Maternal Role Attainment Theory, later renamed “Becoming a Mother”

Contributor – Janet Attisha
PhD Student, University of Kansas

Author – Ramona Thieme Mercer

First published – 1981

Source

Major Concepts

The theory rests on several assumptions: a woman’s core self determines how she perceives and responds to motherhood; the infant actively participates in the process; the father or partner contributes uniquely to role attainment; and maternal identity and maternal-infant attachment develop together, each depending on the other.

Typology

Mercer’s Maternal Role Attainment / Becoming a Mother is classified as a middle-range nursing theory because it focuses on a specific phenomenon, contains measurable concepts, and is directly applicable to nursing practice and research. The work also includes a conceptual model that visually represents environmental influences on maternal role development. When used to guide research studies, it functions as a theoretical framework. It is not considered a grand theory because its scope is limited to the specific process of becoming a mother rather than explaining nursing broadly.

Brief Description

Dr. Ramona T. Mercer’s Maternal Role Attainment Theory, later renamed “Becoming a Mother,” describes the developmental and interactional process through which a woman achieves a maternal identity. The theory provides a framework for nurses to support mothers during their transition to parenthood.

Central Premise

Maternal role attainment is not instantaneous but occurs gradually over time. Through this process, a mother becomes attached to her infant, acquires competence in caregiving tasks, and expresses pleasure and gratification in her role. The endpoint is maternal identity—when a woman sees herself as a mother and feels confident and comfortable in that role.
Four Stages. The process unfolds through four sequential stages:

  • Anticipatory – During pregnancy, the woman prepares psychologically and socially, learning expectations and fantasizing about motherhood
  • Formal – Beginning at birth, the mother’s behaviors are guided by healthcare providers, family, and her social network
  • Informal – The mother develops her own unique mothering style based on what works for her and her infant
  • Personal – The mother achieves harmony, confidence, and competence, fully internalizing her maternal identity
Influencing Factors

Mercer identified multiple variables affecting maternal role attainment:

  • Maternal factors include age, birth experience, self-esteem, self-concept, flexibility, childrearing attitudes, health status, social stress, social support, and the quality of the mother-father relationship.
  • Infant factors include temperament, health status, appearance, responsiveness, and ability to give cues.
  • The infant is viewed as an active partner who both affects and is affected by the mother’s role development.
Ecological Framework

Adapting Bronfenbrenner’s model, Mercer placed the mother-infant dyad within nested environmental systems:

  • Microsystem – The immediate family environment
  • Mesosystem – Interactions between settings such as work, daycare, and community
  • Macrosystem – Broader cultural, social, and economic influences

These interconnected systems shape the context in which maternal role attainment occurs.

Key Assumptions

The theory rests on several assumptions: a woman’s core self determines how she perceives and responds to motherhood; the infant actively participates in the process; the father or partner contributes uniquely to role attainment; and maternal identity and maternal-infant attachment develop together, each depending on the other.

Nursing Implications

Mercer emphasized that nurses have the most sustained interaction with women during the maternity cycle. The support a mother receives during pregnancy and the first year postpartum can have lasting effects on both mother and child. Nurses play a critical role in assessing maternal adaptation, providing education, facilitating attachment, and offering emotional support—particularly for high-risk mothers such as adolescents, older mothers, or those with ill infants.

Evolution of the Theory

In 2004, Mercer proposed replacing “maternal role attainment” with “becoming a mother” to emphasize that motherhood is a continuous, evolving process across the lifespan rather than a fixed achievement.

Primary Sources

Mercer, R. T. (1995). Becoming a mother: Research on maternal identity from Rubin to the present. New York, NY: Springer.
Mercer, R. T. (2004). Becoming a mother versus maternal role attainment. Journal of Nursing Scholarship, 36(3), 226–232. doi:10.1111/j.1547-5069.2004.04042.

Additional Sources

Alligood, M. R. (Ed.). (2014). Nursing theorists and their work (8th ed.). St. Louis, MO: Elsevier Mosby.
McEwen, M., & Wills, E. M. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Application Sources

Rossman, B., Greene, M. M., & Meier, P. P. (2015). The role of peer support in the development of maternal identity for “NICU moms.” Journal of Obstetric, Gynecologic, and Neonatal Nursing, 44(1), 3-16. https://doi.org/10.1111/1552-6909.12527

Application: This research applied Mercer’s theory to understand how mothers of very low birth weight infants develop maternal identity in the NICU setting. The study found that peer support and role modeling by NICU-based breastfeeding peer counselors helped mothers throughout every stage of their infants’ hospitalizations, from giving them hope to helping them begin to develop maternal identity to providing anticipatory guidance about taking their infants home.

Miles, M. S., Holditch-Davis, D., Burchinal, M. R., & Brunssen, S. (2011). Maternal role attainment with medically fragile infants. Research in Nursing & Health, 34(1), 20-34.

Application: This research examined maternal role attainment in the context of caring for medically fragile infants, emphasizing the importance of supporting mothers during the transition to motherhood in challenging circumstances.

Fowles, E. R. (1998). The relationship between maternal role attainment and postpartum depression. Health Care for Women International, 19(1), 83-94. https://doi.org/10.1080/073993398246601

Application: This study examined the relationship between postpartum depressive symptoms and maternal role attainment in 136 primiparous women. Postpartum depression demonstrated a significant negative relationship to all measures of maternal role attainment. The findings emphasized the need to assess all new mothers for depression 2-3 months after delivery.

Jirapaet, V. (2001). Factors affecting maternal role attainment among low-income, Thai, HIV-positive mothers. Journal of Transcultural Nursing, 12(1), 25-33.

Application: This cross-cultural research applied Mercer’s framework to understand maternal role attainment in a vulnerable population of HIV-positive mothers in Thailand.

Author

Dr. Ramona Thieme Mercer was a pioneering American nurse, educator, and theorist whose groundbreaking work transformed how healthcare professionals support new mothers. She is best known for developing the Maternal Role Attainment Theory, a mid-range nursing theory that continues to guide maternal-child nursing practice worldwide.

Born on October 4, 1929, Mercer began her nursing career after graduating from St. Margaret’s School of Nursing in Montgomery, Alabama in 1950. She spent her first decade in nursing working as a staff nurse, head nurse, and instructor in pediatrics and obstetrics—experiences that would profoundly shape her research interests. Mercer returned to academia in 1960, earning her Bachelor of Science in Nursing with distinction from the University of New Mexico in 1962, followed by a Master’s degree in maternal-child nursing from Emory University in 1964. She taught at Emory for five years before pursuing doctoral studies at the University of Pittsburgh, where she met her mentor, Reva Rubin. Rubin’s research on maternal identity significantly influenced Mercer’s theoretical development. She earned her doctorate in maternity nursing in 1973.
Following graduation, Mercer joined the faculty at the University of California, San Francisco, where she would spend the remainder of her academic career, eventually becoming Professor Emeritus in the Department of Family Health Care Nursing. For over 30 years, she conducted extensive research on parenting in low- and high-risk situations and the transition to motherhood.

Her Maternal Role Attainment Theory describes motherhood as a developmental and interactional process occurring over time. The theory outlines four stages: the anticipatory stage during pregnancy, the formal stage at birth, the informal stage where mothers develop individual approaches, and the personal stage marked by confidence and competence. In 2004, she refined this work, proposing the concept of “Becoming a Mother” to emphasize the ongoing, evolving nature of maternal identity.

Mercer authored numerous influential publications, including Nursing Care for Parents at Risk (1977), Perspectives on Adolescent Health Care (1979), First-Time Motherhood: Experiences from Teens to Forties (1986), and Becoming a Mother: Research on Maternal Identity from Rubin to the Present (1995). Her contributions earned widespread recognition. She received the Distinguished Research Lectureship Award from the Western Society for Research in Nursing in 1988 as its inaugural recipient, the American Nurses Foundation’s Distinguished Contribution to Nursing Science Award in 1990, and the Distinguished Alumni Award from the University of New Mexico College of Nursing in 2004. In 2003, she received nursing’s highest honor when the American Academy of Nursing named her a Living Legend.

In her personal life, Mercer married Lewis P. Mercer, an engineer, on New Year’s Eve 1971 after meeting on a Caribbean cruise. They remained married for nearly 40 years until his death in 2009. Dr. Ramona T. Mercer passed away on August 10, 2023, at age 93. Her legacy endures through the countless nurses who apply her theory daily, helping mothers around the world navigate the profound journey into parenthood with confidence and support.