Reva Rubin

1. Reva Rubin Theory of Maternal Identity

2. This presentation is a glimpse of the contributions made by Reva Rubin to the maternal experience. • Who is Reva Rubin’s • What is the Theory of Maternal Identity • The naturalist model used to research and develop her theory • A historical look at maternal nursing • How did her thoughts and observations of the maternal experience • How did her thoughts and observations changed the nursing experience • What Rubin’s Theory means to nursing today • Listening to Reva Rubin discussing the maternal experience

3. EDUCATION AND BACKGROUND • Masters Degree from Yale University • BA in Sociology from Hunter College • Professor and Director of Graduate Programs in Maternity at University of Pittsburgh • Certified Midwife from Frontier Nursing Service • MS from Yale University • Awarded Fellowships by the World Health Organization & Rockefeller Foundation Reva Rubin Middle Range Theorist Scope focused on maternal nursing and developed concepts on maternal identity

4. Awards and Honors • First Annual Award in Nursing from the National Foundation March of Dimes • Distinguished Service Award in Nursing in Maternal – Child Nursing from the America Nurse Association in 1976 • Honorary Doctorate from the University of Calgary 1992

5. Reva Rubin’s concept of maternal role attainment, which ultimately leads to maternal identity was developed to help women and nurses in the maternal experience (Rubin, 1984). By understanding a women’s subjective experience it can help elevate the skills of health care providers practicing maternal medicine and lead to enhanced outcomes for mother’s (Templeton, Edgil and Douglas, 1988).

6. The Naturalist ModelResearch based on Nature • Subject in action • Situation dictated by nature • A setting that is natural • Independent variable • Dependent variable (subject) • Pregnant women, mother to be • Childbirth/Maternal Experience • The Nurse as an observer is natural to the child birth experience in a helpful and functional way (Rubin, 1988). • Nurse • Mother

7. Rubin’s naturalist research included more than 6,000 patients as subject matter (Rubin, 1984). Data collection began from the first missed menstrual period through pregnancy, delivery and the sixth week post partum (Rubin, 1984). The primary question asked was “ How does this this women feel about herself in this situation at this time?” ( Rubin,1984). Another question posed was “ How do women use nursing help in each stage of the childbearing experience if nursing is available and accessible?” (Rubin, 1984). The subjects verbal and nonverbal experience were recorded verbatim for analysis.

8. The History of Maternal Nursing Pre World War I Deliveries were done at home. Mortality for the mother was high and even higher for the infant. This included long labor, poor sterile technique and forced deliveries (Rubin, 1975). Post World War I The 1920s brought the change from home to hospital deliveries. This meant 10-14 day hospital stays, ill equipped rooms w/ community bathrooms (Rubin, 1975). Post World War II Hospitals had access to antibiotics and plastics which decreased infections. Rooming in with infants began and was established by nurses (Rubin, 1975). A notable change in 1908 prior to WWI was the introduction of antepartal care, this nursing practice was not at first accepted but gradually accepted part of maternal care (Rubin, 1975). But with hospital stays came nursing care and nurses who were able to care for patients with bed baths and back rubs. Patients felt cared for by nurses (Rubin, 1975). Nurses started parenting classes. Stayed with women in labor and helped guide the labor process. The rocking chair and on demand feedings were established (Rubin, 1975).

9. Home delivery 1900’s Image retrieved from http://birthanarchy.com/roots-repression

10. Maternity Ward 1915 Image retrieved from http://librarysocietyfriendsblog.wordpress.com/2012/07/03/world-war-i-and-its-aftermath-cataloguing-the-papers-of-hilda-clark-1881-1955/

11. Current Day Hospital Maternity Suite Image retrieved from http://indianapublicmedia.org/news/terre-haute-hospital-unveils-motherbaby-unit-47409/

12. Maternal Identity and the Mother Prior to Reva Rubin’s theory of maternal identity, maternal care focused on the physiological and biological aspect of a woman’s care and ignored the psychological aspect of a women’s care (Mercer, 1995). Rubin noted, “that the formation of a maternal identity that binds the women in to this child and to becoming a mother of this child is gradual, systematic, and extensive” ( Rubin, 1984). She brought to light a women’s self doubt and fears that may materialize during pregnancy or after the birth of a child. A newly pregnant mother has certain expectations of pregnancy and if they do not happen may begin to have self doubt (Rubin, 1984). A new mother with child that does not feed as well as in the hospital setting may begin to feel failure. By observing women throughout the maternal experience Rubin was able to help guide women and develop understanding of these behaviors.

13. Maternal Identity and the Mother Maternal Identity for the mother involves replication in a number of different ways. The new mother during the many phases of the maternal experience begins looking for behaviors to model. Rubin discusses this as a “bridge or linkage to each phase of childbearing” (Rubin, 1984). They may model socially accepted norms, the environment or information from media like the newspaper or magazines. Another model may be the mother of the woman who is pregnant. Role play is another form of replication (Rubin, 1984). Rubin describes this as a “trying on of the maternal role” (Rubin, 1984). Samples of this may be babysitting, placing herself in the role as mother to the child even though it is not her own. Fantasy is another aspect of maternal identity and is it in this aspect that “a women makes the child uniquely her own” (Rubin, 1984). Fantasy also incorporates a women’s fears of labor and the what the outcome may be.

14. Maternal Identity and the Mother The different processes and actions observed by Rubin also included • A woman’s need to address maternal tasks, the task of child bearing, keeping her family unit intact and a balancing social and work relationships with pregnancy. • Body image during the maternal experience begins from conception to the post partum period, women deal not only with the obvious self image of adjusting to weight gain but also the physical difficulty with movement and everyday tasks (Rubin, 1984). • Pain can occur during any part of the maternal experience from the early stages of morning sickness through the post partum period. However, the greatest focus of pain is in labor and delivery and the subjective aspects of this experience women may experience (Rubin, 1984). • Rubin noted that a women’s response to pain was associated with fatigue, isolation, fear and disorientation in labor (Rubin, 1984). • After delivery a woman deals with identification and interaction of the child. This outcome may be determined by a women’s experience during her pregnancy.

15. Nursing and Maternal Identity By observing and discussing the psychological experiences of women through the birth process this opened a better understanding for nurses and healthcare professionals. Some of these key changes were…. The introduction of mother’s and parent’s classes taught by nurses. These classes discussed changes that may take place during pregnancy and helped alleviate some of the fear or anxiousness experienced by new mother’s ( Rubin, 1975). Rubin noted that with nurses guiding women through the labor process this decreased the need for medication, fears were alleviated due to the nurse staying with the mother and not feeling abandoned and left alone (Rubin, 1975). Interaction between mother and infant increased as well as the father participation.

16. A Dialogue of Reva Rubin in her own words https://www.youtube.com/watch?v=DLLgoxLjAXA

17. What have we gained from Reva Rubin’s Theory of Maternal Identity ? The catalyst for ….. • Child birth Classes • Labor and Delivery recovery suites • Less sedation • Father’s participation in delivery • Early discharge • Kangaroo care • Fetal monitoring • Visits to Neonatal Intensive care units by parents/Grandparents

18. Reva Rubin is an inspiration to all nurses in the field of maternity nursing. Her writings are eloquent and heartwarming. Image retrieved from http://acupuncture-pregnancy.com/category/toronto/

19. References Birth Anarchy. (n.d.). Retrieved from http://birthanarchy.com/roots-repression Gay, J. T., RN DSN, Edgil, A. E., RN DSN, & Douglas, A. B., RN MSN. (1988). Reva Rubin Revisited. JOGNN, 394-398. Mercer, R. (1995). A Tribute to Reva Rubin. MCN, 20. Quaker Strongrooms A blog from the Library Society of Friends. (n.d.). Retrieved from http://librarysocietyfriendsblog.wordpress.com/2012/07/03/world-war-i-and-its-aftermath-cataloguing-the- papers-of-hilda- clark-1881-1955/ Rubin, R. (1975). Maternity Nursing Stops Too Soon. American Journal Of Nursing, 1680-1684. Rubin, R. (1984). Maternal Identity and the Maternal Experience. Springer Publishing. Terre Haute Hospital Unveils New Mother-Baby Unit. (n.d.). Retrieved from http://indianapublicmedia.org/news/terre-haute-hospital-unveils-motherbaby-unit-47409/Terr