Document Type : Original Article


1 Department of Midwifery, Evidence‑Based Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences,

2 Department of Clinical Psychology, Psychiatry and Behavioral Science Research Center, IBN SINA Hospital, Mashhad University of Medical Sciences, Mashhad, Iran


INTRODUCTION: Maternal confidence is an extremely important factor in playing the mother’s role
and her identity formation. Loss of self‑confidence occurs in primiparous women due to the lack of
maternal skills. Obtaining the behaviors of maternal role and self‑confidence, the mother provides
better care for her child. Hence, the aim of this study was to examine the effect of maternal role
training program based on Mercer theory on maternal self‑confidence of primiparous women with
unplanned pregnancy.
METHODOLOGY OF THE RESEARCH: This clinical trial was performed on 67 primiparous
women referring to Mashhad health centers. Individuals were randomly divided into intervention
and control groups. A maternal role training program based on Mercer theory was carried out for
intervention group (three sessions of group training in the 34th, 35th, and 36th weeks of pregnancy
and one individual training session before discharge from the hospital and then, weekly follow‑up
over the phone for 4 weeks). The control group received the normal pregnancy care. The research
tools were questionnaires of demographic characteristics, London, DASS 21, Edinburgh Postnatal
Depression Scale, Parenting Sense of Competence, General Impressions on Infant Temperament
Questionnaire, and Six Simple Questions. Maternal self‑confidence was measured before training,
4 weeks after delivery, and 4 months after delivery. Data analysis was carried out using independent
t‑test, Chi‑square test, paired t‑test, Mann–Whitney test, one‑way ANOVA, and Wilcoxon test. P < 0.05
was considered statistically significant.
RESULTS: There was a significant difference between mean maternal self‑confidence
changes (before training and 4 weeks after delivery (P = 0.003) and before training and 4 months
after delivery (P = 0.001) in both groups. After eliminating the effect of interventional variables, the
mean scores of maternal self‑confidence after training in the intervention group had a statistically
significant difference with that in the control group (P = 0.001).
CONCLUSIONS: Maternal role training program based on Mercer theory increases maternal
self‑confidence in primiparous women with unplanned pregnancy. Teaching maternal role is
recommended to all health‑care providers.


1. Ruchala PL, James DC. Social support, knowledge of infant
development, and maternal confidence among adolescent and
adult mothers. J Obstet Gynecol Neonatal Nurs 1997;26:685‑9.
2. Sansom L. Confident Parenting‑A Book Proposal. University of
Pennsylvania; 2010. Available from: http://repository.upenn.
edu/mapp _capstone.
3. Mercer RT. Becoming a Mother: Research on Maternal Role
Identity from Rubin to the Present. New York: Springer; 1995.
4. Lederman RP, Weingarten CG, Lederman E. Postpartum
self‑evaluation questionnaire: Measures of maternal adaptation.
Birth Defects Orig Artic Ser 1981;17:201‑31.
5. Emmanuel E, Creedy DK, St JohnW, Gamble J, Brown C. Maternal
role development following childbirth among Australian women.
J Adv Nurs 2008;64:18‑26.
6. Leahy‑Warren P, McCarthy G. Maternal parental self‑efficacy in
the postpartum period. Midwifery 2011;27:802‑10.
7. Lee LL, Arthur A, Avis M. Using self‑efficacy theory to develop
interventions that help older people overcome psychological
barriers to physical activity: A discussion paper. Int J Nurs Stud
8. Salonen AH, Kaunonen M, Astedt‑Kurki P, Järvenpää AL,
Isoaho H, Tarkka MT, et al. Parenting self‑efficacy after childbirth.
J Adv Nurs 2009;65:2324‑36.
9. Bryanton J, Gagnon AJ, Hatem M, Johnston C. Predictors of early
parenting self‑efficacy: Results of a prospective cohort study. Nurs
Res 2008;57:252‑9.
10. Leahy‑Warren P, McCarthy G, Corcoran P. First‑time mothers:
Social support, maternal parental self‑efficacy and postnatal
depression. J Clin Nurs 2012;21:388‑97.
11. Walker LO, Crain H, Thompson E. Maternal role attainment and
identity in the postpartum period: Stability and change. Nurs Res
12. Maçola L, do Vale IN, Carmona EV. [Assessment of self‑esteem
in pregnant women using Rosenberg’s self‑esteem scale]. Rev Esc
Enferm USP 2010;44:570‑7.
13. Mercer RT. Predictors of maternal role attainment at one year
postbirth. West J Nurs Res 1986;8:9‑32.
14. Halman LJ, Oakley D, Lederman R. Adaptation to pregnancy and
motherhood among subfecund and fecund primiparous women.
Matern Child Nurs J 1995;23:90‑100.
15. Mercer RT. Becoming a mother versus maternal role attainment.
J Nurs Scholarsh 2004;36:226‑32.
16. Badr LK. Further psychometric testing and use of the
maternal confidence questionnaire. Issues Compr Pediatr Nurs
17. Bahadoran P, Azimi A, Valiyani M, Ahmadi SA. The relation
between social support and postpartum physical health in
mothers. Iran J Nurs Midwifery Res 2009;14:19‑23.
18. Grigg CP, Tracy SK, Schmied V, Daellenbach R, Kensington M.
Women’s birthplace decision‑making, the role of confidence: Part
of the evaluating maternity units study, New Zealand. Midwifery
19. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS,
Hoffman BL, et al. Williams Obstetrics. 24th ed. New York:
McGraw‑Hill Education; 2014.
20. Zolfaghari M, Asadi Noghabi AA. Maternal Newborn Nursing.
1st ed. Tehran. Publication Boshra; 2012.
21. Kashaninia Z, Masoomi R, Maddah SS. Effects of Maternal Role
Practical Training on the Maternal Confidence and Maternal
Identity in Primiparous Women, 2013‑14. [Degree of Master
of Science in Nursing]: University of Social Welfare and Rehabilitation; 2015.
22. Delaram M, Jafarzadeh L, Shams S. The effect of fetal
Movement counting on self‑esteem and self‑efficacy of mothers:
A randomized controlled trial. Sci J Hamadan Nurs Midwifery
Fac 2016;24:32‑9.
23. Jaafarnejad F, Azmoude E, Mazlom SR, Reyhani T. The effect
of self‑efficacy training package on maternal self‑confidence of
primiparous women in infant care. Iran J Obstet Gynecol Infertil
24. Hyun‑Ju C, Sue K. Effects of maternal role practice education on
becoming a mother. Korean J Women Health Nurs 2011;17:52‑63.
Available from:
php?id=10.4069/kjwhn. 2011.17.1.52 & vmode=PUBREADER.
25. Ozkan H, Polat S. Maternal identity development education on
maternity role attainment and my baby perception of primiparas.
Asian Nurs Res (Korean Soc Nurs Sci) 2011;5:108‑17.
26. Montazeri A, Torkan B, Omidvar S. The Edinburgh postnatal
depression scale (EDPS): Translation and validation study of the
Iranian version. BMC Psychiatry 2007;11:293‑7.
27. Mollahadi M, Tayyebi A, Ebadi A, Daneshmandi M. Comparison
between anxiety, depression and stress in hemodialysis
and kidney transplantation patients. Iran J Crit Care Nurs
28. MahmoudiH, EbadiA, SalimiSH, Najafi MehriS, Mokhtari NooriJ,
Shokrollahi F. Effect of nurse communication with patients on
anxiety, depression and stress level of emergency ward patients.
Iran J Crit Care Nurs 2010;3:7‑12.
29. Koniak D. Maternal Role Attainment. State Sci 1993;25:257‑62.
30. Russell K. Maternal Confidence of First‑Time Mothers During their
Child’s Infancy. Georgia: Georgia State University; 2006.
31. KuoSC, ChenYS, LinKC, LeeTY, HsuCH. Evaluating the effects of an
internet education programme on newborn care in Taiwan. JClin Nurs
32. Soon KH, Kasil O, Young Y, Hee KD, Mi CS, Hye JJ, et al. Effect of a
maternal self‑efficacy promotion program on maternal confidence
and mother‑infant interaction. Korean Acad Child Health Nurs
33. PhanthufakM, PhumonsakulS, ChareonpolO. The effect of a maternal
role promoting program on maternal infant attachment maternal
role satisfaction, competency in infant behavior learning and infant
growth. Rama Nurs J 2009;15:149‑61.
34. Weis KL, Materna L. Identity Formation in a Military Sample:
ALongitudinal Perspective.[Degree of Doctor of Philosophy in the
School of Nursing]: University of North California: Chapel Hill; 2006.
35. KordiM, FasanghariM, AsgharipourN, EsmailyH. Effect of a maternal
role training program on postpartum maternal role competence in
nulliparous women with unplanned pregnancy. JMazandaran Univ
Med Sci 2016;26:124‑34.
36. Ellen FB. The Effect of Infant Behavior Education on Maternal Role
Attainment. [MS Thesis]. USA: New Hawen University; 1988.