Prenatal bonding: the bond born before birth

The bonding defines an intimate and unique relationship, a process of bond formation between parents and their baby creating a verbal and non-verbal dialogue, a physical, emotional, and hormonal experience. This type of bond has the peculiarity of being able to take place even before birth.

Prenatal bonding as a psychological process

Prenatal bonding can be understood as an active and transformative psychological process that takes shape over the course of pregnancy and through which parents begin to build an emotional relationship with the baby before birth by communicating with the fetus at different levels: physiological, behavioral, with visualization and through movements. Far from being a merely instinctive phenomenon, it emerges from the interaction between bodily changes, mental representations of the fetus, the parent’s attachment history, and the relational and cultural context. In this perspective, prenatal bonding represents a psychic space in which the child is progressively recognized as a distinct subject, although still imagined, laying the foundations for future postnatal interactions.

 

Theoretical references and study models

The classic theoretical models that have contributed to clarifying the multidimensional nature of this bond refer to various scholars. Cranley (1981) highlighted how prenatal bonding manifests through concrete behaviors of anticipatory care and protection of the pregnancy, while Condon (1993) emphasized the affective quality of the relationship, introducing the concept of emotional involvement as the core of the prenatal bond. These contributions have had a significant impact not only theoretically but also on the development of clinical instruments capable of making observable and evaluable an otherwise internal and subjective process.

 

Clinical evidence and relational implications

Empirical evidence suggests that prenatal bonding is not only an indicator of the parents’ emotional state but also a potential mediator between prenatal psychological well-being and the quality of postnatal interactions. A solid prenatal bonding has been associated with greater parental sensitivity, a readier ability to respond to infant cues, and an early relationship characterized by greater affective attunement. Conversely, conditions such as prenatal depression, high anxiety, high-risk pregnancies, or previous traumatic experiences related to birth can hinder bond construction, favoring poorly integrated or markedly defensive representations of the child.

 

Prenatal bonding as a support intervention

From an applied point of view, prenatal bonding is configured as a valuable opportunity for accompaniment and support during pregnancy. Practices oriented towards fostering presence, listening to the body, contact with the child, and attention to the sensations and emotions related to the wait have proven particularly effective in strengthening the prenatal bond, especially in times of major change or vulnerability. These pathways can be naturally integrated into various prenatal care settings and therefore in birth preparation courses, family clinics, and birth centers, enhancing collaboration between the various healthcare figures involved in the care and treatment of women during pregnancy.

 

A dynamic and embodied process

In this perspective, prenatal bonding is not understood as a result to be achieved, but as a living and dynamic process, which is built day after day and can be supported through simple targeted practices. Observation and accompaniment of this process favor the creation of spaces of greater awareness and trust, supporting a more harmonious relationship with the product of conception, the future child, from the earliest stages of life. Investing in prenatal bonding means taking care of a particularly fertile moment of development, where even small daily gestures can generate positive and lasting effects on the well-being of the parent–child dyad and laying the right foundations for the triad: mother, father, and child (Fig. 1).

 

Evidence from biomedical sciences and developmental neuroscience shows how maternal well-being, the perception of calm and safety, and the ability to find bodily balance during pregnancy contribute significantly to the maturation of the fetal nervous system and the regulation of the main stress response systems. In this context, prenatal bonding is configured as a deeply embodied experience, passing through the body, breath, and relationship, creating a more stable, welcoming, and favorable intrauterine environment for the development of the fetus during endogestation.

Neurobiological foundations of prenatal bonding

Numerous studies have also highlighted that the maternal emotional state, the level of perceived stress, and the quality of psychophysiological self-regulation during pregnancy positively influence the regulation of the hypothalamic–pituitary–adrenal axis, supporting a more harmonious functioning of the neuroendocrine systems involved in the stress response. This early regulation represents a key element in predisposing the fetus to postnatal emotional regulation, favoring a greater capacity for adaptation, emotion management, and interaction with the environment after birth. In this perspective, prenatal bonding cannot be considered exclusively as an affective or symbolic experience, but as an integrated process, mediated by neuroendocrine, autonomic, and relational mechanisms, which actively contributes to supporting the child’s well-being and development over time.

 

Prenatal mindfulness practices oriented towards bonding

Therefore, body and breathing awareness practices take on a role of particular clinical and preventive relevance. The experiential sequence described here, when analyzed on a scientific level, configures a structured prenatal mindfulness intervention oriented towards bonding, with potentially measurable effects on the regulation of the maternal autonomic nervous system, on stress modulation, and on the quality of the prenatal mother–child relationship. Such practices are easily transferable to the obstetric context and can be integrated into birth preparation courses or personalized encounters recommended by the Italian National Institute of Health in the Update of the second part of the Guidelines on Physiological Pregnancy year 2025.

 

Posture, safety, and neurophysiological regulation

From a neurophysiological point of view, assuming a stable, relaxed posture symmetrically supported on the ground represents the first regulatory element. A posture that promotes a sense of balance and bodily support activates the parasympathetic nervous system, in particularly through the ventral vagus nerve, as described by polyvagal theory. Conscious perception of body support points increases the sense of internal security and interoception, reducing the sympathetic over-activation frequently associated with prenatal anxiety.

The intentional relaxation of shoulders, arms, and facial muscles performs a bidirectional function: on the one hand it reduces peripheral muscle tension, on the other it sends afferent signals of calm to the limbic centers, contributing to the modulation of amygdala activity. Even the slight smile suggested in the practice takes on a relevant neurobiological value: activation of the zygomatic muscles stimulates neural circuits associated with positive emotions, favoring endogenous affective regulation.

 

Breath, co-regulation, and intrauterine environment

Conscious breathing represents the second pillar of the intervention. Observing the breath, without control or force, constitutes a practice of focused attention with direct effects on heart rate, heart rate variability, and cortisol levels. The spontaneous slowing of exhalation, often observable during practice, indicates an increase in parasympathetic dominance, associated with a state of alert calm and mind-body integration.

From a fetal point of view, the reduction of maternal cortisol and greater stability of heart rate contribute to creating a more predictable intrauterine environment, facilitating the maturation of fetal self-regulation systems. In this sense, maternal breathing (inhalation and exhalation) becomes a true channel of shared biological regulation.

 

Imagination, mentalization, and relationship

Another central element of prenatal bonding is represented by the use of attention and mental images. Imagining the baby’s face, their smile, or future interactions constitutes a process of prenatal mentalization. Affective neuroscience demonstrates that such representations activate overlapping neural circuits to those involved in real interaction, particularly in the medial prefrontal, limbic, and insular areas. This process favors the construction of a coherent internal representation of the fetus, the future child, considered a significant predictor of postnatal maternal sensitivity.

 

Presence, somatic dialogue, and reciprocity

The feeling of “ease” that emerges from the practice is not to be understood as simple relaxation, but as a state of psychophysiological integration in which the body is perceived as safe, attention is stable, and the emotional experience is tolerable and fluid. In pregnancy, this state takes on a relational dimension: through mechanisms of biological co-regulation, the fetus responds to variations in maternal autonomic tone, implicitly learning emotional regulation patterns.

The letting go of thoughts, fears, and tensions reduces cortical ruminative activity and favors access to states of embodied presence, which constitute the fundamental ground for the experience of the bond.

Finally, grounding in the present moment represents the relational space within which prenatal bonding can fully develop. From a neuroscientific point of view, conscious presence reduces the dysfunctional activity of the Default Mode Network (brain neural network active during the state of mental rest, and involved in various cognitive processes) and increases connectivity between the prefrontal cortex and the limbic system, facilitating more flexible emotional regulation. The recognition of fetal movements accompanied by conscious breathing configures a primary form of mother–child somatic dialogue, based on rhythm, attention, and reciprocity.

 

Conclusions

These prenatal bonding practices represent clinically grounded tools, easily applicable and with high preventive value. Transmitted by the midwife, they not only support maternal emotional well-being but also actively contribute to building a favorable relational and neurobiological environment for the child’s development, making prenatal bonding a concrete, experiential, and transformative process and prepares for postnatal bonding during exogestation.