Chapter 1 – When Their Well-Being Begins

You become parents long before the birth of a child. It happens when you discover you’re expecting a baby — and sometimes even earlier, when the desire, even just the thought, of having a child first arises. And it’s right there, in the mind and heart of a mother and a father, that the idea of the little one takes shape — among imagination, dreams, and plans. Pregnancy is a period of deep reflection, allowing parents to lay the foundation of the attachment bond with their baby.

For some, it’s a slow, almost imperceptible process; for others, an overwhelming emotion. Fantasies and emotions are an integral part of the journey. Taking time to listen to the baby’s movements in the womb, imagining what they’re doing, whether and how they’re moving, even what their emotions or mood might be — this isn’t just daydreaming: it’s already a way of connecting, using the waiting period to begin getting to know them, so that birth is not a meeting, but a reunion. This process of listening, imagining, and communicating — through touch and body posture — is known as prenatal bonding.

The English word “bonding” means “connection, attachment” and refers to a process — partly conscious, partly unconscious — through which the baby and parents form an intimate relationship. It’s been shown that building a strong bond with the unborn baby supports attachment between the baby and their parents after birth, and reduces the risk of postpartum depression for the new mother (1).

In 1958, English psychoanalyst Donald Winnicott was one of the first to highlight how the parent-child relationship begins before birth. According to Winnicott, the mother, already in the early months of pregnancy, enters a psychological state he called primary maternal preoccupation — a condition of heightened sensitivity, which he described as a temporary withdrawal that leads the woman to prioritize her baby and tune in to their needs even before birth.

Psychoanalyst John Bowlby, in 1969, recognized the connection between the quality of the mother-child relationship during pregnancy and the healthy development of the individual (2).

Among the most well-known studies, that of M.S. Cranley (3) showed how during the nine months of gestation, both the psychophysical development of the fetus and the transformation of the woman into a mother occur. For the woman, this means becoming aware of a new identity linked to her new role; for the fetus, forming their own; and for both, building a relationship — the first relationship — which Cranley called prenatal attachment, directly linked to postnatal attachment. According to her, the quality of prenatal emotional investment influences the course of pregnancy and birth, the parent-child attachment relationship, and the child’s psychological development (4). But what does prenatal attachment actually involve? It refers to the mother’s emotional and cognitive representations of her baby in the womb — something some researchers have tried to measure and classify.

Cranley proposed a measurement model, the Maternal-Fetal Attachment Scale (MFAS), which includes five dimensions:

• Role-taking (e.g., “I imagine myself taking care of my baby”),
• Differentiation of self from the fetus (e.g., “I like watching my belly move when my baby kicks”),
• Interaction with the fetus (e.g., “I talk to my baby while I stroke my belly”),
• Attributing characteristics to the fetus (e.g., “I imagine what my baby will be like”),
• Giving of self (e.g., “I adopt virtuous behaviors I didn’t have before pregnancy, thinking of the baby’s well-being”).

Other researchers (Müller and Condon) proposed variations of this scale, including factors such as the influence of the woman’s relationship with her own mother, and the thoughts and feelings she has toward her baby. According to Müller, prenatal attachment is “the unique and affectionate relationship that develops between a woman and her fetus,” which she attempted to measure through the Prenatal Attachment Inventory (PAI) — a tool that assesses various aspects of the mother-fetus relationship: interaction, communication, expressions of love, caregiving readiness, projections for the future, and sharing pregnancy milestones with others, starting with the baby’s father (5).

In recent decades, with the rise of increasingly sophisticated ultrasound technology that allows the mother to see a real-time image of her baby, research on the mother-fetus relationship has accelerated. These studies now also take into account social, geographic, and cultural variables, yet they all underscore the same point: the importance of investing in a quality relationship with the baby during pregnancy.

It is now well established that nurturing and supporting prenatal attachment means building a solid foundation for the mother-child relationship, which will be strengthened at birth and in the early years of the child’s life (6).