Pilot study completed · research report of 23 August 2026
Musically Supported Bonding — Results of the Pilot Study
A three-stage music therapy intervention to foster early bonding during pregnancy · MSH Medical School Hamburg
n = 2
participants (weeks 16 and 23)
3 × 90 min
workshop sessions
4 weeks
6 June – 5 July 2026
Mixed methods
convergent parallel
Key findings at a glance
Stronger sense of bonding
Both participants reported a stronger bond with their unborn child and more conscious moments of connection. The mean MAAS score rose by 3.7 % and 20.9 %.
More humming and singing for the baby
Items on humming and singing for the baby rose for both. An actual increase in everyday singing, however, could not be clearly demonstrated.
Partners belong in the picture
“Partner involvement” was the most frequently coded category for both — both explicitly wished their partners had been included.
A relaxing bodily experience
Voice and warm-up exercises were experienced as soothing and relaxing; both would recommend singing during pregnancy.
Context: with n = 2, no control group and a short study period, the findings cannot be generalised and no inferential tests were run. They offer first indications for developing the approach further.
Abstract
Vocalisation and singing are low-threshold forms of pre-linguistic communication; however, they feature very little in the everyday lives of expectant parents in Germany. Drawing on the Songs of Kin approach – in particular the creation of personalised lullabies and the use of one’s own voice – the three-stage music therapy intervention programme ‘Musically Supported Bonding’ (MSB) was developed, implemented and evaluated as part of this pilot project, and its impact on the prenatal bonding experience of expectant mothers was investigated.
Due to n = 2, the lack of a control group and the short study period, the findings cannot be generalised. However, they provide initial evidence that the MSB offers a viable framework for foetus-oriented singing and suggest that partners should be included in the further development of the manual.
Excerpt from the abstract of the research report
The study
Research question
How does the three-stage intervention Musically Supported Bonding foster the active use of the voice and the bond between expectant mothers and their unborn child?
- Design
- Exploratory pilot study in a convergent parallel mixed-methods design (Creswell & Plano Clark, 2018): a quantitative pre-post measurement and qualitative interviews, related to each other.
- Instruments
- Maternal Antenatal Attachment Scale, German short form with 13 items (Condon, 2015; Lehnig et al., 2024; α ≥ 0.69) and a modified 9-item music activity scale (after Politimou et al., 2018), each at T1 and T2.
- Interviews & analysis
- Guided individual interviews after session 3 (13 and 14 min), transcribed and analysed with qualitative content analysis after Kuckartz (2018) — deductive from the interview guide, extended inductively (9 main categories). In addition: observation sheets for every session.
- Sample
- Included: adult women with a physiological pregnancy in weeks 12–26, sufficient German, written consent. Excluded among others: high-risk pregnancy, acute psychiatric crisis. 4–8 participants were planned, 2 took part.
- Ethics & data protection
- Ethics application approved (MSH vote 2026-20). Voluntary participation, withdrawable at any time. Data pseudonymised, key list stored separately, personal details removed from transcripts.
Project timeline
Preparation
Workshop manual developed with midwife feedback
Preparation
Ethics application submitted and approved (MSH vote 2026-20)
Preparation
Recruitment: video, website, 50 posters in Hamburg-Harburg
6 Jun 2026
Session 1 · time point T1 (MAAS + music activity)
20 Jun 2026
Session 2 · developing songs for the baby
5 Jul 2026
Session 3 · T2 measurement · guided interviews
23 Aug 2026
Research report submitted
The method developed: three sessions of 90 minutes
Based on the Songs of Kin intervention (Loewy, 2013/2015), a workshop manual was developed together with a midwife and adapted several times following feedback from birth centres, midwives, music therapists and family counselling services. Core idea: any piece of music a participant brings can become her own lullaby. The lullaby “Thula Baba” is the leitmotif of all sessions.
Discovering one’s own voice
- Introductions, musical resources, questionnaires (T1)
- Warm-up: stretching, tapping, yawning
- Voice exercises: toning, babbling, low humming, humming, bee breath
- First bonding song “Thula Baba” · education: pre-verbal communication
- Closing sound journey
Between sessions: Listen to music, choose a favourite song or possible lullaby
Developing songs for the baby
- Warm-up and voice exercises, review of the week
- Listen to the songs brought along on headphones and vocalise
- Turn a favourite song into a personal lullaby
- Education: effects and uses of lullabies
- Vocal improvisation to the body tambura
Between sessions: Sing the song you developed to your unborn child
Deepening the bond & transfer to everyday life
- Reflection on the previous sessions
- Education: prenatal bonding development
- Finalise the personal lullaby, sing and hum together
- Questionnaires (T2), followed by individual interviews
- How can what was learned continue in everyday life?
Results
Quantitative: before-and-after comparison
Both participants completed the questionnaires fully at both time points. With n = 2, individual trajectories are described descriptively.
MAAS · participant 1
+3.7 %
Ø 4.08 → 4.23
MAAS · participant 2
+20.9 %
Ø 3.31 → 4.00
Music activity · participant 1
+57.5 %
Ø 2.33 → 3.67
Music activity · participant 2
+24.0 %
Ø 2.33 → 2.89
Prenatal attachment (MAAS short form) by item
Show as table
| Item | Participant 1 (T1 / T2 / Δ) | Participant 2 (T1 / T2 / Δ) | ||||
|---|---|---|---|---|---|---|
| Item 3 · Feelings towards the baby | 5 | 5 | ±0 | 4 | 5 | +1 |
| Item 7 · Baby depends on me | 4 | 4 | ±0 | 4 | 4 | ±0 |
| Item 9 · Thoughts (irritated → tender) | 4 | 4 | ±0 | 3 | 5 | +2 |
| Item 10 · Clear picture of the baby | 4 | 5 | +1 | 2 | 3 | +1 |
| Item 11 · Feelings (sad → happy) | 4 | 4 | ±0 | 4 | 4 | ±0 |
| Item 13 · Emotional closeness | 5 | 5 | ±0 | 3 | 4 | +1 |
| Item 15 · Anticipation of first contact | 5 | 5 | ±0 | 4 | 5 | +1 |
| Item 1 · How often thought of the baby | 5 | 5 | ±0 | 2 | 4 | +2 |
| Item 2 · Strength of feelings | 3 | 4 | +1 | 2 | 4 | +2 |
| Item 4 · Wish to read information | 5 | 5 | ±0 | 5 | 5 | ±0 |
| Item 5 · Imagined the baby | 3 | 4 | +1 | 5 | 4 | −1 |
| Item 8 · Talked to the baby alone | 3 | 3 | ±0 | 2 | 3 | +1 |
| Item 17 · Dreams about the baby | 3 | 2 | −1 | 3 | 2 | −1 |
- Rose for both: item 10 (clear picture of the baby) and item 2 (strength of feelings).
- Opposite directions: item 5 (imagined the baby) rose for participant 1 and fell for participant 2.
- Fell for both: item 17 (dreams about the baby).
- The larger rise for participant 2 may relate to her earlier stage of pregnancy (week 16 rather than 23).
Musical activity in the past 14 days by item
Show as table
| Item | Participant 1 (T1 / T2 / Δ) | Participant 2 (T1 / T2 / Δ) | ||||
|---|---|---|---|---|---|---|
| Item 1 · Hummed (low) for my baby | 1 | 4 | +3 | 2 | 4 | +2 |
| Item 2 · Hummed for my baby | 1 | 4 | +3 | 2 | 4 | +2 |
| Item 3 · Sang to my baby | 3 | 4 | +1 | 2 | 3 | +1 |
| Item 4 · Felt fetal movement while singing | 1 | 2 | +1 | 1 | 2 | +1 |
| Item 5 · Sang/hummed at home | 1 | 4 | +3 | 3 | 3 | ±0 |
| Item 6 · Sang/hummed outside the home | 1 | 3 | +2 | 1 | 1 | ±0 |
| Item 7 · Sang/hummed alone | 4 | 5 | +1 | 2 | 2 | ±0 |
| Item 8 · Sang/hummed with others | 4 | 2 | −2 | 3 | 3 | ±0 |
| Item 9 · Listened to music | 5 | 5 | ±0 | 5 | 4 | −1 |
- Items 1–4 (humming and singing for the baby, feeling movements meanwhile) rose for both.
- Items 5–7 (at home, outside, alone) rose only for participant 1.
- Singing with others and listening to music declined for one participant each.
- Session 2 notes show both said they had not sung more often. Part of the rise probably reflects the activity within the workshop itself.
Qualitative: what the participants experienced
Nine main categories — six deductively from the interview guide, three inductively from the material (HK 7–9). Most frequently coded: partner involvement, followed by bonding development.
Coded segments per main category
Show as table
| Main category | Participant 1 | Participant 2 |
|---|---|---|
| HK 1 · Bonding development | 6 | 5 |
| HK 2 · Role & practice of singing | 5 | 2 |
| HK 3 · Partner involvement | 9 | 6 |
| HK 4 · Barriers & facilitators | 3 | 4 |
| HK 5 · Body awareness & regulation | 4 | 5 |
| HK 6 · Recommendation | 2 | 2 |
| HK 7 · Workshop evaluation | 3 | 4 |
| HK 8 · Prior musical experience | 2 | 2 |
| HK 9 · Baby-framing of exercises | 0 | 4 |
“I don’t know whether it changed, but it definitely got stronger.”
“Okay, now we are here for you.”
“It gives you the feeling of having already been connected with the baby.”
“It feels similar to after a yoga class. I feel more relaxed.”
“I found it SO LOVELY that I wasn’t just singing alone at home, but together with the others.”
“But that feeling of three — me, my husband and the baby — I miss that a little.”
Quotes translated from the German interview transcripts.
Discussion
Implementation
All three sessions took place as planned. A song in another language made singing together harder; uncertainty about lyrics can be unsettling in a group. One participant wished the exercises had been explicitly directed at the baby from the start (“baby-framing”).
Singing in everyday life
Questionnaire scores rose, but the accounts also show how hard it is to fit singing into daily life. The workshop offered time, space and structure — and rituals emerged, such as singing together “as three” in the evening.
Partners
Partner involvement was the strongest category for both. Since adults often lack playful, non-verbal access to communication, it may be important to support partners in discovering their voice as well.
Bonding experience
Interviews and MAAS point in the same direction. Even choosing a song brought the baby more into focus — bonding became a more conscious process.
Limitations
- Very small sample (n = 2), not representative
- No control group — effects cannot be clearly attributed to the intervention
- Short period (4 weeks), data collection ends before birth
- German only — 49.8 % of Harburg residents hold a foreign nationality
- Narrow gestational window (weeks 12–26) made recruitment harder
- Partners were not included
Conclusion & outlook
MSB can offer a good way to explore the voice in the service of bonding. Choosing a song for the baby and working with it may be a suitable method to foster expectant mothers’ prenatal bond with their unborn child.
Next steps for research and practice
- 1
Include partners
Open the manual to expectant parents as a couple and to other future caregivers.
- 2
Larger and controlled
A larger sample and a control-group design to allow statements about effectiveness.
- 3
Beyond birth
A longer study period that includes the time after birth.
- 4
Multilingual
Interpreters or multilingual facilitation to reduce language barriers.
- 5
Direct exercises at the baby
Baby-framing from the start; choose short, easy-to-sing song sections.
- 6
In cooperation
Run it with an institution that plans places in advance and integrates the approach into care.
Research report & materials
We provide a redacted excerpt of the (German-language) research report. To protect everyone involved, participants are referred to only as “TN1/TN2”, student ID numbers and co-authors’ surnames are removed, and signatures, consent forms, ethics documents, transcripts and observation sheets are not included.
Research report – redacted excerpt ↓
PDF · 56 pages · approx. 1.3 MB · German
Summary, abstract, chapters 1–6, references, workshop manual, handouts and category system
Workshop manual (intervention protocol) ↓
PDF · 4 pages · German
Structure, components and timings of all three sessions
Suggested citation
MSB research team (2026). Musically Supported Bonding: Eine Pilotstudie zur Evaluation einer dreistufigen Intervention zur frühzeitigen Bindungsförderung während der Schwangerschaft [Research report]. MSH Medical School Hamburg.
Interested in an exchange?
Do you work in obstetrics, music therapy, family counselling or research and would like to discuss the method and results, develop the manual further or explore a cooperation? I look forward to hearing from you.
E-mail Mark SchmidtsProject team
Carried out by students of the BA Music Therapy programme (4th semester, summer 2026) at MSH Medical School Hamburg, Faculty Campus Arts and Social Change, in the module “Empirical Research Methods of the Arts Therapies”. Lecturer: Prof. Dr. Anne-Katrin Jordan.
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