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Adoption Advocate No. 45: Birthparent Counseling in Policy and Practice

Published March 2012 by Chuck Johnson and Kris Faasse

Nicole Callahan, Editor

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The Evolution of Adoption Counseling and Practice

Birthmothers from generations past often report being “counseled” to return home following the birth and adoptive placement, forget about the baby, and live “happily ever after.” It is impossible to know how frequently counselors offered this well-intentioned but unrealistic and misguided advice, but it is clear from the literature and documented case studies that adoption practitioners have not always comprehended the emotional strain that the adoption decision can have on the relinquishing parent(s).

In recent decades, as licensed social workers, licensed private adoption agencies, and other skilled professionals have taken over the practice of adoption, there has been an increased focus on assisting birthparents in their feelings of grief and loss. As the understanding of birthparents’ issues has continued to grow, so has our understanding of the impact of the adoption decision and resulting emotions and grief for birthparents. Today, no competent adoption professional would suggest to a pregnant client that it would be possible to simply resume her life and forget the child she placed for adoption.

Most adoption agencies now provide extensive pre- and post-placement counseling and other support services for birthmothers. These programs are intended to educate pregnant women facing an unplanned pregnancy about their options, help them weigh all relevant factors as they decide whether or not to make an adoption plan, and support them as they face and reconcile their emotions after relinquishment.1

Adoption practice has become increasingly subject to state regulation and oversight over the past several decades, and many states have taken steps to protect mothers who decide to relinquish a child for adoption by regulating pre-adoption counseling. These laws, consistent with the evolution of “best practices” in adoption, are designed both to ensure that expectant mothers understand the legal implications of adoption regarding their parental rights, and that they make the decision to relinquish free from pressure or undue influence. State adoption statutes now often include provisions that recommend, if not require, pre-adoptive placement counseling in the context of relinquishing a child and consenting to adoption.

State adoption counseling laws vary significantly. Some states’ birthparent counseling laws are vague. Many other states, however, have elected to address additional components of adoption counseling, including topics to be discussed (i.e., permanency of placements, current and potential impact on birthmothers, and alternatives to placements), the duration and number of required sessions, who may provide counseling, the right to reimbursement for counseling costs, and verification of the offer and/or receipt of counseling, to name a few. In general, states enact such measures to ensure that birthparents are not able to relinquish their children without first being apprised of the opportunity for counseling. Some state child-placing licensing divisions may also impose counseling requirements, either in addition to, or in lieu of, statutory provisions. Private adoption agencies regulate themselves in their own practice as well; in many cases, more stringently than do state legislatures.

Women making an adoption plan today choose adoption under far different circumstances than they did decades ago. Until the latter part of the 20th century, it was almost unthinkable to raise a child outside of marriage; as a result, unmarried women often placed their children for adoption under pressure or to avoid the associated stigma. Today, social customs have changed to the point that, oftentimes, society is quicker to misunderstand or to judge a birthmother who chooses adoption than a single mother who chooses to parent her child. Despite misconceptions or misunderstanding about adoption that still linger in our society, it should be counted as progress that a woman choosing adoption today has the power to make her own decision about what is best for her and her baby.

For many women facing unintended pregnancy today, parenting may seem like the best choice, while for others, adoption offers other possibilities. The expectant mother exploring adoption because she feels unable to parent her child may be personally opposed to abortion. Or she may simply believe that adoption will provide her child with the stable and loving family she wants for him and is unable, at this time in her life, to offer due to a lack of education, financial resources, readiness to parent, and/or support from her parents, friends, or the father of the baby.

The Importance of Adoption Counseling

Quality adoption counseling is an essential service that must be offered to all women facing unintended pregnancy. It enables them to make pregnancy decisions in an informed manner, after personal reflection, with all the facts and options on the table.

The expectant mother seeking pregnancy counseling needs to explore all of her options and understand what each could mean for her and her child.  Some women seek counseling early in their pregnancies, and for them the discussion of various options, including adoption, may yet be preliminary and exploratory. For other women, who may not reach the pregnancy counselor or adoption professional until later in their pregnancies, the decision to parent the child or make an adoption plan may be far more immediate.

Counseling provides an opportunity for the client who is wrestling with her decision to make an adoption plan, parent the child, or terminate her pregnancy to objectively evaluate all her options. For the client who is already predisposed to one option over another, counseling allows her additional information and the opportunity to formulate her reasons for making that choice and feel certain that she is making the best decision. Deciding on one course of action without fully exploring the other might leave an expectant mother with questions that can no longer be explored once relinquishment or termination has occurred. For the expectant mother considering adoption, a serious exploration of what other options would mean for her often allows her to feel more confident in her ultimate decision.

Counselors can help women with unintended pregnancies differentiate between their own needs and those of their children. Although counseling plans and casework goals vary from professional to professional, even within adoption agencies, skilled counselors always encourage their clients to weigh the advantages and disadvantages of adoption versus parenting, while they assist in facilitating this evaluation process.

Expectant mothers that are leaning towards parenting should be invited to participate in parenting education on a variety of topics, such as the physical, emotional, and developmental needs of children, supervision and daily care considerations, and the financial demands of raising children. Those who decide to parent should also receive information that will help them acquire the skills they need in order to provide a stable family environment for their child. This is especially important for those clients that may lack the support systems critical to parenting.

For an expectant mother considering adoption, the counselor should assist her in making an individualized adoption plan, offering the level of counselor input she desires. As part of case planning and adoption education, counselors routinely discuss legal considerations, such as paternal rights and the time at which a mother may legally consent to the adoptive placement; the availability and role of the father, family members, friends, and other support systems;2 the extent and type of contact the birthmother hopes to have with her child’s adoptive family; and where the baby will be during the period between birth and finalization of the adoption.


Suggestions for Counselors

Following are some recommendations for counselors working with expectant parents and birthparents. While these suggestions were written with the expectant mother in mind, please keep in mind that if and when the expectant father is involved, these suggestions can apply to both parents. Expectant fathers may experience many of the same questions and feelings throughout the counseling process. It is necessary both legally and morally to reach out to fathers whenever possible, and to offer them education and support if they choose to participate in any adoption plans being made.

At the first meeting with an expectant parent, get to know her and try to find out how she views her pregnancy before introducing the topic of adoption.

The purpose of the first meeting is to get to know the mother, so that you can build a relationship with her and discuss how she feels about her pregnancy. It is the role of a counselor to provide her with support and information so she can make the best decision for herself and her baby. If her pregnancy is problematic, if she’s not ready to parent or questions her ability to be a parent at this point in her life, then a counselor must help her explore what she sees as her options.

Find out what she thinks about the pregnancy. Ask her to tell you what she believes her options are. It is appropriate for the counselor to bring up adoption and begin to explore what the expectant mother knows and thinks about it as an option. Remember, however, that what helps one mother will not necessarily help all. At the outset, some mothers will not be ready to hear or talk about adoption in detail. Still others, even if they are not yet ready to seriously consider adoption, do need to hear and know that there are waiting families and adopted children are well cared for and loved.

While some mothers may tell you from the very beginning that they want to know more about adoption, it may be a red flag if a mother refuses to even discuss the possibility of parenting. She needs to think about it seriously and know what it involves before she can make the decision to give up the possibility of parenting this child.

At the first meeting, it is good to listen more than you talk. Find out what the mother thinks and feels about her options, and help her begin to envision what her life would look like with each of them. Have her tell you what she wants or needs to know, and go from there. Never direct or attempt to influence the outcome at any time during the counseling process.

If a mother is seriously contemplating adoption for her child, talk about how she sees the adoption plan “playing out” as you discuss the option, and help her begin to face her feelings of loss.

A mother seriously considering adoption most likely has some vision of how she hopes it will go, as well as her own preferences. Does she want regular and/or frequent contact? Does she see the adoptive family as an extension of her own family, or herself as an extension of theirs? What is her relationship with her family currently, and are there parts of that relationship that she would like to either duplicate or try to avoid?

While some of her ideas may be supplemented and/or tempered by information provided by the counselor, exploring the expectant mother’s own personal hopes is necessary to help her counselor understand what she wants and help her achieve it or something like it. Some birthmothers and birth families have become frustrated with an adoption plan because there was never adequate discussion about what they wanted it to look like. Expectations and hopes must be communicated in order to be recognized and realized.

When it comes to identifying prospective adoptive parents, a birthmother may want to look at profiles right away, in order to feel assured that there are families ready and available to love and care for her child. For some birthmothers, however, it is better to continue discussing what kind of parent she wants to be, and what she values in a parent. Starting to list what she thinks are important parental traits can help her once she is ready to look at profiles.

Counselors must realize that anticipatory grief often begins during this early planning stage, when a mother starts to not only make choices but to think about having her baby raised by another set of parents. This is important for her to contemplate, and it makes the choice and the loss begin to feel real to her, which is a necessary part of grieving and eventual healthy reconciliation. Only when she accepts that this is a real loss, that it is a difficult choice but one she believes is best for her child, can she actually start to grieve and experience the range of emotions that come with it.

It may help her to make plans for what her hospital experience will be like. She should also review relinquishment documents, so she knows what they look like long before she has to sign them. Emotions experienced at this early juncture allow for movement through a grief process, while emotions denied tend to hold people back from acceptance or moving forward.

At this time, it may help if the mother has the opportunity to meet and talk with birthmothers who have chosen adoption – open, semi-open, or closed – to ask them questions and find out more about their experiences.

Once a potential adoptive family has been identified, one that wants a level of interaction similar to that desired by the expectant mother, help her in the initial meetings as they plan for and discuss how much future contact they want.

Expectant parents contemplating adoption, once they have explored what they want an adoption to look like, have to receive honest information about all types of adoption, the pros and cons of all types of adoption (as they see them, and as the counselor sees them), and the possibilities offered by contact plans. If pre-adoption contact agreements are not court-enforceable, the mother needs to be told so she understands that from the beginning. If they are enforceable, she needs to know their limits.3

The biggest thing to remember about an adoption relationship is that it is just that, a relationship. At the heart of open (or semi-open) adoption is this relationship between the birth and adoptive families. It is important for all parties to an open adoption to discuss what they want the relationship to look like. The best birthparent/adoptive parent relationships are respectful, flexible, and built on trust. With trust, they can weather the normal ups and downs that occur in most relationships, including adoption relationships.

Even if the expectant mother initially believes that she wants only minimal contact, such as pictures and letters, adoptive families would be well prepared to remain open to a higher level of contact with her and/or the birth family. Many birthmothers find that updates, pictures, and letters are comforting rather than distressing. If this is the case, adoptive families can rethink their original plans and embrace a higher level of contact with the birthmother or birth family, to help their relationship grow stronger.

Birth and relinquishment can be very difficult for the birthmother, and as her counselor, you must be ready to support her before, during, and after these experiences.

For an expectant mother who decides to proceed with adoption, her counselor helps her prepare for the difficult decisions she must make as the birth approaches, as well as the accompanying feelings and struggles. The expectant mother must also make hospital and discharge plans and, in doing so, she will need to consider how much contact she wants to have with the baby — if she will nurse the baby; if she will have the baby with her in her hospital room; whom she wishes to visit with her; and when and how she will sign her relinquishment paper (depending on individual state law requirements). While it may initially seem easier not to have their newborn child with them in the hospital room, the majority of birthmothers treasure this time as their baby’s only mother. Such time can be precious in a birthmother’s memories, as well as important for both grieving and healing.

Some birthmothers may also wish to keep mementos or photographs from the birth and relinquishment or participate in an “entrustment ceremony” to mark the transition of the child to his new family. All of these important decisions, though ultimately the mother’s to make, should ideally be made with the understanding and input of the prospective adoptive parents.

Many clients report the actual signing of the adoption papers as one of the most difficult points of the relinquishment process. Some birthmothers report a profound sense of loss, fear of future regret, and sometimes shame at the time of relinquishment. Counseling helps prepare a birthmother for the eventual difficulty of this life-changing step, allowing her to acknowledge both her feelings and the impact on her life. It is essential for a birthmother to feel confident that her counselor is willing to walk alongside her and help her face her pain and grief as well as provide knowledgeable and nonjudgmental support.

A birthmother may view her child’s adoption as the right decision — the very best decision — but for many, relinquishment still involves feelings of loss and consequent grief.  Birthmothers need ongoing support to cope with a choice and a loss that is often not acknowledged or understood by others. Lack of support isolates birthmothers emotionally at a time when they most need someone to listen and allow them to give voice to the full range of their emotions without judgment.

After the relinquishment, the counselor should remind the birthmother that healing does occur, although it takes time and the experience and length of grief is highly individual. A birthmother should be reassured that she will not forget her child, and that it is natural for the child to remain in her thoughts as she moves forward with her life plans. There will be particular reminders of the adoption – such as the child’s birthday each year – and she will revisit some of the same feelings, although the intensity will often change and lessen with time.  If it is an open adoption, she may have more ongoing contact with the child and his adoptive family, and in that case counselors should provide additional information about the possibilities of maintaining contact and assist the birthmother however possible.

Be available to the birthmother after the adoption takes place and provide her with the best support and post-adoption services you and your agency can provide.

Given the long-term consequences of making an adoption plan, most adoption professionals now recognize the importance of providing an assortment of post-placement services to birthparents.

In the days following the child’s birth, it is not uncommon for birthparents to experience conflicting emotions; many birthparents report feelings of joy and sadness, pride and shame, and acceptance and regret following relinquishment. The counselor can play an important role in helping the client express her feelings, remember the reasons she chose adoption, and eventually adjust to the consequences of her decision. The counselor can also encourage the client not to blame herself or others for her difficult circumstances, and help her find peace with the decision she has made. As she considers how she has dealt with other, past losses, a birthmother can often identify her own personal ways of coping with her decision and recognize that healing comes with time.

Birthmothers should always be encouraged to ask for the help and support they need. As one birthmother recalled, “I was afraid to ask for help because I felt like I would be burdening someone. I waited until I hit rock bottom to ask for help. As a birthparent, I’d encourage adoption professionals to just let their clients know that help is always available, and they can ask for it anytime, regardless of how long it’s been since the adoption. This way they know that they are not alone and there is always help available.”

When a birthmother faces the reality and pain of her decision, she often feels a need to talk through all of her emotions. Eventually, if the grieving process is healthy, she will begin to withdraw energy from grieving and focus on moving beyond it. A good counselor can help her find ways to not only remember her experience but also begin to incorporate it into the rest of her life. She will realize that, while she will never forget her child or the adoption, it is all right to invest her energy in normal activities again.

Many women choose adoption because they believe that making an adoption plan will ultimately make it possible for them to reach their goals. After the adoption is finalized, a counselor can gently help a birthmother get back on track by asking her, What happens now? Do your plans still seem realistic? Then she can begin to plan for the rest of her life, asking herself what she wants her life to look like in a month, six months, or a year; what she hopes to accomplish in years to come. In the words of one birthmother: “I knew I wasn’t ready to be a parent, but after walking through pregnancy, placement, and relinquishment, I felt I could do anything – that nothing else would ever be as hard. I felt ready to pursue my goals, and achieve them.”

Some birthmothers will remain in touch with their adoption counselor, although most clients will decrease their contact as they reach a place of acceptance. They may connect their counselor with the adoption and find it difficult to maintain regular contact, and contact the counselor only every now and then when an adoption-related memory is triggered. Some birthparents will feel the need for additional counseling and seek out another professional for long-term counseling. Others will find it most helpful to find and speak with other birthmothers who understand what they have been through, and counselors should be ready to refer them to birthmother connections and support groups.



A birthmother’s decision that she is not ready to parent a child is never an easy one.  Being mature and selfless enough to put the needs of her child above her own wants cannot negate the difficulty of the decision or lessen her sense of loss. While the denial of any feelings can be detrimental to anyone, denial of the losses of adoption can result in grief that is lonely and disenfranchised. Only support and the respectful acknowledgment of their choices and their emotions can help birthparents grieve in a healthy manner and, with time, allow for their healing and reconciliation of the adoption as a part of their life story.

Many opponents of adoption or those who simply misunderstand it focus exclusively on the feelings of loss that birthmothers will inevitably experience, ignoring the fact that women who choose to parent under difficult circumstances or terminate their pregnancies may also face their own struggles and conflicting emotions. It is important that we also acknowledge the real and positive outcomes for many women who have chosen adoption for their children. Studies have shown that women who relinquish their children for adoption are better positioned for accomplishing their personal and professional goals than are many of their peers who choose to parent their children under adverse circumstances. Birthmothers also report a high level of satisfaction with their choice to make an adoption plan, particularly when they have received the professional counseling and support needed in order to reach a fully informed decision.

Counseling is a necessary component of infant adoption, not just prior to placement but also, in many cases, after placement as well. Remember that there is an art to good counseling, and every expectant mother is different, so there cannot be universally prescribed, specific guidelines for each meeting or session. It is most important to listen to the individual mother, and know that while the choice to make an adoption plan is a difficult decision, as counselors you will also see many women come through the process. It is possible for a woman to feel empowered by making and following her adoption plan, owning her decision, grieving her recognized loss in a healthy way, and eventually reaching a place of healing and wholeness.

As with any difficult decision, feelings of anxiety, sorrow, and grief are common throughout the adoption process, and will be felt beyond the placement itself.  Good counseling provides a crucial foundation for birthmothers in dealing with their emotions and moving forward – from the beginning, as they decide whether or not to make an adoption plan, throughout the process until relinquishment, and after placement as they undertake the necessary work to grieve and to heal. A birthmother can never forget her child or the immense difficulty of the decision she made, but she can understand and accept it, and know that adoption was the right decision for both her and her child. It is this resolution and sense of peace that will be of greatest help to a birthmother as she moves forward to live her life and pursue her goals, in the knowledge that her child is loved and cared for through adoption.


Editor’s Note: NCFA is especially grateful to birthmothers Amy Hutton and Jessalynn Bills for reviewing this article and offering their valuable feedback and suggestions.

A prior version of this article, written by Chuck Johnson, was published in NCFA’s Adoption Factbook IV (2004).


* Kris Faasse, LMSW, ACSW currently serves as Director of Adoption Services for Bethany Christian Services. In her position at Bethany, she works with staff in pregnancy counseling, domestic infant adoption, international adoption, and post-adoption services. Kris earned both her Bachelor’s and Master's Degrees from Western Michigan University, and has over 20 years of experience in pregnancy counseling and adoption.

Chuck Johnson is president and CEO of the National Council For Adoption. Prior to joining NCFA, he worked for 17 years at an adoption and child-placement agency in Alabama, serving eight years as its executive director. Chuck has been a licensed practicing social worker since 1986, and holds a Bachelor’s Degree in social work from Auburn University as well as a Master’s Degree from Birmingham Theological Seminary.

See also: iChooseAdoption.org, NCFA’s educational resource site for expectant parents considering adoption. This website, featuring Frequently Asked Questions about adoption, birthmother testimonials, and sample adoptive parent profiles, was designed by NCFA as a supplemental resource and a possible starting point for expectant parents considering adoption. It is not intended to take the place of professional counseling.

2 No. 37, “Fathers, Families, and Friends: Involving and Prioritizing a Pregnant Client’s Support System,” available online: https://www.adoptioncouncil.org/publications/adoption-advocate-no-37.html

3 NCFA does not support court-enforceable pre-adoption contracts because there is too much prescription and not enough flexibility. Such plans do not allow for very real changes that can and do occur when it comes to relationships, personalities, wishes, or experiences.



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