Promoting Maternal-Fetal Attachment

The following is a student blog post by Amanda Hopping-Winn

Promoting Maternal-Fetal Attachment

Maternal-Fetal Attachment

Maternal-fetal attachment (MFA) defines the relationship between a pregnant woman and her fetus and is demonstrated through the expression of her feelings and behaviors (1). It often begins when the woman learns that she is pregnant, and increases dramatically as she feels the baby grow and move within her body (2). Through a continuously evolving thought process, the woman develops an internal representation of her unborn baby, and begins the complicated psychological task of identifying as a mother, while simultaneously accepting the fetus as a unique individual who is separate from her. (2). Often, this process is enjoyable, providing a mixture of fantasies and thoughts about the realistic expectations of pregnancy and impending parenthood (3).


Interventions to Promote Maternal-Fetal Attachment

Women can experience positive levels of attachment to their unborn fetuses, regardless of their health status or behaviors (4, 6). MFA typically strengthens over the course of a pregnancy, but it can also be promoted through conscious intention and action. Professionals can utilize multiple interventions to increase maternal-fetal attachment in any population.

·        Provide Health Care Advocacy

Women from marginalized communities who are recipients of free or subsidized health care often have larger distances to travel on public transportation, and are more likely to be whisked through their prenatal appointments with proportionally less physician time (7, 8). With limited time, emphasis is often placed on measuring levels of prenatal risk, rather than on instructing mother about her developing baby. Mothers could benefit from assistance in planning their appointments, accessing transportation, and negotiating childcare logistics, so that they are able to utilize medical interventions (9).

·        Offer Information on Fetal Development

Physicians, nurses, midwives and other clinical personnel can provide women with detailed information about their baby’s development and growth. Verbal and written information can offer weekly or trimester-specific facts about how the baby is developing, and suggestions on how to interact with the baby.

·        Assist Mother in Detecting Fetal Placement and Movement

One of the foremost methods of promoting MFA is to teach women to detect fetal movement (10, 15). By counting kicks and movements, women naturally increase the amount of time they are actively paying attention to the fetus. Additionally, women can learn to detect the placement of the fetus by stroking and palpating their abdomen, taking note of where they imagine the baby’s body parts are located (5, 10, 15). This particular intervention can also increase the partner’s level of involvement, as the movement and activity can be recognized externally (11).

·        Encourage Positive Internal Representation

In order to increase the mother’s capacity for an enhanced sense of her baby, she should be encouraged to talk to the fetus and assign it a pet name.  Directing the mother to verbalize what she believes her baby might be feeling, or designing games where she fantasizes about the baby’s emotions, can promote maternal satisfaction while interacting with the fetus (12). Learning the baby’s gender often reinforces MFA, as mothers report this intensifies their conceptualization of the babies.

·        Educate about Fetal Sensitivity to the Maternal Experience

The mother can be advised about how clearly the baby responds to her voice, and moves more in response to her voice than any other (14). More information about fetal sensitivity to the mother’s emotions and health can include educating the mother about baby’s sensitivity to maternal stress. Reminding the mother that the baby eats what she eats, and feels what she feels, can greatly alter and deepen the mother’s perception of the fetus (14). Often, as mothers learn the extent to which their circumstances affect the experience and development of their baby, they feel much more connected to the fetus. This increases maternal feelings of protectiveness towards the fetus.

·        Plan Ahead for Infant Feeding

Many women find that their level of fetal attachment increases as they begin to contemplate breastfeeding (12). Breastfeeding is a great opportunity for bonding with a new baby, and thinking about future bonding activities can greatly promote MFA.

·        Assist Mother in Building a Support System

Studies indicate that the mother’s feelings of being supported by her social network greatly influence her ability to engage more with her fetus. It is not the number of people in her social support network, but rather her perceived level of support specifically related to her pregnancy and upcoming role as a mother. Discussing with the mother how she might advocate for her needs within her social network, as well as adding supports to her network, can increase her feelings of satisfaction with her supports, lower her anxiety, and increase her ability to be present with the fetus (13).  

·        Connect Mother with Mental Health Services

The maternal/child health community is perfectly situated to connect mothers to mental health services. Since mothers who are experiencing depression, anxiety, or various other mental health concerns are at heightened risk for the development of low MFA and postpartum depression, these mothers should be referred for therapeutic services and supports.


The promotion of maternal-fetal attachment occurs both naturally and in concert with respectful, constructive clinicians and health workers. All women, regardless of age, ethnicity, health status and behavior patterns, are apt to experience shared changes, rates and shifts in MFA. With enhanced MFA, mothers and infants can begin life together in the most productive way possible.



  1. Alhusen, J. (2008). A literature update on maternal-fetal attachment. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 37(3), 315-328. doi: 10.1111/j.1552-6909.2008.00241.x
  2. Cranley, M. (1981). Development of a tool for the measurement of maternal attachment during pregnancy. Journal of Nursing Research, 30(5), 281-284. Retrieved from
  3. Condon, J. (1993). The assessment of antenatal emotional attachment: development of a questionnaire instrument. British Journal of Medical Psychology, 66, 167-183. Retrieved from
  4. Lindgren, K. (2001). Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy. Research in Nursing & Health, 24, 203-217. doi: 10.1002/nur.1023
  5. Muller, M. (1996). Prenatal and postnatal attachment: a modest correlation. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 25(2), 161-166. doi: 10.1111/j.1552-6909.1996.tb02420.x
  6. Siegel, K., & Schrimshaw, E. (2001). Reasons and justifications for considering pregnancy among women living with HIV/AIDS. Psychology of Women Quarterly, 25, 112-123. Retrieved from
  7. Institute of Medicine, Shaping the Future. (2002). Unequal Treatment: What Healthcare Providers Need to Know about Racial and Ethnic Disparities in Healthcare. Retrieved at
  8. Institute of Medicine, Shaping the Future. (2002). Unequal Treatment: What Healthcare Providers Need to Know about Racial and Ethnic Disparities in Healthcare. Retrieved at
  9. Bunton, S., & Seaton, R. (1999). Health care participation of perinatal women with HIV: what helps and what gets in the way? Health Care for Women International, 20, 563-578. doi: 10.1080/073993399245467
  10. Brandon, A., Pitts, S., Denton, W., Stringer, C. A., & Evans, H.M. (2009). A history of the theory of prenatal attachment. Journal of Prenatal & Perinatal Psychology & Health, 23(4), 201-222.Retrieved from
  11. Lerum, C., & LoBiondo-Wood, G. (1989). The relationship of maternal age, quickening, and physical symptoms of pregnancy to the development of maternal-fetal attachment. Birth, 16(1), 13-17.
  12. Cannella, B. (2005). Maternal-fetal attachment: an integrative review. Journal of Advanced Nursing, 50(1), 60-68. doi: 10.1111/j.1365-2648.2004.03349.x
  13. Condon, J., & Corkindale, C. (1997). The correlates of antenatal attachment in pregnant women. British Journal of Medical Psychology, 70, 359-372. DOI: 10.1111/j.2044-8341.1997.tb01912.x
  14. DiPietro, J., Costigan, J., & Gurewitsch, E. (2003). Fetal response to induced maternal stress. Early Human Development, 74, 125-138. doi:10.1016/j.earlhumdev.2003.07.001
  15. Narita, S., & Maehara, S. (1993). [The development of maternal-fetal attachment during pregnancy]. Journal of Japan Academy of Nursing Science, 13(2), 1-9. Retrieved from



Amanda Hopping-Winn, a Master’s level social worker, has spent the past 6 years directing the National Abandoned Infants Assistance Resource Center out of UC Berkeley. There, she trained clinicians how best to support families affected by substance use and/or HIV with young children in the home. Amanda is thrilled to be pursuing her passion in the birth world currently as a postpartum doula and eventually as a midwife.


All student article posts are the expressions of the student who wrote them. We do not take responsibility for the content, these are done as part of the educational experience and we try to encourage students to use their voice and learn to connect with clients through blogging and social media.
To learn more about our educational programs please visit

Sign up for exclusive offers, webinars and news from Birth Arts International.
First Name: Last Name: