“The process of becoming a mother requires extensive psychological, social, and physical work. A woman experiences heightened vulnerability and faces tremendous challenges as she makes this transition. Nurses have an extraordinary opportunity to help women learn, gain confidence, and experience growth as they assume the mother identity.” (Mercer, 2006, p. 649) In early research efforts, Mercer focused on the behaviors and needs of breastfeeding mothers, mothers with postpartum illness, mothers bearing infants with defects, and teenage mothers. Her first book, Nursing Care for Parents at Risk (1977), received an American Journal of Nursing Book of the Year Award in 1978. Her study of teenage mothers over the first year of motherhood resulted in the 1979 book, Perspectives on Adolescent Health Care, which also received an American Journal of Nursing Book of the Year Award in 1980. Preceding research led Mercer to study family relationships, antepartal stress as related to familial relationships and the maternal role, and mothers of various ages. In 1986, Mercer’s research on three age groups of mothers was drawn together in her third book, First-Time Motherhood: Experiences From Teens to Forties (1986a). Mercer’s fifth book, Parents at Risk, published in 1990, also received an American Journal of Nursing Book of the Year Award. Parents at Risk (1990) focused on strategies for facilitating early parent-infant interactions and promoting parental competence in relation to specific risk situations. Mercer’s sixth book Becoming a Mother: Research on Maternal Identity From Rubin to the Present was published by Springer Publishing Company of New York in 1995. This book contains a more complete description of Mercer’s Theory of Maternal Role Attainment and her framework for studying variables that impact the maternal role. Mercer has maintained membership in several professional organizations, including the American Nurses Association and the American Academy of Nursing, and has been an active member on many national committees. From 1983 to 1990, she was the associate editor of Health Care for Women International. She has served on the review panel for Nursing Research and Western Journal of Nursing Research and the editorial board of the Journal of Adolescent Health Care, and was on the executive advisory board of Nurseweek. She has also served as a reviewer for numerous grant proposals. Additionally, she has been actively involved with regional, national, and international scientific and professional meetings and workshops (R. Mercer, curriculum vitae, 2002). She was honored as a Living Legend by the American Academy of Nursing during the Annual Meeting and Conference in Carlsbad, California, in November 2003. Mercer was honored by University of New Mexico in 2004, receiving the first College of Nursing Distinguished Alumni Award. In 2005, she was recognized as among the most outstanding alumni and faculty, and her name appears on the Wall of Fame at University of California, San Francisco. Mercer’s Theory of Maternal Role Attainment was based on her extensive research on the topic beginning in the late 1960s. Mercer’s professor and mentor, Reva Rubin at the University of Pittsburgh, was a major stimulus for both research and theory development. Rubin (1977, 1984) was well known for her work in defining and describing maternal role attainment as a process of binding-in, or being attached to, the child and achieving a maternal role identity or seeing oneself in the role and having a sense of comfort about it. Mercer’s framework and study variables reflect many of Rubin’s concepts. In addition to Rubin’s work, Mercer based her research on both role and developmental theories. She relied heavily on an interactionist approach to role theory, using Mead’s (1934) theory on role enactment and Turner’s (1978) theory on the core self. In addition, Thornton and Nardi’s (1975) role acquisition process helped shape Mercer’s theory, as did the work of Burr, Leigh, Day, and Constantine (1979). Werner’s (1957) developmental process theories also contributed. In addition, Mercer’s work was influenced by von Bertalanffy’s (1968) general system theory. Her model of maternal role attainment depicted in Figure 27-1 uses Bronfenbrenner’s (1979) concepts of nested circles as a means of portraying interactional environmental influences on the maternal role. The complexity of her research interest led Mercer to rely on several theoretical sources to identify and study variables that affect maternal role attainment. Although much of her work involved testing and extending Rubin’s theories, she has consistently looked to the research of others in the development and expansion of her theory. Mercer selected both maternal and infant variables for her studies on the basis of her review of the literature and findings of researchers in several disciplines. She found that many factors may have a direct or indirect influence on the maternal role, adding to the complexity of her studies. Maternal factors in Mercer’s research included age at first birth, birth experience, early separation from the infant, social stress, social support, personality traits, self-concept, childrearing attitudes, and health. She included the infant variables of temperament, appearance, responsiveness, health status, and ability to give cues. Mercer (1995) and Ferketich and Mercer (1995a, 1995b, 1995c) also noted the importance of the father’s role and applied many of Mercer’s previous findings in studying the paternal response to parenthood. Her research required numerous instruments to measure the variables of interest. Mercer has studied the influence of these variables on parental attachment and competence over several intervals, including the immediate postpartum period and 1 month, 4 months, 8 months, and 1 year following birth (Mercer & Ferketich, 1990a, 1990b). In addition, she has included adolescents, older mothers, ill mothers, mothers dealing with congenital defects, families experiencing antepartal stress, parents at high risk, mothers who had cesarean deliveries, and fathers in her research (Mercer, 1989; Mercer & Ferketich, 1994, 1995; Mercer, Ferketich, & DeJoseph, 1993). As a recent step, she compared her findings and the basis for her original theory with current research. As a result, Mercer (2004) has proposed that the term maternal role attainment be replaced with becoming a mother, because this more accurately describes the continued evolvement of the role across the woman’s life span. In addition, she proposed using more recent nursing research findings to describe the stages and process of becoming a mother. For maternal role attainment, Mercer (1981, 1986a, 1995) stated the following assumptions: Mercer (1995) stated that, “Nurses are the health professionals having the most sustained and intense interaction with women in the maternity cycle” (p. xii). Nurses are responsible for promoting the health of families and children; nurses are pioneers in developing and sharing assessment strategies for these patients, she explained. Her definition of nursing provided in a personal communication is as follows: In her writing, Mercer (1995) refers to the importance of nursing care. Although she does not specifically mention nursing care, in her book, Becoming a Mother: Research on Maternal Identity From Rubin to the Present, 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. Mercer (1985a) does not specifically define person, but refers to the self or core self. She views the self as separate from the roles that are played. Through maternal individuation, a woman may regain her own personhood as she extrapolates her self from the mother-infant dyad (Mercer, 1985b). The core self evolves from a cultural context and determines how situations are defined and shaped (Mercer, 1985a). The concepts of self-esteem and self-confidence are important in attainment of the maternal role. The mother as a separate person interacts with her infant and with the father or her significant other. She is both influential and is influenced by both of them (Mercer, 1995). In her theory, Mercer defines health status as the mother’s and father’s perception of their prior health, current health, health outlook, resistance-susceptibility to illness, health worry or concern, sickness orientation, and rejection of the sick role. Health status of the newborn is the extent of disease present and infant health status by parental rating of overall health (Mercer, 1986b). The health status of a family is affected negatively by antepartum stress (Mercer, Ferketich, DeJoseph, May, & Sollid, 1988; Mercer, May, Ferketich, & DeJoseph, 1986). Health status is an important indirect influence on satisfaction with relationships in childbearing families. Health is also viewed as a desired outcome for the child. It is influenced by both maternal and infant variables. Mercer (1995) stresses the importance of health care during the childbearing and childrearing processes.
Maternal Role Attainment—Becoming a Mother
CREDENTIALS AND BACKGROUND OF THE THEORIST
THEORETICAL SOURCES
USE OF EMPIRICAL EVIDENCE
MAJOR ASSUMPTIONS
A relatively stable core self, acquired through lifelong socialization, determines how a mother defines and perceives events; her perceptions of her infant’s and others’ responses to her mothering, with her life situation, are the real world to which she responds (Mercer, 1986a).
In addition to the mother’s socialization, her developmental level and innate personality characteristics also influence her behavioral responses (Mercer, 1986a).
The mother’s role partner, her infant, will reflect the mother’s competence in the mothering role through growth and development (Mercer, 1986a).
The infant is considered an active partner in the maternal role-taking process, affecting and being affected by the role enactment (Mercer, 1981).
The father’s or mother’s intimate partner contributes to role attainment in a way that cannot be duplicated by any other supportive person (Mercer, 1995).
Maternal identity develops concurrently with maternal attachment and each depends on the other (Mercer, 1995; Rubin, 1977).
Nursing
Person
Health
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