Adoption Advocate No. 52: Educating Hospitals About Adoption: How Hospital Staff Can Support Parents Considering an Adoption Plan
Published October 2012 by Devon Karst with Megan Lindsey
Nicole Callahan, Editor
Chuck Johnson, Editor
Imagine a teenager or a young woman in her hospital room, staring at her new baby. She has never seen or felt anything like this before. Despite the enormous emotional difficulty, this particular young woman chose adoption for her child. Today she will sign papers and place her child with his new adoptive family. She believes that this is the best decision for her and her child. Yet she may be thinking: “I didn’t expect to feel so connected to this baby.” “Do other birthparents feel this way?” “Am I doing the right thing?”
Many young women making adoption plans have experienced similar feelings.1 In a perfect world, childbirth and parenting might be both expected and desired for every person involved, every time. In reality, however, pregnancy is often unexpected, and then a woman or couple must deal with this news and make difficult decisions about the future. Will a woman carry her pregnancy to term or choose to terminate? If she goes ahead with the pregnancy, will she parent the child herself? Will she consider allowing others to parent her child through adoption?
Although pregnancy decisions can be difficult to make and adoption is the less frequently chosen option, there are many reasons why adoption can be a positive option for both birthparents and children who are adopted. Many birthparents feel great love for their children, yet they make an adoption plan for them rather than parenting because they believe it is the best choice. Compared with unmarried mothers who parent their children, unmarried teenagers who place their children for adoption are more likely to obtain a higher level of education, obtain better employment, and achieve a higher level of financial stability. They are also less likely to need public assistance, and are more likely to marry in the future – and when they do, are more likely to delay marriage until an older age.2 According to the National Campaign to End Teenage Pregnancies, 62% of mothers who became pregnant under the age of 18 do not receive a high school diploma.3
If an expectant mother believes that making an adoption plan might be best for her and her child, it is an option she should be able to freely consider. Many women report a high level of satisfaction with their decision to make an adoption plan.4 Women who voluntarily choose adoption, free from pressure or coercion, also report a high level of satisfaction with their decision. Many express positive feelings about providing their children with loving families through adoption
Infant adoption also often offers many positive benefits to children. Children who are adopted are less likely than their non-adopted peers to have divorced parents and are more likely to be raised by parents with college degrees. They score higher than others in the general population on many indicators of wellbeing, including school performance, friendships, volunteerism, optimism, self-esteem, social competency, and feelings of support from others. They are also less likely to exhibit high-risk behaviors such as alcohol use, depression, vandalism, fighting, theft, weapon use, and driving/riding while drinking.5
In 2007, infant adoption represented 0.4% of live births – 1.3% of births to unmarried women – in the United States.6 All expectant parents receiving pregnancy options counseling should be fully informed about all of their options, including the option of adoption, and fully supported in the choice they make.
It is essential that parents who have made the complicated but loving decision to make an adoption plan feel supported and respected in their decision. It is especially important that they be treated with respect and understanding during the pivotal time when they are in the hospital for the birth of their child.
Frequently, expectant parents considering adoption are very involved in the process of choosing the potential adoptive parents, and may have even gotten to know them quite well. Hospital staff should be trained on and aware of the emotional and legal implications of adoption, and strict policies should prohibit any medical staff or hospital employee from attempting to influence the mother’s decision for or against adoption. While in the hospital, she should always feel supported and respected in her decision, and free to exercise her right to change her mind about adoption.
When the child is born, parents who have made an adoption plan will have the option to see their baby and spend time with her, and many do. This is a highly emotional time for any family. The birth of their child can cause even parents that might have felt very certain about their adoption plan to question their decision or change their minds, and prospective adoptive parents need to be aware of this. It is important for mothers considering adoption to know their rights, and for hospital staff to be accommodating and respectful of her decisions during the birth and hospital stay.
When considering an adoption plan for their child, parents have many rights that should always be fully communicated to them and respected at all times throughout the adoption consideration and placement process. These rights include:
The right to be fully informed. Expectant parents considering adoption deserve free, accurate, and easily accessible information about all of their options, including adoption, and access to responsive professionals who can help answer all of their questions.
The right to make an independent decision. Adoption can be a positive option for many, but it is important to recognize that an expectant parent knows better than anyone what the best decision is for herself and her child. Counselors, healthcare workers, and adoption professionals can help inform the decision-making process, but should never be permitted to be coercive, present a bias for or against an adoption or parenting decision, or rush any parent to make a choice before she has fully explored and weighed all of the options. Even if an existing adoption plan is in place, a mother has the right to change her mind or revoke her consent according to the laws in her state, and if she does choose to parent rather than place her child, her decision must be honored.
The right to professional counseling. Expectant parents, both mothers and fathers, should have access to compassionate, professional counseling both before and after a child is placed for adoption. Those making a pregnancy decision deserve the opportunity to process all of their thoughts and emotions in a supportive and nonjudgmental environment, both as they consider and after a decision has been made.
The right to a safe and legal process. Birthparents should always have the right to be represented by independent legal counsel if they choose. The adoption process should always be safe, fair, and efficient for all involved, protecting the rights of birthparents while prioritizing the best interests of the child. Expectant parents should have and be advised of the right to change their mind within the legal limitations permitted in their state. This process varies by state, and so an adoption agency or attorney should always explain this process in advance and be available to help implement this process when requested.
The right to their preferred level of continued communication if an adoption plan is made. Parents may wonder if they will be allowed or required to remain connected with their child if they make an adoption plan. Whether no communication, occasional letters and phone calls, or a close relationship with face-to-face visits is preferred, agreements should be made with adoptive parents who support the birthparents’ preferred level of openness and contact in the adoption relationship.
The right to be involved in choosing adoptive parents. Expectant parents have the right to be presented with options and have input regarding their child’s adoptive parents. Expectant parents should be able to ask questions of and meet with different prospective adoptive parents as they consider making an adoption plan.7
Like social workers and adoption professionals working with parents considering adoption, physicians, nurses, and other healthcare staff at the hospital must also be aware and respectful of the parents’ rights. The delivery and hospital stay is an important and emotional time for any parent, and this is equally true for parents who have chosen adoption for their child. Hospital staff should be sensitive and responsive to the needs of women who choose adoption, as well as the adoptive parents who may also be present at or after the birth.
Two hospitals that have set a great example of caring for children, birthparents, and adoptive families are Parker Adventist Hospital in Parker, Colorado, with its Family to Family Adoption Support Program, and Sanford Clinic Women’s Health in Sioux Falls, South Dakota. Following are some of the ways in which these two facilities have integrated adoption-sensitive services into their protocol.
Train staff. The most important thing a hospital can do to support parents considering adoption and prospective adoptive parents is train staff on adoption policy, including the legal basics involved. Training is particularly important for staff members and social workers who might be responsible for reporting pregnancy results, assisting in labor and delivery, or helping new parents during their hospital stay.
Through a federal grant from the Children’s Bureau of the Department of Health and Human Services, the Infant Adoption Awareness Training Program provides free training to many workers in both clinic and hospital settings. This training provides participants with an understanding of adoption policy and practice, an overview of the adoption laws in their state, and ways to accurately and comfortably share the option of adoption with expectant parents and provide the appropriate support should they make an adoption plan.8
It is also valuable to have one designated staff member who is an “expert” in adoption. This person can be the point of contact when other staff members are uncertain how to proceed in a situation with a particular parent or family. This staff member can also build relationships with adoption and other social services providers, and update hospital or clinic policies as needed to reflect current laws, trends, and best practices in adoption.
Establish policies that are birthparent-focused and friendly to adoptive parents. The best way to ensure compassionate care for all participants involved in the adoption process is to plan ahead for it. Hospitals with clear policies in place will understand what it means if a patient makes an adoption plan, and will make sure that staff members are prepared in advance. In most states, birthparents rightfully have parental rights until taking the necessary legal steps to transfer rights to adoptive parents. Clear policies legally safeguard the hospital in sending an infant home with someone other than the biological parent(s).
The Sanford and Parker programs stand out in part because supportive hospital and clinic administrators worked to put clear, ordered policies in place in order to better serve both birthparents and adoptive families. Parents making an adoption plan deserve to have their choices honored and their wishes respected throughout the birth and their stay in the hospital. Following are some important issues to be considered when creating hospital policies regarding adoption:
Having clear policies in place allows hospitals to better inform and assist their patients in advance, ensuring that parents considering adoption are not distracted by unnecessary questions or, worse, judgments about their decision-making process. Such policies also help inform prospective adoptive parents and allow them to better understand the role they will be allowed to play during the hospital experience. At Parker Adventist, if the mother is willing, potential adoptive parents are allowed to “room in” at the hospital and remain there until the infant is discharged. If the mother chooses, the child to be adopted can also stay in the adoptive parents’ room, allowing the parents to benefit from the infant care expertise and guidance of the hospital nursing staff.
Create and distribute helpful resources. Both Parker and Sanford hospitals provide excellent resources that can be given to parents considering adoption. Sanford’s brochure lists the rights and responsibilities of birthparents, and gives quick and clear information about their options under state law. This resource also lists contact information for several local adoption agencies so that further information can be sought if needed.9 Parker’s brochure for birthparents answers frequently asked questions about adoption, provides a basic discussion about the different types of adoption, and includes a list of important things to consider when thinking about adoption.10 Hospitals interested in providing similar brochures to women considering the option of adoption can also request free brochures from the National Council For Adoption.11
Provide opportunities for patients to learn, connect, and support. Some hospitals choose to host support groups or educational trainings regarding adoption. Hospitals might host support groups for birthparents who have made adoption plans, or they might provide special training for adoptive parents. Parker Adventist offers several classes, including one entitled “Maybe We’ll Adopt,” which gives prospective adoptive parents information about a variety of local adoption resources as well as a broad overview of the adoption process. Parker Adventist also provides CPR and Newborn Infant Care classes for parents, which meet the parental training requirements for some adoption agencies.
Assist in recognizing the adoption for the child as well as all parents involved. There are many ways that parents making an adoption plan and prospective adoptive parents choose to recognize and memorialize the adoption during their hospital stay. Fingerprinting is a special and memorable procedure at the birth of any child, and some parents involved in an adoption take this opportunity to honor the special relationship formed by adoption, ensuring that both sets of parents receive a copy of prints to help them remember the birth. Fingerprinting or the exchange of small gifts might also be part of a larger adoption “entrustment ceremony.” At Parker, birthparents and adoptive parents are given the opportunity to take advantage of the hospital chapel should the birthparents choose to have a special ceremony.
For parents considering adoption, the hospital’s policies, knowledge of, and overall attitude towards adoption may have a tremendous impact on the birth experience and adoption process. For those that do make the decision to place their children, the time in the hospital may be the only time they are able to spend as sole parents to their children.
Helping parents considering adoption to feel safe, respected, and empowered throughout their child’s birth and their hospital stay is consistent with the high quality of service, professional ethics, and patient-focused values that good hospitals, clinics, and healthcare workers endeavor to provide. An adoption-friendly hospital environment benefits all involved in the adoption process, and is especially important for parents considering an adoption plan.
1 At times, this article refers to pregnant women and mothers as the decision-makers. This language choice is not intended to deny the importance of fathers or their role in the decision-making process.
2 Donnelly, B.W. & Voydanoff, P. (1996). Parenting versus placing for adoption: Consequences for adolescent mothers. Family Relations, 45, 427-34.
3 Teenage pregnancy and education. (2010). National Campaign to End Teenage Pregnancy.
4 McLaughlin, S., Manninen, D., and Winges, L. (1988). Do adolescents who relinquish their children fare better than those who raise them? Family Planning Perspectives, 20, 25-32.
5 Benson, P., Sharma, A., & Roehlkepartain, E. (1994) Growing up adopted: A portrait of adolescents and their families. Minneapolis, MN: Search Institute.
6 Placek, P. (2011). National adoption data assembled by the National Council For Adoption. Adoption Factbook V. 7-8.
7 Adapted in part from Harmony Adoptions “Birthmother’s Bill of Rights” (http://iaatp.com/docs/bmbor.pdf) and Spence Chapin’s “A Birthparent’s Bill of Rights” (http://www.spence-chapin.org/downloads/BillORights-2008_English.pdf).
8 Six regional grantees and their networks of trainers in every state provide this training throughout the United States. Grantees include: Arizona’s Children Association, Harmony Adoptions, Latino Family Institute, Lutheran Social Services of South Dakota, National Council For Adoption, and Spaulding for Children. For more information on the Infant Adoption Awareness Training Program, please visit www.iaatp.com to learn about the grantee in your region or request a training.
9 Sanford Clinic Women’s Health. Adoption Rights and Responsibilities. Sioux Falls, SD.
10 Family to Family Adoption Support Program at Parker Adventist Hospital. It’s Your Choice. Parker, CO.
11 National Council For Adoption provides free brochures in English and Spanish that can be given to women considering adoption. Two brochure options are available – one to provide information to expectant mothers considering adoption; the other for those individuals that make up an expectant mother’s support system, to help them understand adoption and how to best support mothers considering this option. NCFA recommends that health clinic staff and others add to the brochures relevant information for local adoption agencies and other important resources.
For 33 years, NCFA has been the authoritative voice for adoption. Our research and education programs have led the way in promoting sound, ethical adoption policies and practices that have enabled children to find nurturing, permanent families through adoption.
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