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ISSN: 2690-5760

Journal of Clinical & Community Medicine

Research Article(ISSN: 2690-5760)

Adoption of the Maternal Role and the First Thousand Days Volume 3 - Issue 5

Dr a Cruz Xiomara Peraza de Aparicio*

  • Docente Carrera Enfermera, Guayaquil, Ecuador

Received:August 25, 2021;   Published: September 16, 2021

Corresponding author:Dr a Cruz Xiomara Peraza de Aparicio, Docente Carrera Enfermera, Guayaquil, Ecuador

DOI: 10.32474/JCCM.2021.03.000171


Abstract PDF


Feeding women during pregnancy and the child’s diet in the first two years of life (the first 1000 days) are crucial for development and health at that time and in later stages in this line, the World Health Organization (WHO) points out in its Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition, which prioritizes actions to improve the development and health of children in the world by 2025. The objective of this work is to analyze the contributions of breastfeeding from the approach of Ramona Mercer, during the first 1000 days.

Methodology: Documentary research was carried out through a literature review. Optimal nutrition during the first 1000 days, ranging from conception to two years, is key to health throughout life. The review of several indexed articles shows that the first 1000 days are of vital importance for the achievement of the best development and long-term health, and thus constitute a fundamental strategic period for Primary Care and Collective Health, where the nursing professional provides care at the knowledge of his or her specialized knowledge.

Keywords:Role of Maternal Adoption; Nutrition; First 1000 days; Primary Care; Collective Health


The first thousand days of life, from conception to the first two years, are the most important stage of development and the one that will have the most impact on the rest of the individual’s life. In this period, in which the increase in size and maturation of the brain are faster than at any other stage of life, adequate nutrition and a favorable environment are determinants in the development of the future capacities of the person to know, analyze and respond to the world around him. To do this, it requires the maximum effort to take actions to create a favorable environment from the preconception stage and in the first thousand days of life, taking special care of the provision of adequate nutrition and the physical and emotional environment of future children, adolescents and adults. Optimal breastfeeding of infants under two years of age has more potential impact on child survival than any other preventive intervention, as it can prevent 1.4 million deaths of children under five in the developing world [1]. “Latin America and the Caribbean is among the regions with the highest global averages of breastfeeding, but much remains to be done if the goal of 50% exclusive breastfeeding in the first six months of life by 2025 is to be reached,” they show that breastfeeding babies during the first hour of birth can prevent 22% of neonatal deaths. While breastfeeding rates are not declining globally, and many countries have experienced a significant increase over the past decade, only 38 per cent of children under six months of age in the developing world receive exclusively breast milk and only 39%of children aged 20 to 23 months benefit from breastfeeding.

The Pan American Health Organization/World Health Organization PAHO/WHO, [2] recommends starting breastfeeding in the first hour of life and maintaining it as the only form of food for the next 6 months; thereafter it is recommended to continue breastfeeding until at least 2 years, adequately supplemented with other safe foods. There is now sufficient evidence to show that breastfeeding is beneficial for both boys and girls and mothers and society. The position to breastfeed the baby is essential to avoid problems nipple pains, breast congestion and even inadequate milk supply. In mothers with large nipples, expert breastfeeding professionals can help try to find some posture that makes grip easier. All the world of knowledge that moves between this binomial mother child motivates the realization of this research, which aims to analyze the contributions of breastfeeding from the approach of Ramona Mercer, during the first 1000 days, for the enrichment of both the family and the health team especially the nursing professional.

Materials And Methods

The bibliographic search that was carried out, was oriented documents with maximum 5 years of antiquity for the selection of the information to reflect in the study, considering that this study is a documentary investigation, the information was collected and selected through the reading of documents, books, indexed journals, articles from official sources and experts in the field of breastfeeding.


Breastfeeding and its benefits

Breastfeeding helps the mother to improve her present and future health, reducing postpartum bleeding, providing contraception during the first six months (as long as the baby is less than six months old, breastfeeding is exclusive, there are eight shots and the mother’s menstrual period has not returned), improving postpartum bone remineralization, decreasing the risk of breast cancer, ovarian cancer and type 2 diabetes, among other benefits In addition, it promotes frequent and close physical contact with the infant and the creation of the affective bond, which is optimal for their development and makes the mother experience a great feeling of satisfaction and self-esteem [3].

Breast milk, by its composition and by the act of breastfeeding, is the most complete system of food and upbringing that the mother can provide to her child. This milk is a substance that changes permanently to become exactly what they need, it is different at the beginning of each blowjob. When the baby is hungrier, it contains more protein and water, more substance. Minutes later when the baby is more relaxed, its fat content increases, and it will be digested more slowly. The taste varies according to what moms eat. The frequent flavors for the mother will be for the baby [4]. WHO recommends starting breastfeeding in the first hour of life. In addition, it makes it explicit that it is done “on demand”, that is, as often as the child wants, both day and night. In the first 6 months of the child, breastplates and pacifiers should be avoided [2].

Benefits for infant health

Breast milk is ideal for newborns, as it provides them with all the nutrients they need for healthy development. In addition, it is harmless and contains antibodies that help protect the infant from common diseases such as diarrhea and pneumonia, which are the two leading causes of infant mortality worldwide. Breast milk is also easy to obtain and accessible, which helps ensure that the infant has enough food [4,2].

Benefits for the mother

Breastfeeding also benefits the mother. Breastfeeding exclusively often produces amenorrhea, which is a natural (though not completely safe) method of birth control. In addition, it reduces breast and ovarian cancer and helps the mother regain her prepregnancy weight more quickly and reduce her weight.

Long-term benefits for the child

In addition to the immediate benefits for the child, breastfeeding helps maintain good health throughout life. In the long term, adults who were breastfeeding as children tend to have lower blood pressure, lower cholesterol, and lower rates of overweight, obesity, and type 2 diabetes. There is also data that people who were breastfeeding perform better on intelligence tests [3].

Importance of the first thousand days

Today, [6] has taken on great importance, the stage that covers from the moment of conception to the two years of life; period that has been called: “The first 1000 days of life”. When talking about those thousand days of life, reference is made to the period that comprises: 270 days from conception to birth, plus 365 days of the first year of life and plus another 365 days of the second year of life. This space of time will represent the most important moment in a person’s life, as it is a critical window in the development of our entire life and provides a unique opportunity for children to obtain the nutritional and immunological benefits that they will need the rest of their lives. Nutrition in the first 1000 days of life (7) is the essential key to a healthy future life, as this subgroup of the population is prone to imbalances and dietary insufficiencies. Proper nutrition is vitally important to support proper growth and development. In addition, it is important to control all nutritional disorders that occur in pregnancy and in the first 2 years as they subsequently increase morbidity and mortality, which has a permanent impact on health.

In recent years, there is considerable interest in the effects of excessive weight increase during childhood, because the development of fatty tissue in this period is a determining factor in the body composition of the adult. Breast milk is the unique and irreplaceable food, because it supplies all the nutrients that will ensure proper development [4]. WHO recommends it for the first 2 years. The mission of pediatricians during this critical window stage is to promote exclusive breastfeeding, as there is a lower risk of diarrhea, otitis media, pneumonia, food allergies, urinary tract infections, type 2 DM, APH and obesity. The 1000-day clock cannot be restarted, it deserves to be futuristic and have the proper knowledge about food in this important period [5].

This period is the critical window into the child’s development, as it involves momentous changes to health and provides a unique opportunity for children to gain nutritional and immunological benefits that they will need for the rest of their lives [1-3]. At this stage most of the organs, tissues and also the physical and intellectual potential of each child are formed. Intelligence will be developed, lasting eating habits will be formed, and the nutritional health of the child will be defined since a good diet in these “critical thousand days” will be a health insurance for their future life. The damages that are generated during these first thousand days will have irreversible consequences in the individual, so prevention is essential. The first thousand days of life frame a critical period in the growth of the child [6,7]. A favorable environment characterised by adequate nutrition in quality and quantity, appropriate stimulation and an environment of affection is indispensable for proper brain development and to create the foundations of security and confidence that will generate long-term individual and collective benefits. In particular, nutritional factors in the first thousand days of life are of paramount relevance for the subsequent physical health and mental development of children. Optimizing healthy nutrition and supplementation of folic acid and vitamins in women in the preconception period and during pregnancy and lactation favors the healthy prenatal and early growth of children, a crucial point to prevent adverse repercussions that can be decisive in the achievement of growth and development goals

Ramona mercer and her theory “The adoption of the maternal role”

Among the many theories of nursing care, the intermediate theory was addressed, which focuses on a dimension that represents a model of care and that is why it is proposed to adopt the maternal role of the theorist Ramona Mercer [8] applied to the binomial mother and child, becoming the pillar of nursing work and offers the student the opportunity to validate and confront in practice from any of the selected fields of action applying the scientific method in nursing [7].

Characteristics of the maternal role adoption model

Ramona Mercer with her theory Adoption of the Maternal Role, [8] proposes the need for nursing professionals to take into account the family environment, school, work, church and other community entities as important elements in the adoption of this role. Mercer’s adoption model is situated in the Bronfenbrenner concentric circles of the microsystem, mesosystem and macrosystem.


It is the immediate environment where the adoption of the maternal role occurs, which includes the family and factors with family functioning, mother-father relationships, social support and stress. Mercer expands on the initial concepts and model to highlight the importance of the father in the adoption of the role, as it helps to “blur the tension in mother-child duality”. The adoption of the maternal role is achieved in the microsystem through interactions with the father, mother and child.


It groups, influences and interacts with people in the microsystem. Mesosystem interactions can influence what happens to the developing maternal role and the child. It includes day-today care, school, the workplace, and other entities that are in the immediate community.

The macrosystem, Includes social, political and cultural influences on the other two systems. The health care environment and the impact of the current health care system on the adoption of the maternal role originates the macrosystem. National laws regarding women and children and health priorities influencing the adoption of the maternal role.

Stages Of Maternal Role Acquisition

a) Anticipation: the stage of anticipation begins during pregnancy and includes the first social and psychological adjustments to pregnancy. The mother learns the expectations of the role, fantasizes about it, establishes a relationship with the fetus that is in the womb and begins the adoption of the role [9].

b) Formal: it begins when the child is born and includes the learning of the role and its activation. Role-playing behaviors are guided by the formal and consensual expectations of others in the mother’s social system.

c) Informal: begins when the mother develops her own ways of performing the role not transmitted by the social system.

Women make the new role fit into their lifestyle based on past experiences and future goals.

d) Personal or role identity occurs when the woman internalizes the role. The mother experiences a feeling of harmony, confidence and competence in the way she performs the role and achieves the maternal role.

The interest of Mercer’s theory [8,9], goes beyond the concept of “traditional mother”, covering factors such as: age, state of health, function of the family, father-mother relationship and characteristics of the infant, it is also important to highlight the love and support of the couple as predisposing factors to make possible a comprehensive care of the mother-child binomial. Perinatal maternal care is one of the areas of the nursing profession, where it plays a fundamental role from various fields of action and in the different stages of the life of the process of gestation, labor, childbirth, postpartum and stratification towards the extrauterine life of your newborn.

Diagnostic And Planning Phase

Undoubtedly the puerperium is a period characterized by multi factors such as fears and ignorance of the usual evolution in the mother and the normal development of the child to vulnerability of risk factors that induce possible complications that compromise health and life [10]. It is therefore the responsibility of nursing to identify and teach the user and her family as a support entity to recognize timely problems of the mother-child binomial, to achieve a state of well-being and comfort.

Follow-Up: Assessment of Nursing In The Late Puerperium

The nursing strategy to give continuity to the care initiated in the hospital, with the admission of the mother in labor until she is discharged with her child. Already in their homes they do not have professional accompaniment and sometimes they do not have sources of family or social support, a situation that makes them more vulnerable to complications.


1. Breastfeeding is the best form of feeding for newborns, babies and children is breastfeeding; for providing the best nutrients and the means of defense necessary to protect them from future infections.

2. The benefits of breastfeeding are countless, not only for children but also for the mother and family because of its zero cost in return for the high economic value of artificial feeding.

3. The Adoption of the Maternal Role theory proposes the need for nursing professionals to take into account the family environment, school, work, church and other community entities as important elements in the adoption of this role.


  1. (2017) World Health Organization (WHO) Ministry of Health, PAHO and UNICEF celebrated World Breastfeeding Week.
  2. (2017) Pan American Health Organization/World Health Organization (WHO/PAHO). Breast milk from the first hour of life.
  3. (2017) Ministry of Health, Social Services and Equality (MSSSI) Clinical Practice Guide on breastfeeding. Spain.
  4. Caballero V, Zapata R (2019) Education and health in vulnerable groups. Universidad Almería, Spain.
  5. Gonzalez N, López, G, Prado L (2016) Importance of nutrition: first 1,000 days of life. Acta Pediátrica Hondureña 7(1): 1-9.
  6. Pantoja M (2015) The first 1000 days of life. Rev Soc Bol Ped 54(2): 60-61.
  7. Gonzalez C (2019) A Gift for Life: A Guide to Breastfeeding.
  8. (1991) Modelo de adopcion del rol maternal. (modificado de Mercer, RT Maternal role: Models and consequences. Documento presentado en la International research conference patrocinado por el Council of Nursing Research y la America Nurses Association, Los Angeles, CA. Ramona T Mercer
  9. Mercer R T (1990) Parents at risk. Springer, New York, USA.
  10. Mercer R T (1995) Becoming a mother: Research on maternal identity from Ruby to the present. Springer, New York, USA.