Abstract
Prenatal alcohol and drug use is regarded as a critical public health problem. Most pregnant women report that they try to limit alcohol and drug use because of concern for the fetus. This concern indicates that bonding, the foundation of maternal caregiving, has begun to develop. This paper introduces the Interactional Model of Prenatal Maternal-Fetal Bonding. This model incorporates and overcomes limitations of two earlier models of maternal caregiving behavior: an object relations model, which focuses on the mother's internal working model of attachment but neglects environmental factors, and an ecological model, which incorporates a systems approach but fails to address intrapsychic processes. Case vignettes illustrate how interventions into three domains (1) the characteristics of the pregnancy, (2) the characteristics of the mother, and (3) the characteristics of the environment can increase the strength of the maternal-fetal bond, resulting in a decrease in alcohol and drug abuse during pregnancy