Bonding Analysis: Bonding-related Support in Pregnancy to Promote Prenatal Bonding

Midwifery Today, Issue 144, Winter 2022.
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All my life I had been interested in psychology because I wanted to know what made me suffer, what makes people in general suffer, and how suffering can be alleviated or even healed. Finally, I discovered the new field of prenatal psychology. “The secret life of the unborn child,” as Professor Thomas Verny so brilliantly described, offered satisfying answers to my manifold questions that any other school of psychology had not been able to so far. I continued to read every book available on this science until the day in 2013 when I discovered Dr. Jenö Raffai’s book about the significance not only of prenatal life in general, but particularly of prenatal bonding.

I contacted Dr Raffai and offered to organize his next training course in Cologne, Germany. Part of the training consisted of so-called self-experience exercises, where we were guided into a deep state of relaxation and sent off on a journey into our mothers’ wombs. That changed my life! I discovered that my mother had lost a sibling of mine—a twin boy—in the middle of the first trimester. Raffai explained to us what that experience signifies for the surviving twin: it is extremely traumatizing.

Horizons of understanding opened for me and I finally found the explanation for why I fell into a dark hole at the beginning of my first pregnancy. I had wanted a child; I was very happy when the pregnancy started until the moment my mother—who lived in Germany—called me to tell me that my beloved dog had died. (I lived in Paris at that time with my husband.) For three days I was crying so much that I became weak and had to stay in bed. My husband was worried and brought home a puppy. I slowly calmed down and was able to go through the rest of the pregnancy without further problems. During Bonding Analysis (BA) training, I finally found the cause of my extreme sadness: it was not the death of my dog but unconsciously I was mourning my twin brother. Later, when I set out to develop a script for teaching bonding analysis, I dedicated a long chapter to the subject of twin loss in utero.

After having been certified as Prenatal Bonding Analyst in 2016, I decided to offer a training course especially adapted to the knowledge and skills of midwives and generally to all professionals dealing with pregnancy and birth process. I have been teaching it for years now and also accompany pregnant women with this amazing method.

My Method of Bonding Analysis

Bonding analysis is still relatively new and not yet known worldwide. This method enables pregnant women to experience a different kind of pregnancy and birth process and, most importantly, shows them how to get into mental and emotional contact with their unborn baby—in other words, how to create a deep and intense bonding. I will later explain briefly why prenatal bonding is of such great importance.

Two Hungarian psychoanalysts, Dr. György Hidas and Dr. Jeno Raffai—with Hidas as Raffai’s training analyst—developed BA. They started their research and work in the 1980s, incorporating the findings of prenatal psychology and other scientific disciplines into their work. For example, one of the latest, most significant discoveries was so-called cell memory, identified by molecular biologist Bruce Lipton. Prenatal psychologists now call this pre-linguistic consciousness. As Professor Thomas Verny so brilliantly explains in his most recent book The Embodied Mind, prenatal experiences are stored in all of the baby’s cells and not only in the brain.

Hidas and Raffai who have always emphasized that BA is not only a method for preventing the transfer of trauma but also a tool for creating strong bonding in utero (Hidas and Raffai 2021). In my booklet “Practical Guide to Bonding Analysis,” I explain in more detail what kind of trauma might be transferred from mother to baby, as well as other factors hampering the prenatal baby’s healthy psychological development. These include influence of maternal stress, birth trauma, twin loss, implications of reproductive medicine, and epigenetic impacts.

Origin and Development of Bonding Analysis

The origins of BA go back to Dr Hidas and Dr Raffai’s therapeutic work with psychotic adolescents in Hungary in the 1980s. The psychoanalysts discovered that these mental disorders had been developed throughout the period they had spent in their mothers’ wombs. All the mothers who had suffered a severe loss during pregnancy and held on to their babies in such a way that—and I quote Raffai—“they completely lacked the conscious sensation of their own physical boundaries, which made it impossible for them to perceive themselves as autonomous, independent beings and to develop a self of their own.”(Hidas and Raffai 2021)

It became clear that the lack of self-awareness in these young psychotic patients was tightly linked to their mothers’ bonding problems. The emotional and mental state of pregnant women all through pregnancy, especially their bonding capacity and bonding quality, can have an enormous impact on the unborn baby and its physical and psychological health.

Consequently, these two psychoanalysts set out to develop a preventive method that would enable them to first “analyze” the woman’s bonding quality and capacity in order to improve and strengthen both. They would reveal the origins of existing bonding problems so that the pregnant woman could develop a healthy, stable, protective and supportive bonding relationship with her unborn baby during the nine months in the womb.

It took Hidas and Raffai a couple of years to develop BA further and to accompany pregnant women with their method. Raffai eventually began to teach BA and, together with Dr. Ludwig Janus, the renowned German prenatal psychologist, offered training courses in Germany.

Bonding Analysis represents a new approach to pregnancy and birth. According to Raffai, the major goals of BA are:

  1. Promoting a deep prenatal mother-baby bond
  2. Strengthening pregnant women on many levels
  3. Supporting the maternal maturation process.
  4. Preventing cesareans, because they are most traumatizing for the baby.
  5. Satisfying the unborn baby’s primary need to be accepted and loved, to be provided with affectionate care, to be given protection and, above all, to be securely attached (Hidas and Raffai 2021).

A baby who has experienced a secure attachment before birth is more capable of bonding with other people by resorting to prenatal experiences. The knowledge about the importance of prenatal life and experiences has not yet reached the general public. Because positive prenatal bonding experiences create the basis for stable psychological and physical health in adulthood, this method should be made widely available worldwide.

So, why is prenatal bonding so important, especially for the emotional development of the baby and even more so for the development of its brain?

A leading German neurobiologist and brain researchers, Dr. Gerald Hüther, explains the importance of prenatal experiences as follows: “During its first nine months, a child presumably learns far more than in the course of its entire later life, and what it has already learned before birth in terms of bonding experiences is obviously quite decisive for its later life.” (Hüther 2018) If a baby experiences secure bonding before birth, it is able to develop self-confidence very early on, which is followed by the perception of self-esteem. Through emotional and mental interactions with the mother, through the images and emotions she sends to her baby, the latter becomes aware of being perceived as an independent human being.

According to the findings of modern developmental psychology and especially prenatal psychology, a child’s personality is formed from conception on, throughout the nine months in the womb. The mother shapes the baby’s psychic and emotional development. The best tool to achieve that is to build a deep, intensive, positive, emotional bond by conveying reliability and trust, which will provide the unborn baby with a strong feeling of security and protection.

Raffai points out that babies whose mothers had bonding analysis were able to better self-regulate their affects and emotions, react more appropriately to stressful situations, and control negative feelings.

They acquire what Raffai called “psycho-social competence,” which means these babies are more empathetic toward their fellow beings. They develop self-confidence very early, so they feel quite comfortable exploring the world around them. Developing the ability to self-regulate affect requires repetitive, secure, sustainable bonding experiences.

How Bonding Analysis Is Structured Within its Application Procedures

The best time to start a bonding analysis is between the 12th and 17th week of pregnancy.

The Bonding Analyst and the pregnant woman usually meet once a week, if possible one the same day and same time. This is because, as Raffai explained, the baby gets used to this regularity, which becomes a fixed ritual. That way the mother conveys to her baby that she is reliable. The consultation sessions are called baby sessions.

Raffai developed a questionnaire the pregnant woman must complete before starting sessions. This questionnaire is a shortened version of the woman’s biography, which allows the bonding analyst to learn everything about the woman’s network of relationships, such as the kinds of relationships she has with her partner, her parents, her parents-in-law and her maternal and paternal grandparents.

Some midwives in my training courses have been uncomfortable with the word “analysis.” They were afraid they would have to deal with a lot of psychology when applying the BA method. However, it is not difficult to perceive bonding problems the pregnant women might have. The participants in my course learn how to interpret a woman’s answers and how to help her to solve bonding problems, difficulties, or blockages so that mother-baby bonding can develop smoothly.

Part of the baby sessions consists of guiding the pregnant woman into a state of deep relaxation, allowing her to tune in to her baby and establish a first mental and emotional contact with the baby. This takes place via what Raffai called inner dialogue, during which mother and baby exchange images, emotions, and even wordy dialogues. This interaction and connection works both ways. Raffai called this kind of communication “the umbilical cord of both souls,” which is the title of the only book he wrote that was translated from Hungarian to German (but unfortunately not yet into English).

The communication between mother and baby gets more intimate and deeper, so that at a very early stage of pregnancy the mother can learn how her baby feels in the womb, how it is developing, and what its needs are. Knowledge about the baby increases.

In the course of the sessions, the baby can also be prepared, for example, for upcoming medical interventions such as ultrasounds or gynecological exams.

About 4 weeks before the estimated date of birth, birth preparation sessions begin. Altogether six or eight sessions must be completed 10 days before the estimated date of birth. During these birth preparation sessions, mother and baby prepare for the upcoming physical separation and the birth process that they will manage together. Mother and baby say goodbye to each other in order to be reunited after birth.

To initiate and accompany this process of separation, Raffai has worked out specific instructions that the mother imparts to her baby.

In his book, Raffai discusses different communication channels between mother and baby, through which information flows back and forth: physiological/biological—physical—empathetic/intuitive—emotional/mental (Hidas and Raffai 2021). After having done some intensive research I added another channel which seemed to me the most probable to show how this inner dialogue works.

Much research about the behavior of brain waves in the state of deep relaxation has been carried out in the last few decades. One result showed that Alpha waves serve as a gateway to deep relaxation, supporting the visualization of inner images. If we go deeper into relaxation, our brain switches to Theta waves. Our unconscious mind is located in this area. It is highly probable that the baby’s Theta waves are tuned in the same way and that mother and baby meet on this level.

Another explanation for why inner dialogue functions is the fact that mother and baby share the same body.

Advantages of Being Accompanied with BA

  • BA can help a pregnant woman turn pregnancy and childbirth into a positive experience.
  • BA strengthens the emotional bond between mother and baby.
  • BA has a positive influence on breastfeeding.
  • Postpartum depression/baby blues almost never occurs (less than 1 %, compared to an average of 19%).
  • The caesarean rate is remarkably low.
  • Premature birth is only 0.2%, compared to the usual 9.2%.
  • The birth process is on average a lot easier and faster, less painful, and less likely to require peridural anesthesia or the use of obstetric means.
  • BA contributes to the psychological stabilization of a pregnant woman, reduces her fears and shows her, if needed, how to better cope with stress.
  • The pregnant woman undergoes a maturation process when accompanied by a bonding analyst.
  • Quoting Raffai: “In the course of the BA, the pregnant woman changes from still being her mother’s child to becoming her child’s mother.” (Hidas and Raffai 2021)

Benefits for the Baby

  • Babies whose mothers have been accompanied by a bonding analyst show fewer head deformities.
  • BA babies, in general, do not experience physical or emotional trauma.
  • Abdominal colic and crying spells occur much less frequently.
  • The same applies to sleeping disorders. BA babies sleep through the night and seem a lot more balanced and in harmony with themselves.
  • Psychomotor development progresses more quickly.
  • BA babies acquire strong social competence right from the start.
  • They self-regulate better.
  • They develop strong self-confidence, due to the prenatal bonding experience. (Blazy 2018)

Individuals for Whom BA is Suitable and Recommendable

  • Every pregnant woman, whether she has bonding problems or other difficulties in connection with her pregnancy.
  • Every woman who has experienced a dramatic birth or suffered from postpartum depression after giving birth.
  • Women who have had difficulty getting pregnant, for whatever reason. Special support is given to pregnant women in connection with reproductive medicine.
  • First-time mothers who are afraid to give birth.
  • Women who had twins or even multiples in their womb at the beginning of their pregnancy, but one or more of them died or slowly dissolved in the first trimester or later.
  • Those needing preparation for a planned caesarean.
  • Women who have experienced violence or abuse.

In my booklet “Practical Guide to Bonding Analysis,” you will find some impressive statistical data showing the effectiveness of BA. You will also find information about the correlation between bonding and brain development, how the baby experiences birth, the role of epigenetics in the transgenerational transfer of trauma, how to help pregnant women deal with prenatal twin loss or extreme stress, and how to help them to alleviate the impact of artificial conception.

In addition to the BA elements I work with, I have developed a concept to further help pregnant women gain confidence in their strengths and capacities. I call this concept self-parenting (not to be confused with re-parenting, which is a form of psychotherapy in which the therapist actively assumes the role of a parental figure for the client, in order to treat psychological disturbances caused by defective or abusive parenting).

In the course of my work, I perceived that almost all bonding difficulties pregnant women have,stem from the way they were treated as a child. They all have emotional deficits that may deeply mark their psychological state of health. Consequently, prospective parents should address the issue of their own bonding experiences, allowing themselves to have a critical and open look at their emotional deficits, accepting them and doing everything to avoid passing them on to their children.

Self-parenting is the act of giving oneself what one did not receive as a child. It is a longer process, is not easy, and takes time, commitment, and a lot of patience. It allows healing. One can then look back on one’s childhood without feeling anger, grief, sadness, guilt, shame, or disappointment.

My aim is to encourage pregnant women to name and define their emotional deficits and then to show them how they can “take good care of” themselves by following a well-defined “self-parenting” process.

Example of a Successful Bonding Analysis

Annette’s case history:

Annette, 24 years old, student, unmarried, started the bonding analysis in the 13th week of pregnancy. She was unhappy about her pregnancy. She did not want to continue the short relationship she had had with the father of her baby, also a student. She had intensely pondered having an abortion, but decided against it. However, she was still unable to accept her baby.

Annette was tormented by conflicting feelings. This unwanted and unplanned pregnancy had made her life situation difficult because she could not hope for support from her parents, especially her mother. She seemed to be particularly afraid of her mother. She was amazed to hear that the relationship with her mother would be an important topic in the course of the bonding analysis.

In the first baby session, I asked Annette to mentally imagine the fetus in her womb. She felt great disgust about this foreign body that had taken residence in her without her permission. She perceived her baby as an enemy that was about to destroy her life.

Her baby’s father had been horrified when he had learned about the pregnancy. He had commanded her to immediately have an abortion They got into a heated argument over this, which hurt her a lot, but it had also given her the strength to completely break off contact with him.

When she informed her parents about the pregnancy, they showed no understanding of her decision to keep the child. For them, abortion was also out of the question, so they demanded that she give the child up for adoption immediately after birth.

Annette felt completely overwhelmed by the situation. She would probably have to give up her studies, which would make her a failure in her mother’s eyes. Annette resented everything about her baby, and accepting it was becoming increasingly difficult for her.

Annette admitted to having suffered all her life because her mother had favored her brother who was two years younger. Her mother had frequently made her aware that she had been disappointed about the birth of a daughter. During the baby sessions, we talked a lot about the meaning of womanhood, femininity, and motherhood, and their value and appreciation.

When she found out during her second ultrasound that the baby was a girl, she was again completely devastated. How could she accept a female baby inside her when she could not accept her own sex?

We drew parallels between the adverse attitude of Annette’ s mother toward a female child and her own rejection of the girl growing inside her. That made her think a lot.

In another baby session I asked Annette to mentally visualize her womb with the baby inside. That was still not possible for her. From the bonding analysis point of view, there was a connection between this blockage and the fact that the womb is the most significant female sexual organ.

Annette’s mother had rejected her femininity and Annette had internalized this attitude. At the same time, she had suffered because of her mother’s disdain for her and had never understood why a son was loved more and worth more in the mother’s eyes than a daughter.

How could she develop a different attitude toward her pregnancy and her daughter? We worked with my self-parenting concept and I suggested that Annette name all the deficits she was aware of and had suffered from. Then together we looked at each deficit and discussed how she could fill them herself.

That helped her finally accept and even value her femininity and it also enabled her to detach herself from her mother’s attitude and allow herself to have her own thoughts and feelings.

In one of the following baby sessions, I asked her to use inner dialogue and explain to her daughter that her own mother had not loved her because she was a girl, but that she was happy about having a daughter. She told her then that she would find a beautiful name for her. Annette reported in amazement that she had not found this dialogue difficult!

In the next baby session, I instructed Annette to imagine her daughter’s life after birth and told her to visualize her life in nursery, kindergarten, and primary school. She succeeded very well in doing so and reported that she had found great pleasure in nicely dressing up her daughter in her imagination and she enjoyed the admiration of those around her for having such a pretty daughter.

In another baby session, she managed for the first time to see her daughter in her womb and to greet her with a warm smile. She told me that she had felt a wonderful warmth in her belly.

Memories of a loving and caring grandmother, who had obviously shown her real affection, came up. Annette was able to draw new strength from this experience that she clearly remembered. In the next baby session, she was full of joy, telling me that she had gone shopping with a friend and gotten nice things for her daughter, which she had chosen with a lot of love.

In the meantime, she had made contact with an aunt who resembled her grandmother a lot. She received a lot of backing and support from her. Her aunt even offered to take care of her daughter when Annette resumed her studies. She rarely kept in touch with her mother.

Annette even decided to start more “feminine” studies and enrolled in a fashion design school. This would probably have caused a heated argument with her mother, but she felt so empowered and strengthened by then that she was sure to be able to plead her case to her mother, knowing that this would also be extremely beneficial for her baby.

As the baby sessions continued, the affection Annette felt for her baby grew more and more. Shortly before we started the birth preparation sessions, she could happily assure her baby that she would love and protect her. She was happy about the baby’s movements and was very proud of her baby belly.

In the course of the bonding analysis, Annette realized that her need for independence and autonomy was legitimate and that her baby was basically a fantastic opportunity to continue on this path.

Bonding analysis helped Annette grow up and detach from her mother, in order to devote herself fully to her baby. She gained self-confidence and new courage and no longer perceived her daughter as an enemy. On the contrary, she viewed her daughter as an ally with whom she would master life together.

Without the bonding analysis, the rejection of a daughter would have been transferred and Annette’s suffering would have continued in her daughter. Annette allowed herself to question her mother’s negative attitude, which made it possible for her to distance herself from her and permit herself to have thoughts and feelings of her own. The bonding analysis helped Annette to be strengthened in her womanhood, her femininity, and motherhood and to be able to pass on to her baby this new attitude toward life.

By fortifying Annette’s resilience, her baby gets the message that her mother has become a stronger person and the positive experience is transferred to her baby, who in turn will be able to already develop resilience in her mother’s womb.

Accompanying pregnant women with BA has an enormous impact on the baby insofar as healthier babies are being born into this world and at the same time women are empowered. Learning how to apply this method will enrich a midwife’s professional activity. Moreover, more women have gained knowledge about the significance of prenatal bonding and are seeking midwives who have learned Raffai’s method.

For more detailed information please go to my website:


  • Blazy, Helga. 2018. “Quantifizierung von häufigen Erfahrungen mit der Bindungsanalyse.” Polyphone Strömungen, Erfahrungen mit der Bindungsanalyse, Mattes Verlag Heidelberg Der Erfahrungschatz der Bindungsanalyse in Zahlen, Anne Görz-Schroth. Pp. 8–18.
  • Hidas, György, and Jenö Raffai. 2021. Nabelschnur der Seele, Psychoanalytisch´ orientierte Förderung der vorgeburtlichen Bindung zwischen Mutter und Baby, edition psychosozial, Giesen: Psychosozial Verlag.
  • Hüther, Gerald. 2008. Die Macht der inneren Bilder, Wie Visionen das Gehirn, den Menschen und die Welt verändern. Göttingen: Vandenhoeck & Ruprecht.

About Author: Christa Balkenhol-Wright

Christa Balkenhol-Wright has a diploma in translation from the University of Geneva in Switzerland. She worked for many years in the language and translation service of a federal agency, specializing in psychology, medicine, biotechnology, and biomedical engineering. She extensively studied the different psychological disciplines autodidactically for many decades. She organized and attended Dr Raffai's BA training course and became certified as prenatal bonding analyst in 2016. In addition, she was trained in hypnosis and regression techniques.

Christa is the main author and publisher of Mit deiner Liebe wächst meine Seele (Your Love Makes my Soul Grow), Life and Experience in the Womb, The Method of Promoting Prenatal Bonding in Theory and Practice. She is translating the book into English, with publication planned for 2023. She offers BA training courses online in English, German, and French.

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