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Bonding With Your Baby During Pregnancy

Pregnant woman and child
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Prenatal attachment

What is bonding with your baby during pregnancy?

Bonding with a baby during pregnancy refers to a process through which a pregnant woman experiences feelings and emotions for her foetus, interacts with her foetus and develops a maternal identity (i.e. begins to identify herself as a mother) during pregnancy. The bond between a woman and her foetus is often conceptualised by health professionals in terms of maternal-foetal attachment or prenatal attachment.

Defining and measuring the extent of bonding during pregnancy

Scientists first began studying the maternal-foetal bond in the 1960s and 1970s, after observing women grieving for infants who died during childbirth. They believed that the women’s grief would not have been possible if they had not developed a bond with the infant during pregnancy.

Since then, numerous definitions of the maternal-foetal bonding have emerged. While there are many differences in the definitions, they are generally split into two groups:

  1. Definitions which describe attachment in terms of the woman’s emotions during pregnancy; and
  2. Definitions which describe attachment in terms of the woman’s behaviours during pregnancy.

Questionnaires have also been developed to measure the extent to which a woman bonds with her foetus during pregnancy. These questionnaires are used to assess levels of maternal-foetal bonding in pregnant women, as well as describe the different characteristics (e.g. age) of women who bond with their foetus to a greater or lesser extent.

Health benefits of bonding with the foetus during pregnancy

Prenatal attachmentThe extent to which a woman bonds with her foetus during pregnancy is an important determinant of the extent to which she bonds with her newborn baby after childbirth. Women who bond more during pregnancy, also develop a greater bond with their baby during infancy.

The bond between a mother and her newborn in turn influences the baby’s future growth and development. A strong bond between a mother and her baby is associated with better development outcomes later in life.

Factors which influence a pregnant woman’s bonding with her foetus

Research using questionnaires designed to assess maternal-foetal attachment has identified many factors which influence the extent to which a woman bonds with, or feels attachment to her foetus during pregnancy.


Socioeconomic and health status and health seeking behaviours

Like other poor maternal health outcomes (e.g. premature birth, delivering a low birth weight infant), failure to bond with the foetus during pregnancy is thought to be more common amongst women from poor social and economic conditions. Women from low socio-economic backgrounds tend to have poorer health status and are also less likely to access health care facilities than women have higher socio-economic status.

Scientists are still studying whether or not maternal-foetal bonding is associated with indicators of socio-economic status like income and level of education.

There is some evidence that positive health seeking behaviours (which are more prevalent in women from better socio-economic backgrounds) are associated with increased maternal-foetal bonding. These include:

  • Receiving prenatal care: women who receive prenatal care are more likely to bond with their foetuses than those who do not;
  • Maintaining a healthy diet: women on a healthy diet have greater levels of maternal-foetal bonding than women on an unhealthy diet; and
  • Obtaining regular exercise: exercising women developing greater bonds with their foetuses than non-exercising women.


Race or ethnicity

Prenatal attachmentWomen from ethnic minorities are more likely than Caucasian women to have low socioeconomic and health status and thus it would be expected that they would also experience lower levels of prenatal attachment. However scientists have not yet produced strong evidence to determine whether or not race or ethnicity is associated with greater or lesser maternal-foetal bonding.


Age

Evidence suggests that age does not influence the extent to which a woman bonds with her foetus during pregnancy.


Number of previous births

Evidence suggests that women who have less maternal experience (those that have experienced fewer previous pregnancies) experience higher levels of prenatal attachment than women with more maternal experience (those with greater numbers of children).


Social and relationship support during pregnancy

There is evidence that social support from a relationship with a significant other, such as the father-to-be or the pregnant woman’s mother, influences maternal-foetal bonding. Studies have reported higher levels of maternal attachment in women with:

  • A positive and satisfying relationship with the father-to-be;
  • Attachment to a significant other characterised by high levels of trust; and
  • High levels of emotional closeness and intimacy in family relations.


Stage of pregnancy and awareness of the foetus

Prenatal attachmentAs a woman’s pregnancy progresses, she becomes more aware of her foetus, and the foetus starts to grow and move. It would therefore be expected that a woman would become more attached to her foetus as her pregnancy progresses and her awareness of the foetus increased.

A number of studies have reported that women develop a greater bond with their foetus as the pregnancy progresses. Some studies have also found that women experience higher levels of maternal-foetal attachment after they become aware of foetal movements.


Mood disorders

Mood disorders such as depression are highly prevalent during pregnancy and evidence suggests that that these conditions may affect as many women during pregnancy as they affect after childbirth (i.e. in the period when women experience postnatal depression). Evidence from scientific studies suggests that women who experience depression or other mood disorders (e.g. anxiety) during pregnancy, do not bond with their foetus as much as women who do not experience mood disorders.

 


High risk pregnancy

Some women have a higher risk for poor pregnancy outcomes than other women, for example women who have previously had a miscarriage or those who are pregnant with twins or triplets.

Studies have examined whether or not there are differences in the extent to which a mother bonds with her foetus in high vs low risk pregnancies. They have looked at bonding in:

  • Pregnant women who have previously had a miscarriage;
  • Pregnancies where the foetus has been diagnosed with a non-life threatening, congenital abnormality;
  • Pregnancies which were conceived through in vitro fertilisation; and
  • Multiple pregnancies – pregnancies in which the woman is carrying more than one foetus (e.g. twins or triplets).

None of the studies have found differences in the extent of maternal-foetal bonding between women with high risk pregnancies and those with normal pregnancies.


Substance abuse

Substance abuse during pregnancy is associated with poor maternal and infant outcomes (including an increased risk of low birth weight and impaired childhood development). Women who abuse substances during pregnancy may therefore find it more difficult to accomplish many of the tasks which are vital to bonding with their infants. These tasks include things like feeling love or compassion for the foetus or acting in the interests of the foetus and to ensure its safety.

No studies have directly compared maternal foetal bonding in substance abusing and non-substance abusing women. There are studies which have examined maternal-foetal bonding in different groups of substance users. These studies reported that substance users struggle to feel attachment with their foetus and experience guilt, uncertainty and concern throughout their pregnancies.


Ultrasound

Prenatal attachmentUltrasound technology enables women to view their foetus growing in their womb. It has been argued that ultrasound is likely to allow a woman to bond with the foetus earlier in the pregnancy than she otherwise would (e.g. women may otherwise only begin to feel attachment once they feel the foetus moving).

One study which examined the difference between having an ultrasound and not having an ultrasound reported greater maternal-foetal attachment amongst women who had ultrasound.

The type of ultrasound (eg two, three and four dimensional ultrasound) does not affect the extent to which a woman bonds with her foetus.

Research has found that 76% of men bonded with the foetus before an ultrasound.


Maternal serum screening and amniocentesis

A number of studies have examined the use of a variety of tests for foetal abnormalities, and whether or not the use of these tests is associated with greater or lesser bonding between a woman and her foetus.

One study examined differences in maternal-foetal bonding between women using maternal serum screening (testing the pregnant woman’s blood for signs of birth defects in her foetus), women using amniocentesis (testing the pregnant woman’s amniotic fluid for signs of birth defects in her foetus) and a group of women who used neither of these tests. It reported that women who used maternal serum screening were less attached to their foetuses than women who used amniocentesis or those who used neither test.

Strategies for increasing maternal bonding

Prenatal attachmentBonding with a foetus during pregnancy enhances the bond between the woman and baby after childbirth and has ongoing positive implications for the child’s development. Thus increasing the extent to which women bond with their foetuses would be expected to improve child development outcomes.

Despite this, few interventions which aim to increase maternal-foetal bonding have been evaluated.

There are a number of practices which are not scientifically proven but are popularly believed to increase the bond between a woman and her baby, such as talking to the foetus and massaging it in the womb.


Increasing foetal awareness

Interventions which have educated women about their foetus and encouraged them to bond with it, as well as those which have encouraged women to monitor the movement of the foetus, have been successful in increasing the bond between pregnant women and their foetuses.


Maternal massage

Interacting with the foetus in the womb is an indicator of maternal attachment. Questionnaires about maternal-foetal bonding ask women whether or not they do things like poke the baby or move it around in their womb. One might thus expect that interventions which encouraged women to massage or in other ways make physical contact with the foetus might increase maternal bonding. However, there have however been no studies conducted to prove this.


Talking to the foetus

Similarly talking to the foetus is a behaviour often investigated in questionnaires about maternal-foetal attachment, and talking to the foetus indicates a level of attachment or bonding to it. However, similar to maternal massage, interventions encouraging women to talk to their foetuses have not been assessed.

More information

PregnancyFor more information on pregnancy, including useful animations and videos see Pregnancy.
ParentingFor more information on various aspects of parenting, see Parenting.

 

References

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  3. Muller, M.E. Development of the prenatal attachment scale. West J Nurs Res. 1993;15(2):199-215.
  4. Yarcheski, A. Mahon, N. Yarcheski, T. et al. A meta-analytic study of predictors of maternal-fetal attachment. Int J Nurs Studies. 2009;46:708-15.
  5. Canella, B.L. Maternal-fetal attachment: an integrative review. J Adv Nurs. 2005;50(1):60-8.
  6. Armstrong, D. Emotional distress and prenatal attachment in pregnancy after perinatal loss. J Nurs Scholarship. 2004;34(4):339-45.
  7. Tsartsara, E. Johnson, M.P. The impact of miscarriage on women’s pregnancy specific anxiety and feelings of prenatal maternal-fetal attachment score during the course of a subsequent pregnancy: an exploratory follow-up study. J psychosom Obstet Gynaecol. 2006;27(3):173-82.
  8. Hedrick, J. The lived experience of pregnancy while carrying a child with a known, nonlethal congenital abnormality. J Obstet Gynecol Neonatal Nurs. 2005;34(6):732-40.
  9. Hjelmstedt, A. Widstrom, A. Collins, A. Psychological correlates of prenatal attachment in women who conceived after in vitro fertilization and women who conceived naturally. Birth. 2006;33(4):303-10.
  10. Damato, E.G. Predictors of prenatal attachment in mothers of twins. J Obstet Gynecol Neonatal Nurs. 2004;33(4):436-45.
  11. Freeman, A. The influences of ultrasound stimulates paternal fetal bonding and gender identification. J Doiagnost Med Sonog. 2000;16(6):237-41.
  12. Lawson, K.L. Turriff-Janasson, S.I. Maternal serum screening and psychosocial attachment to pregnancy. J Psychosomat Res. 2006;60:371-8.
  13. Nelson, L.J. Fazio, A.F. Emotional content of talk to the fetus and coping behaviours during pregnancy. J Infant Mental Health. 1995;16(3):179-91
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Dates

Posted On: 18 September, 2009
Modified On: 18 January, 2016

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