Introduction of Theory
Reva Rubin first developed a theory on maternal identity and role attainment in 1967, which was taken and expanded upon by Ramona Mercer. The initial work by Rubin inspired nurses to look at the challenging psychological process of becoming a mother and aid in the process rather than focusing only on the physical aspect of childbearing. This is a woman-centered theory that adapts to each mothers’ individual needs. Mercer later improved the application of the theory by lengthening the postpartum timeframe to twelve months to fully evaluate the mother’s change into motherhood (Noseff, 2014).
Mercer (2004) addresses four global concepts in the model: nursing, person, health, and environment. The focus of nursing is to provide care and education to women, during major life milestones, for maternal role attainment. The concept of person is described as a woman attaining the role of motherhood through achieving a strong maternal identity, which consists of maintaining or developing self-confidence and by interacting as a separate person with her child and with her significant other. Focusing on the concept of health, one can assess the mother’s stressors, including the perceived stress of the mother, father, and infant. This is important to consider while caring for the family unit because health status is an important indirect influence on satisfaction with relationships (Mercer, 1995). Last, Mercer specifies the influence that the environment has on maternal role attainment, as well as paternal role attainment and the development of the child (Mercer, 2004). Mercer (1995) goes on to explain that there is a mutual accommodation between the developing person and the changing properties of the immediate settings, relationships between the settings, and the larger contexts in which the settings are embedded.
The nursing process in the Maternal Role Attainment Theory follows four stages. The anticipatory stage is the social and psychological adaptation to the maternal role. This includes learning expectations and may involve fantasizing about the role of a mother. The formal stage begins at birth and is when the mother imitates experts on mothering skills. In this stage, the new mother’s behavior is influenced by other beings in her social group. Many times the mother will rely on the advice of others in decision-making. The informal stage is when the mother develops her own maternal style, in which decisions are not conveyed by a social system. The mother 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 (Rubin, 1967).
Mercer’s Maternal Role Attainment Theory serves as a framework for nurses to provide appropriate health care interventions for traditional and nontraditional mothers in order for them to develop a strong maternal identity. This mid-range theory can be used throughout pregnancy and postnatal care. It can also be utilized for adoptive or foster mothers, and others who find themselves in the maternal role unexpectedly. This model helps mothers develop an attachment to the infant, which in turn helps the infant form a bond with the mother. It assists in the development of the mother-child relationship as the infant grows. Nurses who work in the perinatal field help foster this relationship, and nursing theory can provide the resources and tools to promote these goals. Nurses can help women develop their maternal roles with the help of Ramona Mercer’s Maternal Role Attainment Theory (Mercer, 2004).
Relevance of Theory to Midwifery
Nurses, doulas, childbirth educators, and healthcare professionals are at the forefront of the birth experience. Each has an impact on the experience of each mother. Each member of the profession has the opportunity to promote healthy maternal role attainment and work to develop positive outcomes for the childbearing family. Educating mothers about their own care and newborn care reduce mother’s anxiety and increase a feeling of competence and maternal role attainment. A mother attaining maternal role and self-confidence is better equipped to take a better care of the baby. Education provided by midwives and women’s health personnel on the maternal role to soon-to-be-mothers can help women achieve appropriate maternal role attainment and maternal role satisfaction (Kordi, Fasanghari, Asgharipour, & Esmaily, 2017).
The Maternal Role Attainment Theory is applicable to everyday practice and assists health care providers in planning and delivering competent care to the mother and child. Furthermore, this practice promotes positive bonding for the mother and infant. When compared to the mothers and infants that were separated at birth, application of this theory has resulted in a stronger mother-infant bonding, positive maternal mentality, improved infant behavior, and a longer period of breastfeeding immediately after birth when the newborn was put skin to skin with the mother. By using the theory of maternal role attainment and ensuring the mother properly transitions through the four acquisition stages, nurses, midwives, and doulas can help the mother avoid experiencing negative mother-infant bonding and reduce harmful outcomes (Noseff, 2014). By applying the Maternal Role Attainment Theory to postpartum care, healthcare providers are better able to educate, support, and intervene appropriately to help the mother achieve a strong maternal identity while also promoting the health of the mother, child, and family.
Description of Chosen Issue
Research supports immediate, uninterrupted skin-to-skin care after vaginal birth and after cesarean surgery for all stable mothers and babies, regardless of feeding preference. Opportunities for skin-to-skin care and breastfeeding promote optimal maternal and child outcomes. All routine procedures such as maternal and newborn assessments can take place during skin-to-skin care or can be delayed until after the sensitive period immediately after birth. However, in most cases, health care professionals pay little attention to the findings despite significant advantages to mother and child togetherness highlighted throughout the literature (Crenshaw, 2014).
Problem Solving Using the Maternal Role Attainment Theory
The sensitive period during the first hour or so after birth is significantly influenced by elevated levels of the maternal reproductive hormone, oxytocin, which crosses the placenta to her baby. Oxytocin increases significantly during skin-to-skin care and promotes maternal-newborn attachment, reduces maternal and newborn stress, and helps the newborn transition to postnatal life. Disrupting or delaying skin-to-skin care may suppress a newborn’s innate protective behaviors, lead to behavioral disorganization, and make self-attachment and breastfeeding more difficult. Lack of skin-to-skin care and early separation also may disturb maternal-infant bonding, reduce the mother’s affective response to her baby, and have a negative effect on maternal behavior. These results have been shown by more rough handling of the baby during feedings, lower affective responses, and fewer maternal behaviors in response to a baby’s cues at 4 days, 1 month, 4 months, and at 1-year post-partum, compared to mothers who were not separated from their newborns (Crenshaw, 2014).
Effective bonding between mother and infant has been shown to produce systemic stabilization of the infant, prolonged breastfeeding, love, trust, and decreased postpartum depression or anxiety. However, in the postpartum population, mothers do report difficulty bonding with their newborns, which can lead to detrimental effects in the mother including maternal depression, sadness, and decreased self-esteem. Perceived ineffective bonding can lead to difficulty in achieving maternal identity and can lead to long-term problems (Cabrera, 2018).
It is thought that the formation of a strong bond between a mother and her infant can lead to more positive parenting behaviors and improved the cognitive and neurobehavioral development of a child. Failure to establish this bond during infancy can have serious long-term effects on the mother-child relationship, affecting the child’s development. When health professionals respect, honor, and support the physiologic need that mothers and babies have for each other after birth, they also improve the short- and long-term health outcomes for mothers and babies. Preventing separation except for compelling medical indications is an essential, safe, and healthy birth practice and an ethical responsibility of healthcare professionals (Crenshaw, 2014). The healthcare system will benefit through decreased costs associated with fewer future mother and infant hospitalizations, increased length of breastfeeding, and fewer total medical costs throughout the mother and child’s lifespan (Kinsey ; Hupcey, 2013).
Childbirth educators and healthcare practitioners are in a unique position to promote bonding by being attentive to cues of impaired maternal-newborn bonding by assessing the stages of Ramona Mercer’s Maternal Role Attainment Theory. Patients benefit from ongoing education. Therefore, the more education parents and families receive during prenatal visits, hospital admissions, and follow-up appointments for mothers and infants, the more positive the health outcome for families (Kinsey & Hupcey, 2013). Healthcare professionals will be able to use the information from this theory in helping pre- and post-partum patients. Education regarding infant care and instilling confidence in a mother’s ability to care for her child is essential to achieving maternal role attainment.
Introduction of Theory