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Maternal Role Attainment
MATERNAL ROLE ATTAINMENT 2
Maternal Role Attainment
In 1967 Reva Rubin began a threshold of theories that would find ways to explain and
understand the development of becoming a mother beginning with a positive pregnancy test.
Rubin’s Theory of Maternal Identity paved the way for more theorists to use as a foundation and
catalyst to grow theories that would encourage, enhance, and adapt to pregnancy, impending
delivery, and adjustment to postpartum life. As a student of Rubin, Romana Mercer enhanced her
knowledge and in 1985 developed the Maternal Role Attainment Theory which branched out to
beyond traditional, healthy mothers and pregnancies and includes those pregnancies whose
outcomes are not desirable, adoptive, or foster mothers, and unexpected pregnancies (Alligood,
1998).
Mercer’s Maternal Role Attainment (MRA) is multi-faceted and ever expanding to find
ways to include the research of all maternal women from teenage to advanced maternal ages.
This middle range nursing theory grew out of need to understand and develop nursing
interventions to those women whose pregnancy may not be ideal or typical. The ultimate goal is
to cultivate a nursing model which helps mothers grow their attachment with their newborn,
develop the maternal dyad as the infant grows and in turn supports the child form a bond with
their mother. Due to the complexity of pregnancies, Mercer’s development of this theory is
multi-faceted and adaptive to pregnancy scenarios and eventually comes to include fathers in the
equation of infant bonding and growth.
This theory strives to develop the maternal definition. It is inclusive of adolescent
mothers, older than average mothers, mothers who have given birth to a child with severe
disorders or mothers who have lost their child or early pregnancy (McEwen & Wills, 2018).
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Maternal roles are loosely defined to incorporate all facets of women and their personal
pregnancies. This theory continues to evolve to the extent that Mercer chose to change the name
from Maternal Role Attainment to the 2004 title of Becoming a Mother. Since this revision it,
this theory has become highly accepted and used in current nursing practice.
There are four stages within the Maternal Role Attainment: anticipatory, formal, informal,
and personal. These stages overlap and can be impacted by the paternal relationship, family and
significant individuals, social support, and undue stress (Fasanghari et al., 2018). The MRA is a
progressive timeline that develops over the period of pregnancy to after delivery and beyond.
This is the time when the woman becomes attached to the growing embryo, fetus, or infant
dependent on which stage the attachment happens. This attachment is a sense of harmony,
certainty and ability is the goal of MRA or maternal identity (Mercer, 1985).
Birth experience, confidence, and self-esteem can play an important role in how a mother
view herself. If the birth experience is not as expected or traumatic, if the infant is admitted to
NICU, or if mom feels alienated from her social circle the mother may worry about the bonding
process with the infant and feel overwhelmed because the birth process was disappointing.
Knowing that flexibility is a key component in this process is significant too. Children are not all
the same and mom must recognize that what worked well for a friend may not have the same
effect on her child (Alligood, 1998).
My tenure as Mother Baby nurse for the past twenty years has been a mostly happy
occupation. I find great joy and pride in welcoming new life, watching families form and grow,
teaching new parents the basic concepts of parenting and often being the first person to call them
mom and dad. As I have studied Mercer’s Theory, I have understood this process because I have
watched it unfold and form with each very different birth. The one that is most recent that tugs at
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my heartstrings is a difficult delivery that resulted in an infant death. This mother had come in
laboring and upon vaginal exam was found to be 6 cm dilated and mostly effaced, in other words
delivery was imminent and very much active. This mother was term at 40 weeks and was
laboring naturally on her due date. All seemed well with a very active fetus and healthy heart
rate. Labor progressed quickly and very soon after admission this mom began pushing. Sadly, the
infant’s heart rate was lost, and cesarean section was called. The infant had become wedged
within the birth canal and perished. The mother and father were admitted to the postpartum unit
and the infant came to the floor in mom’s arms. We provided a means to keep the infant cool
during the admission for as long as the parents wanted the infant to be with them. They held the
infant often, talking to him, crying over him, and rocking him. Family members came in to
mourn with them. Mom stayed on our floor and extra day due to the trauma to her body and the
infant was by her side during the entire stay. You could hear this mother’s guttural cry when the
funeral home came to pick the baby up upon mom’s discharge from the hospital. This mother and
father were parents well before the delivery of this infant. They had formed a bond with their
embryo and fetus during the pregnancy. They recalled when they found out they were pregnant,
elated and so excited. I heard about the nursery and theme, the many baby showers, how they
had called the baby by his name, Luke, from the moment they found out that he was a boy. They
were calling each other momma and daddy from the moment they found out about being
pregnant at six weeks. The Maternal Role Attainment was very alive and real for this woman
who did voice her concern that is she really a mom now that she doesn’t get to carry an infant
home with her. She now not only grieves the loss of the baby but also of the future she saw with
this child, the birthday parties, potential sports games, and the rites of passages she was fully
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ready to live through. I assured her that she and dad are very much parents, and their grief is
pronounced and must be worked through.
It is apparent that Mercer’s theory is inspired by her nursing experience and her mentor
Reva Rubin. This theory focuses on the maternal child dyad and may seem narrowly focused on
this couple it does reach beyond to encompass fathers and families as well. Its application is
focused on prenatal and postnatal time frame and cannot be applied to other nursing areas. It will
be necessary to evaluate the mother from the exemplar if she becomes pregnant again and if the
MRA is stunted during the next pregnancy (Mercer, 2004).
Mercer devoted her nursing career to this theory and encouraged its relevance as the
theory developed to include complex cases. The stages of becoming a mother in this theory can
be applied to many scenarios within maternal child nursing. It is a theory that has been
incorporated into nursing practice and education and provides a framework to help nurses do best
with these new mothers as they navigate the journey into parenthood and family.
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References
Alligood, M. (1998). In Nursing theorists and their work (4th ed., pp. 432–444). Mosby-Year
Book.
Fasanghari, M., Kordi, M., & Asgharipour, N. (2018). Effect of a maternal role training program
on maternal identity in primiparous women with unplanned pregnancies. Journal of
Obstetrics and Gynaecology Research, 45(3), 565–572. https://doi.org/10.1111/jog.13866
McEwen, M., & Wills, E. M. (2018). Theoretical basis for nursing (5th ed.). LWW.
Mercer, R. T. (1985). Maternal identity and the maternal experience by reva rubin. 242 pp. new
york, springer publishing co., 1984,. AJN, American Journal of Nursing, 85(1), 103–106.
https://doi.org/10.1097/00000446-198501000-00037
Mercer, R. T. (2004). Becoming a mother versus maternal role attainment. Journal of Nursing
Scholarship, 36(3), 226–232. https://doi.org/10.1111/j.1547-5069.2004.04042.x
