Adoption: Hurtful Words Said in a Time of Grief Can Sear the Heart

Many hospitals are well equipped to handle intense grief – ranging from the earliest neonatal losses to the death of an elderly person who has lived a long and full life.

But what about the ambiguous loss that occurs for mothers who place their living babies in the arms of another? It’s time for hospitals to apply what they know about grieving and healing to situations that may (or may not) result in an adoption placement.

As the Adoption Liaison for the past eight years at Parker Adventist Hospital near Denver, Colorado, I have spent sacred time with many women (and some men) as they have considered adoption.  I’ve sat at their bedsides and cried with them. I’ve watched them memorize every feature of their baby’s face. I’ve heard them whisper lovingly how they couldn’t wait to meet her and that they are so glad she is here.

I have made sure the voices of birth parents were heard when some change their mind about placement.  Since our program is not funded by adoption agencies, we are able to be guardians of the process rather than the outcome of adoption situations, affording me the privilege of witnessing such intimate and pivotal experiences.  When the process unfolds well, guided by the patient and supported by hospital staff, all parties are best served in the long run – the mother, her family, the hopeful adoptive parents, and most of all, the baby at the center.

When I created the hospital-based Family to Family Adoption Support Program in 2006, I wanted to ensure that nurses and doctors were trained in the complexity of adoption and to help them meet the needs of those involved in infant placements.

In the old hospital model, an Adoption Liaison was not important.  The patient gave birth; she was told to forget about it and go on with her life. The baby was whisked away and given to a social worker to be transported to new parents, who may or may not ever speak of this life-changing transfer.  Few healthcare workers addressed the situation, and if they did, it was often with judgment and shame.

As an adopting mom in 1998, I was told by my caseworker, When you go to the hospital, get in, get out, don’t make anyone mad, and expect they are not going to get it.

We did just that. Our first hospital experience, the one that brought us our daughter, was amazing for us.  But our last experience with our son was awkward and difficult. As an educator, I had to figure out why.

How could two hospital experiences just two years apart be so vastly different? At this point, I had also started teaching adoptive parenting classes and was privy to more stories. I would hear about a wonderful adoption experience at a Denver-area hospital one day. But the next week, I would hear about a horrible experience at that very same hospital.

I also started talking to women who had placed babies. It seemed to always come down to the same thing, a feeling of being judged by hospital staff:  There was this one nurse… or You should have heard what the doctor said!

Hurtful Words Sear Grieving Hearts

Hurtful words said to us in a time of grief can be seared onto our hearts.  Maybe it was that insensitive comment made after a miscarriage or a death, a catch phrase that falls cold on our tears. Word for word, we can recall the helpful words and the hurtful comments, all having a lifelong effect on our healing.

The need for more education of hospital staff became apparent to me.  The more I got to know hospital workers, the more I realized that it was rarely their intent to be malicious. They were not trying to say the wrong thing, but no one had ever taught them what the right thing to say was.

Through adoption education, I’d found my passion, but my purpose came into focus as I lived through placements with so many women. I learned that education was only part of what was needed. Sure, it’s helpful for hospital personnel to discern between comforting words and hurtful words. It can be healing to create rituals and keepsakes that honor the child’s story during that fleeting time in the hospital.

But it took me awhile to stumble onto the key missing ingredient –the acknowledgement of loss for that patient, the life-changing, heart-wrenching grief that is experienced differently by every mother.

In the past fifty years, hospitals have become very aware of the added support needed during loss, and thankfully, programs have been put in place for the patients and their families. Where hospitals once whisked away stillborn babies, now there are bereavement programs that enable parents to acknowledge the existence of their beloved baby. Pictures are taken, keepsakes are created and that child’s existence is celebrated, even though the loss is felt intensely.

In a country where hospice and bereavement care is common practice, such compassion must now extend to adoption loss. With hospice, we honor the wishes of patients and care for them physically AND emotionally, with compassion and understanding for their journey.

The women who walk on the adoption path deserve no less.

Putting the Patient in the Driver's Seat

Healthcare providers understand the hospice model — it’s in place because it’s the right thing to do. We offer families of a dying loved one grace and understanding.  We accommodate that patient’s wishes and desires, their interactions and their contacts. We put the patient in the driver’s seat and this has become the expected standard of care. Yet when facing an adoption decision, we often micro-manage loss and set expectations for what we think our patients need.

“She shouldn’t spend so much time with that baby!  She is getting too attached.”  (I will take the baby out and say some tests need to be done.)

“She should see the baby to be sure.  I think she is in denial.”  (I will take the baby back to her room, even though she has asked not to see him.)

We would be shocked if a nurse asserted her own opinion when a family decided to take a loved one off life support, or if a technician questioned a patient’s decision to pursue chemotherapy instead of radiation.

Personal biases around adoption can be just as inappropriately inserted regarding adoption situations. Each day, in hospitals around the country, there are real-life examples of how care in the hospital can be manipulated, how a woman’s decisions may not be honored, and how — without training to do otherwise — personal biases can get in the way either for or against the choice of adoption.  Patients are subjected to unsolicited outside opinions:

• She should do this.
• She shouldn’t do this.
• I was a single mom, and it was so hard.
• I was a single mom and I did it – she can too.
• I think she is a saint – what a gift to give to another family.

In addition to unspoken thoughts that can impact care for the mother, there are also diverse attitudes towards potential adoptive parents that may be present during this tumultuous time which complicate care further.

We shouldn’t force or micro-manage the adoption loss experience for these patients any more than we would with a family crafting their goodbye to a loved one in a hospice setting.

Think of family members preparing to say goodbye to a beloved parent in the last days of life. During this time, all the siblings may react differently. Some may say, “I don’t want to come. I have made peace. More contact will be too hard.”  Others come and sit at the bedside and say what they need to and then leave.  While others sit at the bedside until that very last breath — so painful to watch, but what is needed by that person to move forward.

The patient considering adoption at our hospital is no different.  Some don’t choose to have time in the hospital with their baby, because it would be too hard. Others may want to see the potential adoptive family holding the baby, because this would help to bring peace. Some may desire to sit alone with that baby until the last possible moment, pouring into that child all the love they feel, saying what needs to be said, and memorizing moments as this child’s Mother.

Who am I, as a hospital employee, and especially as a member of support staff, to say that any of these responses are right, or wrong, or too hard, or cold, and indifferent?  My job is to be there no matter what that Mom needs. To walk alongside her during those fleeting hours that will change her life forever, to remind her to listen to her heart as she decides, whether to say goodbye to the role of Mom in this child’s life, or to support her if she decides she cannot go through with the adoption.

Regardless of her decision, her life will be forever changed, and I have the honor of witnessing this time and to hopefully ensure that it is what shewants and what she needs to move forward in her new normal.  Hospitals will not implement a program to support patients in potential adoption situations until adoption placement is seen as a very real loss.

It’s clear we need to evolve from the old school, shame-filled mentality that a woman is getting what she deserves.  “She made her bed, she needs to lie in it.” I cringe to think that there is still a punitive aspect to adoption in a civilized society.

I observed a placement recently with a couple working with my former caseworker.  I asked how they were prepped for the hospital time ahead of them. The response?

“The Caseworker told us: When you go to the hospital, get in, get out, don’t make anyone mad and expect they are not going to get it.

Sixteen years later, and the warning is the same.

It is time to treat adoption loss like other losses that unfold in a hospital. We must press to lift the veil of shame and give our patients voice, honor, and dignity.  Hospitals should be expected to do loss well, not only at the end of life, but at the beginning of life also.