Let’s stop reducing matrescence to the perinatal window, and take a humanistic, gender-responsive, lifespan approach

Reprinted with permission from: Slootjes, H., & DeRolf, A. (2025). The occupational nature of matrescence. In H. Slootjes (Ed.), Enhancing women’s wellbeing during matrescence, motherhood, and perinatal transitions: An evidence-based guide for occupational therapists (p. 187). Routledge. https://doi.org/10.4324/9781003397724-9

This is a bit of a different post from me today. I really want to talk about matrescence and to share a bit about what we’ve included in the textbook to help communicate more about matrescence from an evidence-based perspective.

Matrescence is still in the spotlight! But let’s stop boxing it into the perinatal period and fourth trimester.

So, we know matrescence is not simply a phase around birth. We understand it’s a rite of passage and metamorphosis that unfolds through shifting identities, roles, relationships, resources, bodies, beliefs and power over time (Raphael, 1978). But the desire to anchor back to the perinatal transitions and birth are really strong! So I wanted to use this post to discuss things in a bit more depth.

With permission from Routledge (the publisher) to post the figures in colour, we’re going to revisit my textbook chapter with Annie DeRolf, where we locate matrescence within an occupational lens and a bioecological framework to guard against this reductionism. In short, this chapter talks about how mothers’ development is co-created by what they do and the environments that enable or constrain that doing, from the intimate to the structural, across the whole lifespan. It’s basically OT 101. But we’re taking things up a knotch to the next level to help understand matrescence from an human occupational perspective.

The figure, in two paragraphs

The figure above adapts Bronfenbrenner’s (2006) ecology of human development to matrescence. Imagine nested “dolls” – at the centre sits the mother (in this context, bio = person): Her characteristics, capacities, and experiences. Around her are immediate settings (the microsystem), the interactions between those settings (the mesosystem), the systems that shape her indirectly (the exosystem), and the wider cultural, ideological, and institutional forces, including the patriarchal institution of motherhood itself (the macrosystem). All are held in time (the chronosystem), because matrescence unfolds across a lifetime. It’s illustrative, not exhaustive — a living model.

Across these layers, matrescence develops through interwoven domains – not just bio-psycho-social, but also spiritual and political. Hormones and sleep. Identity and mental health. Kinship and work. Digital communities, rites of passage, belonging, policy, money, safety, gendered power. These forces wax and wane across time and intersect across diverse mothering pathways – birth, adoption, fostering, kin and community mothering, and other care roles. Together, these factors intersect and evolve over time to continuously shape girls and women’s health, wellbeing, and quality of life – as gendered beings navigating the culturally nuanced rite of passage of matrescence.

What gets lost when we reduce matrescence to “perinatal”?

  • Lifespan context | Mothering is a lifetime occupation and matrescence is a lifelong socialisation process that is culturally bound. The diversity of challenges and meanings associated with navigating mothering roles/identities and motherhood start from the birth of a female child and continue to evolve over time – often spiking again with the onset of menstruation and/or puberty, during perinatal transitions, grandmothering, onset of menopause, and end of life transitions. Collapsing matrescence into a perinatal episode erases these rich cumulative transitions of separation, adaptation, change, and consolidation.
  • Structural determinants | Perinatal services rightly focus on mortality and clinical needs, but mother’s wellbeing is also shaped by housing, income, leave, childcare, safety, relationships and psychosocial factors, local politics and cultural ideologies. If matrescence is treated as a clinic-only matter (a health perspective), upstream levers will get ignored (the wellbeing perspective).
  • Diverse mothering | There is no universally correct way to mother. Mothering is distinct from parenting or fathers, and not synonymous with motherhood as an institution. Mothering experiences range from joyful to catastrophic. Roles may be shared, non-biological, chosen, or imposed. Narrow perinatal framings can erase (m)others, queer parents, kin-care, and culturally distinct rites of passage.
  • Agency and identity | Matrescence is not just something that happens to women in midlife – it’s an ongoing socialisation and practice that deeply culturally nuanced. Matrescence is often characterised by an accumulation of occupations and co-occupations that build – or strip – female agency in relation to motherhood. Reducing matrescence to the perinatal period for screening and symptom management has capacity to strengthen mother-centred care, however overlooks complexity, individuality, meaning, mastery, and power from a lifespan perspective.

A wider, wiser brief for practice and policy

The mother-centred approach suggested by Neely & Reed (2023) can help us to reframe services around mothers’ lived contexts, not just diagnoses – connecting local systems, building parenting skills inclusively, addressing upstream determinants – to fund flexible, equitable support; and investing in real-world “villages”, both face-to-face and digital. This multi-level strategy pairs naturally with the bioecological view in the figure and protects us from siloed, perinatal-only thinking.

So, what can we do now?

First things first. Let’s stop and take a moment to pause and reflect.

  • Clinicians and practitioners – Before we reach for diagnostic maps, perhaps we can pause to map the mother’s world. What surrounds her? What sustains or drains her energy each day? The home, the workplace, the care spaces between. The policies that influence her “choices”. The cultural stories that quietly tell her who she should be as a gendered female being in society – or who she has failed to be, and in what way she isn’t meeting sociocultural nuanced expectations as an idealised ‘mother’. When we notice the life stage or phase she’s in, as well as intergenerational and bioecological factors, a fuller picture of her wellbeing needs and challenges begins to emerge.
  • Educators and researchers – Maybe it’s time to expand how we hold matrescence in our teaching and inquiry? Not as a chapter tucked into perinatal care, but as a lifelong unfolding – social, cultural, political, spiritual, and deeply occupational. When we frame it this way, we give language and legitimacy to the slow transformations that mothers live long after the baby books end.
  • Policymakers and leaders – To truly support mothers, we might begin not with programs, but with the environments that make mothering possible. Safe housing. Paid leave. Affordable childcare. Flexible work. Freedom from violence. Cultural safety and community. These are not extras – they are the ecosystem of matrescence and the gendered context influencing wellbeing determinants.

We can’t change everything, but we can definitely take accountability for our own practices and prioritise an evidence-based perspective that responds to women as human occupational beings.

Matrescence is a gendered human developmental story and a concept developed through anthropological research. From an occupational perspective, we can recognise matrescence is lived through occupations, relationships and structures, across time. When we hold that human occupational breadth, we can understand why we need to hold the perspective that perinatal care can fill one strong chapter without dominating the whole book.


Further reading: This post heavily summarises ideas from our chapter, The occupational nature of matrescence (Slootjes & DeRolf 2025), where we situate matrescence within an occupational and bioecological framework from an evidence-based perspective. Annie and I invite readers to read our chapter and to critically consider how their understanding of matrescence aligns within the nested systems and matrescence development domains in Figure 7.1, and reflect of how mother-centred health promotion can extend beyond perinatal care.

References

Bronfenbrenner, U., & Morris, P. A. (2006). The bioecological model of human development. In R. M. Lerner (Ed.), Handbook of child psychology: Theoretical models of human development (Vol. 1, pp. 793–828). Wiley.

Neely, E., & Reed, A. (2023). Towards a mother-centred maternal health promotion. Health Promotion International, 38(2), 1–14. https://doi.org/10.1093/heapro/daad014

Raphael, D. (1975). Matrescence, becoming a mother: A “new/old” rite de passage. In D. Raphael (Ed.), Being female: Reproduction, power, and change (pp. 65–72). Mouton Publishers

Slootjes, H., & DeRolf, A. (2025). The occupational nature of matrescence. In H. Slootjes (Ed.), Enhancing women’s wellbeing during matrescence, motherhood, and perinatal transitions: An evidence-based guide for occupational therapists (pp. 121–142). Routledge. https://doi.org/10.4324/9781003397724-9

Matrescence or perinatal? How language choices define our understanding of women’s journeys to motherhood

Becoming a mother is known to be a significant life event for women. It means different things to different women in different communities and cultures, in a kaleidoscope of ways. An increasing number of occupational therapists around the world are working to support women’s unique and individual issues and needs as they become mothers. They identify occupational performance issues women experience during these life transitions, and ways to support women according to client-centered and evidence-based practice principles.

Recently I’ve been preoccupied with wondering about our professional vocabulary. In the same way we’ve been debating the appropriateness of the term “occupation” to describe what type of therapy we provide, I wonder if we should redirect some of that curious energy to question the words we use to understand maternal health? What influence does the language we use to interpret and understand the role of occupational therapy in supporting women during the transition to mother? How does the terminology we use influence our clinical practice decisions? Are we limiting our professional knowledge acquisition by feeling obligated and bound to using medical definitions of maternal healthcare models and systems?

How do the words we use and choose shape our understanding of the OT role in women’s maternal health?

Words we use to understand women as they become mothers.

Occupational therapists work with women during so many stages of their journeys to and through motherhood. For me, the more I learn about ‘matrescence’, the more I feel clear about it’s relevance to the occupational therapy role in women’s health during motherhood transitions. I’m still learning – there’s a lot to learn! – but I want to share moments of my knowledge journey in discovering this term, including how it changes my thoughts and perspectives on both women in the context of becoming a mother, and the occupational therapists who support them. I hope that sprinkling little ‘new’ knowledge kernels might help occupational therapists to perpetuate their curiosity and question their understanding, familiarity and confidence in using and applying a professional vocabulary which is true and authentic to their practice.

Let’s start with the basics and tackle things bit by bit… Here’s my current interpretation of some key terms I’ve noticed occupational therapists are using to describe their practice and clients, and some I use when I’m listening to their stories:

Motherhood: A life phase/chapter of being a mother

Mothering: The duties and tasks of mothering occupations

Mother: A person who identifies themselves as such

Perinatal: There are a handful of definitions for this term, which describes a period from late pregnancy through to early postpartum. This term was originally developed for using medical maternal health and obstetrics, and includes prenatal, antenatal, labour, birth, postpartum and postnatal (the three trimesters, [arguably four: https://jordaninstituteforfamilies.org/collaborate/community-initiatives/4thtrimesterproject/]).

From what I’ve heard and learned along the way, I am currently considering that ‘perinatal’ is part of matrescence. I wonder; How much has our respect for and value of medical terminology biased how we understand women’s health and wellbeing when becoming mothers? Are we allowed to look outside the obstetric and medical definitions of maternal health and perinatal status to better understand how occupational therapists interpret and address women’s issues and needs? Yes. I think we can.

Matrescence: Refers to the developmental transition of becoming of mother (likened to the term ‘adolescence’, for becoming an adult). Originally developed and used exclusively by anthropologists. In the last 10-15 years is being revived and refreshed by sociologists and psychologists to interpret women’s maternal health and mothering in contemporary societies.

“The process of becoming a mother, coined by Dana Raphael, Ph.D. (1973), is a developmental passage where a woman transitions through pre-conception, pregnancy and birth, surrogacy or adoption, to the postnatal period and beyond. The exact length of matrescence is individual, recurs with each child, and may arguably last a lifetime! The scope of the changes encompass multiple domains –bio-psycho-social-political-spiritual– and can be likened to the developmental push of adolescence”, Aurélie Athan, Ph.D.

“An experience of dis-orientation and re-orientation . . . in multiple domains: physical (changes in body, hormonal fluctuations); psychological (e.g., identity, personality, defensive structure, self-esteem); social (e.g., re-evaluation of friendships, forgiveness of loved ones, gains in social status, or loss of professional status), and spiritual (e.g., existential questioning, re-commitment to faith, increased religious/spiritual practices)” (Athan & Reel, 2015, p. 9).

I’m going to leave this post hanging without drawing any major conclusions. I hope that by doing this there might be cause to wonder what should be written next.

What do you think? Does this resonate with occupational therapy conceptual philosophies as you understand them?

Sleeves are rolled up, and more blog posts are coming…

References, and links for the curious:

Aurélie Athan, Ph.D. – Webpage: https://www.matrescence.com/

Athan, A., & Reel, H. L. (2015). Maternal psychology: Reflections on the 20th anniversary of Deconstructing Developmental Psychology. Feminism & Psychology, 25(3), 311-325. https://doi.org/10.1177/0959353514562804

Book – Raphael, D. (1975). Matrescence, Becoming a Mother, A “New/Old” Rite de Passage. In D. Raphael (Ed.), Being Female: Reproduction, Power, and Change (pp. 65-72). Mouton Publishers.