Journal of Reproductive and Infant Psychology

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Books before birth: a qualitative multiple case

study of mothers reading to babies in utero

Keely D. Cline, Elizabeth Dimmitt & Mariah Gann

To cite this article: Keely D. Cline, Elizabeth Dimmitt & Mariah Gann (2024) Books before birth:
a qualitative multiple case study of mothers reading to babies in utero, Journal of Reproductive
and Infant Psychology, 42:2, 166-179, DOI: 10.1080/02646838.2022.2077922

To link to this article: https://doi.org/10.1080/02646838.2022.2077922

Published online: 16 May 2022.

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JOURNAL OF REPRODUCTIVE AND INFANT PSYCHOLOGY
2024, VOL. 42, NO. 2, 166–179
https://doi.org/10.1080/02646838.2022.2077922

Books before birth: a qualitative multiple case study of

mothers reading to babies in utero
Keely D. Cline, Elizabeth Dimmitt and Mariah Gann
School of Health Science and Wellness, Division of Behavioral Sciences, Northwest Missouri State University,
Maryville, MO, USA

ABSTRACT ARTICLE HISTORY

Background: This study is informed by research connecting par­ Received 15 May 2021
ent–child book reading and attachment and by the concept of Accepted 7 May 2022
maternal-foetal attachment. KEYWORDS
Aim: To explore experiences of pregnant mothers who read picture Pregnancy; maternal-foetal
books marketed to be read while their babies are in utero. attachment; parent-child
Study Design: This study utilised a qualitative, multiple case study book reading; prenatal
design involving 10 pregnant women from the Midwestern region parenting; mothers
of the United States. Participants read picture books marketed to be
read by expectant families and participated in an interview focused
on their experiences and reflections, and completed a follow-up
survey 24–27 months later.
Results: Themes identified included (1) Learning and Love; (2)
Seeing the Baby as a Person; (3) Natural or Weird?; (4) Fathers’
Involvement; (5) Slowing Down: Focusing on Now and
Envisioning the Future; and (6) Who is this for?
Discussion: Findings suggest providing books to expectant
families may be a promising practice and should be further
researched.

Introduction
Parent–child book reading is widely recognised as an important activity for supporting
young children’s development (e.g. see, Law et al., 2018 for a systematic review of
research focused on using this practice to promote language development and school
readiness). The same underlying belief that inspired award-winning children’s author
Emilie Buchwald’s famous quotation, ‘Children are made readers on the laps of their
parents’ has driven several decades of research that provides evidence about the efficacy
of this practice (as cited in ReadAloud.org, 2010). Today’s parents may receive the
message that it is never too early to start reading to their child. Websites, magazines,
and parenting programmes may even promote reading to babies in utero and there are
picture books being marketed for this purpose. The current study seeks to explore if there
may be benefits of parents reading to their children even before they can hold them on
their laps.

CONTACT Keely D. Cline [email protected]

© 2022 Society for Reproductive & Infant Psychology
 JOURNAL OF REPRODUCTIVE AND INFANT PSYCHOLOGY 167

Parent–child book reading has been found to have a positive impact on children’s
cognitive competencies (Bojczyk et al., 2016; Ece Demir-Lira et al., 2019; Niklas et al., 2016;
Raikes et al., 2006), language development (Crowe et al., 2018; Niklas et al.), and pro-social
behaviour (Aram et al., 2017; Blewitt & Langan, 2016). Reading together may also provide
a special opportunity for parents and children to engage emotionally (Bus et al., 1997;
Canfield et al., 2020; Lariviere & Rennick, 2011). The intimacy of the activity, having one-on
-one dedicated time, and sensitive interactions in the context of book reading may
increase the positive feelings between the parent and child. Parent–child book reading
can be examined through an attachment framework (Ainsworth et al., 1978; Bowlby,
1970). Bus, van IJzendoorn, and colleagues (Bus et al., 1997; Bus & van Ijzendoorn, 1988,
1992, 1995, 1997) have used an attachment framework to explore links between the
quality of the parent–child relationship (i.e. attachment status) and the frequency and
quality of parent–child book reading. They theorised that based on past experiences,
children with a secure attachment relationship with the parent would be more willingly
explore unfamiliar aspects of their environment, such as book text, and that they would
be more trusting of their caregiver as a teacher. They also expected that parents of
securely attached children would be more effective and engaging instructors for their
children during shared reading. Consistent with their framework, Bus, van IJzendoorn, and
colleagues found that secure attachment status related to more frequent and higher
quality parent–child book-reading interactions. Teufl et al. (2020) found that links
between attachment, book-reading interactions, and children’s language development
previously observed among mother-child dyads were also observed among father-child
dyads. Cline and Edwards (2013, 2017) found that instructional and emotional qualities of
parent–child book reading interacted to predict infants’ and toddlers’ cognitive out­
comes. Parents’ shared book-reading behaviours when children are 6 months old have
even been found to predict parental warmth and sensitivity and parents’ decreased stress
when children are 18 months old (Canfield et al., 2020).
Despite the recognised benefits of parent–child book reading, there is variation in the
degree to which families engage in this practice. Programmes have been developed to
promote early shared book reading. In the United States, examples include ‘Dolly Parton’s
Imagination Library’, ‘First Book’, and ‘Reach Out and Read’. The ‘Reach Out and Read’
programme involves medical providers giving families children’s books during the child’s
paediatric well-child visits beginning around 6 months of age and continuing until 5 years
of age (Zuckerman, 2009). This evidence-based programme started out in a single clinic in
Boston City Hospital in 1989 and has since grown to be provided in all 50 states of the
United States (Zuckerman). It serves 4.2 million children every year, with half of those
children being from low-income families (Reach Out and Read, n.d.). Though a modest
early intervention, ‘Reach Out and Read’ has been found to have significant impacts on
children’s literacy outcomes (Weitzman et al., 2004; Zuckerman). One particular pro­
gramme, ‘Reach Out and Read Colorado’, piloted an initiative that introduces parents to
the concept of reading to babies in utero, citing that the prenatal period is a natural time
of information gathering for expectant mothers (Reach Out and Read Colorado, 2018).
Parents may be encouraged to read to their babies in utero by programmes, parenting
websites, and magazines, and they can purchase picture books marketed for this purpose.
What is known about the practice of reading to babies in utero? Considering prenatal
auditory development and related research helps to provide the context for considering
168 K. D. CLINE ET AL.

the practice. Auditory development occurs during prenatal development with foetuses
responding to auditory stimuli from the external environment (Hepper & Shahidullah,
1994). Foetuses may respond to the mother’s voice with a change in heart rate starting at
32–34 weeks after conception (Kisilevsky & Hains, 2011). DeCasper and Spence (1986)
conducted research involving mothers reading to babies in utero, finding that new-borns
preferred to hear speech passages that were repeatedly read by their mothers in the third
trimester of pregnancy.
Currently, there is no evidence to suggest that reading to babies in utero is associated
with long-term impacts on cognitive or language development. However, could the
practice have benefits by setting the stage for parenting behaviours that support optimal
child development? Parenting attitudes, practices, and views developed during preg­
nancy may be indicative of patterns once the child is born (Chang et al., 2015); it remains
to be fully explored if reading to babies in utero may lay a strong foundation for future
parent–child book reading. There is also a lack of research examining the potential of
reading to babies in utero to promote bonding that starts during the prenatal stage and
continues once the child is born. Examining the practice of reading to babies in utero in
relation to the concept of maternal-foetal attachment may provide meaningful insight.
Maternal-foetal attachment has been described as ‘the extent to which women engage in
behaviours that represent an affiliation and interactions with their unborn child’ (Cranley,
1981, p. 282). Busonera et al. (2016) referred to how maternal-foetal attachment relates to
‘attitudes, behaviours, representations and fantasies that expectant women gradually
develop towards their unborn babies’, (p. 80). Rather than focusing on direct effects of
reading to babies in utero on the unborn children’s development, our study is aimed at
giving voice to parents regarding how they perceive the activity, including how it may
promote bonding and commitment to certain practices, including parent–child book
reading.
The central research question guiding this qualitative multiple case study (Creswell,
2013) study was: How do families who are expecting a baby experience and perceive
books designed to be read while babies are in utero? Sub-questions guiding the study
were:
(1) How do families approach, read, and/or share the books?
(2) What are families’ perceptions of the books?
(3) What underlying themes emerge from interviewing families?
(4) What assertions can we make as we (a) attempt to interpret these themes in relation to
attachment theory and early parent–child book-reading research, and (b) consider if offering
books to be read while baby is in utero may be a promising practice for encouraging bonding
and promoting positive attitudes about early parent–child book reading?

Materials and methods

Ethical permissions
Permission to conduct the research was granted by Northwest Missouri State University’s
institutional review board (IRB Approval Codes: 1819–025 for Phase 1 and 2021–014 for
Phase 2).
 JOURNAL OF REPRODUCTIVE AND INFANT PSYCHOLOGY 169

Participants
The one eligibility criterion for the study was that participants had to be pregnant at the
time. There was no particular stage of pregnancy specified. Expectant mothers were
recruited through flyers and word of mouth at the local library, university, hospital and
family clinic, and a midwife practice, as well and through various forms of social media
between November 2018 and February 2019. Spouses/partners of the expectant mothers
were also invited to participate with the mothers if applicable and desired. The sample
included 10 expectant mothers from the Midwest in the United States. One father also
participated with his wife. At the time of the interviews (during Phase 1 of the two-phase
study), the mothers’ ages ranged from 20 to 40 years, and they reported their pregnancies
being between 10 and 34 weeks of gestation. An overview of the participants’ demo­
graphic characteristics (e.g. age, week of pregnancy, marital status) at the time of the
interview is provided in Table 1.

Materials and procedures

After signing an informed consent form for the study, participants received four books
specifically designed to be read by expectant families. The books included ‘Oh, Baby, the
Places You’ll Go’ (Rabe, 2015); ‘Ma! There’s Nothing to Do in Here! A Word from your Baby-in-
Waiting’ (Park, 2008); ‘Nine Months in My Mommy: Autobiography of an Unborn Baby’ (Marsh-
Longmeyer, 2015); and ‘Can’t Wait to Show You: A Celebration for Mothers-to-Be’ (Boyle &
Stonis, 2014). The books were selected by the researchers to fit the needs of the study. The
researchers collectively searched for picture books (written in English) online that were
intentionally designed to be read by expectant parents. At the time of the study, the
researchers were able to identify six potentially relevant books. The researchers reviewed
and selected four books that would provide some variation in characteristics including length,

Table 1. Demographic characteristics of mothers.

Other
Participant Week of Marital Children/ Highest Level of
ID Age Pregnancy Status Age(s) Education Completed Occupation Description
M1 24 27 Engaged 15 months High School diploma or Gas Station Cashier
equivalent
M2 36 29 Married 14 & 15 years Master’s Degree Elementary School Teacher
old
M3 22 34 Married No High School diploma or Early Head Start Infant/
equivalent Toddler Teacher
M4 20 29 Single No High School diploma or Client Support Staff
equivalent
M5 27 11 Married No Master’s Degree Librarian
M6 34 27 Single No Bachelor’s Degree Cartographer
M7* 40 30 Married 18 months Bachelor’s Degree Community Support
Specialist
M8 26 10 Married 12 months Bachelor’s Degree Nursing Home Social Service
Director
M9 30 12 Married 16 months Master’s Degree Farm Service Agency
Program Technician**
M10 27 24 Married No Associate Degree Surgical Technologist
*Note: M7ʹs husband participated in the interview with her; they were the only family who indicated that they were
expecting twins.
**Recently resigned position to be a stay-at-home parent.
170 K. D. CLINE ET AL.

voice (i.e. if the story is told through the parent’s or baby’s voice), and tone (e.g. comical;
endearing; serious, dealing with challenges). The participants were asked to read at least three
of the four books before the interview in whatever way they felt comfortable. They could
choose when, where, how (e.g. silently or aloud), how many times, and with whom (if anyone)
to read the books. A reading log was provided for the participants to track their process and
reflections.

Data collection and analysis

Phase 1
Interviews took place approximately 1–3 weeks after the families received the books in
either a library meeting room or by phone. Interviews (ranging from 21 to 48 minutes in
length) consisted of open-ended questions about the book-reading experiences which
were informed by the central research question and sub-questions. Participants also
answered demographic questions. The interviews were audio-recorded and transcribed.
Each of the eight researchers independently coded the transcripts line-by-line using
qualitative procedures informed by Creswell (2012, 2013). The researchers looked for
the codes’ meaning through ‘direct interpretation’ (p. 199) of single instances as well as
‘categorical aggregation’ (p. 200) of multiple instances (Creswell, 2013). Categories were
collapsed into themes. As a team, the researchers discussed codes and themes that
emerged from the data, coming to consensus on six main themes. When possible, the
researchers used ‘in vivo’ coding (p. 185), a qualitative process in which the language used
to label codes and themes reflects the exact words expressed by the participants
(Creswell, 2013).

Phase 2
Approximately 24–27 months after the initial interview, participants completed an
online, follow-up survey. This interval was chosen to allow data to be collected when
the participants’ children were toddlers, as this tends to be an important stage for
language development and engaging in parent–child reading interactions (e.g. see,
Fletcher & Reese, 2005; Lorio et al., 2021 for relevant reviews). The survey develop­
ment was informed by the study’s central research question and sub-questions and
designed to invite participants to share how their views and practices had evolved
since the first phase of the study. Questions invited parents to further reflect on
reading to babies in utero (e.g. their personal beliefs and ongoing practices after
Phase 1 of the study) as well as their current bonds and book-reading practices with
their children (toddlers at the time). Survey responses were coded line-by-line using
the qualitative analysis methods informed by Creswell (2012, 2013) described above.
With Phase 1 themes in mind, the researchers intentionally examined if there was
continuity in the codes and themes identified across the two phases of the study.
The researchers also simultaneously explored if additional themes emerged. Finally,
assertions were developed based on the two phases of the study.
 JOURNAL OF REPRODUCTIVE AND INFANT PSYCHOLOGY 171

Results
Six main themes emerged from the Phase 1 data and were further confirmed by the Phase
2 data. These themes included: Learning and Love; Seeing the Baby as a Person; Natural or
Weird?; Fathers’ Involvement; Slowing Down: Focusing on Now and Envisioning the
Future; and Who is this for?

Learning and love

Parents expressed that a main goal of parent–child book reading, in general, is to promote
learning, but parents also focused on social-emotional benefits of this activity, including it
being a way to bond. Parents appreciated that reading to their babies in utero offered an
opportunity for bonding even before the baby was born. This theme was further illu­
strated in Phase 2 of the study, as parents expressed parent–child book reading as being
both a way to stimulate their toddlers’ learning and language development and to
promote bonding. The majority of mothers (6 of the 10) reported that their families
continued reading the same study books (that they read when their children in utero)
to their children after they were born. This continuity seemed to hold special emotional
significance for families. Sample quotations from participants illustrating this theme are
presented in Table 2.

Seeing the baby as a person

Mothers expressed that reading to their babies in utero helped them and family members
to conceptualise their baby as a person and helped them feel more connected to their
baby. One mother (M10) explained that having her niece involved in the reading helped
her niece think of her unborn cousin as ‘more than a bump’. Mothers were at different
stages in their pregnancies when they participated in the first phase of study. Some
mothers noted that they perceived their personal experiences of reading to their baby in
utero as being impacted by whether they could feel their baby move yet. One mother

Table 2. Sample quotations illustrating ‘Learning and Love’ theme.

Participant Study
ID Phase Quotation
M1 1 I feel like [reading] can help parents connect with their children, [reading to baby in utero]
gives them a chance to bond with them even before they’re here.
M10 1 I feel like reading [. . .] is a very big, a very big thing and even infants, I mean just listening to
you talk definitely helps their development and language and a socioemotional side of
things.
M9 2 [Reading to the baby in utero] reinforced our love for reading to our children and familiarising
them with the sound of our voice before we could even hold them. We love our children’s
love for reading.
M9 2 [. . .] we read to our daughter daily, and almost always multiple times a day. This is a time
where she can sit on our laps to get her need for physical touch met, while we are also
stimulating her brain, and teaching her, early on, a love for reading and learning. Hearing
the words we read so often, along with using sign language, seems to have drastically
benefited her early ability to communicate with us, thus allowing us to meet emotional
needs we may not have otherwise been able to do.
M10 2 It is important to read! When you stop nursing you still need a way to bond and connect in
a special way and I believe that is reading. Plus they learn so much about words and stories.
172 K. D. CLINE ET AL.

Table 3. Sample quotations illustrating ‘Seeing the Baby as a Person’ theme.

Participant Study
ID Phase Quotation
M1 1 Well they say that talking to the baby, rubbing your stomach, reading to the baby, things like
that, is a great way to pre-bond. Cause you – I mean you can’t physically bond with them.
There’s not much you can do physically with the baby while they are growing inside you so
this is a way for you to interact with the baby while still in utero. [. . .] I feel like [reading to
baby in utero] can help parents connect with their children. It gives them a chance to bond
with them even before they’re here.
M3 1 You know I almost felt like I was holding him in my arms and reading to him even though
I wasn’t.
M4 1 I definitely feel more comfortable talking with him [baby in utero] and maybe imagining how
I’ll talk to him once he is here.
M4 1 [My boyfriend] thought [the books] were silly at first, but he said after he heard me read them,
he could actually visualise a baby, not just my stomach.
M6 2 I enjoy reading these books to my daughter because it makes me remember when I was
pregnant with her and all the feelings and anticipation for her to arrive. Also, the message
of the books are so sweet and it makes me connect with her being here and also her in my
belly.

(M10) noted in her response to the survey (collected in Phase 2 of the study) that she was
expecting again; she explained that she planned to read to this second baby in utero as
well but that she was waiting to find out the baby’s sex because knowing this would make
the experience more ‘personal’. Sample quotations from participants illustrating this
theme are presented in Table 3. As a note, the ‘Learning and Love’ and ‘Seeing the
Baby as a Person’ themes, while distinct, do go hand-in-hand. Establishing book-reading
practices that combine learning and love even before the baby is born may also provide
parents a unique opportunity as they develop their representation of their baby.

Natural or weird?
Mothers chose a range of approaches to reading the books, sometimes reading alone, but
sometimes reading with a spouse/partner or with another child (i.e. their first-born child
or niece). All mothers read at least some of the books out loud. Some mothers expressed
feeling very comfortable with reading aloud to their babies in utero. Two mothers (M7
and M9) said they had engaged in this activity even before participating in the study in
their current and/or a previous pregnancy. One mother (M9), who was expecting
her second child, specifically said she owned and had read the ‘Oh Baby the Places You
Will Go’ book aloud when she was expecting her first child. However, other mothers
reported feeling awkward reading aloud to their baby in utero. Another mother (M8) who
was expecting her second child also already owned ‘Oh Baby the Places You Will Go;’ she
indicated she had received it as a baby shower gift when she was expecting her first child,
but she had placed it on a bookshelf and not actually read it until the time of the study.
This mother noted that when she read the study books aloud, she read them with her
toddler child and she would not have otherwise felt comfortable reading them aloud. To
some extent, the degree to which mothers felt comfortable reading the books aloud was
intertwined with the child’s father’s response to and involvement in the activity. As noted
in the next theme, some fathers became more involved in the reading after the interview
from Phase 1 of the study. Sample quotations from participants illustrating the ‘Natural or
Weird?’ theme are presented in Table 4.
 JOURNAL OF REPRODUCTIVE AND INFANT PSYCHOLOGY 173

Table 4. Sample quotations illustrating ‘Natural or Weird?’ theme.

Participant Study
ID Phase Quotation
M2 1 And I think it probably would have been better if [my husband] would have been with me.
Like if we were to read it together that probably wouldn’t have been quite so weird for me.
M3 1 I always felt weird reading out loud and so I always chose to do it whenever I was alone.
M8 1 [. . .] if I didn’t have [our older child] to read to, I would feel like weird reading to myself, like to
my stomach.
M9 1 I’m huge on reading to our [older child] already and we read with him in utero as well. [. . .]
We actually had been gifted the ‘Oh Baby the Places You’ll Go’ with our first pregnancy.
[. . .] I thought [reading to babies in utero] was an interesting concept. I’ve heard of, you
know, playing music for children in utero and stuff. I hadn’t necessarily heard a lot about
reading to them. [. . .] Again, with our first son’s condition, we read to him beforehand and
once he arrived and he was in critical state at the hospital. It’s, I think, not just calming to
him but calming to me and my husband to read him something we had done before we
knew anything was wrong with him.
M10 1 They talk about all playing music for your child and especially they talk about talking to your
child, especially the father and how important it is that they can recognise your voice and
I think this is, like I said a lot of people forget what you can say to your baby. ‘Oh I love you’,
or ‘You’re growing so big’, ‘Oh, you’re kicking me’, whatever. But this gives you like, hey,
there are things out here. It kind of makes you think outside the box and it’s just a really
great way to be able to share your voice with them and also it gets you thinking about all
the beautiful things that are to come. I think it is a really great way to bond with your child.

Fathers’ involvement
At the time of the interviews, five of the mothers reported that the unborn babies’
fathers had some involvement with the books. This ranged from simply looking at the
books (2 fathers), to listening as the mother read the books (1 father), to actively
participating in reading the books aloud with the mother (2 fathers). According to the
mothers, three of the fathers engaged in reading the study books to their babies in
utero even after the Phase 1 interview (one of these fathers had not previously
participated in the reading at the time of the interview); mothers also indicated that
two of the fathers read the study books to their children after they were born. According
to some of the mothers (and the one father who participated in the interviews), reading
to the baby in utero offered the father a special opportunity to bond with the unborn
child. The couple who participated in the interview together explained that they chose
to read the books to their twins who were in utero after their older son went to bed;
they explained that they already read to their older son multiple times a day so they
wanted this book-reading activity to offer ‘quality time’ for the two of them and their
unborn twins. However, there was variation in the degree to which fathers were
involved in the activity across families, with some mothers emphasising the lack of
the father’s involvement. Sample quotations from participants illustrating this theme are
presented in Table 5.

Slowing down: focusing on now and envisioning the future

Parents expressed that reading the study books made their pregnancy seem more real.
According to the parents, the activity helped them to slow down and experience their
pregnancy in-the-moment while also prompting them to envision the future with the
baby in it. Additionally, some parents seemed to draw a parallel between having a child
snuggled up on their lap to read a book and reading to their baby in utero. Whether the
174 K. D. CLINE ET AL.

Table 5. Sample quotations illustrating ‘Fathers’ Involvement’ theme.

Participant Study
ID Phase Quotation
M3 1 [My husband is] a really private person anyway and so like I know he’s excited and he thinks
about it and talks about it some but he doesn’t always talk about his feelings so I don’t
know, maybe having him read one of these would be good because then he would maybe
feel kind of the things that I feel.
M4 1 So I actually read through them twice. The first time I did it by myself, and I just read quietly.
But then by the time I went through all of them I felt more comfortable and so I decided to
read through them again in front of my boyfriend and it was a lot more comfortable
the second time.
M5 2 [My husband and I] read two of the four books [after the first phase of the study]. I was
present for all of them. [My husband] doesn’t read [a lot] but I had him purposely read to
the baby. We tried to read books nightly so the baby could hear his voice. We started
adding this once I was in my mid-second trimester. There really wasn’t too much of
a response from the baby from the reading until near the end of pregnancy. At that point,
he moved a lot of books that rhymed.
M10 1 My husband really felt like it was a way he could connect to our child, you know, an
opportunity for [unborn child’s name] to hear him talk and bond with his voice. And I know
that means a lot to him because we have separate schedules, and of course she is going to
hear my voice all the time, so anything he can actually talk to her. And sometimes you
forgot, you know, what you can actually say to a baby, you know that you can’t really see or
really respond [. . .] [My husband] always says like the same stuff and this kind of gave him
something else to say, where she could pick up on the tones and the different tones of his
voice.
M10 2 [My husband] read all of them when I was 8 and 9 months pregnant. We both cried.

Table 6. Sample quotations illustrating ‘Slowing Down: Focusing on Now and Envisioning the Future’
theme.
Participant Study
ID Phase Quotation
M3 1 [. . .] whenever it would say the word ‘baby’ [in the book], I’d just replace the word ‘baby’ with
his name, and you know, it really made me feel like I was talking to him or well, which
I was, you know, but like he was here and I was really connected to him. Even though, you
know, I don’t have any idea what he looks like yet, I don’t know anything about him, it still
made me think of whenever he is born and as he grows up the things I will be able to show
him and teach him. Thinking about that while he’s not even here definitely makes me feel
very close to him and excited for the adventure to come.
M5 1 So reading [these books] made me like do a ‘Holy crap, it’s actually going to happen!’ [. . .] It
made me [. . .] think, ‘Hey you’re pregnant!’ [. . .] Especially I will say the ‘Nine Months in My
Mommy’ because it [. . .] took you through all of the stages.
M8 1 Like I feel for [our first child] we were all more concerned about getting her room ready and
all this like making everything perfect for her but you’re not really thinking about just the
things that you will do with your kid [like emphasised in the book].
M10 1 Honestly, I think that it really does connect a mother to her baby, and especially in this
culture, I think that connection gets lost because everyone is so busy, we’re easily
distracted from what’s going on. Even though, you know, I’m five months pregnant,
I forget all the time that I am pregnant because I am a full-time student and I also work, and
I’m in a program where I am in clinicals at the hospital, and I work at the hospital so it’s like
your busy, busy, busy, go, go, go and then the next thing I don’t know, I’ll randomly be like.
‘Oh I’m pregnant, what that’s so crazy!’
M9 2 I practice gratitude journaling every night, and reading [‘Can’t Wait to Show You’] helped me
reflect on ‘little’ things we sometimes take for granted as adults that are interesting beyond
measure to a young child experiencing it for the first time.
 JOURNAL OF REPRODUCTIVE AND INFANT PSYCHOLOGY 175

Table 7. Sample quotations illustrating ‘Who is this for?’ theme.

Participant Study
ID Phase Quotation
M1 1 I feel like it would be great for the parents to get a chance to go through the same kind of
experience I did with reading, you know. If it was an interesting experience, I mean I feel
like [the baby in utero] understood what I was saying to him and was taking in what we
were reading. And I just feel like they could enjoy it the same way I did. It’s a different
experience, different types of books, you know. Not many people find anything that’s for
just the babies in the womb and I didn’t even know they made it. It was news to me when
I read the books.
M2 1 I think the week that I started reading them was the first week that in the book it says that
they can hear so I mean we, like my husband and I, talked about that and so I don’t know
that it really changed anything, but like, I did make a decision to read them that week.
M6 1 I just wonder, there’s like kind of a new market for stuff to do in your stomach while the
baby’s in utero, like music and books. So, I’m just kind of curious the science to that and
anything I can do to, you know, better help the research. [. . .] I’ve heard the music thing,
Baby Mozart and that whole genre, and then I heard the books, and I don’t know, part of
me is cynical about it, like you know, I talk all the time, how does reading really affect that?
So, I don’t know. Maybe it’s just getting in the habit of reading. You know, I went into it, I’m
like, I don’t know. But then I read like one of these books and I was like, this is sweet, you
know? And I’m actually into it now.
M7* 1 [. . .] as a first-time parent we had no clue what we were getting into and I thought if we read
[books out loud] a lot together we would get quality time [and that the baby in utero]
would get benefits [. . .]
M9 2 [. . .] we strongly believe in the importance of reading to our children in utero, and continuing
to read to them on a daily basis after birth.
* Note: M7 was describing how she and her husband read books out loud in their previous pregnancy when they were
expecting their first child. They also explained that she got the idea to do it from her own mother who read to her in
utero.

child was in their arms, or in utero, reading was perceived as an opportunity to focus on
the child. Sample quotations from participants illustrating this theme are presented in
Table 6.

Who is this for?

All mothers (and the one father who participated) in the study reported seeing value in
the practice of reading to babies in utero. They reflected on the benefits of reading to
their baby in utero. Some mothers focused on how they saw the practice offering direct
benefits for the baby (e.g. hearing words and the mother’s voice). All mothers reflected on
the activity as being an opportunity to start bonding with their child. One parent (M6) in
particular, clearly articulated that the practice may shape parenting behaviours around
shared book reading. Table 7 that presents sample quotations from participants illustrat­
ing the ‘Who is this for?’ theme.

Discussion
What assertions can we make as we interpret the themes in relation to attachment theory
and early book-reading research? What insight does our study offer those who may be
considering the value of providing families books to be read to babies in utero? Might this
be a promising practice for encouraging bonding and promoting positive attitudes about
early parent–child book reading? There was diversity in: how frequently the mothers read
the study books; whether or not a partner, spouse, or other family member participated in
176 K. D. CLINE ET AL.

the reading with the expectant mother; and how comfortable the mother felt engaging in
the practice. Nonetheless, all mothers reported that they: saw value in the practice;
continued to read the study books during their pregnancy even after the interview;
would give these types of books as gifts to other expectant families; and would read to
another baby in utero were they to have a subsequent pregnancy.
The mothers were told about the initiative piloted by ‘Reach Out and Read Colorado’
that involved giving books to expectant families and promoting reading to babies in
utero. When asked how they would feel if their doctor gave them the types of books used
in our study at prenatal check-ups, the mothers in the study were generally positive about
the idea. However, one mother expressed that expectant mothers who are young and/or
have unplanned pregnancies may feel overwhelmed by all of the health and medical
expectations of a pregnancy and that adding the recommendation of reading to the baby
in utero on top of that may add more stress. At the same, themes that emerged across
mothers in the study included that reading to their babies in utero helped them to slow
down, to see their unborn baby as a person, and to connect with their unborn baby, which
may be especially applicable to such situations. Another mother brought up the impor­
tant consideration of making sure that books were carefully selected to be sensitive to
diversity in family demographics (e.g. religion, sexual orientation). We would also like to
suggest that the selection and presentation of books should be sensitive to the possibility
that the families have experienced loss. One of the books, ‘Nine Months in My Mommy’
acknowledged the topic of miscarriage. Representative of the wider population, some
families in this study expressed having experienced miscarriage and/or other pregnancy-
related challenges. It may be possible to carefully select books for particular families that
help them to cope with such challenges. Last, given findings described in the ‘Fathers’
Involvement’ and ‘Weird or Natural?’ themes, we suggest that there may be value in
considering and offering opportunities for participation of spouses/partners.
This study provides an important first step in examining an underexplored topic. Based
on the experiences and views described by participants, it seems that there may be
promise in providing books designed to be read by expectant families (including books
designed be read aloud to babies in utero) to promote bonding and to set the stage for
continued parent–child book reading. As one mother (M3) expressed, ‘I feel like [. . .]
reading these books while they’re in the womb would give parents more of the push they
need to be like, okay, if I can read to a baby who’s not even born, then I can definitely read
to a baby who’s actually in my arms’. However, it is important to emphasise that with only
10 participants, this small-scale study was exploratory in nature and findings cannot be
generalised. Related, even though there was variation in participants’ age, marital status,
and educational background and occupation, there was limited diversity with all mothers
being white and from the Midwestern region of the United States. Also important,
mothers were at different stages of pregnancy (ranging from 11 to 34 weeks). This is
significant since pregnancy can be considered as the dawning of attachment (Brazelton &
Cramer, 1990) when a mother’s representation of ‘her fetus (as a baby) increases in
richness and specificity from the 4th to 7th month of pregnancy’ (Stern, 1991). While
our findings suggest that parents did experience the book reading differently based on
the stage of pregnancy, the scale and methods of our study limited how deeply we could
explore this topic. In addition to these limitations, there may have been self-selection bias,
with parents who already valued reading being more likely to volunteer for the study.
 JOURNAL OF REPRODUCTIVE AND INFANT PSYCHOLOGY 177

Furthermore, with the qualitative methods, causal relationships between the practice of
reading to babies in utero and parenting views and behaviours cannot be assessed. With
these limitations in mind, we assert that the rich findings of this study point to a need for
additional research. We propose this includes larger scale, controlled experimental studies
utilising mixed methods (qualitative and quantitative) to examine if and to what degree
the modest intervention of receiving books designed to be read to babies in utero
(possibly at prenatal check-ups) impacts parents’ views and behaviours during pregnancy
and beyond. This line of research has the potential to assess the degree to which
engaging in book reading even before the parents can hold their children on their laps
may offer unique benefits.

Acknowledgments
We would like to thank the families who participated in this study for offering their time and
perspectives. This research was funded by a grant from the School of Health Science and Wellness at
Northwest Missouri State University.

Disclosure statement
No potential conflict of interest was reported by the author(s).

Funding
This work was supported by the Northwest Missouri State University School of Health Science and
Wellness.

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