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Supporting Birth Mothers, Strengthening Families

Women who place a child for adoption often have many unmet needs, says a new national survey. On Your Feet Foundation provides insight into birth mothers' emotional experiences and life after placement.

by Diane Landino, MSW, Susan Dusza Guerra Leksander, LMFT, and Susan Romer, Ph.D., J.D.

It's twilight in Marin County, California, and 25 women of all ages and backgrounds are gathered around flickering candles arranged in the shape of a heart. The group leader reads a list of statements, and asks the women to step forward if the statement holds true for them.

"Step into the heart if you have ever been pregnant." All the women step forward, some giggling nervously, others somber, then step back.

"Step into the heart if you have placed a child or children for adoption." All the women again step forward, then back.

"Step into the heart if you had never met another birth mother before today...if you have felt ashamed or guilty about your decision...if you were able to help name your child...if you placed in the last year...if you have seen your child in the last year...if you hid the pregnancy from anyone...if you have struggled with depression that feels related to your loss." Some women are now weeping openly, leaning onto each other for support. Others exchange smiles of recognition.

"Step into the heart if you love your child." All the women step forward, as far as they can go, until they are a mass of love, tears, anger, grief, betrayal, laughter, and loss. And so begins the biannual retreat for birth mothers, sponsored by On Your Feet Foundation Northern California (OYFF), a coalition of birth parents, adoptive parents, and adoption professionals that provides services and support to women who have placed a child for adoption.


Birth parents remain the most under-served members of the adoption community, with little access to meaningful services, pre- or post-placement. Much research has been conducted on the health and development of adopted persons, but little attention has been devoted to birth parents. Pre-placement counseling for expectant mothers has become more common in the last decade, with many domestic agencies requiring sessions and attorneys recommending it as best practice, yet women may not be aware of or ready to explore their complex emotions at that time. And while there is more recognition that placing a child is one of the most significant, painful, and traumatic life events a woman can experience, that understanding has not yet led to comprehensive development of post-placement supports and services. It is not uncommon for women to feel that, once they leave the hospital, they are left to fend for themselves.

OYFF was founded in Chicago in 2001 to help meet that critical need. Today, chapters exist in Chicago, Northern California, and Colorado. In order to strengthen and refine our services, the Northern California chapter commissioned renowned scholars in the field of adoption, David Brodzinsky, Ph.D., and Susan Smith, MSSW, LCSW, to illuminate the emotional experiences of women who have placed a child for adoption. Here are key points from the national survey of 235 birth mothers (on average, 3.5 years post-placement), begun in 2011 (full survey data will be published in 2014). We hope that, in sharing these findings with the broader adoption community, agencies, mental health professionals, and adoptive parents will provide more effective and compassionate services and support to expectant parents who are considering their options during the pregnancy and to birth parents during the placement process and crucial first years after placement.


 The Birth Mother Profile: First, let's take a closer look at who places a child for adoption. The study documents information previously considered anecdotal, including the fact that the profile of the women who place a child for adoption has changed. In the 1950s and 1960s, these women tended to be in their teens, unmarried, and may have been coerced into placing their children for adoption. Today, most birth mothers are in their twenties, have had some college education, and may be parenting other children at the time of the adoption. Contact with the adoptive family is now commonplace, with 83 percent of the women who participated in the survey reporting being involved in some type of open adoption. Nearly 70 percent of the women surveyed were Caucasian, yet all major ethnic groups were represented.

 Why Women Choose to Place: Unplanned pregnancy is, by nature, frequently experienced as a crisis, something that the mother did not expect or want, and is not prepared for. Historically, adoption was the only option for unmarried women, as social and religious forces conspired to pressure a woman to place her child or face a life of ostracism and scorn. As some of the stigma has fallen away from single parenthood, and domestic adoption has become a more empowered choice, with some legal protections for the birth parents, women make the choice for myriad personal reasons. The common thread is an awareness of the limitations of her current situation—emotional, physical, familial, financial, or a combination of all of these factors. Universally, a birth mother's core motives include love for her child and a genuine desire to provide her child with the best possible circumstances, even if that means conceding her right to parent in a traditional sense.

 Hopes for Their Children: Birth mothers, like all mothers, want their children to have resources and opportunities, to have a stable home, to be cared for and loved. They also want their children to know that they are loved by their birth parents, that they were not rejected or abandoned. Finally, most birth parents hope to have ongoing contact with their children in some form, realizing that their presence fills a need in the child's life, as has been demonstrated by adults from the era of closed adoptions.

"I placed my daughter for adoption because I wanted her to have the kinds of things I could not provide for her at that time. Her father and I were both 21. We could have parented her, but it would have been a struggle. We wanted her to live in a stable, two-parent home, with a family who had an abundance of time and resources. I was still in college, and significant people in my life discouraged the idea that I could be a good, competent parent. I grew up in a rigid, shame-based religion, and had internalized the church's doctrine about unwed mothers. Although I was undeniably influenced by these external messages, I was ultimately guided in my decision by a deep, maternal love for my daughter, even though it broke my heart." —SUSAN LEKSANDER


 Compromised Emotional Health: Seventy-five percent of the women surveyed reported that their emotional health was very poor, poor, or neutral in the first year after placement. Eighty percent of the women directly attributed one or more of their problems to the loss of their child, and 90 percent reported one or more clinical symptoms or life stressors. The most common problems reported by one third or more of the respondents in the year following placement included depression (71 percent), guilt (64 percent), anxiety (48 percent), diminished self-esteem (55 percent), and sleep problems (51 percent). Taken together, these findings reinforce other research and self-reports that the loss of a child through adoption is a serious life stressor which poses a significant risk to a woman's emotional and physical well-being.

"I was an absolute wreck after I placed. I found I was a completely different person than I was before, and I struggled to connect the two. I felt like no one on earth could understand what I was going through, and I myself couldn't understand why I was so hurt over something that I had decided completely on my own." —ANN OWEN

 Ongoing Grief: The study by Brodzinsky, Smith, and OYFF demonstrates that a vast majority of women who place a child for adoption experience some level of grief surrounding the placement, and may continue to for years without necessary support. The grief is particularly salient in the first year following placement, and the outcome is dependent on the type and sources of support she receives. The loss and subsequent grief is further complicated because the loved one is psychologically present but physically absent.

The grief a birth mother experiences is complex in that it is not often openly acknowledged. Consider the experience of a divorce or other major life stressor—one often confides in one's peers for empathy, comfort, and support. A woman who has placed a child for adoption may not know another human being who has experienced such a loss, and may not be comfortable talking about it with family or friends for fear of being judged. OYFF holds retreats so that birth mothers can connect with other women who share the same experience, as well as participate in restorative exercises and establish a support system that will be in place well beyond the weekend.


 Unmet Needs: Respondents were asked about the kind of supports they needed but did not receive. The three greatest unmet needs were financial support (34 percent), emotional support from family (42 percent), and support from a mental health professional (34 percent). In addition to birth mother retreats, OYFF matches women (who find us through social media, area adoption agencies, professionals, and word of mouth) with volunteer mentors who work with them to plan and meet goals. It offers modest scholarships as well as grants for psychological counseling.

"I placed my son for adoption 15 years ago. For those 15 years, not only did I ache over the loss of my child, I ached for a certain understanding. Connecting with other birth moms at an On Your Feet Foundation retreat last summer was incredible. There is no better support system than one comprised of other women who have worn the same shoes." —ANDREA SHAW

 Expectations About Openness: A vast majority of the women surveyed (83 percent) reported being involved in some type of open adoption, and more than 70 percent reported currently being satisfied or very satisfied with the adoption. Openness was a significant factor related to a birth mother's well-being, with women who were in regular, ongoing contact with the adoptive family reporting better emotional and physical health than women whose contact was limited or non-existent in the first year post-placement.

Perhaps more important than the extent of contact was the degree to which the birth mother's expectations were met. Survey respondents who had identifying information about the adoptive family, but who had no contact after placement, and those whose contact was limited and later terminated, reported the greatest physical and emotional problems.


 Expanding Services: To effectively grieve and heal from the loss, women need understanding, validation, and support from those around them, including family and friends. Birth mothers also benefit greatly from contact with other birth mothers to reduce stigma, normalize their experience, and provide an informal network of ongoing support. It is our hope that adoption professionals will incorporate these findings into their practices by providing expectant parents with more information about how the placement may affect them, immediately and in the long term, by offering more pre- and post-placement services, and by educating prospective adoptive parents about the importance of openness and honoring the expectations of future contact.

For prospective and adoptive parents, we hope the information presented in the study and in this article will help guide and shape your relationships with your child's birth parents. Patience, honesty, and empathy are critical in forming and maintaining healthy and sustainable relationships. We hope that adoptive parents whose relationships with the birth parents are strained or broken will make an effort to repair them, with an adoption-competent mediator. For many birth mothers, the OYFF weekend retreats have come to symbolize everything we hope to offer them—recognition, emotional support, access to practical resources, and a chance to be part of a community. We hope that this type of support is available to all birth mothers on their journey toward acceptance and healing.

A NOTE ON THE LANGUAGE: The authors chose to use the term "birth mother" to describe a woman who has placed a child for adoption, but realize that this term does not represent the experiences or opinions of all women who relinquish their parental rights, and some may find it offensive. Other terms, such as first mother, natural mother, biological mother, birthmother, and, simply, mother, are also used to describe her. Most of the terms have fans and detractors in each corner of the adoption triad. The best way to determine a woman's preference is to ask her.

DIANE LANDINO, MSW, is the managing director of On Your Feet Foundation Northern California (OYFF; SUSAN DUSZA GUERRA LEKSANDER, LMFT, is vice president of the board of directors of OYFF. SUSAN ROMER, PH.D., J.D., is the founder and board president of OYFF.

CAPTION: Ann poses with a photo of her daughter, Sarah, at a birth mother retreat.



Ann was a single mother to eight-year-old Kailee when she became pregnant with her second child. Without the support she needed to raise two daughters, Ann decided to place her baby for adoption. This was the most difficult decision she'd ever made, and she realized that her children would lead very different lives. Kailee never met her father; her second child would live with two active, engaged parents. Ann lived paycheck to paycheck, while the adoptive parents she selected were comfortable financially. Although Ann felt it was right for Kailee and for the baby she carried, she was ashamed and worried about how Kailee would feel about growing up separately from her sibling, so she hid the pregnancy.

Six months into the placement, Ann's relationship with the adoptive parents grew stronger. She felt she could trust them, and that they would honor and nurture the girls' relationship. Ann realized that she wanted her daughters to be part of each other's lives, and told Kailee that she had a sister named Sarah who lives on the other side of the country. Kailee struggled with that knowledge, but with her mom's patience and understanding, she eventually became comfortable with Ann's decision.

Ann's relationship with Sarah's adoptive parents grew stronger still, and, in May 2012, she visited two-year-old Sarah and her family. Ann described one special interaction with her daughter:

"Sarah pulled out a book they had made for her, her very own fairy tale, that they read to her often. 'Did YOU know I'm adopted?' she asked as she climbed on my lap and started to flip the pages. 'I live in New Jersey, but I'm FROM California, and hey! I was in your belly! My mommy and daddy flew on a big airplane to come get me. See, look, here you are feeding me a bottle after I came out of your tummy.' That exceeded all my expectations. She already knew exactly who I was, and who she is, as well."

Ann and Kailee connect with Sarah through Skype and Facetime, and continue to build a relationship. They draw pictures and make scrapbook pages for each other. The next time Ann visits Sarah and her parents, she'll bring Kailee, and she can't wait for her to meet her little sister.

Share Your Experiences What was contact with your child's birth mother like during the first year after the adoption? In the years since? Discuss this article and share your story in the Fall 2013 Issue group on

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©2014 Adoptive Families. All rights reserved. Reproduction in whole or in part is prohibited.


my two sons came to be mine when they were infants 3 years apart. I am so grateful to two young women who made such amazing decisions to relinquish their children. we adopted in 1975 & 1978 through an agency that required closed adoptions. At age 11, each of my sons wanted to visit the adoption agency & ask questions. These were heartbreakingly-wonderful visits - thank God for the agency's Social Workers who talked with my children. Later, my oldest son died in a motorcycle accident at age 20 yrs, 3 months, 7 days. The adoption agency helped us locate the birth mother. There are no words to describe the loss of my son, but to be able to share his life information with the woman who gave him birth was such a gift. She had married someone other than the birth dad but helped us make contact with him. Again we were blessed to have the opportunity to spend several hours with the dad, his wife & his mother. Hearing their reasons behind the WHY of the adoption was very healing. I believe my son was with me in spirit in those two visits. Both biological parents attended the 1 year memorial service we held for our son. Although we do not stay in touch since those meetings (at their request), I will always treasure this knowledge of their love for my son. My younger son has mixed feelings on whether he wants to find his birth parents. He has children of his own now. Knowing the birth parents health history would be so helpful, but I leave this to my son to decide. He knows I'll support him in any choice he makes.

Posted by: Jan L at 1:41am Oct 22

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