Ramona Mercer’sBecoming a Mother

Matthew Medina, RNC-OB, BS

Ramona Mercer, RN, Ph.D.

Nursing Diploma from St. Margaret’s School of Nursing in Montgomery, Alabama

BSN from the University of New Mexico at Albuquerque

MSN focused in Maternal Child Nursing from Emory University in Atlanta, Georgia

Ph. D. in Maternal Nursing from University of Pittsburgh, Pennsylvania

2003 American Academy of Nursing Living Legend

http://nursing.unm.edu/alumni-and-friends/profile-images/mercer,r.gif

Background

Student of Reva Rubin while in Ph.D. program at University of Pittsburgh.

Rubin was published on maternal role attainment

Defined and described maternal “binding-in” and with achieving comfort in the maternal role (George, 2011, p. 607)

“Rubin’s work stimulated nurses to look beyond the physiological and pathological aspects of childbearing to the intricate process of becoming a mother, and to identify areas for providing help” (Mercer, 2004, p.227).

Background Maternal Role Attainment

Mercer created studies that focused on Maternal Role Attainment (MRA) that focused on events and situations in the first year of motherhood

Four stages of role acquisition Anticipatory: Pregnancy

Mother is preparing for her new role Formal: Birth

Views newborn as her own; begins caretaking by mimic and seeking advice

Informal: Puerperium (6 Weeks)Begins to develop own judgment about infant

care Maternal Identity:

“Congruence between self and motherhood”

Becoming a Mother

In 2004, amidst research by other professionals, criticisms of MRA called for a change in the name, citing that motherhood is “unending and evolving” vs. a goal to attain

In Mercer’s review of various qualitative studies that looked at MRA, she concluded that the argument is made to replace ‘maternal role attainment’ with ‘becoming a mother’ to connote the initial transformation and continuing growth of the mother identity” (Mercer, 2004, p. 231)

Becoming a Mother

Given the changes to the theory focus and name change, Mercer updated the stages of role acquisition Commitment, Attachment, and Preparation

Acquaintance, Learning, and Physical Restoration

Moving Toward the New Normal

Maternal Identity

1st Stage

Commitment, Attachment, and Preparation Pregnancy Birth Initial 2 weeks

postpartum

Time of psychosocial preparation Emotional

Anxiety Fear Excitement Happiness Ecstasy Nervous

Developing attachment in a loving environment

2nd Stage

Acquaintance, Learning, and Physical Restoration

Birth to 6 weeks postpartum

Acknowledges infant

Learning infant cues

Developing competence in activities

Period of healing

3rd Stage

Moving Toward the New Normal

2 weeks postpartum until about 4 months post partum

Small successes Successful Feedings Adequate Weight Gain

Develops routine Into the “swing of

things” Adequate Weight Gain

4th Stage

Achievement of Maternal Identity

Intimate knowledge of infant

Feels competent Feels confident

Mother’s identity as self expands to include identity as mother as one with self

Metaparadigms

Nursing

Professional(s) who maintain “Sustained” and “Intense” interaction with women in the maternity cycle

Health

What is the mother and family’s perception of prior, current, and future health?

Person

The mother seeking to develop her maternal role.

Who else could person refer to?

Metaparadigms

Environment -Micro, -Meso, and –Macro Systems Metaparadigm was reconsidered in 2004

with the other changes• Family & Friends• Community • Society at Large

Model

Becoming a Mother - Conceptual Model

Factors of influenceMaternal Variables

Age Birth Experience

Her perception of performance

Her satisfaction Social System

Supportive Partner Other supports

Infant Variables Temperment Appearance Responsiveness Health Status

Preterm gestation Compromise Prolonged Transition Neonatal ICU admission

References Alves Correa Neiva, C., de Oliveira Guimarães, K., Nogueira do Vale, I., &

Valentim Carmona, E. (2013). Opinion of mothers of hospitalized babies about nursing interventions: a descriptive study. Online Brazilian Journal Of Nursing, 12(4), 844-853. doi: 10.5935/1676-4285.20134197

Bialoskurski, M., Cox, C., & Hayes, J. (1999). The nature of attachment in a neonatal intensive care unit. Journal Of Perinatal & Neonatal Nursing, 13(1), 66-77.

Emmanuel, E., Creedy, D., St John, W., Gamble, J., & Brown, C. (2008). Maternal role development following childbirth among Australian women. Journal Of Advanced Nursing, 64(1), 18-26. doi:10.1111/j.1365-2648.2008.04757.x

George, J. (2011). Nursing Theories. The base for professional nursing practice (6th edition). Saddle River, New Jersey. Pearson

Husmillo, M. (2013). Maternal Role Attainment Theory. International Journal Of Childbirth Education, 28(2), 46-48.

Mercer, R. (2004). Becoming a mother versus maternal role attainment. Journal Of Nursing Scholarship, 36(3), 226-232. doi:10.1111/j.1547-5069.2004.04042.x

Parker, M.E. & Smith, M.C. (2010). Nursing Theories and Nursing Practice (3rd ed.). Philadelphia: F.A. Davis Company