Birth Parent Grief in Adoption

Birth Parent Grief

Most people anticipate experiencing grief around the end of life, typically following the death of a loved one. However, fewer are familiar with grief after a healthy birth of a child, when a birth parent has made an adoption plan for their newborn. In the 1970s and earlier, social workers assured their clients that they would forget this experience and swiftly move on with their lives.^[1] During the 1980s and 1990s, as birth mothers began to publicly share their experiences, research revealed that the grief process following relinquishment was far from simple or insignificant, contrary to the beliefs held by social workers at that time. ^[2],^[3] Over the 30-year period between 1980-2010, there was a shift in the general consensus: The grief following relinquishment was now documented and confirmed.^[4]

Several factors contributed to society’s delayed understanding of birth parent grief. First, out-of-wedlock births were heavily stigmatized, leading some to a focus on facilitating adoption plans—under any means necessary.^[5] It has been estimated that one-third of infants born to unmarried Caucasian women were relinquished for adoption in 1965 compared to 20% in 1970.^[6] Additionally, adoption has often been perceived, both historically and presently, as a happy ending for all involved: a solution that resolves the birth parent’s “problem” while blessing a family in need. As Sharon Roszia and Allison Davis Maxon write in their book Seven Core Issues of Adoption and Permanency, adoption is often portrayed as “a problem solving event filled with joy.”^[7] Furthermore, social workers were hesitant to deter young apprehensive mothers from making adoption plans, opting instead to reassure them, their families, and society that “this isn’t going to hurt.” Additionally, society’s tendency to belittle and condescend to the emotions of teenagers, dismissing their love as “puppy love” and similarly minimizing their grief, further contributed to the dismissal of birth parent grief when the birth parent was a teen. Lastly, the lack of language to identify and understand adoption loss posed a significant barrier to its study and comprehension. It is not surprising that as psychology gained terminology such as “ambiguous loss” in the 1970s and “disenfranchised grief” in 1989, there was an improvement in understanding the complexities of birth parent grief. 

In today’s world, social workers acknowledge and validate birth parent loss, yet evidence-based training designed for this population is limited.^[8] The majority of adoption-specific literature tends to center on adoptees and adoptive families, who are more likely to have access to services due to their socioeconomic status. For those publications that do address the experience of birth parents, they often adopt a “one size fits all” approach. Moreover, most grief literature predominantly focuses on losses related to death, with limited coverage of reproductive loss and even less inclusion of adoption-related grief. The scarce resources available on adoption loss, particularly those concerning birth parents, typically consist of outdated nonfiction works or memoirs written by birth mothers.

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In today’s world, social workers acknowledge and validate birth parent loss, yet evidence-based training designed for this population is limited.

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The purpose of this article is to provide professionals with a framework for approaching grief work with clients, offering language suggestions, and presenting a range of intervention methods. It is worth noting that grief experiences after relinquishment are as varied and individualized as the babies themselves. Birth parent experiences are diverse, there is no single grief model that universally applies to every adoption experience, and grief is among many emotions that birth parents experience post-placement. When a birth parent grieves for their child, it does not speak to their satisfaction with their adoption decision, as both grief and confidence about the adoption can and do coexist.

Disenfranchised Grief

Disenfranchised grief occurs when an individual’s grieving process is not publicly acknowledged or validated. It arises when the mourner’s experience does not align with

society’s norms and attitudes regarding death and loss. Examples of disenfranchised grief include death by suicide, the loss of an ex-spouse, pet loss, and divorce, among others. Adoption loss, lacking a death component, falls under the category of disenfranchised grief. Moreover, it can be considered twice disenfranchised due to its elective nature. While no one gets pregnant with the goal of placing a child for adoption, the voluntary aspect of adoption assigns responsibility to the birth parent, thereby, in many people’s eyes, diminishing their right to grieve. There is often a lack of understanding or empathy regarding the profound agony associated with voluntary decisions.

Ambiguous Loss

Ambiguous loss is a type of loss characterized by the absence of a clear resolution, such as death. There are two distinct forms of ambiguous loss: psychological absence with physical presence (such as dementia) and psychological presence with physical absence (such as adoption). Coined by Pauline Boss in the 1970s, this term describes a particularly stressful form of loss due to the absence of closure or clarity typically associated with death. While the symptoms of ambiguous loss may resemble those of complicated grief, it is the context surrounding the loss that is complex, not the grief itself. Psychological treatment for individuals experiencing this type of loss focuses on helping them navigate their emotions and move forward despite the uncertainty of their loved one’s whereabouts.

In birth parent grief, where death is not a factor, what one grieves for changes over time, presenting researchers with a moving target to study. The tangible loss of adoption, the loss of the baby, is fairly easily understood. Intangible losses, however, are less obvious: support from peers, watching the baby’s “firsts,” raising siblings together, decisions about the child’s future, peace of mind, and more. Accessing and studying birth parents can present unique challenges due to high levels of shame and stigma, limited financial resources, and rare help-seeking behavior. Many birth parents never seek out support and post-placement care is often not widely known or easily accessible. Consequently, it is common for birth parents to either disengage from their connection with adoption professionals or for the professionals to not offer post-placement services to maintain that connection.

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Many birth parents never seek out support and post-placement care is often not widely known or easily accessible.

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Anticipatory Grief

During the third trimester of pregnancy, adoption counseling often includes discussions about anticipatory grief with expectant parents. Anticipatory grief, a type of ambiguous loss, occurs as the expectant parent prepares for the impending separation from their baby. This period serves as a valuable clinical opportunity to address various aspects, including expectations of emotions during the hospital stay, strategies for coping with past losses, and developing new coping mechanisms for the upcoming adoption. One effective strategy involves identifying two individuals within the expectant parent’s support system to serve as designated “check-in friends.” These friends should have clear directions from the expectant parent regarding how often to check in and how to show up for them. 

However, it is essential to acknowledge that anticipatory grief cannot fully prepare the expectant parent for the intensity of emotions experienced during the actual loss. Pregnancy introduces additional factors that can exacerbate the trauma, as the pregnant body and brain undergo physiological changes geared towards bonding with the baby. Hormonal surges during birth and the priming of brain structures over the nine months of pregnancy, described by scientists as “a second puberty” contribute to this process. Despite the cognitive commitments to the adoption plan, expectant parents may find themselves grappling with conflicting emotions fueled by biological instincts. Sharon Roszia and Allison Davis Maxon aptly describe this period as a transition from “a thinking parent to a feeling parent” forcing the expectant parent to recommit to their adoption plan amidst newfound emotional complexities, in immediate contradiction to every screaming cell in her body for the unknown but hopefully “better” future of the child.

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Despite the cognitive commitments to the adoption plan, expectant parents may find themselves grappling with conflicting emotions...

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Acute Grief

In her book Atlas of the Heart, Brené Brown explores the unique nature of acute grief, which manifests immediately after a loss and completely consumes one’s life. This intense form of grief encompasses a myriad of powerful emotions, including yearning, longing, sadness, anxiety, bitterness, anger, remorse, guilt, and shame. Acute grief is as unexpected as it is devastating, capable of knocking someone off their feet. Despite the presence of a detailed and thoughtful adoption plan in place for sometimes months prior, many birth parents are taken aback by the overwhelming difficulty of the weeks following placement. They often express an inability to stop thinking about their child and their decision, persistent tears, difficulty caring for their other children, and a loss of appetite. Nighttime exacerbates the anguish, as the world quiets down and internal turmoil intensifies. Nightmares and waking up in a cold sweat are common occurrences during this period. 

During such intense suffering, filling one’s day with distractions can offer a measure of relief. The misconception particularly present among parents of young mothers is that they need time to slow down, relax, and grieve. Acute grief leaves little space for anything other than survival. Structuring the day with a to-do list and focusing on tasks to accomplish within 15-minute intervals can help birth parents navigate each day at a time. Adoption counselors can assist in brainstorming activities to occupy the empty hours. Creating a checklist of daily activities such as consuming enough calories, staying hydrated, spending time outside, engaging in physical activity, and ensuring sufficient sleep can provide a sense of stability. Another common misconception is to immediately initiate grief counseling to kickstart their healing process. While establishing a connection for grief counseling is beneficial, the primary focus should initially be on stabilizing rather than immediate healing. Stroebe and Schut created the Dual Model of Coping with Bereavement to emphasize the importance of oscillating between grief-focused work and relief/restoration-focused work, and how both are needed to process a loss.

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While establishing a connection for grief counseling is beneficial, the primary focus should initially be on stabilizing rather than immediate healing.

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Panic and Grief

Neuroscientist Jaak Panksepp studied brain neural systems and their role in various emotions. He termed the system that controlled the response to loss as “panic/grief,” emphasizing the intertwined nature of panic and grief. While not all grief feels like panic, Panskepp was specifically referring to acute grief that has not yet been processed neurologically., It is therefore not surprising that during the depths of acute grief, individuals often experience heightened anxiety. Therefore, another area that adoption professionals should prioritize is supporting birth parents in developing anxiety coping mechanisms and common grounding techniques for managing panic attacks.

Counseling During Acute Grief

One of the most challenging aspects for adoption professionals is providing compassionate, unbiased, ethical care during the revocation period amidst acute grief. Ideally, a counselor unaffiliated with adoption would provide this counseling. It is critical to remove pressures that can create bias, with the easiest solution being to assign a different adoption counselor to the expectant parents and the adoptive family. Recognizing the humanity in adoption counselors, it is crucial to avoid placing one counselor in a position where they may encounter conflicting interests while serving both parties. Additionally, adoption agencies should acknowledge both an adoption placement decision and a parenting decision as equally valid and successful outcomes, especially when the parent is supported and is as confident as possible in either decision. To make this happen, the agency’s revenue should not be solely dependent on adoption placements. 

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…adoption agencies should acknowledge both an adoption placement decision and a parenting decision as equally valid and successful outcomes…

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Counseling during this sensitive post placement period, especially when parental rights are still intact, is a delicate situation. Counselors often lack specific training on how to ethically navigate this phase. For a clinical approach, implementing the “companion model of bereavement” by Alan Wolfelt can serve as a valuable starting point for counselors (see table below). This model emphasizes the importance of adoption professionals continually monitoring themselves, ensuring their biases do not impede their ability to provide effective counseling and the outcome of the expectant parent’s decision.

Grief Symptoms

General Grief Symptoms: Sadness, fear, panic, anger, despair, guilt, shame, difficulty sleeping, change in appetite, irritability, fatigue, inability to concentrate, jumpiness, racing thoughts, nightmares, feeling like you are going crazy.

Worsening Symptoms: Development of phobias, sleep disturbances, panic attacks, depression, alcoholism, drug abuse, self-harm, suicidal ideation.

Somatic Symptoms: The body may find physiological outlets for emotional pain such as headaches, allergies, muscle tension, aching limbs, heart palpitations, digestive disturbances, bowel problems, vomiting, back pain, and abdominal pain. It is important to see a doctor to rule out any medical problems. 

Ongoing Grief

Acute grief does not have an end date, but eventually, it becomes less dominating and overpowering. It does not go away, but rather it becomes part of the individual’s new normal. The misconception about healing is that it insinuates that one day the individual will be completely restored. If only grief worked that way… Many birth parents resonate with the car accident analogy: If someone were to survive a serious car accident and lose a leg, life would never go back to the way it was before the car accident. That person has no other option but to learn how to navigate life in a new way. For birth parents, adoption may feel like a psychological amputation. However, unlike physical injuries that receive support and rehabilitation, birth parents often navigate their loss, open adoption, identity, intimate relationships, and societal stigma with limited guidance and support. 

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…unlike physical injuries that receive support and rehabilitation, birth parents often navigate their loss, open adoption, identity, intimate relationships, and societal stigma with limited guidance and support.

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As painful as grief is, it remains the birth parent’s enduring connection to their baby. Grief is love with nowhere to go. Suppressing the pain or attempting to forget about the baby is to disconnect from the child. So rather than wishing the grief away, it should be treated as an appropriate, healthy response that should be honored, cradled, and nurtured. In his book, The Wild Edge of Sorrow, Frances Weller speaks of embracing sorrow as an apprentice, emphasizing the importance of learning how to tenderly hold and warmly acknowledge our grief. This acceptance and acknowledgment mark the first step in the journey of apprenticeship to sorrow.

Abubakar Salim, designer of the video game Tales of Kenzera: Zau released April 2024, created it as a way to process his grief after the death of his father. He says, “grief isn’t always sad. And it’s one of those ones where as long as you accept the fact that the grief isn’t going away you just have to, you know, almost accept that it is there. You get comfortable with it, and you can find almost, like, the sort of - the relief in it as well as the anger, as well as the happiness, and use that as a fuel source to keep pushing you forward.” As adoption professionals, highlighting for the birth parent that grief can exist without sadness for many may give them permission to separate the two, or invite other emotions. At its core, grief is the connection between two souls, which is as devastating as it is tragically beautiful. 

One strategy to increase compassion for grief is personifying it. If grief were a living creature, what would it look like? If it had a voice, what would it say? Although at first it may seem silly, one strategy that some birth parents relate to is shifting one’s grief into a grief “pet.” Since caring for oneself is oftentimes more difficult than caring for someone or something else, a grief pet offers this perspective shift. A grief pet is the internal pain transformed into an external imaginary companion that although unwelcome, has found its way into their space. As much as they may like to banish it from their home, it is here to stay. Their ongoing grief journey is now caring for their grief pet the best way they can. At times it will cry for attention and unexpectedly take over the plans they had for the day. And other days it will snooze with you quietly present on the couch. For better or for worse, it is here to stay, and it is now about learning its cues, its needs, and above all coexistence. 

When a birth parent feels intense feelings of guilt and shame, which may be exacerbated after making an adoption plan, self-punishment may occur. These emotions may drive them towards engaging in risky behavior, toxic relationships, substance misuse, or other activities that perpetuate their sense of unworthiness. In some cases, these actions may serve as a form of self-flagellation; when this occurs, it is especially important to connect birth parents to a long-term therapist, provide comprehensive case management services, and screen for suicidal ideation. By addressing the underlying issues contributing to their self-punishment in a therapeutic environment, birth parents can begin to heal and cultivate healthier coping mechanisms. 

Pain vs. Suffering

In her book, “It’s Ok That You’re Not Ok” Megan Devine distinguishes between pain and suffering. She writes how pain is a healthy and essential human experience, requiring support rather than solutions. Conversely, suffering arises when one feels dismissed or unsupported in their pain. It thrives when people are told that their feelings are invalid or abnormal, exacerbating their sense of isolation. Suffering tends to manifest when individuals are unable to sleep, eat, or acknowledge the depth of their emotional distress. For instance, when a birth parent constantly replays in their mind the events leading to the conception and decision to place for adoption, chastising themselves for perceived failings or missed opportunities, it often leads to feelings of anxiety, fear, and isolation. In such cases where birth parents exhibit symptoms of suffering, which can overlap with complicated grief, social workers should refer to long-term therapy with an adoption-competent specialist. 

Mediating Factors 

It is worth discussing what factors contribute to easing birth parent grief over time. Numerous studies have found that maintaining some level of openness and ongoing contact with their child aids birth parents’ healing process., , , Research indicates that ongoing contact with their child alleviates anxieties regarding the child’s welfare and diminishes concerns about feelings of abandonment. Moreover, higher levels of openness in adoption generally correlate with greater satisfaction with the decision to place the child for adoption. Conversely, birth parents who have identifying information about the adoptive family but have no contact post-placement, have limited contact, or had their contact cut-off report the lowest levels of satisfaction and often suffer from physical and emotional issues. Openness, however, is not a cure for grief. Regular contact with the child can bring its own set of challenges and heartaches. Additionally, choosing the adoptive family and career satisfaction correlated with increased overall satisfaction with the adoption. Adoption professionals can learn from these findings that it is imperative to educate expectant parents and prospective adoptive families about the benefits of committing to openness, providing lifelong support and mediation to families struggling with relationship challenges, encouraging birth parents to meet and choose the adoptive family, and providing support and referrals that invest in the birth parent’s long term career goals. A commitment to lifelong openness should serve as a prerequisite for each prospective adoptive family prior to approval of their home study. 

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…higher levels of openness in adoption generally correlate with greater satisfaction with the decision to place the child for adoption.

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Anniversaries and Rituals

Anniversaries and holidays require preparation and planning. Sometimes it is best to spend the day with loved ones and keep as busy as possible; other days are about taking out the hospital mementos and reminiscing over those first few days together. Regardless of the level of openness in the adoption arrangement, writing a letter to their child on important days can be profoundly meaningful. For birth parents, keeping a journal, writing poetry, immersing themselves in melancholic music, or expressing emotions through art can all help in the process of navigating grief, allowing it to flow through the body and find release. 

Rituals hold particular significance during challenging days, especially amidst the chaos brought on by ambiguous loss. They provide order and tangible activities that can be undertaken alone or with others. Rituals witnessed by others can be especially powerful for birth parents since their pain has historically been unacknowledged or invalidated. Rituals consist of two parts: 1) containment- holding space for the griever and 2) release- having a safe place to fall. When considering what ritual might be right for a birth parent, first consider their ethnic and cultural background. Is there a meaningful cultural or religious element that can be incorporated into the ritual? Many rituals take place in nature, with notes thrown into a fire, casting rocks into the water, or speaking words directly into the earth. 

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Rituals hold particular significance during challenging days, especially amidst the chaos brought on by ambiguous loss.

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An adoption entrustment ceremony or placement ceremony is an example of a ritual that can mark the transition of parentage from the birth parents to the adoptive parents. An example of a placement ceremony may unfold as follows:  Two tall lit candles, representing the birth and adoptive families, with a shorter unlit candle between them. Together, the birth parents and adoptive parents light the middle candle in unison, symbolizing the joining of the two families and their shared love for the child. A poem or religious passage may be recited, and prepared letters of heartfelt well-wishes and promises may be shared by any participant. Gifts may be exchanged as tokens of gratitude and commitment. The candles are extinguished, signifying the end of the ceremony.

It is important to consider the emotional capacity of both the adoptive parents and the birth parents before proceeding with such a ceremony. It is also recommended to prepare all participants in advance with what to expect and invite them to be engaged in the planning process. While young birth siblings may have their own version of a ceremony featuring drawings, letters, or gifts to pass to the adoptive family, they typically do not partake in the placement ceremony itself. 

Counterfactual Thinking

In the book, Seven Core Issues of Adoption and Permanency, the authors identify the following seven issues as those that affect anyone touched by adoption: loss, rejection, shame and guilt, grief, identity, intimacy, and mastery/control. I would add an eighth issue that is unique to birth parents: counterfactual thinking. Counterfactual thoughts are cognitive alternatives to past events. This can include asking “what if” questions and considering what might have been in situations that a person now has no control over. These thoughts are more prevalent in situations of choice or decision, which often results in the chooser ruminating over their choice for years. 

An ongoing struggle for birth parents is the questioning of whether they made the right choice. Counterfactual thinking is more prevalent when individuals feel higher levels of guilt and desire for greater control, or when they repeatedly mentally seesaw between parenting and adoption until ultimately landing on adoption. This form of contemplation can lead to an immediate subsequent pregnancy, driven by a panicked attempt to have a different outcome this time around. Counterfactual thinking is a normal reaction to birth parent loss and should not be equated to regret. Rather, it reflects the complex and multifaceted nature of the decision-making process surrounding adoption. 

Support Groups

Needless to say, the grieving process for every birth parent is different. However, the most significant recommendation is joining a support group. Healing takes an entirely new form when there is a connection with other birth parents, others who know the same yearnings, and the same heartaches. More importantly, when birth parents share their stories with one another and receive empathy, healing can truly begin. 

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…when birth parents share their stories with one another and receive empathy, healing can truly begin.

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Perinatal Mental Health

Perinatal mental health refers to a spectrum of experiences that can affect individuals during pregnancy or postpartum, which most commonly includes symptoms of depression and anxiety. Screening for perinatal mental health symptoms typically occurs at the pediatrician’s office, a setting most birth parents do not visit with the newborn. Consequently, they miss out on this crucial screening. This oversight is ironic given that the risk factors for postpartum depression are some of the same reasons that push expectant parents to consider adoption: a personal history of depression and/or anxiety, previous postpartum depression, lack of support, PMS, financial stress, relationship stress, complications with pregnancy, a major recent life event, and being a mother of multiples. Screening birth parents for perinatal mental illness and connecting birth parents with therapists who specialize in these issues, is invaluable in providing much-needed support and intervention. 

Trauma

Not all birth parents would describe their relinquishment experience as traumatic, but it is common enough that directly addressing it is important. Many birth parents report dissociative experiences during the relinquishment process., For instance, some may describe feeling as if they were watching themselves from a bird’s-eye view while signing the adoption paperwork. Others may find parts of their memories from the hospital stay were fragmented or absent. 

These experiences can leave birth parents feeling as though a part of themselves is frozen in time, specifically the version of themselves at the time of relinquishment. This frozen aspect of their identity may influence their decisions and behaviors in the years that follow, potentially leading to maladaptive coping mechanisms. Research has shed light on the prevalence of post-traumatic stress disorder (PTSD) among birth parents., In treatment, PTSD is treated first, before grief therapy begins. Seeking therapy from a professional specializing in trauma therapy, internal family systems therapy, or eye movement desensitization reprocessing (EMDR) can be a beneficial starting point for birth parents grappling with the aftermath of relinquishment. 

Anger 

Anger is an “explosive emotion” and even therapists may feel uncomfortable addressing it. When anger is discussed as a birth parent emotion, it is often suggested that the birth parent is avoiding responsibility for their choices and the role they played in the pregnancy. Sometimes the anger is directed toward the other birth parent, their family, or the adoption counselor for pressuring the decision to place for adoption. Sometimes the anger is directed inward, toward themselves, for not having prevented the pregnancy or not having a more stable situation to bring a baby into. It is important that birth parents take ownership of the anger. Owning one’s anger means they are aware of it, acknowledging it, and consciously deciding what to do with it. Sometimes anger is a shield from emotions that are more corrosive. With the support of a counselor or therapist, birth parents can work to differentiate between restorative and damaging expressions of anger. 

The Bigger Picture

Expectant parents and birth parents occupy uniquely vulnerable positions, necessitating additional care and consideration from professionals to prevent exploitation and coercion. Consequently, it is imperative for adoption professionals to advocate for state and federal laws that facilitate access to supportive services, promote ethical adoption practices, and enable comprehensive data collection and research regarding domestic infant adoption. More research is needed to explore the nuances of grief experienced by birth parents and its long-term effects.

It is also important to examine the larger context in which expectant parents relinquish. While some feel empowered and adequately supported in their decision, others experience coercion or a lack of support or resources, which may make them feel compelled to relinquish. When financial insecurity is present and an expectant parent experiences homelessness, unemployment, and/or poverty then extra support should be provided to seek an informed, empowered decision. As part of the all-options counseling and when the expectant parent is open to it, the adoption professional should provide case management and counseling to support them in finding safe ways to parent the children they birth. Therefore, advocating for policies that address these systemic issues and provide comprehensive support to expectant parents is an essential harm reduction measure.

While birth parents will likely experience some form of grief regardless of their circumstances, the grief process can be significantly different for those who do not feel empowered in their decision. By prioritizing the needs of birth parents (and expectant parents) and fostering a supportive environment, we can work towards reducing the burden of grief and promoting healing for birth parents.