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Objective Childbirth readiness can reflect women’s childbirth readiness in terms of knowledge, psychological aspects and planning. The purpose of this study was to evaluate childbirth readiness, its related factors and consequences in Iranian pregnant women.Design This longitudinal study was the first stage (quantitative stage) of a sequential explanatory mixed-method study. It followed women during late pregnancy (from 37 weeks of gestation) and the postpartum period (4–6 weeks after childbirth) from March to September 2023.Setting Health centres of Tabriz, Iran.Participants This study involved 360 pregnant women with a gestational age of 37 weeks and above, selected via cluster sampling. Participants were excluded for high-risk pregnancies, unfavourable incidents in the last 3 months, mental-psychological diseases or a prior caesarean section.Outcome measures Childbirth readiness and its related factors were assessed using several instruments completed from the 37th week of pregnancy onward, including the Childbirth Readiness Scale, a sociodemographic questionnaire, the Pregnancy Experience Scale and the Wijma Delivery Expectancy/Experience Questionnaire Version A. The consequences of childbirth readiness were then evaluated 4–6 weeks post partum using the Childbirth Experience Questionnaire, the Edinburgh Postnatal Depression Scale and the Postpartum-Specific Anxiety Scale.Results The mean (SD) childbirth readiness score was 67.83 (9.41) out of 90. In the adjusted general linear model (GLM), several factors were significantly associated with lower readiness. These included a higher fear of childbirth score (β −0.12, 95% CI −0.16 to −0.08, p<0.001), first pregnancy (β −5.84, 95% CI −9.71 to −1.96, p=0.003), nulliparity (β −12.50, 95% CI −15.95 to −9.05, p<0.001), no history of abortion (β −2.90, 95% CI −5.42 to −0.43, p=0.021), non-participation in readiness classes (β −2.24, 95% CI −4.41 to −0.08, p=0.042), lower educational attainment (β −4.55, 95% CI −7.60 to −1.50, p=0.004) and having a husband who was a worker (β −2.07, 95% CI −3.87 to −0.28, p=0.023). In contrast, being a homeowner was associated with a higher readiness score (β 2.14, 95% CI 0.05 to 4.24, p=0.045). Based on GLM, pregnancy experience was not significantly associated with childbirth readiness, and childbirth readiness was not significantly associated with childbirth experience or postpartum anxiety.Conclusions Key factors associated with readiness included fear of childbirth, obstetric history (gravidity, parity, history of abortion and participation in childbirth readiness classes), maternal education, home ownership, husband’s occupation—though several associations showed small effect sizes. After adjustment, readiness did not independently predict childbirth experience or postpartum mental health. The low participation rate in readiness courses highlights a major service gap. Integrating readiness assessment into prenatal care and expanding access to targeted education are recommended to improve outcomes such as birth satisfaction and caesarean rates.