J Pediatr Adolesc Gynecol (2004) 17:299–300

Perspectives on Pediatric and AdolescentGynecology from the Allied Health CareProfessional

Adoption as an OptionMargaret Tonelli, NP

Recently, Sara, a nineteen-year-old primigravida, pre-sented for prenatal care. She was very happy to be preg-nant and her current homelessness was not of greatconcern to her. She reported a very complicated socialhistory with a long history of abuse and neglect by herbiological family. She had been in multiple foster homesfrom a young age and on her own since she aged out ofthe system. She had a history of depression with multiplehospitalizations; at present she was not on any medica-tions. The father of the baby was her only current support,she had no contact with any family members, and at pres-ent she was “couch surfing,” staying wherever she couldand working part time as a cashier.

On a followup visit, her affect had changed. She wassad, flat, and distant. She reported she was staying in awomen’s shelter. She had ended the relationship with thefather of the baby, as he had another relationship, andshe had decided to place the baby for adoption.

On her own she had contacted one of her former fostermothers and asked her if she would adopt this baby. Thewoman agreed and immediately began to provide food,transportation and emotional support for Sara.

The number of teens choosing adoption as an optionfor an unplanned pregnancy has dropped dramaticallyover the last twenty years. This is certainly true formy practice. I have had only two adoptions in 22 years.Before 1973, 8.7% of all premarital births were placedfor adoption. The current percentage is less than 2%.1

This decline is primarily due to the significant declinein the number of white women with premarital birthschoosing adoption, from a high, pre-1973, of 19.3% toless than 3% in 1996.1 The adoption rate for black womenwith premarital births has consistently been less than 2%.Many childbearing trends may contribute to this decline:declining pregnancy rates for teens; the proportion ofteens relinquishing their babies, less than 1%; the dimin-ishing negative stigma and society’s acceptance of single

� 2004 North American Society for Pediatric and Adolescent GynecologyPublished by Elsevier Inc.

motherhood due to increasing birthrates for unmarriedwomen in addition to high divorce rate and possibly peerpressure to parent. Though some argue the abortion rateimpacts adoption rates, abortion rates are also declining.1

Research indicates that woman who choose adoptionhave higher educational and career aspirations, familiessupportive of the decision, and a strong sense of self.4

These are characteristics I would not use to describe Sara,but that I would use to describe the two young womenin my practice who completed their adoptions.

Sara continued to be steadfast in her desire to placeher child: “I am not in a position to raise a child, Ihave nowhere to live, no money. I want my baby to havemore.” Sara was also beginning to show increasing signsof depression and expressing thoughts of hurting herself,though she wouldn’t act on her thoughts because of thebaby.

A referral to a psychiatrist, confirmed the depressiondiagnosis and antidepressants and weekly therapy began.

The adoption triad, the child, the adoptive parents, andbirthparents—all have specific concerns and rights and thehope is to maximize the benefit to the child by an adop-tion. With the bleak future of children of teen motherswell documented, it is imperative for teen providers tobe aware of their personal feelings and biases surroundingadoption, abortion, and parenting in order to provide theteen with much needed information about all her options.As an adolescent provider you may be the first personthe teen talks with about her options.

The adolescent needs a supportive forum to discussher pregnancy options exploring her own needs andplans, needs of the baby, the feelings of important peoplein her life, and how would she support herself and a baby.Many cultures have strong beliefs about adoption andabortion, and the teen needs to explore this importanceto her and her decision. The ability to place the child’sneeds above one’s own needs involves abstract thought

1083-3188/04/$22.00doi:10.1016/j.jpag.2004.05.007

300 Tonelli: Adoption as an Option

and a high cognitive ability, a skill many younger teenshave not yet formalized. Often teens idealized the preg-nancy and are unrealistic about the serious responsibilitiesof parenting. The important point is that the teen makesthe right choice for her and we as providers providethe resources and support for whatever she decides.

Though the percent of teens placing for adoption hasfallen, providers need to provide adoption informationand resources to inform the teen of the adoption option andwhether adoption is a choice for her. The National Adop-tion Information Clearinghouse (NAIC) is a comprehen-sive resource on all aspects of adoption. Its website, http://naic.acf.hhs.gov, includes an in-depth fact sheet, “Are youPregnant and Thinking about Adoption?” Topics include:

Who can I talk with about my options?Should I place my child for adoption?What are the different types of adoption?How do I arrange an adoption through an agency?How do I arrange a private adoption?What if My Baby is a Child of Color?How do I arrange for future contact with my child ifI want it?2

An excellent book to recommend to a pregnant teenthinking of adoption is Jeanne Warren Lindsey’s Parents,Pregnant Teens, and the Adoption Option.3

The stigma of an unmarried mother has changed, ashas the adoption process. Adoption can be confidentialor varying degrees of an open adoption, through whichthe birth parents and adoptive parents are in contact. Itis critical for all parties in the birth triad to be legallyrepresented to protect their interests. Comprehensivecounseling by trained professionals familiar with the legaland emotional aspects of adoption is imperative.

The decision to relinquish a child is a difficult one;it takes courage and love, and birth parents choose itbecause they see it as the best they could do for theirchild.

Often, as with Sara, homelessness, depression, andlack of money can be overwhelming and adoption seemsright, but these maybe temporary problems and re-sources to address these issues should be explored. Coun-seling will aid the teen to explore her inner resources andidentify a support network to cope with the grief and lossthat birth mothers experience. If the prospective adoptivemother has provided financial and/or emotional support,she may feel “entitled” to this child when the adoptionis not completed.

As Sara’s due date approached, she become increas-ingly concerned if she would be able to deal with thefeelings of loss, and what her baby would think of her forplacing her for adoption. Though the father of the babywas not involved, his family was not supportive of theadoption plan. Sara felt free to talk about these feelingswith her social worker, her therapist, and me, thoughnot with the prospective adoptive mother. She worriedabout disappointing her.

In the end, Sara did not place her baby. The prospectiveadoptive mother was frustrated and disappointed. Saracontinues to work hard to parent and has been receptiveto ongoing counseling and support.

References

1. National Adoption Information Clearinghouse: PlacingChildren for Adoption. U.S. Department of Health andHuman Services. Updated November 13, 2002. http://naic.acf.hhs.gov

2. National Adoption Information Clearinghouse: Are YouPregnant and Thinking about Adoption? U.S. Departmentof Health and Human Services. Updated July 2000. http://naic.acf.hhs.gov

3. Lindsay JW: Parents, Pregnant Teens, and the AdoptionOption. Buena Park, CA: Morning Glory Press; 1989

4. Stolley KS: Statistics on adoption in the United States.Future Child 1993; 3:26