Objective: To examine the relationships among special care nursery design, parental presence, breastfeeding, psychological distress, hospital-related stress, and maternal parenting self-efficacy at the infant's discharge from hospital and at 4 months postdischarge.

Design: We used a causal comparative design to compare two special care nursery designs: open ward nursery (OW) and single-family room (SFR) nursery.

Setting: Special care nurseries of two tertiary hospitals on the Gold Coast, Australia, with the newly built second hospital replacing the first.

Participants: Fifty-six mothers of infants cared for in the special care nurseries (OW, n = 31; SFR, n = 25).

Methods: Participating mothers completed parental presence records during their infants' stays in hospital and completed two surveys, one at discharge and the other at 4 months postdischarge, to measure their psychological distress, hospital-related stress, parenting self-efficacy, and infant feeding method.

Results: Mothers with newborns in SFR nurseries spent markedly more time with their newborns, without any more visits or fewer visits, than mothers of newborns in OW nurseries during the first 2 weeks of their newborns' lives. For mothers with low levels of presence, parental role alteration stress was significantly greater for mothers in OW compared with SFR nurseries. Compared with mothers of infants in OW nurseries, mothers of newborns in SFR nurseries were significantly more likely to exclusively breastfeed their newborns at discharge from the hospital and at 4 months postdischarge.

Conclusion: Compared with mothers with infants in OW nurseries, mothers with infants in SFR nurseries were more likely to be present and to initiate and maintain breastfeeding. Likewise, the SFR nursery was protective against stress related to changes in the parenting role for mothers who had low levels of presence.