Nursing Theory of Ramona T.

Mercer: Maternal Role Attainment - Becoming a Mother

Ramona T. Mercer is well known in the specialty of maternal-child nursing. Mercer developed

the “maternal role attainment - becoming a mother” model. This model is important because it

provides the framework for mother-infant bonding that affects the health and development of

individuals and families throughout the lifespan (Role Attainment, 2005). Maternal role

attainment is a process in which the “mother achieves competence in the role and integrates the

mothering behaviors into her established role set, so that she is comfortable with her identity as a

mother” (Mercer, 1985, p. 198). Successfully obtaining infant care-taking skills and being able to

read infant cues are important to the development of maternal competence. Through interaction

with the infant, the mother's self-confidence is influenced by the infant's responsiveness to her

care-taking skills (Bullock & Pridham, 1988). Learning how to read and respond to her baby's

cues, such as how to soothe a crying infant, facilitate the mother's maternal competence (Mercer

& Ferketich, 1995). Furthermore, mothers who report more maternal competence report more

positive feelings about their infant (Erickson, 1996).

Many factors affect the development of maternal competence, including: parity and previous

child care experience, sense of mastery, the mother's mental state, and the mother's

age. Self-esteem and self-efficacy have both been shown to be key predictors and mediators of

maternal competence. Research has also shown that infant temperament may affect the mother's

appraisal of her care-giving skills and that infant feeding and infant responsiveness to the

caregiver positively influence the caregiver's evaluation of self. The nursing process in the

Maternal Role Attainment Theory follows four stages of acquisition. They are: anticipatory,

formal, informal, and personal. The anticipatory stage is the social and psychological adaptation

to the maternal role. This includes learning expectations and can involve fantasizing about the
role. The formal stage is the assumption of the maternal role at birth. In this stage, behaviors are

guided by others in the mother’s social system or network, and relying on the advice of others in

making decisions. The informal stage is when the mother develops her own methods of

mothering which are not conveyed by a social system. She finds what works for her and the

child. The personal stage is the joy of motherhood. In this stage, the mother finds harmony,

confidence, and competence in the maternal role. In some cases, she may find herself ready for

or looking forward to another child. Mercer’s research has been so influential that the foundation

of much of the current maternal-child nursing practice is based on her work (Freda, 2005).

“Theory of Becoming a Mother” has become widely accepted, especially since its revision in

2004. It is used extensively in educational texts of maternity and pediatrics. This model

incorporates global concepts of nursing and is applicable to nursing practice today (Meighan,

2010).

Personal Background of Ramona T. Mercer

Ramona T. Mercer has a varied and comprehensive educational background. She graduated in

1950 with her nursing diploma at the age of 21 in Montgomery, Alabama. For the next 10 years

she worked as a nurse and instructor in pediatric and obstetrical nursing in addition to the field of

contagious diseases (Meighan, 2010). Her early nursing experience molded her interests toward

pediatric and obstetrics. She returned to school in 1960 and earned her master’s degree

specializing in maternal-child nursing at the University of New Mexico in 1964(Meighan, 2010).

She continued pursuing her passion for maternity nursing and completed her Ph.D. at the

University of Pittsburgh in 1973. Dr. Mercer then moved to California and worked as a nursing

professor at the University of California until she retired in 1987. Even in her retirement, she still
continues to revise and clarify her work because she believes that “theory building is a continual

process” (Mercer, 2004, p.226).

Ramona Mercer’s early work in the 1970’s was focused on the needs of breastfeeding mothers,

teenage mothers, postpartum illness, and mothers bearing children with defects. She had a deep

interest in the development of the maternal role as well as self-esteem and self- concept of

mothers (Meighan, 2010). During the span of Mercer’s career, her work expanded further in the

area of maternal-child nursing and she authored books such as Perspectives on Adolescent

Health Care, Transitions in a Woman’s Life, and Parents at Risk (Ramona Mercer,2011). She has

written a total of six books, published six book chapters and numerous journal articles.

Throughout her career Dr. Mercer has received a great deal of awards and is a member of several

professional organizations and national committees (Meighan, 2010).

Significance and Purpose of the Study

The purpose of this study is to know the women's perceptions regarding the role of maternal self-

care and applications of self-care in new motherhood.

Description of the Maternal OR Child Health Nursing Practice – Self-care

Self-care isn’t a new concept. Defined by the World Health Organization in the 1980s, it is the

activities an individual and communities can take on behalf of their own health, including

leveraging local knowledge and resources — a concept which has a profound impact for women

and children’s health. Simply put, supporting self-care actions results in informed and confident

women who are able to lead their own health care and that of their families (Rodriguez, 2017).

New motherhood is laden with challenges and represents a transition period for women. During

this time of change, women must learn to integrate the responsibilities related to infant care into

their existing set of responsibilities (Mercer, 1985). This represents a delicate balancing act due
to the multiple roles (employee, family member, friend, mother and wife) (O’Hara et al., 1992) a

woman often possesses. Rubin (1967a, 1967b) has described maternal role attainment (MRA)

as a complex process which is learned, reciprocal and interactive. Building on this work, Mercer

(2004) describes the process of becoming a mother (BAM) as dynamic and constantly evolving

rather than a state that is attained. Postpartum fatigue (Runquist, 2007), which can persist well

into the second year after childbirth. A lack of clear expectations related to the maternal role

(Burret al., 1979) represents an additional challenge for new mothers. Although social norms and

a woman’s culture provide some information regarding the expectations of new motherhood,

there is no specific set of rules or guidelines (Mercer, 1981). Therefore, a woman must determine

over time and through trial and error, what works best for her and her child. The demanding

nature of this process can both stress the mother (Beck, 1996) and exceed her expectations

(Logsdon et al., 2006). A discourse analysis by Weaver and Usher (1997) revealed that mothers’

overwhelming love for their infants motivated them to persevere despite the apparent stressors.

In addition to the considerable learning curve associated with motherhood, a woman must also

grapple with the significance of her added responsibilities. A child’s first interactional

experiences are with his or her mother, and these interactions have the power to shape the child

in a multitude of ways. In fact, Bowlby’s (1951) pivotal work on attachment suggested

that the absence of a close and sustained bond with a mother (or mother figure) would have

irreversible mental health consequences on the child. Fowles and Horowitz (2006) concur,

describing infant development as particularly sensitive to the quality of mother–child interaction

in the first postpartum year. For these reasons, mothers make a tremendous contribution to

society (Logsdon et al., 2006) as well as the family unit. Although some responsibilities related

to infant care such as feeding, diapering and bathing are common to all mothers, women’s social
circumstances may differ substantially. mothers are usually the primary caregivers of infants

regardless of marital or employment status (Logsdon et al., 2006). In order to flourish in this role

of primary caregiver, a woman must develop a set of skills specific to mothering and the

integration of mothering into her life. The operationalization of this skill set can be referred to as

maternal functioning. Barkin et al. (2010a) describe a woman who (1) has adequate social

support (social support), and is able to (2) take care of her own physical and mental needs (self-

care and psychological well-being), (3) take care of her infant (infant care), (4) attach to her

infant (mother–child interaction), (5) juggle her various responsibilities (management) and (6)

adapt over time (adjustment) as a high-functioning mother. The seven functional domains (social

support, self-care, psychological well-being, infant care, mother–child interaction, management

and adjustment) referred to in this characterization of a capable mother.

Application of the Theory into Practice / Relevance of the Nursing Theory to Nursing

Practice

The maternal self-care domain is the focus of this paper as the mother’s ability (and willingness)

to take care of herself both physically and emotionally. Proper nourishment, taking time out for

one’s self when necessary, attention to hygiene and physical appearance, adequate sleep,

willingness to delegate and the ability to set boundaries are practical applications of self-care in

motherhood.

Self-care is of primary importance - many of the women expressed the importance of self-care.

These women felt that effective mothering was contingent upon their own physical and

emotional health state and exhibited an awareness of women’s tendency to neglect self-care.

‘When you’re in the middle of it, it’s so hard to see. And I think that’s the most important thing

for a mom is just to take care of herself.’ (Barkin et al., 2010b). A mother described her struggle
to balance infant care and self-care: ‘Because I really didn’t pay attention to myself. Like my

main focus was on him. Making sure he was eating every, when a counselor came in and she was

like, ‘Well, are you eating breakfast?’ ‘Are you eating lunch?’ And you really have to stop and

look back and think like okay, yes, I need to take care of myself as well as the baby’. But you

don’t really think about that until someone brings it to your attention.’ There was also substantial

discussion of maternal self-care in relation to breast feeding. For a portion of the women, breast

feeding was physically and mentally uncomfortable. The women described guilty feelings

associated with deciding to artificial milk-feed their child. Despite the guilt, some of the mothers

made the ultimate determination to transition to formula feeding. This was recognized as an act

of self-care. ‘For you to not be healthy and not be able to physically and mentally be there 100

percent for your kid, give up the breast milk. Everybody’s lived on formula for hundreds of

years. There’s no reason why they can’t do it now.’ Selflessness is synonymous with

motherhood.

Applications of self-care in new motherhood - a new mother will sometimes feel overwrought,

she will give the infant to her husband and takes time to do something that she enjoys. Women

who reported taking time out for themselves often reported returning to the child in a more

relaxed state. It is also important to note that certain aspects of self-care are specific to each

woman. Low-income, adolescent mothers, self-care strategies included talking to social support

providers, praying and going to church, writing one’s feelings down, playing with the infant and

sleeping.

The relationship between a mother and child is an important one. The foundation of this

relationship is the basis for how the mother and child grow and change together, as well as how

the child develops individually. Many nurses work in the perinatal field in order to help foster
this relationship, and nursing theory can give them the resources and tools to do it. Nurses can

help women develop their maternal roles with the help of Ramona Mercer’s Maternal Role

Attainment Theory. It guides nurses in how they care for their patients. The tools a nurse can

provide to new mothers - helping them breastfeed, showing them how to encourage language

development, walking them through the terrors of teething, setting goals for everything from

employment to education for themselves and their children can make the journey a little bit

easier. The success of the more interactive nurse-client interventions in becoming a mother

supports the key therapeutic role that nurses have in the care of new mothers.

Conclusion

Nursing is a dynamic profession with three major focus: health promotion and prevention of

illness, providing care for those who need professional assistance to achieve their optimal level

of health and functioning, and research to enhance the knowledge base for providing excellent

nursing care. Nurses provide health care for individuals, families, and communities. Following

assessment of the client’s situation and environment, the nurse identifies goals with the client,

provides assistance to the client through teaching, supporting, providing care the client is unable

to provide for self, and interfacing with the environment and the client. Mercer emphasizes that

the kind of help or care a woman receives during pregnancy and over the first year following

birth can have long-term effects for her and her child. Nurses in maternal-child settings play a

sizable role in providing both care and information during this period.

Time, limited resources and difficulty in accepting help and setting boundaries are barriers to

practicing effective self-care. Demands of work and family life left little time for the women to

engage in restorative activities. Some women reported having given up exercise and socializing

due to a lack of time.

maternal child nursing education and practice. The theory of maternal role attainment provides

nurses the framework and guidance to help families handle the journey of parenthood and

support the process of becoming a mother.

Barkin, J. L., & Wisner, K. L. (2013). The role of maternal self-care in new

motherhood. Midwifery, 29(9), 1050-1055.

Bullock, C. B., & Pridham, K. F. (1988). Sources of maternal confidence and uncertainty and

perceptions of problem‐solving competence. Journal of Advanced Nursing, 13(3), 321-

329.

Erickson, M. E. (1996). Factors that influence the mother-infant dyad relationships and infant

well-being. Issues in mental health nursing, 17(3), 185-200.

Freda, M. C. (2005, March/April). [Review of the journal article Toward evidence-based

practice: Becoming a mother versus maternal role attainment]. Journal of Nursing

Scholarship, 30(2), 145. Retrieved from CINAHL database.

Meighan, M. (2010). Ramona T. Mercer: Maternal role attainment-becoming a mother. In M. R.

Alligood & A. M. Tomey, Nursing theorists and their work (7th ed., pp. 581-597).

Maryland Heights, MO: Mosby Elsevier.

Mercer, R. T. (2004, Fall). Becoming a mother versus maternal role attainment. Journal of

Nursing Scholarship, 36 (3), 226-232.

Mercer, R. T. (1985). The process of maternal role attainment at one year post birth.

Nursing Research, 34(4), 198-204.

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