Prenatal Bonding through Attunement, Connection, and Engagement (ACEs) Mothers, Fathers and Siblings can practice and bond with the infant during pregnancy. Infants develop hearing and the capacity to bond earlier than you think! Check out the resources at the end as well as the information presented in the powerpoint. I provide Infant Massage Education, Sign Language and Baby Whispering to support the post partum experience to mothers, fathers, siblings and grandparents. Find me at marykaykeller.com

1. 2023 Infant Massage US Chapter Virtual Conference
The Science of Infant Massage: Prenatal Bonding through Attunement, Connection, and Engagement.
Mary Kay Keller, Ph.D., C.E.I.M., C.F.L.E.
Family Scientist and Ecological Researcher
Infant massage US Chapter - Board President
Chair of the Applied Family Science (accelerated) M.S. program at Wilmington University
Private Practice at marykaykeller.com

2. Introduction to Prenatal Bonding
❖ Infants' hearing develops at about 19 weeks in the pregnancy.
❖ By week 20 they can hear the mother's voice and the voices around the mother.
❖ Dr. Gehard Schoth is the leading expert on prenatal bonding. Dr. Schoth's exercises
involve the mother's relaxation and internal dialogue with the infant.
❖ However, the potential to increase prenatal bonding with fathers and siblings through
conversations with the infant has yet to be extensively explored.
https://www.schroth-apv.com/PrenatalBondingBA.html#eight

3. The Inception of Prenatal Bonding
Prenatal Bonding (BA) originates in the early 1990s, when Dr. Jenoe Raffai, Hungary did basic psychoanalytic
research with young psychiatric in-patients. Subsequently, Raffai developed this preventive method which helped
mothers to create a far deeper bonding with their unborn baby than conceivable until now. Mothers can as well
experience inner boundaries between themselves and their unborn babies, which is substantial for the emotional
maturation of the baby.
Raffai has provided more than 4,350 women with Prenatal Bonding (BA) in Hungary for more than 30 years. He
carefully documented the outcomes by observation and found that the method has a profound effect on pregnancy
and childbirth in general and on the development of the child’s personality (for details see figure 1). Raffai noted
that Prenatal Bonding (BA) is intended primarily as a facilitating process and may be applied by many professions
dealing with pregnancy, giving birth, and the postpartum period.
(https://www.schroth-apv.com/PrenatalBondingBA.html#two
This Family Scientist postulates that further research is warranted on how to support nurturing attunement,
connection, and engagement (positive ACEs) with Fathers and their infants and siblings.

4. The Method of Prenatal Bonding
❖ Prenatal Bonding (BA) starts at about the 20th week of pregnancy.
❖ The following setting is required: The pregnant woman lies on a comfortable mattress in a relaxed position
with the intention to focus on her inner perceptions, often induced by a relaxation process.
❖ Sessions start with centering on awareness of breathing, body feelings and emotions. By focussing on her
awareness the facilitator helps the woman to come more and more into contact with inner images, as known
from dreams. Images are seen to be symbolizations of words, body feelings and emotions.
❖ Gradually the images become more frequent, creating a flow of information and communication between the
mother and the unborn and this creates the “soul's cord.” Mothers find out how their babies are developing,
what they are feeling and needing, even about things that might be threatening or dangerous.
❖ It is much easier and more impressive for mothers, as well as less expensive, less invasive and less dangerous
for babies to gain information this way, as compared to ultrasound or medical tests. The most powerful effect:
Prenatal Bonding (BA) enables an inner dialogue with the unborn.
https://www.schroth-apv.com/PrenatalBondingBA.html#eight

5. Improvements in the Pregnancy
❖ Raffai recommends that the pregnancy and the development of the baby has a better outcome if a inner
separation between the pregnant woman and her own mother has taken place, which concerns the growth of
the pregnant woman from the role of the “daughter of her mother” to the “mother of her baby.”
❖ Prior to birth a second process of separation is facilitated by a number of explicit steps. For example, the
unborn is invited to say goodbye to the intrauterine world of his mother. Or the mother and baby speak
separately about their recollections during the pregnancy.
❖ The story, the mother tells, is partly or sometimes completely different to the experience, the baby tells. This
substantiates that the baby has its own mind, perceptions and experiences and makes its own decisions.
❖ At the end giving birth itself is simulated in a “final rehearsal” as a mental training. The mother-to-be is
invited to let go and open herself for a new step in her life, to explore inner obstacles to that new family
constellation. So inner hindrances that could have evoked a somatic tenseness during giving birth can be
eliminated a long time in advance.
❖ Depending on the starting point about 20 to 25 sessions are needed for the whole process of Prenatal Bonding.
https://www.schroth-apv.com/PrenatalBondingBA.html#eight

6. Effects on the Infant
❖ Babies who are connected through Prenatal Bonding (BA) feel themselves to be seen and heard at a deep
level. This makes them feel respected as they are and for their unique personality and situation.
❖ The existence of a kind of personality even during the pregnancy has not yet been taken in account until
Alessandra Piontelli's research on twins in utero by Ultrasound assessment in 1996.
❖ The very special communication between the mother and the unborn baby by the Prenatal Bonding (BA)
facilitation creates a situation of a "safe container" and in addition, the reflections of the baby’s feelings and
perceptions by the mother allows for the fetus to expand and express itself, so a profound self-esteem can
grow.
❖ The development of the brain is intensely stimulated and the interest and trust of the baby in the outside world
are empowered.
https://www.schroth-apv.com/PrenatalBondingBA.html#eight

7. THE IMPORTANCE OF FATHER ENGAGEMENT
❖ The important role the father has in the process of Prenatal Bonding (BA) should be emphasized.
❖ The research of Prenatal Bonding (BA) has proven that the unborn baby is aware of the father and significant
others as well. So the father also has the chance for an early bonding with the unborn. He is important to the
unborn baby right from the beginning and his role is to provide a “social womb” for his pregnant wife.
❖ This means creating a safe space for the pregnancy, allowing the mother to encounter the extensive changes in
her womb and body and widespread changes in her life as well.
❖ For that very reason the father is as well invited to participate in the sessions as often as possible.
❖ In addition the father is instructed to regularly have his time with the unborn baby e.g., by touching the womb
and singing lullabies or poems.
❖ In similar ways siblings are invited to contact the baby in the womb. Thus long before birth a counter wise
familiarity is built preparing the baby's arrival in the "new world.”
https://www.schroth-apv.com/PrenatalBondingBA.html#eight

8. 12 COMMON RESULTS OF PRENATAL BONDING (BA)
1. The mother’s inner perceptions are well attuned to her pregnancy and the unborn. She has access to her
own as well as to her baby’s wisdom.
2. Her natural female capabilities are empowered by Prenatal Bonding (BA) and create greater assertiveness
and security during childbirth.
3. Mother and baby become a good team experiencing less anxiety and pain.
4. There is less effort in giving birth and fewer complications.
5. The need for obstetrical interventions goes down significantly.
6. Caesarean sections are decreased substantially by Prenatal Bonding (BA), natural vaginal birth is usual.
Thus birth is safer and less costly.
https://www.schroth-apv.com/PrenatalBondingBA.html#eight

9. 12 COMMON RESULTS OF PRENATAL BONDING (BA)
7. Pregnancies treated by Raffai's method premature birth rates were less than 0.2 percent - as compared to an average of 9.2% in
Germany and 12% in USA. The general experience tells us that most babies after Prenatal Bonding (BA) are born within 5 days around
the due date, without any medical intervention.
8. Birth trauma is of low degree as indicated by natural, round shaped heads and little crying after birth, excessive infant crying is
unknown after Prenatal Bonding (BA).
9. The babies are curious about the world, emotionally stable, socially mature and have complete access to their personal potential.
10. There is less sleeping during daytime, but longer and deeper sleep at night, with few awakenings, so parents suffer less from sleeping
disorders.
11. Babies and children are easy to communicate and dealing with them becomes completely intuitive. Babies have a lot of self-awareness
and self-esteem. They are patient and understanding of their parent’s intentions and needs, as well as their own.
12. Postpartum depression is expected to become a thing of the past, as in the sample of over 6750 by Raffai and his colleagues facilitated
pregnancies worldwide far less than 1% postpartum depression was reported. On average about 19% of mothers experience postpartum
depression for several months after birth.
https://www.schroth-apv.com/PrenatalBondingBA.html#eight

10. Research Implications
❖ As full implementation of Prenatal Bonding (BA) can largely prevent manifest peripartum depression, this
represents fundamental progress for the pregnant woman, the unborn child, and the respective family.
❖ Furthermore post partum, the appropriate and loving care of the baby that arises from Prenatal Bonding (BA)
is the optimal way to prevent psychological illness in this new generation. It can be assumed that for the first
time, the taxonomy of the Jenoe Raffai method has succeeded in providing an appropriate psychodynamic
explanation for the nature of peripartum depression.
❖ On the basis of his 40 year treatment-experience as a psychiatrist and psychoanalyst, he ventured to propose
that Prenatal Bonding (BA) not only represents an excellent method of preventing mental illness.
❖ In addition, Prenatal Bonding (BA) may open up new dimensions in terms of both our understanding of major
psychiatric illnesses, and the chances of recovery from them.
https://www.schroth-apv.com/PrenatalBondingBA.html#eight

11. ATTUNEMENT
What is Attunement?
Attunement describes how responsive an individual is to another's emotional needs and is marked by language and behaviour which
reflect awareness of the individual's emotional state. It has its origins in the attachment theory that underpins nurture group practice
(Bennathan and Boxall, 1996.)
How do you practice attunement with infants and children?
1. Tune in to yourself. Listen more talk less.
2. Be aware of your own triggers and do not project them onto the infant or the child. They are separate human beings.
3. Read their cues. What does their body language look like?
4. Give them grace. Pause to consider why they are acting a certain way.
5. Practice active listening. This can be as basic as acknowledging what they have to say.
6. Reflect what you think is happening to them, then allow them to correct you and accept what they tell you. .
7. Understand them through healthy compassionate touch.
Further reading https://www.tandfonline.com/doi/abs/10.1080/13632752.2017.1331985?journalCode=rebd20

12. CONNECTION
What is human connection? Human connection is a deep bond that's formed between people when they feel seen and valued. During an authentic
human connection, people exchange positive energy with one another and build trust. Human connection makes you feel heard and understood and
gives you a sense of belonging.
Types of Human connection:
❖ Family relationships
❖ Friendships
❖ Acquaintances
❖ Romantic relationships
❖ Sexual relationships
❖ Work relationships
❖ Situational relationships (sometimes called "situationships")
Connecting with others is more important than you might think. Social connection can lower anxiety and depression, help us regulate our emotions,
lead to higher self-esteem and empathy, and actually improve our immune systems. By neglecting our need to connect, we put our health at risk.
https://cmha.ca/news/the-importance-of-human-connection/

13. ENGAGEMENT
Engagement is a process of attunement and connection within a family that “engages” in interaction and a variety of
developmentally appropriate activities.
Engagement within families changes over time according to the child’s developmental stages and needs within each
stage.
When Enagement is dynamic (applicable to the age and stage of development) and practiced over time it results in a
healthy adult to adult relationship that endures over the life time.
Ideally according to Ecological theory when the community and society embrace a healthy system of interaction
with families it supports the families and the children and society.
https://iris.peabody.vanderbilt.edu/module/fam/cresource/q1/p01/

14. How to ACE with the Baby in Pregnancy
❖ Bonding through touching the mothers stomach (with permission), talking to the mothers stomach calling to
the baby and sharing with the baby are all opportunities to attune to the baby, connect with the baby and
engage with the baby. Talk can become a game as well.
❖ Reading stories and singing to the baby are also appropriate activities to ACE with the baby.
❖ Develop family time around the mothers stomach.
❖ Be conscious that the infant can hear all conversations in range of the mother. It is important that conflict is
resolved or conducted respectfully for the infant’s emotional comfort.
❖ Encourage siblings to interact with the infants while in utereo, i.e., talking to the infant, games, reading
stories, etc.
❖ Be mindful violence on TV is not descernable by the infant. The infant hears everything you hear.

15. CONCLUSION
Further research should include exploring how negative conversations impact an infant during pregnancy,
❖ Traumatic events
❖ Domestic violence
❖ Racism
❖ Sexism
❖ Childism, etc.
Infant Massage has a milieu of benefits including supporting brain development, emotional and physical development. Premature
infants leave the NICU 6 weeks earlier than anticipated.
After birth:
Infant Massage is the perfect opportunity to attune, connect and engage (ACE) with infants via the mother, father and siblings.
Sign Language supports attunement, connection and engagement. Infants are less stress and so are the parents when the infant can
communicate basic needs such as changing diapers, being fed, held and comforted.
Baby whispering is the result of attunement to the infant’s needs by anticipating the next right response.
https://marykaykeller.com

16. REFERENCES
Cubeddu D. & MacKay T.
Pages 261-274 | Published online: 07 Jun 2017
https://www.tandfonline.com/doi/abs/10.1080/13632752.2017.1331985?journalCode=rebd20
Schroth G. (2013). Somatic Psychotherapy Today. Spring USA Body Psychotherapy Magazine Link: Somatic Psychotherapy Today,
Spring 2013
https://www.schroth-apv.com/Bilder/downloads/SOMATIC_PSYCHOTH_2013_G_Schroth_InterV_PBBA_40406.pdf
prenatal bonding (bindungsanalyse by raffai)* introduction
https://www.schroth-apv.com/pdf/Homepage%20PB_BA_englisch50525b.pdf
The IRIS Center Vanderbuilt University. The importance of family engagement.
https://iris.peabody.vanderbilt.edu/module/fam/cresource/q1/p01/

17. Additional Resources
Attachment and Bonding During Pregnancy https://www.nhsinform.scot/ready-steady-baby/pregnancy/relationships-and-wellbeing-in-pregnancy/attachment-
and-bonding-during-pregnancy
Bonding with your baby during pregnancy https://psycnet.apa.org/record/2022-71267-001
https://www.pregnancybirthbaby.org.au/bonding-with-your-baby-during-pregnancy
https://www.routledge.com/Prenatal-Bonding-Analysis-The-Invisible-Umbilical-Cord/Hidas-Raffai-Vollner/p/book/9781032346335
https://www.webmd.com/baby/features/bonding-with-baby-before-birth
https://www.zerotothree.org/resource/bonding-with-your-baby-before-birth/
https://www.lamaze.org/bonding-with-baby
Fathers Prenatal Bonding https://www.healthpartners.com/blog/tips-for-father-baby-bonding/
https://drjaywarren.com/new-dads-classes/
https://www.babycentre.co.uk/a1049630/10-ways-to-bond-with-your-baby-bump
Ideas for Prenatal Bonding https://www.verywellfamily.com/ideas-for-prenatal-bonding-2760162
https://www.spinningbabies.com/enhancing-prenatal-bonding/
https://www.bellybelly.com.au/pregnancy/bonding-with-your-unborn-baby/
https://www2.hse.ie/pregnancy-birth/baby-development-pregnancy-stages/baby-development/bonding-with-baby/
https://www.bringbackthevillage.org/prenatal-bonding/
Introduction to Prenatal Bonding https://link.springer.com/chapter/10.1007/978-3-030-41716-1_39
https://www.swedish.org/locations/first-hill-campus/center-for-perinatal-bonding-and-support
https://www.acog.org/womens-health/experts-and-stories/the-latest/bonding-with-your-newborn-heres-what-to-know-if-you-dont-feel-connected-right-away

18. Additional Resources
Prenatal Bonding https://birthful.com/podcastprenatalbonding/
https://www.pacificmft.com/prenatal-bonding
https://sakurabloom.com/blogs/news/prenatal-bonding
https://www.amazon.com/Prenatal-Bonding-Analysis-Gy%C3%B6rgy-Hidas/dp/1032346337
https://www.youtube.com/watch?v=Cr-YkEn-dyw
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239208
During Covid Pandemic https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-04272-9
Massage https://www.tinylove.com/pregnancy/prenatal-bonding/
https://journals.sagepub.com/doi/full/10.1177/21677026211049430
Pre-natal and post-natal bonding https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8175017/
Sixteen Ways to Bond with your Baby while pregnant https://americanpregnancy.org/healthy-pregnancy/while-pregnant/16-
ways-to-bond-with-your-baby-while-pregnant/
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-04367-3