Ramona Mercer developed the Maternal Role Attainment Theory in the 1970s based on her experience as a nurse and research on mothers. The theory proposes that a mother acquires competence in her maternal role over time through a process of attachment to her infant, learning caretaking skills, and finding satisfaction in her role. Mercer identified numerous factors like age, social support, infant health and cues that can influence a woman's attainment of the maternal role. She refined the theory over her career and emphasized nursing's important role in supporting women's transition to motherhood.

1. MATERNAL ROLE
ATTAINMENT
THEORY
RAMONA T. MERCER,
Ph.D, RN, FAAN

2. CREDENTIALS AND
BACKGROUND
Born in 1929
Mercer began her
nursing career in 1950
and she graduated from
St. Margaret’s school of
nursing, Montgomery, ala
bama.

3. 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).

4. Her early nursing experience
molded her interests toward
pediatric and obstetrics.
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).

5. She continued pursuing
her passion for maternity
nursing and completed
her Ph.D. at the
University of Pittsburgh
in 1973.

6. 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).

7. Ramona Mercer’s early work
in the 1970’s was focused on
the
1.needs of breastfeeding
mothers
2.teenage mothers
3.postpartum illness
4.mothers bearing
children with defects.

8. She had also a deep
interest in the
development of the
1.maternal role
2.self-esteem
3.self-concept of
mothers
(Meighan, 2010)

9. During the span of
Mercer’s career, her work
expanded further in the
area of maternal-child
nursing.

10. She authored books such
as:
1. Perspectives on
Adolescent Health Care
2. Transitions in a
Woman’s Life
3. Parents at Risk
(Ramona Mercer, 2011)

11. 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).

12. Maternal Role Attainment
Theory
Defined as an interaction and
developmental process occurring
over time, in which the mother
becomes attached to her
infant, acquires competence in
the care-taking tasks involved in
the role, and expresses pleasure
and gratification in the role.

13. Maternal Role Attainment
is also as defined a process
of binding in or being
attached to the child and
Maternal Role Identity or
seeing oneself in the role
and having a sense of
comfort about it. (Rubin)

14. FACTORS THAT DIRECTLY OR
INDIRECTLY INFLUENCE ON THE
MATERNAL ROLE
The maternal factors included:
•age at first birth
•birth experience
•early separation from the infant
•social stress
•social support personality
traits,self-concept
•child-rearing attitudes
•health

15. FACTORS THAT DIRECTLY OR
INDIRECTLY INFLUENCE ON THE
MATERNAL ROLE
She also included the infant
variables:
•temperament
•appearance
•responsiveness
•health status, and ability to give
cues

16. FACTORS THAT DIRECTLY OR
INDIRECTLY INFLUENCE ON THE
MATERNAL ROLE
She also noted the importance
of the father's role, the
mother-father relationship.
She also noted the importance
of the father's role and applied
many of her previous findings
in studying the paternal
response to parenthood.

17. CONCEPTS
MATERNAL IDENTITY
Maternal identity is defined as
having an internalized view of the
self as a mother (Mercer, 1995).
PERCEPTION OF BIRTH
EXPERIENCE
A woman’s perception of her
performance during labor and
birth is her perception of the birth
experience (Mercer, 1990)

18. CONCEPTS
SELF-ESTEEM
Mercer, May, Ferketich and DeJoseph
(1986) describe self-esteem as “an
individual’s perception of how others view
one and self-acceptance of the perception
“.
SELF-CONCEPT (SELF-REGARD)
Mercer (1986) outlines self-concept, or
self-regard, as “The overall perception of
self that includes self-satisfaction, self-
acceptance, self-esteem, and congruence
or discrepancy between self and ideal self
“.

19. CONCEPTS
FLEXIBILITY
Roles are not rigidly fixed; therefore,
who fills the roles is not important
(Mercer, 1990). “Flexibility of children
attitudes increases with increased
development …., Older mothers have
infants and to view each situation in
respect to the unique nuances”.
CHILDREARING ATTITUDES
Childrearing attitudes are material
attitudes or beliefs about childrearing.

20. CONCEPTS
HEALTH STATUS
Health status is defined as “ The
mother’s and father’s perception
of their prior heath, current
health, health outlook, resistance-
susceptibility to illness, health
worry concern, sickness
orientation, and rejection of the
sick role” .

21. CONCEPTS
ANXIETY
Mercer and colleagues (1986)
describe anxiety as “ a trait in which
there is specific proneness to perceive
stressful situation-specific state” .
DEPRESSION
According to Mercer and colleagues
(1986), depression is “having a group
of depression symptoms and in
particular the effective component of
the depressed mood”.

22. CONCEPTS
ROLE STRAIN-ROLE CONFLICT
Role strain is the conflict and
difficulty felt by the woman in fulfilling
the maternal role obligation.
GRATIFICATION-SATISFACTION
Mercer describes gratification as “the
satisfaction, enjoyment, reward, or
pleasure that a woman experiences in
interacting with her infant and in
fulfilling the usual tasks inherent in
mothering.”

23. CONCEPTS
ATTACHMENT
Attachment versus a difficult
temperament is related to whether the
infant sends hard-to-read cues, leading
to feelings of incompetence and
frustration in the mother.
INFANT HEALTH STATUS
Infant health status is illness causing
maternal infant separation, interfering
with the attachment process.

24. CONCEPTS
INFANT CHARACTERISTICS
Characteristics include infant
temperament, appearance, and
health status.
INFANT CUES
Infant cues are infant behaviors
that elicit a response from the
mother .

25. CONCEPTS
FAMILY
Mercer and colleagues define
family as “a dynamic system
which includes subsystems-in-
individuals (mother, father,
fetus/infant) and dyads (mother-
father, mother-fetus/infant, and
father fetus/infant) within the
overall family system.

26. CONCEPTS
FATHER OR INTIMATE
PARTNER
The father or intimate partner
contributes to the process of
maternal role attainment in a way
that cannot be duplicated by any
other person. The father’s
interactions help diffuse tension
and facilitate maternal role
attainment

27. CONCEPTS
FAMILY FUNCTIONING
Family functioning is the individual’s
view of the activities and relationships
between the family and its subsystems
and broader social units.
STRESS
Stress is made up of positively and
negatively perceived life events and
environmental variables.

28. CONCEPTS
MOTHER-FATHER
RELATIONSHIP
The mother-father relationship
is the perception of the mate
relationship that includes intended
and actual values, goals, and
agreement between the two. The
maternal attachment to the infant
develops within the emotional held
of the parent’s relationship.

29. CONCEPTS
SOCIAL SUPPORT
According to Mercer and colleagues,
social support is “the amount of help
actually received, satisfaction with that
help, and the persons (network)
providing that help”.
Four areas of social support area as
follows:
•Emotional support; “Feeling loved,
cared for, trusted, and understood”

30. •Informational support: “Helps the
individual help herself by providing
information that is useful in dealing
with the problem and/or situation”
•Physical support: A direct kind of
help
•Appraisal support: “ A support that
tells the role taker how she is
performing in the role; it enables the
individual to evaluate herself in
relationship to others “ performance in
the role”

31. ASSUMPTIONS
•A relatively, stable core
self, acquired through lifelong
socialization, determines how
a mother defines and perceive
events; her perceptions of her
infant’s and others responses
to her mothering, with her life
situation, are real world to
which she responds.

32. ASSUMPTIONS
•In addition to the mother’s
socialization, her developmental
level and innate personality
characteristics also influence her
behavioral responses.
•The mother’s role partner, her
infant, will reflect the mother’s
competence in the mothering role
through growth and development.

33. ASSUMPTIONS
•The infant is considered an active
partner in maternal role-taking
process, affecting and being
affected by the role enactment.
•The father or mother’s intimate
partner contributes to role
attainment in a way that cannot
be duplicated by any other
supportive person.

34. ASSUMPTIONS
•Maternal identity develops
concurrently with maternal
attachment and each depends
on the other.

35. ASSERTIONS
•Mercer’s original Theory and
Model of Maternal Role Attainment
were first introduced in 1991. It
was refined and was presented
more clearly in her 1995 book,
Becoming a Mother: Research on
Maternal Identity

36. ASSERTIONS
•From Rubin to Present. Her
recent revision focuses on
woman’s transition in becoming a
mother. It involves an extensive
change in her life space that
requires her ongoing development.
.

37. ASSERTIONS
•According to Mercer, becoming a
mother is more extensive than just
assuming the role. It is unending
and continuously evolving
therefore she recommends that
the Maternal role attainment be
retired.

38. PARADIGMS
NURSING
Mercer stated that, “Nurses are the
health professionals having the most
sustained and intense interaction with
women in the maternity cycle. She
emphasizes that the kind of help of a
woman receives during pregnancy and
over the first year following birth can
have a lifelong term effects for her and
her child.

39. PARADIGMS
PERSON
She refers the person as self or
core self, view the self as separate
from the roles that are played.
The mother interacts with her
infant and with the father or her
significant other; influential and is
influenced by both of them.

40. PARADIGMS
HEALTH
She defines health status as the
mothers and father’s perception of
their prior health, current health,
health outlook, resistance,
susceptibility to illness, worry or
concern and rejection of sick role.
Health status of newborn is the extent
of disease present and infant health
status by parental rating of overall
health. She also stresses the
importance of healthcare during
childbearing and childrearing process.

41. PARADIGMS
ENVIRONMENT
She conceptualized the environment
from Bronfenbrenner’s definition of the
ecological environment. Development
of a role/ person cannot be considered
apart from the environment; there is a
mutual accommodation between
developing person and the changing
properties of the immediate settings,
and the larger context in which the
settings are embedded.

42. Proposed Model of Maternal
Role Attainment

44. Proposed Model of Maternal
Role Attainment
1.) The microsystem is the
immediate environment where
maternal role attainment occurs.This
indicates the family and factors such as
family functioning, mother-father
relationships, social support and stress.
The infant is an individual embedded
within the family system. This system
is the most influencial on maternal role
attainment and attainment is achieved
within the microsystem through the
interactions of father, mother and
infant.

45. Proposed Model of Maternal
Role Attainment
2.) The mesosystem encompasses,
influences, and delimits the
microsystem. The mother-infant unit is
not contained within the mesosystem,
but the mesosystem may determine
in part what happens to the
developing maternal role and the
child. It includes extended family,
school, work church and other entities
within the mother's more immediate
community.

46. Proposed Model of Maternal
Role Attainment
The exosystem, the previously
used term, is an extension of the
mesosystem. It is the
interrelationships of two or more
settings or subsystems that more
directly influences the mother
such as interactions between
works setting, daycare,local laws
and rules, community and church.

47. Proposed Model of Maternal
Role Attainment
3.) The macrosystem refers to the
general prototypes existing in a
particular culture or transmitted
cultural consistencies which include the
social, political and cultural influences
on other two systems. It is in the
macrosystem where the health care
environment and the impact of current
health care system on maternal role
attainment originate.

48. Proposed Model of Maternal
Role Attainment
Maternal role attainment is a
process that follows four stages
of role acquisition;these stages
have been adapted from Thornton
and Nardi's 1975 research. These
four stages are indicated as
microsystem within the evolving
model of Maternal Role
Attainment.

50. Proposed Model of Maternal
Role Attainment
a. Anticipatory Stage: Begins
ion the pregnancy and includes
the initial social
and psychological adjustments to
pregnancy. The mother learns the
expectations of the
role, fantasizes about the
role, related to the fetus in the
uterus, and begins role play.

51. Proposed Model of Maternal
Role Attainment
b. Formal Stage: Begins with
the birth of the infant and includes
learning and taking of the role of
the mother. Role behaviors are
guided by formal, consensual
expectations and others in the
mother's social system.

52. Proposed Model of Maternal
Role Attainment
c. Informal Stage: Begins as
the mother develops unique way
of dealing with the role not
conveyed by the social system.
The woman makes her new role fit
within her existing lifestyle based
on past experiences and future
goals.

53. Proposed Model of Maternal
Role Attainment
d. Personal Stage: Role
Identity Stage occurs as the
woman internalizes her role. The
mother experiences
harmony, confidence and
competence in the way she
performs the role and the
maternal role is achieved.

54. Proposed Model of Maternal
Role Attainment
These four stages of role
acquisition overlap and are altered
as the infant grows as and
develops. The final stage of
maternal role identity may be
achieved in many period of time.
The stages are influenced by social
support, stress, family
functioning,and the relationship
between the mother and father or
significant others.

55. Proposed Model of Maternal
Role Attainment
Traits and behaviors of both the
mother and the infant may influence
maternal role identity and child
outcome. Maternal traits and behaviors
included Mercer's model are empathy,
sensitivity to infant cues, self-esteem
and self-concept,parenting received as
a child, maturity and flexibility, attitude,
pregnancy and birth experience, health,
depression and role conflict.

56. Proposed Model of Maternal
Role Attainment
Infant traits having an impact on
maternal role identity include
temperament, ability to send cues,
appearance, general
characteristics, responsiveness
and stress.

57. Proposed Model of Maternal
Role Attainment
According to Mercer, the maternal
role is attained when the mother feels
internal harmony with the role and its
expectations and described three major
components of the role:
1. attachment to the infant
2. gaining competence in mothering
behaviors
3. expressing gratification in
maternal-infant interactions.

58. Proposed Model of Maternal
Role Attainment
Outcome for the child includes
cognitive, mental development
attachment, health, and other
social competence.

59. Refer to the given
diagram.

60. Theoretical Underpinnings
•Mercer believes that nurses can
play a vital role in promoting
health of families and children.
Mercer stated in her book
Becoming a Mother: Research on
Maternal Identity from Rubin to
the Present that “nurses are the
health professionals having the
most sustained and intense
interaction with women in the
maternity cycle” (1995, p. xii).

61. Theoretical Underpinnings
Mercer’s theory is practice
oriented and has consistently
evolved over time because of
her commitment to connect
research to practice (Meighan,
2010).

62. Theoretical Underpinnings
•In addition to the renaming of
maternal role attainment stages,
the model has undergone ongoing
revision since its original
publication. The work of Walker,
Crain, and Thompson indicated
that a change was needed because
the term role attainment indicated
an end to the process as a final
goal.

63. Theoretical Underpinnings
Mercer began to reexamine her
theory and felt the need to revise
the model’s title to “Becoming a
Mother” in order to connote a
continued growth in mothering
throughout the lifespan (Mercer,
2004).

64. Stages of Becoming a Mother
•The concepts of Mercer’s theory center
on the bond between mother and child
which fosters competency, confidence
and joy in the motherhood role (Role
Attainment, 2005).
• Mercer’s original maternal role
attainment theory follows a process
that has four stages. In 2004 Mercer
revised the terms of these stages
although the stages themselves remain
basically the same.

65. Stages of Becoming a Mother
• “Commitment, attachment, and
preparation” stage during pregnancy
when the mother makes psychological
adjusts and prepares for the
expectations of her new role.
•“Acquaintance, learning, and
physical restoration” stage which
begins with the infant’s birth when the
role of mother is assumed and learned
in the contexts of her social system.

66. Stages of Becoming a Mother
• “Moving toward a new
normal” stage in the first few
months of the infant’s life where
the mother makes her new role fit
her lifestyle in a personal way
instead of in context with a social
system.

67. Stages of Becoming a Mother
“Achievement of maternal
identity” stage when the mother
internalizes her role and
experiences a sense of harmony,
competence and confidence which
usually occurs about 4 months
after birth.

68. Stages of Becoming a Mother
These stages can overlap and the
timing is highly variable however
the stages usually progress in a
sequential, predictable manner
(Mercer, 2004).

69. Thank you
for
listening!
ABDUL AZIZ JAJA AHID, RN