Friday, December 25, 2015

Research: Is it a good idea for the biomom to hold the baby?

     As I mentioned in my last update, we now have more information about Anne's birth plan. The basis of a birth plan is for the biomom to have an idea of how she wants everything to look at the hospital. Who will be in the delivery room? Who will be in the waiting room to come in after the baby is born? Will the baby be taken out of the room or stay in? Will the biomom see the baby? Hold the baby?

      It is these last two questions that tend to make some people feel all prickly and uncomfortable. For years, the idea was that the healthiest thing at the hospital would be for the baby to be taken away as soon as he or she was born, and for the biomom to not see or hold the baby. In fact, many hospitals had policies that if a woman was placing her child for adoption, she would not be allowed to see the baby, even if she asked. Even though there is very little empirical research on this either way, the commonly accepted idea today is that this method is, in fact, incredibly unhealthy. One of the often quoted lines about this issue is "It is harder to say goodbye if you haven't said hello."
      In all of my searching, I only found one one webpage that claimed that a biomom spending time with the baby was related to her changing her mind. But, upon closer inspection, this was a webpage for a specific adoption consulting agency, and it was in the sense of (this isn't a direct quote, just the idea behind it) "If a birthmother (their word) spends time with the baby, this can put the adoption in jeopardy. That is why you should hire our agency, because we are aware of these risks and will have a counselor at the hospital to make sure everything is happening in a healthy way." So, this claim was being made as part of an advertisement, without citing any sources that would verify that a biomom spending time with the baby was related to her changing her mind.
     That being said, I really only found one research article that has information about this issue. It was in the Social Work journal and is a bit dated (1993),  but from what I was able to find, nothing has ever been published that would contradict its findings. I went through the article database and checked all of the articles that have ever cited this article, and none of them were citing it with the purpose of arguing or refuting it.
    Here's the context of this study: there were 215 participants who were age 21 or younger and unmarried who were interviewed during their last trimester and then again at 6-8 months post-adoption. These young women were recruited for the study from 13 states. All 215 participants who were interviewed during their last trimester did end up placing their babies for adoption. The authors did not clarify if there were additional young women who had been recruited during their last trimester that ultimately decided to parent, but nothing in the write-up of the recruitment methods would indicate that this was the case. This study looked at several different things, but I am going to focus on the findings related to seeing and holding the baby.

Some of the findings about how common it is for the biomom to see and hold the baby, and whether she regrets doing so, are as follows:

  • 96% of the biomoms saw the babies
  • 98% of that group also held the babies
  • Those who chose not to see or hold the baby were not prevented by doing so based on any type of hospital policy-- all made the decision that they did not want to do so. The 5 young women who saw but didn't hold the baby stated that they could have held the baby if they had wanted to. 
  • Most of these young women first saw and held the baby soon after birth
    • 36% saw the baby within the first few hours after birth, and 20% of them first held the baby at this time
    • As a side note to the above finding, our agency told us that the norm is for the biomom to hold the baby immediately after birth. It is kind of uncommon for her to choose to wait until later. 
    • 37% saw the baby within the first day or two after birth, but not necessarily within the first few hours (the author didn't specify what the cutoff was for being considered "a few hours" versus "within the first day"), and 51% of them first held the baby at this time
    • Only 8% waited until the baby was a week old 
  • Most biomoms saw and held the babies multiple times
    • 27% saw the baby only once
    • 24% saw the baby 2-3 times
    • 22% saw the baby 4-10 times
    • 27% saw the baby more than 10 times
    • 33% held the baby only once
    • 22% held the baby 2-3 times
    • 19% held the baby 4-10 times
    • 26% held the baby more than 10 times 
  • Most biomoms were happy with the amount of time they chose to spend with the baby. 
    • 70% said they would have wanted the same amount of time that they had
    • 30% said they would have wanted more time
    • 0% said they would have wanted less time
      • This is really important. Not a single biomom who ended up placing the baby for adoption indicated that she wished that she hadn't held or seen the baby. Even the ones who did so 10 or more times. 
    • The small percentage of women who chose not to hold the baby were more likely to say that they wished they would have had more time with the baby.
So what were the effects of the biomom holding the baby? 
  • Spending more time with the baby had a positive correlation with a biomom's level of grief at post-placement interview
  • Shorter intervals between birth and the first time to see and hold the baby were associated with higher levels of grief
      At first glance, that seems negative, right? She is experiencing grief, and grief is an unpleasant emotion. But, the conclusion of the authors was that this was actually the more healthy option. Grief is a necessary part of coping, whether someone has died, a relationship has ended, or some other trauma has occurred. Those who actually experience grief over their loss/trauma have better long-term coping outcomes than those who take steps to mask their feelings. As someone who has done grief counseling, I 100% agree with this idea. One direct quote from the article is "It is important to stress that such feelings may be appropriate six months after the birth and perhaps are necessary for the future well-being of the birthmother. As others have noted, grieving and mourning are components of the relinquishment experience that, if denied or repressed, can cause severe dysfunctioning later in life. It is likely that seeing and holding the infant facilitates such a process." This is supported by the fact that none of the biomoms wished they had spent less time with the baby, even if they were going through grief at the post-placement follow-up. If they had said "I am grieving, and I wished I hadn't held the baby because that would have been easier," this research would have different implications. But again, no one said that. 
      There are also 3 pieces of anecdotal evidence that I would like to include here. The first is a write-up done by a social worker who has been working with biomoms in adoption situations for 18 years. The link to her brief statement is here.  First, she said that it is recommended that all biomoms see and hold the baby. This is consistent with what our agency told us when I asked if I should be concerned or if it is a red-flag about Anne's desire to see and hold baby girl (I'll talk about this more later). Second, she pointed out that almost all "prospective birthmothers" reconsider their decision after the baby is born, regardless of whether or not they even see the baby. She explains that this is a natural process of making the adoption decision. I read one time that a woman makes her adoption decision 3 times: while pregnant, after giving birth, and with the pen in her hand before signing papers. Of course it is going to be normal for her to think "do I really want to do this?" while she is sitting there staring at the document that legally declares that she will not be parenting the baby that she has carried and given birth to. Apparently, seeing and holding the baby doesn't really impact the intensity of that internal debate (according to this anecdotal evidence-- again, I am not aware of any empirical study to verify this).  However, in support of the study referenced above, this social worker states that her agency has found that none of their biomoms have "ever regretting seeing or holding their babies." Finally, she ends on an excellent point that I had never really thought of: the act of seeing and/or holding the baby "does not change the reasons that brought a mother to considering adoption for her child in the first place." Sure, there may be a surge of emotion, but underneath those emotions are still the facts of her situation. Feeling love and desire for the tiny baby she is holding does not change the fact that she has made the assessment that she is not in a position to be able to adequately provide for that baby to the extent that she would desire. 
      The second piece of anecdotal evidence was written by a biomom for an adoption blog. Here is the link. She talks about some of the things that she considered in making her birth plan, and came to the conclusion that she wanted to "focus on the memories I would need to hold on to, grieve, and place in a sacred place in my heart...I believed it contained the moments that would help me let go." This biomom did hold and see the baby, and made a statement that again supports the above article: "Having a say in how it played out helped me remain strong in my commitment. Looking back, even as I grieve, I am at peace with my decision."  
     The third piece of anecdotal evidence I wanted to talk about was what our agency told us. When we first matched with Anne, we were told to expect her to want to be pretty hands off at the hospital. Apparently, early on, she alluded to the possibility that she might not want to see or hold the baby, at least until she had signed the papers. So when we were on the phone with our caseworker a couple of days ago and found out that her birth plan involved seeing, holding, and spending time with the baby, I had an ignorant adoptive parent moment of worry: "Is this a bad thing? Does this mean she might be changing her mind? Is this healthy? Is this a red flag that she isn't serious about the adoption?" I think I spurted off all of these questions in one breath to our poor caseworker. Thankfully, our caseworker avoided making me feel like a terrible control freak/awful person for having this concern (even though in hindsight I do have to admit that I am very embarrassed that my gut reaction was to be worried about Anne wanting to say hello to and meet the little person that she has been carrying around for 9 months but will never get to take home with her).  
     Our caseworker reassured me that Anne wanting to spend time with the baby is not a red flag. She said it is actually the opposite. In their opinion, the women who do not want to see or hold the babies are operating from a place of avoidance and denial: I am going to have the baby, distract myself for a couple of days, sign the papers, and just move on. The ones who desire to "say hello" have a more realistic evaluation of what it is they are going to have to cope with. Like the blog post by the biomom that I referenced above, they are thinking through the memories they want to carry with them to help them cope with their decision. She also said that the fact that Anne wants to see and hold the baby with us in the room with her was a very good sign. If she was saying that she wanted us to leave so that she could have time alone seeing and holding and taking care of the baby, that would be more of a red flag (although this doesn't always mean the biomom is changing her mind by any means). She wants us to totally take care of the baby-- she doesn't want to do any care on any level-- and just wants to be in the room to see the baby in the way that a visitor would be.  She wants to have the reassurance of seeing us bond with the baby and the baby bonding with us. Her reasoning for why she wants to spend time with the baby is more important than her desire for the actual action of spending time with the baby in evaluating if anything is a red flag of her reconsidering. The bottom line is that neither caseworker, people who are involved with adoption as their careers, is worried about any element of Anne's birth plan. If they are not seeing red flags anywhere, we are not going to be concerned, either. 
      Here is a final thing to think about: at the end of the day, an adoption agency is a business. They make money from adoptions, and getting PAPs as clients is how they stay in business. Statistics are important. No one wants to sign with an agency that says "60% of our biomom's change their minds and decide to parent." While an ethical agency will have a biomom's best interest at heart and will in no way push her towards an adoption decision that she is not certain about just to make money, it would be a stupid business move to intentionally encourage actions that would lead to a biomom changing her mind at the last minute in situations where adoption truly is the best/healthiest/least terrible option. If seeing and holding the baby caused the majority (or even a significant percentage) of biomoms to change their minds, you wouldn't find reputable agencies with strong statistics making statements like "We always encourage the biomom to hold the baby." 

Cushman, L., Kalmuss, D., & Namerow, P.B. (1993). Placing an infant for adoption: The experiences of young birthmothers. Social Work, 38, 264-272. 

No comments:

Post a Comment