Birthparent Loss and Grief

In the last decade, there has been a growing acceptance that a loss occurs for birth parents when adoption takes place. In the past, the emphasis in the adoption process has largely been on the reception of the child into the adoptive family rather than the reciprocal loss of the baby for the birth parents and extended family. The bonding process for the birth mother, who carried the baby inside her during pregnancy and experienced the miracle of birth with this baby, had not been previously acknowledged in society at large or by the professionals working in adoption and mental health.

Adoption relinquishment involves a grief process not unlike other types of grief such as death or separation. There are, however, some significant differences for birth parents, due to the nature of the loss, which will be noted during the description of the grief process.
Grief Process:

1. Numbness and Denial: During the initial phase of grief, the birth mother is trying to cope with the realization that the birth has become a reality. In the midst of the physical and emotional strain of having given birth, she faces the decision of relinquishment and the loss this decision involves, all in a very short space of time. Trying to make such a painful decision in the middle of all this change and intense emotional upheaval can lead to a period of shock, numbness, confusion and at times denial. Denial is a very primitive defense mechanism that can be effective in protecting a person from emotional collapse. Denial may have been a mechanism the birth mother utilized to cope during the pregnancy. Defenses such as denial need to be respected.

Numbness, confusion, shock or denial can result in birth mothers having little recall of events such as the baby's birth, or they may forget significant details such as the day or time of the baby's birth. These episodes can result in terrible guilt and can, as well, diminish her already-limited store of memories of the baby and events to validate the birth and the ensuing loss.

2. Eruption of Feelings: As the shock and confusion lessen and the denial or numbness recedes, floods of intense feeling may erupt without specific triggering events; this eruption can be an overwhelming experience involving a range of feelings such as sadness, emptiness, anger, fear, panic, anxiety, despair, guilt, shame, helplessness, hopelessness, loneliness, irritability, fatigue, or difficulty concentrating. Feelings might get expressed indirectly through physical symptoms such as headaches, sleep disturbances, nightmares, back pain, stomach pain, or bowel problems. As emotions find avenues for direct expression, they gradually decrease in intensity and become more connected to triggers associated with the memories and loss.

Secrecy, shame and lack of public acknowledgment of the loss by family, friends and society mean that the fact of the loss is never validated. What follows, then, is a subsequent lack of natural opportunities for expression of feelings and therefore diminished opportunities for support.

3. Accepting the Adoption Decision: The fact that the adoption process involves a birth mother's active choice in determining the course of events sets this loss apart from other losses such as death, aligning it instead to the loss experienced when an individual decides to separate from a spouse. In a marital separation, the initiating spouse is motivated to the decision because of some type of untenable situation and may feel anger toward the spouse, allowing emotional distance. In contrast, the decision resulting in loss of an innocent baby or child only brings sadness and guilt, even when others try to reinforce that it is "in the best interests" of the child and that the child will be "loved." The love of others for the child does not cancel out the pain of the loss for the birth parents.

This aspect of decision-making is complex, as birth mothers may have experienced coercion, pressure or lack of support for options other than adoption, reducing their effective control of the adoption decision. This can leave birth parents with a great deal of legitimate pain, anger and regret. Ensuring that birth parents are in charge of their decisions and that they retain control of their choices is vital to the process. However, it is this very act of making a conscious and informed decision that then provokes the birth parents' feelings of responsibility for their own and their baby's loss. It is painful to feel responsible for such a difficult choice. However, birthmothers and birthfathers who have retained control of their own decisions, rather than surrendering to the influence of others, find it easier to accept responsibility for these choices and are less likely to hang onto anger. This sense of responsibility does not necessarily lessen the grief process, but birth parents who have retained control may be less likely to find themselves stuck in anger and blame in years to come.

4. Accommodation to and Living with Uncertainty: If feelings are granted expression, then the feelings gradually become more manageable, and emotional reactions are in manageable response to natural reminders of the loss. Birth parents can find ways to live with the repeatedly sensitive areas: the child's birthdays, others' pregnancies, their own future pregnancies, baby showers, meeting children with the same name, and other losses. Birth parents have to find ways to answer such questions as, "Don't you want to have any children?" or "You'll know what being separated from a child is like when you have children of your own." Birth mothers listen in silent pain to other women's stories of labour and delivery, often unable to join in this connecting female discussion.
Living with the unknown can be one of the most difficult aspects of this type of loss. Birth parents with closed adoptions live in a state of limbo, forced to create fantasies as they envision their child growing up with the adoptive parents. False hope can also be created if it is suggested to the birthmother that an open adoption will result in only a temporary and transient sense of loss; expectations born of such misinformed counseling can lead to disappointments later in life. Open-adoption contracts or potential reunions do not come with guarantees.

When loss comes from death, the survivor may still feel an impulse to search for something. However, this sort search is eventually recognized as irrational, as the individual comes to appreciate the permanence of the loss and move past the behavior. But in loss through adoption, the search behavior is not irrational. The form of search that birth parents may undertake may include checking birth dates of children the same age as the child who was relinquished; looking for children who look similar to birth parents, scanning faces in a crowd; seeking more information about the child or adoptive family; or seeking out the relinquished child. In part, searching allows birth parents to form a mental image of the child, validating that the loss indeed occurred; it also provides reassurance that the child is doing well in the adoptive home.

5. Re-evaluating and Rebuilding: The secrecy, shame, guilt, self-blame, feelings of selfishness and loss leave scars on birth mothers' self-esteem. Birth parents may struggle as they re-evaluate their decisions later in life. Birth parents might feel incapable of making decisions, feel unlovable, or feel unable to handle having another child. At such moments, they need to realize that they made the decision at a particular time and place, perhaps as a vulnerable teenager without adult skills or resources. Restoring self-esteem is an ongoing process, and rebuilding self-esteem also depends on the degree of self-esteem possessed prior to the pregnancy crisis and relinquishment.

Conclusion:
Resolving birth parent loss and subsequent grief is an individual process. The issues highlighted here are only a guide illuminating the complexity of loss through adoption, a lossthat interweaves with other elements in a context of diverse societal, cultural, religious, and family values. It is, however, important to encourage birth parents to focus on this issue. By attending openly to the grief of this loss, those working in the adoption field and those personally affected by adoption can acknowledge, validate and value this experience and its losses. This process, though painful, is hopeful as well, helping to break down the barriers of judgment, secrecy, and consequent shame for birth parents. It can enable private grief to be publicly acknowledged, providing the context for grief's expression, highlighting the need for increased support, and ultimately increasing respect for the voice of birth parents in the adoption process.