THE EFFECT OF HAPTONOMY PRACTICE ON PREGNANT WOMEN WITH A HISTORY OF ABORTION. (Haptonomy)

THE EFFECT OF HAPTOTHERAPY APPLİCATİON ON PRE-NATAL ATTACHMENT AND ANXİETY LEVELS İN PREG-NANT WOMEN WİTH A HİSTORY OF ABORTİON

Pregnancy is a period of comprehensive adaptation for a woman in physiological, psychological, and social terms. During this process, physical and mental transformations occur due to hormonal changes; multifaceted changes emerge, such as adopting the role of motherhood, developing a new sense of identity, and adapting to increased responsibilities. These changes during pregnancy affect not only the mother but also the fetus. Especially from the 26th week of pregnancy onwards, with the development of the fetus's auditory and sensory perception capacity, a process of reciprocal interaction begins between mother and fetus. This early interaction forms the basis of prenatal bonding.Prenatal bonding is a dynamic process involving behaviors such as the mother developing emotional closeness towards the fetus, talking to it, making contact, and preparing for care. This bonding directly affects the post-natal mother-baby relationship. However, prenatal bonding is influenced by many factors such as anxiety, stress, history of psychiatric illness, pregnancy complications, socioeconomic status, social support, and previous pregnancy experiences. Women who have experienced prenatal loss (abortion, stillbirth, neonatal death) frequently experience increased anxiety, stress, and difficulty bonding in subsequent pregnancies. High levels of uncertainty, fear, and anxiety in these individuals can negatively impact both the pregnancy and postpartum periods. The literature indicates that women who have experienced prenatal loss have lower levels of prenatal bonding and increased risks of anxiety and depression compared to those who have had healthy pregnancies. Increased stress and anxiety during the prenatal period have also been shown to be associated with negative outcomes such as low birth weight, premature birth, and neurodevelopmental problems. Therefore, supporting psychological well-being during pregnancy is critically important.In this context, interventions aimed at strengthening the bond between mother and fetus are gaining importance. Haptonomy, as a touch-based approach, is a holistic method that supports the establishment of emotional bonds between mother, father, and fetus. This method aims to develop trust-based communication by prioritizing the physical and emotional acceptance of the individual's presence. In haptonomy practices, the goal is for expectant mothers to first increase their own bodily and emotional awareness, and then to establish a conscious interaction with the fetus. Studies show that haptonomy reduces stress, anxiety, and fear of childbirth in pregnant women, while increasing prenatal bonding levels. It is also reported to have positive effects on newborns, improving their adaptation to environmental stimuli. However, the number of studies on haptonomy is limited, and research is needed, particularly focusing on its effects in pregnant women who have experienced prenatal loss. The aim of this research is to examine the effect of haptonomy on prenatal bonding and anxiety levels in pregnant women who have experienced abortion. It is hypothesized that haptonomy may strengthen mother-fetus bonding by reducing negative emotions experienced during pregnancy after a loss. The findings are expected to contribute to evidence-based care approaches applicable to high-risk pregnancy groups.

Study Overview

• Status: Not yet recruiting
• Conditions: Pregnant Women
• Intervention / Treatment: Behavioral: Haptonomy

Detailed Description

Pregnancy is a multifaceted transformation in a woman's life that goes beyond biological changes, encompassing psychological, social, and existential dimensions. During this process, significant changes occur not only in the mother's body but also in her sense of identity, emotional regulation skills, and interpersonal relationships. As the fetus's neurodevelopmental capacity progresses, a reciprocal, interactive relationship begins to develop between mother and fetus, particularly from the second half of pregnancy onwards. This relationship is defined as the prenatal attachment process, which forms the basis of postnatal bonding. Prenatal attachment is a critical developmental area for the mother to mentally and emotionally represent her fetus, interact with it, and prepare for her role as a mother. This attachment process is influenced by numerous variables, including individual characteristics, psychological state, level of social support, and obstetric history. Experiences of loss before or during pregnancy can significantly alter the course of this process. Increased anxiety, feelings of uncertainty, and negative expectations are commonly observed in women who have experienced abortion, stillbirth, or neonatal loss in subsequent pregnancies. This situation can make it difficult for the mother to emotionally invest in the fetus, leading to delays or weakening of the bonding process. Anxiety and stress responses following prenatal loss experiences can affect not only the mother's mental health but also the physiological course of pregnancy and fetal development. Research shows that women who experience high levels of stress and anxiety during the prenatal period are more likely to have premature birth, low birth weight, and long-term cognitive and behavioral problems in their children. Therefore, it is important to provide psychosocial support to pregnant women, especially those in at-risk groups, and to implement interventions that will strengthen prenatal bonding. At this point, holistic approaches aimed at increasing mother-fetus interaction are noteworthy. Haptonomy, as a method based on tactile contact and emotional awareness, aims to support the establishment of a trust-based bond between mother and fetus. This approach is based on accepting not only the physical existence of the individual but also their emotional and existential integrity. During haptonomy interventions, the goal is to increase the expectant mother's awareness of her own body and emotions, and then to encourage conscious and reciprocal communication with the fetus. Including the partner in this process can contribute to strengthening family bonds. Current studies show that haptonomy can reduce perceived stress levels in pregnant women, alleviate fear of childbirth, and strengthen prenatal bonding. There is also evidence that this method can have positive effects on newborn behavior. However, studies examining the effects of haptonomy, particularly in pregnant women who have experienced prenatal loss, are limited. This indicates a significant research gap in identifying effective and applicable interventions in this population. This study aims to evaluate the effect of haptonomy intervention on prenatal bonding and anxiety levels in pregnant women who have experienced abortion. The study hypothesizes that haptonomy intervention will strengthen mother-fetus interaction by reducing anxiety, stress, and negative cognitive processes frequently observed in post-loss pregnancy. The results are expected to contribute to the development of evidence-based practices for supporting mental health during pregnancy and to provide guidance for improving the quality of care, particularly in high-risk pregnancy groups.

• Study Type: Interventional
• Enrollment (Estimated): 80
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Burcu FIRAT; Phone Number: +905060503078; Email: burcum_oskaan@hotmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Primiparous pregnant women with a history of abortion
• Singleton pregnant women with a healthy pregnancy between 28 and 32 weeks
• Women who conceived naturally
• Pregnant women without psychiatric disorders
• Pregnant women without a diagnosed genetic disease
• Pregnant women without a history of two or more abortions

Exclusion Criteria:

• Pregnant women diagnosed with high-risk pregnancies during the study
• Pregnant women who were included in the study but could not be reached
• Pregnant women who did not continue with the treatment during the study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Haptonomy; Pregnant women with prior abortion experience who will undergo haptonia treatment constitute the intervention group.	Behavioral: Haptonomy; The intervention will be conducted at the antenatal clinic of a Training and Research Hospital. The training is planned to be conducted face-to-face in groups of 6-8 people in a suitable environment. Pregnant women included in the intervention group will receive a total of 5 haptonomy sessions, 2 sessions per week. Each haptonomy session is planned to last 45 minutes. Group rules will be determined before each training session begins. The training covers topics such as basic communication and bonding between mother and baby, energy work and visualization, baby communication through breathing techniques, baby communication through suggestion, and baby communication through touch techniques. The application program, determined according to the schedule, will continue until the last session is completed.
No Intervention: Control; Pregnant women with a history of abortion and ongoing routine monitoring will be included in the control group.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Stirling Antenatal Anxiety Scale	Developed by Sinesi and colleagues in 2022, the Stirling Antenatal Anxiety Scale is used to assess the level of prenatal anxiety common in pregnant women. This scale is a 5-point Likert type and consists of 9 items. Scale responses are scored as follows: "never" = 0, "rarely" = 1, "sometimes" = 2, "frequently" = 3, "always" = 4. The Cronbach's Alpha coefficient is 0.88 in the original study and 0.87 in the Turkish validity and reliability study. The scale scores range from a minimum of 0 to a maximum of 36 points. A higher score indicates a higher level of anxiety experienced by pregnant women during the antenatal period.	3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Prenatal Attachment Inventory	Developed by Müller in 1993, the Prenatal Attachment Inventory (PAI) is used to describe the emotions, thoughts, and situations experienced by women during pregnancy and to determine their level of attachment to the baby during the prenatal period. It consists of 21 items. Each item is scored on a 4-point Likert scale, ranging from 1 to 4: 1: Never, 2: Sometimes, 3: Frequently, 4: Always. The minimum score is 21, and the maximum is 84. A higher score indicates a higher level of attachment. In a validity and reliability study of the inventory by Dereli Yılmaz and Kızılkaya Beji (2013), the Cronbach Alpha value was found to be 0.84.	3 months

Collaborators and Investigators

• Sponsor: Uskudar University

Publications and helpful links

General Publications

• Atabakhsh, T., Salehi, K., & Mohammadi, F. (2024). Investigating the impact of haptotherapy on maternal-fetal attachment in unplanned pregnancies. Journal of Education and Health Promotion, 13(1), 301.
• Nur Yilmaz, A., & Aksoy Derya, Y. (2025). The effects of haptonomy and virtual reality, anxiety, prenatal attachment and acceptance of pregnancy in unplanned pregnancy. Journal of Reproductive and Infant Psychology, 1-15.
• Alivand, Z., Nourizadeh, R., Hakimi, S., Esmaeilpour, K., & Mehrabi, E. (2025). The Effect of Haptonomy on Fear of Childbirth and Maternal-fetal Attachment: A Systematic Review and Meta-analysis. Current Psychiatry Research and Reviews, 21(4), 555-566.
• The effect of haptonomy applied to pregnant women on perceived stress, fear of childbirth, and prenatal attachment: randomized controlled experimental study

Helpful Links

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Study record dates

Study Major Dates

• Study Start (Estimated): March 30, 2026
• Primary Completion (Estimated): June 29, 2026
• Study Completion (Estimated): August 28, 2026

Study Registration Dates

• First Submitted: March 23, 2026
• First Submitted That Met QC Criteria: March 23, 2026
• First Posted (Actual): March 27, 2026

Study Record Updates

• Last Update Posted (Actual): March 27, 2026
• Last Update Submitted That Met QC Criteria: March 23, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: anxiety; attachment; abortion; haptonomy
• Additional Relevant MeSH Terms: Mental Disorders; Anxiety Disorders
• Other Study ID Numbers: UU-SBF-BF-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be publicly available due to participant confidentiality and ethical obligations. However, de-identified data may be obtained from the corresponding author upon reasonable request and with ethics committee approval.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No