Arch Womens Ment Health (2010) 13:449451

DOI 10.1007/s00737-010-0152-8

SHORT COMMUNICATION

Definitions matter: if maternalfetal relationships

are not attachment, what are they?
Judi Walsh

Received: 11 August 2009 / Accepted: 17 January 2010 / Published online: 9 March 2010
# Springer-Verlag 2010

Abstract Since Cranley's conceptualization in 1981, which

produced a useful measure to investigate the construct,
maternalfetal relationships have most often been referred
to as maternalfetal, antenatal or prenatal attachment.
However, critical analysis of the literature suggests that this
relationship is not an attachment relationship at all, as
Bowlby and Ainsworth first defined it, but a multi-faceted
construct guided instead by the caregiving system, the
reciprocal partner to the attachment system, which evolved
to provide care and protection.
Keywords Maternalfetal attachment .
Prenatal attachment . Caregiving . Fetal representations .
Relationships . Pregnancy

Why are maternalfetal relationships not attachment?

Bowlby's original definition of attachment was to describe
one half of the childparent bond, whereby the child seeks
care from someone designated better able to cope: someone
older and wiser (although, of course, this perception is not
always accurate). The attachment system and its behaviors
develop from a genetic bias which interacts with the
environment to produce behaviors which will, in response
to real or perceived stress or danger, promote proximity and
contact in order to maximize physical and psychological
protection and security. The attachment behavioral system
is shaped by cognition, affect, and experiences of interactions with the caregiver (Cassidy 2008). In addition, the
J. Walsh (*)
School of Social Work & Psychology, University of East Anglia,
Norwich, Norfolk NR4 7TJ, UK
e-mail: judi.walsh@uea.ac.uk

child also has a number of other behavioral systems which

interact with the attachment system. One of these is the
exploratory system, in which the child uses the attachment
figure as a secure base from which to explore the world
(Ainsworth and Bell 1970). The attachment system supports the exploratory system: a securely attached infant can
explore the world, safe in the knowledge that their
attachment figure will provide comfort and security if
needs be (Cassidy 2008).
Because the substance of maternalfetal relationships
deals with the development of feelings of love and
protection, and these relationships are a strong emotional
tie, it seems intuitive to want to refer to them as attachment,
as a generation of researchers has done (e.g., Cranley 1981;
Mller 1992; Condon 1993). However, attachment behaviors are essentially about eliciting care from others. Bowlby
himself suggested that there is a strong casefor restricting the term attachment to the behaviour typical of the child
to parent and the behavioural system responsible for it, and
to avoid using it to describe the complementary behaviour
and behavioural system of the parent (Bowlby 1982:377).
This complementary behavioral system is known as the
caregiving system.
If the research on maternalfetal relationships did not
come from Bowlby's and Ainsworth's conceptualizations of
attachmentcaregiving bonds, then referring to the concept
as attachment would not be problematic: the term is not
the exclusive property of attachment theorists and researchers in this tradition. However, because theoretical ideas
about the construct of maternalfetal relationships are
rooted in this work, using the term attachment to describe
this bond is misleading. Some might even say that using the
term relationship or bond is misleading, if those terms
refer to a situation where two partners construct programmes of dyadic interaction that are shared with the

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other (Bowlby 1982:376). It is not that attachment is

simply the preserve of children and caregiving the preserve
of adults either. Recent research has demonstrated that
attachment can apply to adult pair bonds as well as child
parent relationships (e.g., Hazan and Shaver, 1987). In adult
relationships, partners are both careseekers and caregivers.
For example, we may see attachment behaviors if partners
are separated, particularly where a partner dies, or we may
see caregiving behaviors in response to a partner's distress.
However, even in adult relationships, the premise remains
the same: attachment is about careseeking as compared to
caregiving. Mothers do not (usually) seek care from their
unborn children.
Although it may seem like quibbling over semantics,
making the distinction between attachment, caregiving, and
other systems is important for our interpretation of research
exploring how mothers (and fathers) feel about their unborn
children and what might guide the development of these
feelings or representations. It is also important to utilize the
most useful theoretical framework to guide intervention and
support to maximize subsequent development and experience
for parents and their children. A number of studies in the
parentalfetal literature have begun to make important
distinctions between attachment, caregiving, love, and other
kinds of relationships (e.g., Van den Bergh and Simons 2008;
Seimyr et al. 2009), but these have not always elaborated on
what the prenatal relationship is if it is not attachment.

Is the caregiving system the basis of maternalfetal

relationships?
There is an increasing sense within the literature that the
terminology of attachment is not accurate in describing how
parents feel about their unborn children, and that instead
what is driving these representations, feelings, and attitudes
is the parental caregiving system. The caregiving system
has been described by George and Solomon (Solomon and
George 1996; George and Solomon 1996, 2008) as a
behavioral system reciprocal to the attachment system. The
main function of the caregiving system is to provide
protection, comfort, and care for a child, and according to
Solomon and George (1996), has its roots in an individual's
early attachment experiences, is consolidated in adolescence, and changes during the transition to parenthood. As
George and Solomon (1996, 2008) make clear, the two
behavioral systems of attachment and caregiving are
distinct, and although the adult caregiving system is based
on the early childhood attachment experiences of that adult,
it is also informed by hormonal changes and actual
caregiving experiences, making it the mature transformation of the attachment system (George and Solomon
1996:202). Studies investigating maternalfetal attach-

J. Walsh

ment seem to include these caregivingbased concepts

within their discussion of the underlying substrate of the
maternalfetal bond. For example, Sandbrook and
Adamson-Macedo (2004) found within their qualitative
study that the overwhelming feeling their sample of
pregnant women had was not love, which has formed
the basis of other conceptualizations of prenatal attachment
such as that advanced by Condon (1993), but an innate
desire to protect (Sandbrook and Adamson-Macedo
2004:169). Similarly, Shieh et al. (2001) identified three
dimensions of prenatal attachment, including altruistic
attachment which is explained by Yarcheski et al. (2008)
as the desire to protect the fetus. Although these studies
appear to be describing behaviors motivated by the
caregiving system rather than the attachment system (which
would instead promote the seeking of protection when an
individual is under threat rather than the providing of
protection to prevent threat to the fetus), they have still
conceptualized the bond as attachment.
Discrepancies in terminology make it difficult to synthesize
findings, but there is much to be gained from looking across
different disciplines in order to increase our understanding of
the parentalfetal bond. Parallel literatures in developmental
psychology and relationships science have begun to explore
parental views of the fetus from a caregiving perspective, but
these are not often referred to in the more recent maternalfetal
relationships literature. For example, George and Solomon
(2008) have reviewed research on the transition to parenthood
within the field of developmental psychology, and have
identified that the caregiving system goes through a qualitative shift in pregnancy. They suggest that this shift impacts at
a hormonal and neurological level on the maternal circuit
(Kinsley et al. 1999) and on the cognitions and emotions
connected to parenting and relationships, where an increase in
anxiety might be crucial in the reorganization of the self to
see oneself as a caregiver for a child (George and Solomon
2008). Investigating the concurrent validity of the constructs,
other psychology studies have found that representations of
the fetus are more strongly related to maternal representations
of the self as caregiver than they are to predictors of infant
attachment like the ability to comment appropriately on
internal mental states at 6 months (Huth-Bocks et al. 2004;
Arnott and Meins 2008). These findings lend weight to the
idea that where some studies have used the term prenatal
attachment, much of the theoretical framework actually
reflects prenatal caregiving rather than attachment. These
theoretical commonalities are sometimes masked by the
different terms and conceptualizations used.
Calling for greater clarity and distinction with regard to
the terminology used to describe maternal (and paternal)
views of the fetus is not to denigrate the work that has
already contributed to our understanding. Within the
literature on what has been termed prenatal attachment,

Maternalfetal relationships

we have discovered much of what underlies this complex

relationship, such as the importance of distinguishing views
of the fetus from views of the pregnancy (Condon 1993).
But the application of our understanding can be hindered by
difficulties of definition. The use of different terminology
by different disciplines, researchers and studies may, of
course, reflect a different underlying conceptualization of a
similar construct, or a different construct entirely, but this
seems not to be the case for parentalfetal relationships:
most researchers appear to be working with ideas that are
conceptually, if not theoretically, similar. Issues of measurement can further complicate our understanding because
the underlying theoretical framework, development of
measures, and resulting confirmation of factors or facets
of a concept are inextricably linked, and each available
instrument for prenatal relationships appears to measure
something different, with a different underlying factor
structure (Yarcheski et al. 2008). It is because of these
issues that researchers in all disciplines have called for
greater clarity in the conceptualization, definition, and
measurement of the prenatal bond, in order that we are
better able to understand and promote optimal relationships
for parents and children alike.
There is a great deal more work to be done to further
explore our understanding of parentalfetal relationships,
how they develop, and how they change. It is likely that the
parentalfetal bond is much more complex than to be the
product of one system alone, so perhaps, even conceptualizing it as the beginnings of the caregiving system is overly
simplistic. Affective components are likely to play a role:
we know that parents can develop intense and complex
feelings about their unborn children, and this strong
emotional tie can be demonstrated in reactions to perinatal
bereavement (Badenhorst and Hughes 2007; Brier 2008).
But precise definitions are critical, and the caregiving
system provides a useful framework to guide theory and
research. We do not yet have a full understanding of what
parentalfetal relationships are, but it seems that we can at
least venture as to what they are not.

Conclusion
Research investigating the nature of the parent's tie to the
unborn child has, in the last two decades, contributed much
to our understanding of the concept. This research has often
been conceptualized as prenatal attachment, but it appears
that this tie has more in common with the caregiving
system than the attachment system. Thus, we may consider
the caregiving system to provide a useful theoretical
framework in which to interpret past work and guide future
work, to provide a starting point to capture the complexity
of parentalfetal relationships, how they differ between

451

mothers and fathers, how they develop, and what impact

they have on subsequent family development.
Acknowledgements The author would like to thank Ben Marshall and
Abigail Millings for their assistance and the two anonymous reviewers for
their very helpful comments on an earlier draft of the paper.

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