Hospitals' Treatment Of Birthmothers

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hospitals' treatment of birthmothers

Hospitals play a critical role in dealing with birthmothers who are considering an adoption plan, far beyond assisting the birthmother with the delivery of her child and providing immediate postpartum care. The attitude of hospital staff, particularly nurses, may mean the difference between a woman deciding to parent her baby or to proceed with her previous plan of adoption, despite counseling beforehand by experienced social workers.

In addition, although she may follow through with her original plan, whether it was adoption or parenthood, the reactions and behavior of the hospital staff can affect the birthmother's own self-image, both during her stay and after she leaves; for example, if she felt the hospital staff were understanding and positive, she could begin the process of reorienting herself to her own individual goals. Conversely, if she perceived the hospital staff as very negative, the birthmother could have many lingering doubts about her decision.

Most hospitals have an adoption policy, and some hospitals even have separate policies for agency adoptions, independent adoptions and special needs adoptions. Because of turnover in nursing staff, it is possible new staff members may not have received in-service training on adoption policies. One way to avert potential errors is to involve the hospital social worker from the point of admission until the birthmother's discharge.

Some hospitals also offer birthmothers the opportunity to visit the hospital before the delivery, meet with the hospital social worker and be introduced to the head nurses of labor, delivery, obstetrics and the nursery. This advance visit can alleviate much of the anxiety of the pregnant woman, including both the fear of a first-time mother as well as a dread about later telling hospital staff about her adoption plan.

Ideally, the agency social worker or the attorney who is initially contacted by the pregnant woman about adoption will formally notify the hospital social work department by letter of a woman considering adoption who will deliver in their hospital. As much time as possible should be allowed so the hospital social worker can notify key people in labor and delivery, the nursery and, of course, the obstetrician.

The role of the hospital social worker will vary, depending on whether the pregnant woman has an established relationship with another counselor (usually a social worker) and whether that worker is on the staff of an adoption agency or retained through private adoption intermediaries.

The hospital social worker's role should be very minimal in relation to the pregnant woman when the woman already has a counseling relationship with a professional who specializes in working with pregnant women considering adoption. Upon admission of a pregnant woman without a counselor, however, the hospital social worker begins the evaluation and support process. The social worker interacts with medical personnel, the patient's family, agency social workers, attorneys and adoptive couples.

Although the pregnant woman should have already received counseling about her options, the hospital social worker is another checkpoint to ensure adoption really is what the birthmother wants for herself and her child. The hospital social worker can discuss what plans the birthmother has made for after her recovery, for example, if she will return to work or school and what her long-term goals are.

Many issues are involved during a hospital stay;for example, the birthmother may wish to see her baby after its birth or may even opt for "rooming in" (wherein the baby stays in the room with the mother throughout her hospital stay). Policy decisions regarding birthmothers should be carefully considered by hospital staff.

The choice to have the child "room in" may not always be advisable for women considering an adoption plan. It is the view of Jerome Smith and Franklin Miroff, authors of You're Our Child, that at some point in such a process, the bond between the birthmother and child becomes so strong that to continue with the adoption plan could cause emotional trauma, including clinical depression over the experienced loss.

In addition, Smith advised against the birthmother nursing her child unless she plans to parent the baby. His general advice for the birthmother planning an adoption is to see the infant and hold it if she wishes but not to have constant close contact with the baby while in the hospital.

Smith also recommends that the birthmother be allowed to grieve her loss and be counseled about the feelings she will probably experience after she leaves the hospital.

Most hospital staffs know a birthmother has the right to see her child unless and until she signs consent papers for adoption (or even after signing consent, depending on state law and circumstances). But birthmothers may sometimes not realize this entitlement and wrongfully believe they have no rights.

Nurses and other well-meaning people sometimes mistakenly believe a woman "giving up" her child could not possibly want to see or hold it. They may also think it would be easier for a mother to follow through with an adoption decision if she does not risk bonding to the infant, a logical conclusion supported by some research.

Nonetheless, most social workers and other adoption practitioners today believe it is important for the birthmother to see for herself that the child is physically well and to observe the appearance of the child. (The birthmother should not, however, be overly pressured to see the child if she does not wish to.)

Some birthmothers wish to say goodbye to the child before signing the agreement to adoption. Although, as far as we know, the farewell will be meaningless to the newborn infant, the saying of goodbyes may be profoundly important to the birthmother as she explains to the child (and herself) why she has made this adoption decision and what she hopes the future will hold for the child. If the birthmother is deprived of the opportunity to say goodbye, such a deprivation could make the resolution of her loss even more difficult.

Jeanne Lindsay and Catherine Monserrat wrote in Adoption Awareness: A Guide for Teachers, Counselors, Nurses and Caring Others:

Hospital staff need to be reminded how vulnerable a woman is during labor and delivery and immediately afterward. She is likely to take seriously everything said by the doctor and nurses. "I don't know how you could do this" or "Adoption must be really hard. I could never do that .?.?."

The authors believe such comments, combined with the guilt and emotional pain the mother may be feeling, could lead her to decide impulsively that she should parent the baby.

One author was concerned about an apparent lack of confidentiality when nurses knew new mothers were considering adoption, and she stated that one nurse examined a baby who was not supposed to be shown to the public because the nurse was considering adopting a child herself. Nurse Susan Malestic has stated that sometimes nurses providing prenatal care tell friends about single pregnant women in an attempt to arrange an adoption. She cautioned that it is better to remain neutral about adoption and to refer the woman to adoption agencies where she can obtain counseling and assistance.

Hospital social workers may wish to bring adoption up if the birthmother has not made any plans for her child and seems unsure of the immediate future.

Many birthmothers are afraid to broach such a subject, thinking they will be judged as unfeeling, but if a nurse mentions it, they may be interested. (Again, the nurse should not promote adoption or parenting at this very vulnerable time; however, the patient may be afraid to verbalize her unspoken need for assistance.) In such a case, the hospital social worker should be contacted and can then follow up the case and provide referrals and counseling as needed.

Older single mothers are also sometimes interested in adoption for their babies. The average person can understand why a teenager would want to place her child for adoption (although most teenagers choose to parent) but might wrongfully presume that a 35-year-old single woman would invariably choose to parent.

Despite her age, the older single mother should also be advised of the option of adoption, to consider or reject according to her own desires.

In addition, married birthparents sometimes opt to place their baby for adoption. The family may be divorcing or may already have several children and feel unwilling or unable to parent an additional child. Although it may be difficult to withhold judgment in such a case, it's imperative to understand adoption or parenting is their decision to make. If the birthparents felt unwilling to abort and yet believed adoption would be a positive answer for the child, they should be supported in this decision.

Sometimes when nurses and other staff members are unsure of how they should treat a new mother planning to place her baby for adoption, they may avoid the woman altogether, not wishing to make a mistake and not really knowing what to say. As a result, they may leave her alone, bringing in trays and medication and keeping the door shut otherwise.

Experts such as Lindsay and Monserrat say just listening to a birthmother can help her considerably. Rather than conveying his or her own views for or against adoption, the nurse can listen to the birthmother in a compassionate manner. If the birthmother feels the staff is trying to avoid her, she may believe she is an object of shame and what she is doing is wrong and bad. If staff members are willing to talk with her, her psychological pain can be eased, although not erased.

It may be difficult for a nurse to merely listen to the birthmother when a nurse's role is generally to offer exact advice on actions a patient should take; however, listening is often what the birthmother needs as much or more than the physical care the nurse can provide. Most hospitals are short-staffed but even five minutes could help the birthmother.

Where the birthmother stays in the hospital is also important. Most women planning to place their child for adoption do not wish to be in the same area with other women who are joyous about the child they will bring home and are nursing or feeding their infants, nor do they wish to discuss their decision with other women who, particularly at this point in their lives, would have tremendous difficulty understanding why a woman would choose not to parent.

As a result, whenever possible, birthmothers are placed in rooms by themselves or in a surgical ward.

Hospital staff may understandably be confused by the array of options offered to birthmothers today. Although most adoptions are confidential, some birthmothers know the identity of the adoptive parents. Nurses who try to keep adoptive parents and the birthmother apart are looked at askance by both parties in an OPEN ADOPTION.

Yet if the adoption is confidential, the parties involved do wish to remain apart. If an attorney has arranged for a couple to see the baby, there is a risk that they may encounter the birthmother, and hospital staff should be alerted by the attorney if he a possible meeting of the couple and the birthmother in the hallway is to be avoided.

Even when an adoption is planned as an open adoption, the birthmother may wish to be alone and not want to see the adoptive parents. The hospital social worker and her own social worker should ensure the birthmother's desires for privacy are met.

Increasing numbers of hospitals are now offering seminars to their staff on adoption and are enhancing staff awareness of why women choose adoption for their babies.

Seminars may include panels of adoptive parents, birthmothers and adopted persons as well as talks by trained social workers. Staff members may ask questions and enhance their understanding of the adoption process. Seminars also provide the opportunity to bring issues and problems out in the open and help nurses and other staff members offer the compassionate care they strive to give all patients. (See also PHYSICIANS.)


Susan L. Malestic, "Don't These Patients Have a Right to Privacy? (Pregnant Women Planning to Give Baby Up for Adoption)," RN, March 1989, 21.

Jeanne Lindsay and Catherine Monserrat, Adoption Awareness: A Guide for Teachers, Counselors, Nurses and Caring Others (Buena Park, Calif.: Morning Glory Press, 1989).

Jerome Smith, Ph.D., and Franklin I. Miroff, You're Our Child: The Adoption Experience (Lanham, Md.: Madison Books, 1987).

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