
Study design and methods
Qualitative evidence synthesis
Population/sample
800 family members, including fathers, partners, coparents, grandparents, parents’ siblings, and aunts
and uncles of the parents
Objective
To explore factors influencing women’s and families’ uptake of postnatal care
Findings
Barriers
Limited paternity leave
Many fathers felt anxious and insecure in their parenting role because concern for their partner’s
health took priority.
Health professionals provided conflicting advice.
Facilitators
More home visits; flexible opportunities for contact during the postnatal period; 24-hour access to a
professional when needed; and dedicated father-only support groups, particularly for fathers
experiencing difficulties during the postnatal period.
A3.
Authors, year, and country
Shorey, S., Ang, L. & Goh, E. (2018) Singapore
Study design and methods
Descriptive qualitative study; interviews
Population/sample
50 fathers
Objective
To understand new fathers’ lived experiences
Findings
Barriers
Limited paternity leave
Fathers’ fear of bathing their newborns because they lacked the necessary skills and confidence, which
hindered their involvement; lack of information and guidance from health professionals after hospital
discharge; and conflicting advice.
Facilitators
Measures to promote father involvement, including longer paternity leave and requiring fathers to
take parental leave; enhanced prenatal classes that more actively involve fathers; social support from
grandparents; and previous experience caring for older children.
A4.
Authors, year, and country
Athavale,P., Hoeft, K., Dalal, R., Bondre, A., Mukherjee, P. & Gutierrez, K. (2020) India
Study design and methods
Cross-sectional qualitative study; semistructured interviews
Population/sample
33 mothers and paternal grandmothers caring for children aged 0–2 years
Objective
To assess barriers to and facilitators of caregivers’ implementation of recommended infant and toddler
feeding practices in two urban communities
Findings
Barriers
Family members’ work commitments, which limited the support available to mothers; communication
gaps; conflicting recommendations from health professionals and family members; family power
imbalances that limited mothers’ decision-making authority; and limited social support.
Facilitators
Extending professional nutrition guidance to households and communities; family support, including
time spent in the maternal home or a positive relationship with the mother-in-law.
A5.
Authors, year, and country
Shorey, S., Yang, Y. & Dennis, C. (2018) Singapore
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Study design and methods
Descriptive qualitative study; face-to-face semistructured interviews
Population/sample
17 participants (5 couples, 4 fathers, and 3 mothers)
Objective
To explore the views of parents of newborns regarding the content and delivery of an mHealth app–
based postnatal educational program
Findings
Barriers
Facilitators
Use of technology
Parents viewed the mHealth app as an accessible source of information tailored to their individual
needs; it also allowed them to revisit content. They used it to confirm routine newborn care
procedures and manage difficulties during the first week. Through the discussion forum, parents could
receive clear, individualized responses from a midwife that they considered more reliable than generic
information found online. Participants reported that the app supported continuity of care and
connected them with a virtual community of parents undergoing the same transition. These features
increased their confidence and satisfaction in caring for their newborns.
A6.
Authors, year, and country
Cummins, A., Griew, K., Devonport, C., Ebbett, W., Catling, C. & Braird, K. (2022) Australia
Study design and methods
Qualitative descriptive study; focus groups and one-to-one interviews with service users and maternity
care providers
Population/sample
7 pregnant women, 2 partners, 9 midwives, and 1 obstetrician
Objective
To explore the value and acceptability of an antenatal and postnatal midwifery continuity of care
model among women, midwives, and obstetricians before implementation
Findings
Barriers
Facilitators
Participants valued the model for promoting a sense of safety and connection, allowing more quality
time and greater confidence, fostering a sense of community, and respecting cultural diversity. Women
reported that receiving care from the same midwife throughout pregnancy and the early postnatal
period made them feel safe and connected. Continuity enabled midwives to know women better and
reduced the time spent on initial assessments and documentation. Women and providers considered
implementing a model similar to those used in the United Kingdom valuable and consistent with high-
quality maternity care. The absence of intrapartum care by the same midwife was considered
acceptable. Midwives believed that providing care in women’s homes would help them anticipate and
better understand women’s needs and reinforce women’s capabilities during the transition to
parenthood.
A7.
Authors, year, and country
Levi, D., Ibrahim, R., Malcolm, R., MacBeth, A. (2019) United Kingdom
Study design and methods
Uncontrolled prospective cohort study; Mellow Babies or Mellow Toddlers group-based program
delivered 1 day per week for 14 weeks
Population/sample
183 mother–child dyads
Objective
To investigate the association between participation in Mellow Parenting and improvements in
maternal and child outcomes
Findings
Barriers
Facilitators
Participation in the parenting program was associated with significant improvements in maternal
mental health and parental confidence. Mothers with partners attended more sessions and showed
greater improvements in mental health and confidence than single mothers.
A8.
Authors, year, and country
Perez, A. et al. (2021) United Kingdom
Study design and methods
Cross-sectional mixed-methods study; online survey with forced-choice and open-ended questions
Population/sample
590 expectant parents and parents of infants, including 564 women
Objective
To investigate how COVID-19 and associated restrictions influenced mood and parenting confidence
among expectant parents and those in early parenthood and to identify barriers and facilitators
Findings
Barriers
Reduced physical contact; unreliable health information; reduced support; and loss of childcare.
Facilitators
Technology
Social isolation may become a facilitator, particularly for first-time parents. Fathers had more time
with their families and cared for their children independently, which made them more attentive. For
mothers, having to rely on their instincts in the absence of additional support also made them more
confident and resilient.
A9.
Authors, year, and country
Consales, A. et al. (2020) Italia
Study design and methods
Descriptive study; structured interviews
Population/sample
328 mothers and 333 newborns
Objective
To investigate maternal knowledge of rooming-in and barriers to and facilitators of adherence
Findings
Barriers
Fatigue and cesarean delivery were indirect barriers because mothers reported them as the main
obstacles to rooming-in.
Facilitators
Rooming-in
A10.
Authors, year, and country
Demirci, J. et al. (2019) United States
Study design and methods
Randomized controlled trial; semistructured telephone interviews conducted 4–6 weeks postpartum
Population/sample
17 mothers
Objective
To assess the feasibility, acceptability, strengths, and limitations of telelactation services for rural
mothers
Findings
Barriers
Facilitators
Telelactation via a mobile app
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The “hands-off” nature of video support, which required mothers to “do the work,” was viewed as
potentially increasing maternal confidence. Reported benefits included greater breastfeeding
confidence; resolution of breastfeeding problems; prevention of worsening problems; and more
efficient use of time during newborn visits. The findings indicate that telelactation offers convenient
access to breastfeeding support and triage for breastfeeding-related concerns. It may also increase
breastfeeding confidence when transportation is difficult or access to lactation support is inadequate.
A11.
Authors, year, and country
Lee, I. (2023) South Korea
Study design and methods
Descriptive qualitative study; interviews
Population/sample
165 refugee women
Objective
To generate data to inform the development of a newborn care education program
Findings
Barriers
Lack of knowledge and younger age
Facilitators
Greater knowledge and older age
A12.
Authors, year, and country
Biringer, A. et al. (2024) Canada
Study design and methods
Qualitative study; semistructured telephone interviews
Population/sample
18 service users
Objective
To explore the impact of a hybrid perinatal care model during pregnancy and the early postnatal period
Findings
Barriers
Facilitators
Perinatal social support
Participants described the postpartum period as challenging and reported feeling vulnerable as new
mothers. They reflected that the relationships developed through the Group Perinatal Care model
provided support in multiple ways and increased their confidence and competence. Their partners’
involvement in the process and the entire group’s support helped them feel less alone during
challenging times. The model was designed to support families through the transition from prenatal
care to the intrapartum and immediate postpartum periods.
A13.
Authors, year, and country
Veltkamp, G. et al. (2020) Netherlands
Study design and methods
Longitudinal qualitative study; two interviews conducted 6 months apart
Population/sample
12 first-time couples
Objective
To describe how social contexts relate to the competencies parents develop
Findings
Barriers
Facilitators
Experiential knowledge from other family members
A14.
Authors, year, and country
Robinson, A. et al. (2019) United States
Study design and methods
Prospective cross-sectional qualitative study; online focus group interviews
Population/sample
22 participants
Objective
To identify African American mothers’ experiences with Facebook breastfeeding support groups and
their breastfeeding beliefs, decisions, and outcomes
Findings
Barriers
Facilitators
Online support groups
Participants reported that these groups made them feel more confident and empowered in their
breastfeeding decisions.
A15.
Authors, year, and country
Dol, J. et al. (2019) Tanzania
Study design and methods
Descriptive qualitative study; demographic survey followed by semistructured interviews
Population/sample
8 mothers and 8 midwives
Objective
To explore mothers’ and midwives’ experiences with postnatal discharge
Findings
Barriers
Facilitators
Sufficient knowledge and higher educational attainment
Mothers felt that any information they received and any opportunity to provide care while in the
hospital increased their ability to care for their newborns, helped them build their knowledge and
experience, and helped them gain confidence in newborn care.
A16.
Authors, year, and country
Fisher, E. et al. (2025) United States
Study design and methods
Exploratory mixed-methods study; interviews and questionnaire
Population/sample
16 participants in the qualitative phase and 62 in the quantitative phase
Objective
To examine clients’ perspectives on how the Healthy Start program supports parent and child well-
being during and after pregnancy
Findings
Barriers
Facilitators
Community health worker programs
The program empowered participants and strengthened their confidence in advocating for
appropriate care. Interviewees reported greater confidence and lower stress levels, which they
associated with better overall health, mental health, and child health.
The findings are presented in Table 2 and accompanied by a narrative synthesis. Data charted from the studies
were organized into five categories: technological facilitators; social barriers and facilitators; physiological
barriers and facilitators; educational barriers and facilitators; and professional and gender-related barriers
and facilitators.
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Table 2. Synthesis of findings.
Social barriers
Physiological barriers
Educational barriers
Professional and gender-related barriers
Technological facilitators
Social facilitators
Physiological facilitators
Educational facilitators
Professional and gender-related facilitators
Technological facilitators. Several studies identified technology as a facilitator.27,28,29,30 One study28 addressed
the period of COVID-19 restrictions. The authors examined barriers to and facilitators of confidence in early
parenthood and reported that, although participants preferred face-to-face contact, online resources and
interactions were useful during lockdown.28 Technology provided practical health care resources, social
interaction, and psychological support when in-person contact was not possible.28
Another study30 examined a 4-week educational program delivered after postnatal hospital discharge.
The program enabled couples and midwives to exchange photographs and messages and allowed parents to
submit questions that were answered within 24 hours.30 It also provided parental education through videos on
newborn care procedures.30 Participants reported satisfactory continuity of care and indicated that interacting
with a community undergoing the same transition increased their confidence and satisfaction in caring for their
newborns.29,30 This interaction facilitated a smooth transition from hospital to home and contributed to
satisfaction with the parenting role and a positive experience of parenthood.30
Finally, telelactation—a mobile app through which mothers could access unlimited free video calls with an
International Board Certified Lactation Consultant—expanded access to breastfeeding support for mothers
with limited access to professional lactation support.27 The app was reported to strengthen maternal confidence,
allow more isolated mothers to have their questions answered, help prevent complications, and make more
efficient use of home visits for newborn care.27
Social barriers and facilitators. Social support may act as either a facilitator or a barrier, depending on parents’
attitudes and the type of support they receive. Several studies examined support provided through online
groups.27,29,30 These groups formed online communities that included licensed professionals who provided
breastfeeding support and enabled new mothers to interact with one another, become empowered, and make
informed breastfeeding decisions.29 In one focus group, all participants reported feeling more confident and
empowered to breastfeed.29 Perceiving an online group as large was positively associated with breastfeeding
confidence and duration.29
The presence of trusted, knowledgeable people who can provide advice in these groups is therefore important.29
In another study, mothers—particularly first-time mothers—reported feeling unsupported during the
postpartum period and while breastfeeding.31 Mothers also reported needing access to a 24-hour service where
they could have their questions answered.32 Health professionals’ heavy workloads prevented them from
answering mothers’ questions, leaving mothers without the guidance needed to feed their
newborns appropriately.31
These difficulties prompted mothers to seek information from family and friends. When this information
conflicted with guidance from health professionals31,33, mothers felt confused, and most followed their relatives’
advice.31 Mothers reported stress and insecurity, which reduced their sense of control while caring for their
newborns and made them more likely to defer to a family member’s authority.31 Fear of making the wrong
decisions, together with guilt about not following guidance from community leaders and family members,
undermined their confidence in newborn care.31 Counseling sessions involving families and communities may
help reduce this barrier and strengthen maternal confidence by providing reliable information.31
Mothers who had reliable information about their children’s health were more confident in providing care and
better able to resist social pressure from family members, friends, neighbors, and advertising, even when these
sources appeared credible.31 However, the same study found that support from the maternal grandmother or a
positive relationship with the mother-in-law may promote more positive maternal attitudes, greater confidence,
a greater ability to care for the child, and adherence to recommendations from a trusted professional.31 In this
context, social support acted as a facilitator. The experiential knowledge of family members may also instill
confidence in new parents by encouraging them to trust their own intuition, thereby strengthening their
confidence in caring for their children.34 During the COVID-19 pandemic, the loss of social support was
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sometimes experienced as beneficial to parental confidence: managing childcare without outside help gave
parents more direct caregiving experience and encouraged them to trust their instincts and judgment.28
A continuity-of-care model spanning the prenatal and postnatal periods was positively evaluated and was
associated with feelings of safety and confidence during the postnatal period.35 Perinatal support groups that
extended support into the community were also reported to have positive effects.36 Mothers who felt
unsupported during the postpartum period received several forms of support from these groups, which
strengthened their parental confidence and competence.36 The groups brought together mothers with similar
expected delivery dates and included a midwife and two family physicians.36
Parenting programs for parents and children provided follow-up beyond prenatal and postpartum care37,38,
sometimes until the children reached 5 years of age.38 These programs consisted of workshops and home visits
tailored to the children’s ages. Although parental confidence was not the primary focus of some programs, it
emerged as a secondary outcome38: most respondents reported greater confidence in providing care and lower
stress levels.38 Some parenting programs also highlighted the importance of having someone consistently
available to listen to and validate concerns and to address problems during the early stages of parenthood.37
Physiological barriers and facilitators. Skin-to-skin contact after cesarean delivery was described as shifting
control from health professionals to the mother.39 Participants reported that this contact helped alleviate
feelings of guilt about having undergone a cesarean delivery and strengthened their confidence during the
transition to parenthood. They also reported a different breastfeeding experience, including a longer duration
of breastfeeding and, consequently, greater confidence.39 Another study highlighted rooming-in40, which was
associated with greater maternal confidence in newborn care and improved breastfeeding.40 Similar findings
were reported in a study conducted during COVID-19-related isolation, in which reduced physical contact was
associated with lower confidence.28
Maternal characteristics such as age, family structure, and obstetric history may influence confidence in
newborn care.41 Younger age—under 30 years—and primiparity were associated with lower confidence in
newborn care.41 Conversely, having more children, greater experience33,41, and older age were associated with
higher confidence.41
Educational barriers and facilitators. Education may influence parental confidence. Women with an
elementary school education or less had lower parental confidence.41 Limited knowledge of newborn care was
associated with lower confidence in providing care and inadequate parenting behaviors.41 Mothers reported
that receiving sufficient education was important for developing confidence and that such confidence was
essential for caring for their newborns.42 This education focuses largely on the prenatal and intrapartum periods,
whereas the postnatal period receives less attention in both clinical care and education.42 Although this period
is critical to the development of confidence, providing postnatal education in the hospital is difficult because
of limited technical and human resources and a lack of guidelines for postnatal care.42
Models providing continuity from prenatal to postnatal care support the need for education throughout this
period.38 One model identified in the included studies emphasized the importance of continuity during the
postnatal period. Parents reported that this continuity made them feel safer and strengthened their confidence.38
Professional and gender-related barriers and facilitators. Fathers’ work commitments and limited paternity
leave were identified as barriers that restricted father involvement and contributed to insecurity and fear about
providing newborn care.33 Fathers prioritized maternal well-being over their own needs and felt insecure and
anxious in their new role.32 They suggested longer parental leave, father-only support groups for those
experiencing the transition to parenthood, and parenting preparation programs with a stronger focus on
father involvement.32,33
Discussion
This scoping review identified 16 studies published between 2018 and September 2025 that examined factors
influencing parental confidence and addressed the review question: What are the barriers to and facilitators of
parental confidence in newborn care?
The barriers identified were social28,31,32; physiological28,39,40,41; educational41; and professional and
gender-related.32,33 The facilitators were technological27,28,29,30; social28,29,31,32,33,34,35,36,37,38; physiological28,33,39,40,41;
educational38,41,42; and professional and gender-related.32,33
Digital technologies can help maintain communication and access to specialized support when in-person
contact is not possible, as observed during COVID-19-related isolation27,28 and when families live in areas with
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limited access to services.27 Digital applications that provide easily accessible information tailored to individual
needs can help answer routine questions not addressed by standardized information freely available online.30
Programs that included support from health professionals with specialized expertise reassured parents as they
cared for their newborns after hospital discharge and increased their satisfaction with the parenting role.30
The videos and documents provided during the program offered guidance and strengthened parents’
confidence in their parenting role.30 Other findings indicated that support groups on digital platforms provided
continuously available spaces for obtaining information, sharing experiences, and seeking support from
specialized health professionals and peers.29 Users valued the platforms’ ease of access and their ability to go
beyond simply conveying information by enabling the development of broader support networks.29 These
resources enabled users to acquire new knowledge and develop greater confidence.29
Despite the benefits of technological advances in contemporary society, technology should not be used as the
sole source of support. Many participants still preferred in-person contact28; therefore, digital communication
should be used to provide targeted support and address minor difficulties.29 This approach may facilitate the
assessment of potential problems and allow in-person visits to be used more effectively.27
Across the included studies, social support was the factor most frequently identified as either a barrier or a
facilitator. It is particularly important during the transition to parenthood and may benefit mothers, newborns,
and couples.43 Support may take several forms, primarily family and professional support; its availability may
positively influence the transition to parenthood.43 Partners can support one another, and a partner’s absence
from appointments, labor, and postnatal programs may affect mothers’ participation in these programs and the
development of their confidence.28,38 Mothers can also provide support to fathers.33 Groups formed through
perinatal support programs and social networks enable participants to build relationships, thereby increasing
parental confidence and competence.28,29,36 These groups provide reassurance by connecting people undergoing
the same transition36 and are often created through technology, demonstrating that social support can extend
beyond in-person contact when it is accessible and timely.27,30
Family support can act as either a facilitator or a barrier to couples’ confidence when conflicting opinions and
disagreements arise between family members and health professionals31,37, potentially creating additional stress
for parents.33 This barrier was examined during COVID-19 restrictions.28 Although family support may protect
parents’ emotional well-being and thereby enhance parental confidence, losing this support and having to rely
on their own instincts when caring for their newborns were also reported to foster confidence.28 At the same
time, family members’ experiential knowledge may strengthen new parents’ confidence.34
Families can be empowered to support a positive transition, thereby strengthening parental confidence.31
The EEESMO therefore plays an important role at this stage by serving as a mediator within the social support
network and providing health education not only to couples but also to their extended families.31
Early identification of people who are significant to the couple and their inclusion in the transition to
parenthood may promote consistent messaging and support evidence-based decision-making. The possibility
that couples may turn to less reliable sources, such as social media, advertising, and conflicting information,
should be addressed. Beginning in the prenatal period, couples should be provided with reliable sources of
information and dependable social support to foster parental confidence.37 This intervention may help reduce
conflicts arising from traditional beliefs and promote a more consistent and reliable support network.
A trusting relationship with the EEESMO and continuity of care provided by this professional are therefore
important. The EEESMO supports couples during the prenatal period and continues to provide care during
the postnatal period. This continuity is expected to improve the quality of care.30,32,35,36 Often provided through
perinatal programs, continuity of care also reassures couples during a period of major change35,37 through home
visits, regular contact37, and greater access to psychosocial support. Parents reported needing feedback on the
care they provide.33 These programs may strengthen parental confidence, reduce stress, and connect families
with other community resources, including specialized support related to feeding, mental health, and other
aspects of physical, psychological, and emotional recovery.37 Establishing a communication network between
couples and the EEESMO may facilitate follow-up and help answer questions.
These interventions align with the Quality Standards for Specialized Nursing Care in Maternal and Obstetric
Health19 because they support adaptation to parenthood, empower families during the transition to the
parenting role, and optimize health–illness processes among women living in the community.19
Physical contact may influence parental confidence.28,39 Given that barriers to skin-to-skin contact persist
during the postpartum period, understanding them is essential to overcoming them. In one included study39,
participants reported that skin-to-skin contact after cesarean delivery strengthened their confidence during the
early stages of parenthood and helped alleviate feelings of shame and guilt associated with having undergone a
cesarean delivery.39 These feelings may hinder the development of confidence.39 Skin-to-skin contact requires
changes to routine procedures because it can disrupt the sterile field. Implementing this practice requires
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logistical changes within an already overburdened system, sufficient nursing resources, and a willingness to
improve or revise procedures and protocols.39
Nevertheless, the literature indicates that these changes are feasible.39 Care teams should be made more aware
of the importance of this practice, and appropriate nurse staffing ratios should be ensured to support best
practices that foster parental confidence. Rooming-in facilitates skin-to-skin contact and may strengthen
parental confidence by helping parents recognize their newborn’s needs.40 Fatigue may hinder rooming-in,
highlighting the central role of the EEESMO in supporting these mothers.40
Each couple’s individual characteristics may influence the development of confidence.41 An individualized
assessment is therefore needed to tailor parenting preparation programs.41 Some studies identified greater
vulnerability among women younger than 30 years, primiparas, and women with an elementary school
education. In contrast, others found that experienced parents were more confident, competent, and motivated
in newborn care.37 The EEESMO should pay particular attention to this more vulnerable population by
developing and implementing effective programs that prepare them for the postpartum period and support a
positive transition to parenthood. The organization of health services should also be reconsidered to improve
continuity from prenatal to postnatal care, which has been studied as a factor that may support a successful
transition.35 Services should be organized so that the EEESMO can support couples throughout the continuum
from prenatal to postnatal care.
Effective programs must also address educational barriers and facilitators. Studies indicate that greater
knowledge and opportunities for hands-on practice are associated with higher levels of parental
confidence.38,41,32 Conversely, limited knowledge is associated with lower confidence41, while the absence of
standardized educational guidance, gaps in the content provided, and limited time may affect the quality of
learning.42 Mothers value the education they receive and recognize its importance in enabling them to care for
their newborns.42 Opportunities to provide newborn care under the supervision of an EEESMO help
consolidate parental confidence.42 These findings underscore the importance of structured parenting programs
that integrate emotional support and learning while strengthening the mother–father–newborn triad; such
programs have been associated with higher confidence levels.38
Care should include fathers rather than focus solely on mothers. Fathers play an important role in this process
and increasingly wish to participate actively rather than remain passive participants.32,33 One study suggested
extending parental leave and noted that shared parental leave may not be ideal because it may require mothers
to relinquish part of their leave and may affect newborn care.33 Another study described maternal behavior that
excluded fathers from childcare based on the belief that they lacked competence; this behavior limited father
involvement and affected paternal confidence.33 Social beliefs about masculinity may also discourage fathers
from participating in postnatal activities.32 Thus, traditional gender norms act as barriers to paternal confidence,
whereas contexts that include fathers in care may support the development of such confidence.32,33 Parenting
preparation focuses more heavily on the maternal role.33 Fathers’ participation in these programs is also
constrained by their availability and limited ability to take time off work to accompany their pregnant partners.44
Therefore, EEESMO-led courses specifically for fathers, in which they could share common difficulties with
other fathers, may help foster a sense of security and parental confidence.32
Conclusion
This scoping review identified barriers and facilitators that may influence the development of parental
confidence in newborn care. Identifying, analyzing, and discussing these factors is important because the World
Health Organization includes parents’ confidence in caring for their newborn among the criteria used to assess
readiness for discharge.45 The findings indicate that parental confidence may be influenced by technological,
social, physiological, educational, and professional and gender-related factors, underscoring the
multidimensional nature of the transition to parenthood. Most of the barriers identified in the included studies
concerned mothers, and only two studies examined fathers as distinct participants in this transition. This finding
points to a gap in the scientific evidence on fathers’ involvement in the transition to parenthood. Further
research should examine paternal confidence and the interventions best suited to fostering it.
The findings may help the EEESMO develop and implement interventions to eliminate or minimize some
barriers and build on facilitators. Interventions designed to foster parental confidence should not be limited to
a single stage of the transition to parenthood; they should begin during the prenatal period and continue after
birth into the postnatal period. This continuity is needed because parents perceive the postnatal period as
receiving less attention and report feeling insufficiently supported during it. Continuity of care with the same
EEESMO during the prenatal and postnatal periods may offer a useful model. Health services should assess
the feasibility of this model, given constraints on the availability of health personnel.
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In clinical practice, postnatal consultations should include ongoing monitoring of parental confidence and
continuous support, with an emphasis on assessing parents’ educational and emotional needs and providing
opportunities for supervised hands-on practice. Complementary digital support programs should also be
developed. However, technology should not be the sole source of support; rather, it should complement care
by facilitating communication and thereby contributing to the success of EEESMO interventions during this
period of major change for couples. Parenting preparation programs should be restructured to promote greater
inclusion of fathers and accommodate work-related constraints by offering father-only sessions throughout the
transition to parenthood.
Finally, continuing education for EEESMOs is important because the findings point to the need to develop
educational strategies, strengthen content designed to promote parental confidence, establish standardized
protocols, and build professional capacity in these areas. These measures are intended to support individualized,
family-centered interventions grounded in the best available scientific evidence.
Study limitations
Restricting the publication period was a limitation of this scoping review because relevant studies may have
been excluded.
Author contributions
RM: Study conception and design; Data collection, analysis, and interpretation; Drafting the manuscript;
Approval of the final version of the manuscript and taking responsibility for it.
SR: Study conception and design; Data analysis and interpretation; Critical review of the manuscript; Approval
of the final version of the manuscript and assumption of responsibility for it.
MHP: Study conception and design; Data analysis and interpretation; Critical review of the manuscript;
Approval of the final version of the manuscript and assumption of responsibility for it.
Conflicts of interest and funding
The authors declared no conflicts of interest.
Sources of support/funding
The study did not receive any funding.
Data availability statement
Data sharing is not applicable.
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