It’s somewhat fitting that I begin this blog by quoting Moses from the Old Testament, who became the adopted son of an Egyptian princess. I use these words to convey how I felt at a recent conference sponsored by the National Council for Adoption (NCFA), a national organization of adoption professionals. Encouraged to submit an abstract by the NCFA, I was the only nurse in a field of adoption staff, social workers, and those whose lives have been touched by adoption.

Two things struck me as I presented my work on parental postadoption depression. I felt proud to present my nursing theory, the middle-range theory of parental postadoption depression (Foli, 2019). During my presentation, I shared the diagram of the theory, emphasizing the major constructs and relationships between variables. I highlighted the empirical work that I had done to support the major associations between parental unmet and unrealistic expectations and depressive symptoms in adoptive parents.            

I prepared diligently, knowing it would be a group of professionals who worked daily with members of the adoption triad: the child, birth parents, and adoptive parents. I scoured the seminal, historic, and current literature for new trends and treatment of parental postadoption depression. Finally, after several iterations, I finalized my presentation, what I hoped was a coherent and audience-centered discussion that included my theory. In addition to my work, I represented my profession, whose member created a highly useable theory, and sought to dispel the myths and notions of nursing being a “less than” profession (Chinn, 2019). I ensured there were evidence-based interventions prior to and after placement of the child that these professionals could apply in their practices. I reminded the audience of the literature that described how parental depression is associated with negative outcomes for children in the family, such as depression, anxiety and acting out behaviors. And in the case of children who are adopted, they may enter their families with histories of trauma and maltreatment.            

I was ready. The morning arrived for my presentation, and just prior to it, I squeezed into the audience of a panel of birth mothers who had relinquished their children to adoptive parents. The four-person panel’s narratives were both deeply personal and political in nature. The experiences spanned from the 1970s inhumane practices of forcing women to leave their homes to give birth and have their babies taken from them into a closed adoption, where the birth mother could only wonder what happened to their child; to the early 2000s when young mothers with no source of income and lacking family support, also decided to relinquish their babies. Open adoption arrangements were offered to the more recent birth mothers, but with no legal enforcement, the agreements became fluid with time. One birth mother emphasized – and rightfully so – that such open arrangements are not necessarily for the birth parent, but for the child so responses to their questions of “who” and “why” are available and developmentally sensitive.            

It’s common knowledge that so much of adoption is rooted in loss. The women’s narratives deeply touched me. They had moved forward with their lives, attending college, marrying and in some instances, having children. Yet, their losses were simultaneously idiographic and political. While this blog cannot possibly discuss the gender, age, and cultural forces that impact the decision to relinquish a child, the voices I heard struck me as both tragic and constructed from hegemonic forces that create unnecessary and lifelong suffering. It wasn’t always about the decision itself; it was how the women were treated by their families, adoption staff and health providers, and society, and the lack of compassionate care and recognition of their loss.            

Reunification with birth children had eased some of the loss and given rise to new narratives. However, a new political event has created conversations about birth parents’ choices. When I was speaking to a member of the hosting organization, she shared how media had contacted her about the effect of the June 24, 2022, Supreme Court decision to overturn Roe v. Wade and allow states to set their own policies on abortion. The adoption organization had been contacted by journalists to offer insight into how this ruling had impacted the number of infants placed for adoption. The results are mixed with some agencies showing increased contact with birth mothers and earlier in the pregnancies. But there are unscrupulous agencies who prey on both vulnerable birth mothers and prospective adoptive parents in arranging placements. Full, non-coercive and compassionate counseling is needed to ensure decisions are made freely and with full disclosures. Even with such ethical practice, the acknowledgement and support for birth parent acute grief and loss must be present at the time of relinquishment and the months following.            

Yet I’ve learned, being an adoptive mother, part of the triad, and a member of a conspicuous family (when parents and children differ in physical characteristics), that being a part of adoption is lifelong and to think otherwise is unwise. The second thing is that your joy may another’s loss and making sense and processing that is important. Adoption is affected by historical, cultural, racial/ethnic, religious, and political forces. Adoption practices move with such forces and create ripples in families forever. It is also intimate and personal and brings together strangers into our lives for us to love. Feedback on my presentation has been positive, and I was asked to offer training to adoption staff in an agency who heard I “was very knowledgeable about post adoption depression.” I have accepted. Since the presentation, I no longer feel quite so out of place as a nurse among social workers. Still, I hope to convey the appropriate context to this training, one that marries theory to practice, acknowledges grief and loss, and crosses the political divide to support individuals and families touched by adoption.    

References

Foli, K. J. (2019). The middle range theory of parental postadoption depression. Nursology.net. https://nursology.net/nurse-theories/middle-range-theory-of-parental-postadoption-depression/

Chinn, P. L. (2019, March). Keynote address: The discipline of nursing: Moving forward boldly. Presented at “Nursing Theory: A 50 Year Perspective, Past and Future,” Case Western Reserve University Frances Payne Bolton School of Nursing. https://nursology.net/2019-03-21-case-keynote/

Pflum, M. (2023, July 3). ‘Adoption, not abortion?’ How the Dobbs decision is affecting adoption in the U.S. https://www.nbcnews.com/health/parenting/adoption-abortion-dobbs-decision-impact-rcna92104