An adoption story

I’ve mentioned before the baby friends of mine adopted a few weeks after my younger son was born. Although today isn’t his birthday, I’m including the story of his birth and adoption now, because it is just a cool story.

His adoptive parents had been unable to conceive, and had looked into adoption a couple of years before the baby’s birth. They contacted an adoption agency in another state that friends of theirs had used (or perhaps knew personally or professionally), and had gone out there to start the adoption process… but found out that this particular agency only dealt in open adoptions (when the birth mother has the ability to keep in contact with the child), and my friends wanted a closed adoption. They didn’t even fill out the application. Instead, they became foster parents of two lovely little boys, which plays into the story.

Fast-forward a couple of years, to three years ago.

A woman in the town where the adoption agency was located walked into an obstetrician’s office and announced that she was pregnant, nearly due, and wanted to have a scheduled C-section and give the baby up for adoption. Talk about a bombshell. The doctor knew a friend who was a lawyer for the adoption agency, so they got things squared away. The only problem was, the agency dealt in open adoptions only, and this woman wanted a closed adoption — she didn’t even want to know whether she had a boy or a girl. The lawyer (or someone on staff at the agency) remembered a couple who had wanted a closed adoption, but they didn’t fill out an application, so they couldn’t get in touch with them. But the person at the agency knew that they went to church with friends of friends, so they called the only person in our church they knew, to see if they could get the information on this couple.

He happened to be home when all of his family was gone — and he really should have been gone, too, but he really needed to mow his lawn, so he was home instead of with his family. He came into the house to get a glass of water and just happened to be in the house when the phone rang. [I always get chill bumps when I think about this.] Sure enough, he had the phone number of my friends, which he gave to the adoption agency. [Cue more chill bumps.] My friend also had been gone almost all day, and had just rushed home to get her foster sons ready for their baseball game, and were actually running late. They were already supposed to be out of the house, and were just leaving when the phone rang. My friend almost didn’t answer the phone, but went back in to get it. And the woman on the phone was offering her a chance to adopt a baby — something they had given up hope of ever doing some years ago.

The rest, as they say, is history. My friends have been so blessed as the parents of this baby. They love him as much as I love my own sons. They are as thrilled and proud of him as they possibly could be. In some ways, they probably love him more than the average parents love their baby, because he was so unexpected yet so longed for. Most parents get 9 months to prepare for a baby; they got one day.

Thoughts on Surrogacy

When I mentioned to my husband about the “serial surrogates” on 20/20’s “Extreme Motherhood” show, and the fact that they were paid about $25,000-30,000, he jokingly asked me if I’d be a surrogate. Not that we couldn’t stand to have that much extra money, but I don’t think I could, for several reasons.

First, while I understand the desire of couples to have children from their own genes — my husband and I enjoy looking at our children and seeing features from each other or our other family members in their faces, for example — I don’t think that genetics is the primary “thing” in having children or raising children. I know numerous adoptive couples — most who could not have children for one reason or another, but a few that adopted children in addition to their biological children — and I would never say that they loved their biological children more than their adopted children. So, I would encourage couples considering surrogacy to instead adopt a child. Many of the adoptive parents I know have adopted across racial or ethnic lines, some chose foreign instead of domestic adoptions, and some have adopted older children.  While white newborns may be “hard to come by”, they are not the only adoptable children! One exception to this would be “snowflake adoptions” or embryo adoptions — adopting leftover embryos from couples who have undergone in vitro fertilization and have decided they don’t want any more children. If these embryos are not adopted, they will be destroyed.

Also, when adopting a child, you know you’ll be getting a living child; when pursuing having a child through surrogacy, the possibility of losing that baby at any time from implantation through birth is there. [Interesting side note just popped into my mind — when infertile women use IVF to get pregnant, they have, or seem to have, a higher rate of miscarriages and other fetal loss; I wonder if there is the same rate of pregnancy loss when fertile women use IVF to get pregnant with other people’s babies.] I’ve read enough infertility blogs to know that requiring multiple attempt at IVF to produce a living child is not uncommon.

I assume that the couple who chooses surrogacy to have a child has to pay, in addition to the surrogate mother fee of perhaps $30,000, all expenses related to the pregnancy and birth (which may include numerous IVF attempts, as well as all prenatal visits and the thousands of dollars surrounding the birth itself — although I suppose it’s possible that she could have her insurance be billed for most of it, and the other couple would just pick up her out-of-pocket expenses; plus any postnatal expenses for, as an example, longterm NICU care for premature triplets). This can add up to quite a lot! From various adoption stories I’ve heard, I assume most adoptions to cost in the neighborhood of $20,000-30,000 total, for all lawyer fees, plane tickets to China, paperwork filing, etc. However, I did read a disturbing article which pointed out some abuses in the field of adoption, with some white newborns being sold to the highest bidder for even $250,000. Quite revolting, and I assume and strongly hope, representative of only a tiny minority or adoptive couples or sleazy adoption lawyers and/or agents.

But enough of general reasons — onto specifics.

I’d be concerned that I would become too attached to the baby. Maybe I could keep myself emotionally distant enough to realize that it’s not “my” baby, I’m just gestating him or her, so that there wouldn’t be any qualms when the baby was born and taken to its parents; maybe not. I also have enough of a knowledge and/or belief about the in utero life of the baby to feel somewhat guilty about growing him in my womb, and have my smell and heartbeat and voice be most familiar to him, and then to be given to people who are strangers to him, even though they are his genetic parents or (in the case of “snowflake adoptions”) his adoptive parents. Yes, the same thing holds true about adoptions; but many of the couples who done international adoptions have taken their children out of orphanages which house and attempt to care for numerous children at once, and cannot possibly give care to them individually. I think it is better for them to come to a completely new place where they will be loved as a son or daughter than to be kept in an institution, no matter how familiar.

I’m not sure I’m done with my own child-bearing, and I wouldn’t want to put my own future fertility in jeopardy so that someone else could have a child. Perhaps that’s selfish, but that is a consideration to me. This consideration has several branches to it.

Unlike one of the “serial surrogates,” I simply could not use my own eggs and adopt out my own babies, so I would have to undergo implantation of embryos from in vitro fertilization. Since they often implant two or even three embryos in the hope that at least one will take, it is not unlikely I would become pregnant with multiple children. I wouldn’t want to have twins or triplets, but would refuse “selective reduction,” since it is a form of abortion. Yet, twins and triplets are frequently born by Cesarean — many times necessarily, many times unnecessarily — and I don’t want to set myself up for that possibility.  It would be one thing to do it for my own child, but another to do it for someone else. I’d do it; but sitting here not pregnant, I wouldn’t want to do it, so wouldn’t want to set myself up for that much higher possibility or probability when I don’t have to.

The more children a woman has, the higher the risk of certain complications, including neonatal mortality. While first-born children have higher perinatal mortality than subsequent children, I think once women have 5-6 children, the risk increases yet again. Also, there are maternal risks associated with grand multiparity — particularly with repeat C-sections, and with the VBAC situation as it is in many areas of the country (including mine!) of no VBACs allowed, or being very difficult to attempt, I wouldn’t want to end up with a necessary C-section for a surrogate baby, and then forced “elective” repeat C-sections for any future children I might have — surrogate or my own.

I daresay that the average surrogate-adoptive family would not like the idea of their baby being born at home, and I would really not like the idea of giving birth in the hospital without a good reason. Call me stubborn. Would it not be hypocritical of me to refuse an epidural with my own kids (because of potential negative side effects I’d rather avoid), but have an epidural with somebody else’s? Yet I do believe that I’d probably have an epidural if I were to give birth in a hospital, and am only surprised when people have a hospital birth without an epidural. There would likely be other factors in this “baby’s parents telling surrogate mom what to do” area that would also make me less likely to become a surrogate mother.

In years past, back when my sister was having her miscarriages, and didn’t know if she’d ever be able to carry a baby to term, I thought about (in a kind of fantasy soap-opera world) being a surrogate mother for her. Or maybe other women I knew who could not have their own children. While part of that appeals to me — it would be a great gift to a loving mother — the only reason I’d become a surrogate mother, in light of all that I’ve said above, would be for the money. And I don’t think that’s the right reason; nor do I think it’s enough money to overcome all the personal objections. You remember that movie — I think it had Demi Moore, Robert Redford, and Woody Harrelson in it, although I never watched it — in which R.R. played a very wealthy man who offered to give D.M. and W.H. (who were married) a million dollars if she would just spend the night with him. A million dollars is a lot of money; but is any amount of money enough justification for adultery, and cheating on your loving husband? It’s so mercenary and base. That’s the kind of reaction I have to my own cogitations about becoming a surrogate mother for the money — it’s just crass. Nor is money a good enough reason to overcome the objections I have.

Breastfeeding an Adopted Baby

I’ve heard about that — I think Dr. Sears has it in his The Baby Book — but as far as I know, none of the adoptive parents I know have breastfed their children (although many of them adopted older children). Anyway, it was discussed a few weeks ago on the Permission to Mother blog, and out of curiosity I asked what the protocol was to induce milk production in a woman who had not been pregnant — perhaps ever — so that she could nurse the baby. Here is the link that was provided. It has a lot of information and insights into it, so I thought I’d pass it along in case anyone else was curious or needed the information for themselves or someone they know.

Obstetric History and Adoption

In thinking about my previous post on gravidity and parity (how many times a woman has been pregnant and given birth), I was made to think about a woman I know of — a beautician where my mom gets her hair done. This woman had several miscarriages before finally making it to term once (for the purposes of this post, I’ll assume she had 4). The baby had several congenital defects and died a few days after birth. A few months after that, the couple adopted twins who were born a few weeks premature.

Obstetrically speaking, the woman is G5P1A4, or G5P1-0-4-0 (five pregnancies, 1 birth at term, no preterm births, 4 miscarriages, no living children). But legally speaking, she is the mother of twins. Although I don’t know anything about the birth mother, in obstetric terms, she is probably a G1P1, or G1P0-1-0-2 (1 pregnancy, no term births, one preterm birth, no miscarriages, two living children). But legally speaking, she has no children.

Another friend of mine’s husband is sterile, so they don’t have biological children; she’s a G0P0. But they were able to adopt a baby, so they have a child. The baby’s biological mother is a G1P1 or G1P1-0-0-1… except she hid her pregnancy from everyone including her family, and no one knows she ever had a baby. She had an elective C-section (to avoid going into labor or having her water break, and letting the secret out), and lied to her family about needing to have some other surgery done, to cover for her surgery and recovery. Her family assumes she’s never been pregnant, never had a baby.

I don’t know much about the ins and outs of adoption. One thing I do know is that when someone is adopted, the information is changed on the birth certificate to match the family’s legal standing, whether the child was adopted as a newborn or an older child. My friend and her little brother were adopted by her mother’s second husband when they were 12 and 2 years old; their father’s information was removed from their birth certificates, and their stepfather’s name was put in. One person whose blog I keep up with recently adopted a baby in an open adoption, and the adoptive mother was a little perturbed that there was no mention of the baby’s biological family on the birth certificate, because she is very much of the opinion that the birth parents should be mentioned and acknowledged, at least in her situation. But, legally, they are not, and I suppose they have no rights whatsoever. The family gave the child up for adoption because they were struggling to make ends meet, with the children they already had. They had also previously given up a child. She should be G4P4, or G4P3-1-0-4 (the last baby was born preterm)…but since they legally only have two children, I don’t know if that changes anything.

Someone else commenting on that blog said that she was adopted before her mother had any biological children, so she was listed as her mother’s firstborn on the birth certificate; and then when her mother gave birth to a daughter after the adoption of her first daughter, and that baby was also listed as her mother’s first-born. Obstetrically speaking, she was; legally speaking, she wasn’t.

So, things can get a little sticky sometimes.

I wonder how this might play out in statistics — especially neonatal and infant mortality. When looking just at birth certificate data, if an adoptive mother and father are listed as the child’s parents (which they legally are, but for purposes of biology, they aren’t), I wonder how much information is actually carried over? On my birth certificate worksheet, as well as the ones I filled out for my children, there was a lot of information about both myself and my husband — our age at the time of birth, where we were born (city, county, state), occupation, education, race, etc. There were also health factors about me (I think my height, prepregnancy weight, and weight gain were all noted, and possibly other factors). Both the mother’s and the father’s ages are factors in the risk of certain conditions, especially genetic disorders like Down Syndrome. If researchers look at birth certificate data — which would list the adoptive family’s information — might they be getting an incorrect picture?

Of course, most babies aren’t adopted, so any skewing of the data might be slight; and I would assume that for the purposes of research, any known adoptions would be excluded… but how would they exclude them when just looking at birth certificate data? However, as I said before, I don’t know just too much about the paperwork of adoption. However, my friends I mentioned above are both Caucasian, and the baby they adopted is Hispanic, or at least, the mother is Hispanic… the father may be too. The adoptive mother is short and thin; the biological mother was tall and big (which is how she was able to conceal her pregnancy from everyone). The baby has always been big for his age, and is now wearing almost the same size clothes as my 4-year-old, although he’s a few weeks younger than my two-year-old. There is great genetic disparity between the child’s adoptive and biological families, and since statistics are kept by race, I wonder how these things work. I must admit, part of me gets a devilish sense of glee at messing with the minds of bean-counters — a Hispanic boy born to two Caucasian parents; when he gets older, he’ll probably be 6’2 and weigh 250 lb., bigger and taller than either of his parents. That doesn’t fit within the narrow confines of genetics! 🙂

And then you’ve got embryo adoption, in which parents legally adopt another couple’s embryos (after the other couple has had all the children they want through IVF), so the adoptive mother actually gestates and gives birth to a baby that is not genetically her own — kind of like a surrogate mother, except instead of just gestating for another women, she is gestating another woman’s fertilized eggs, for her own baby.

So, variations I see that might delightfully mess with the whole “nature vs. nurture” question because things don’t fit into neat little boxes:

  • a couple adopts a child genetically similar to themselves (same race, perhaps even same ethnicity or ancestry — like my aunt and uncle who are both full-blooded Dutch Americans did, in deliberately requesting a baby born of a Dutch-American mother)
  • a couple adopts a child genetically different from themselves (crossing racial lines completely, as in a Caucasian couple adopting an African child; or partially, as in a Caucasian couple adopting a mixed-race child; or partially, as in a mixed-race couple adopting a child completely of one or the other race; or completely, as in a mixed-race couple adopting a child from a different race entirely)
  • a woman becomes a surrogate mother for a couple, being impregnated with their biological child
  • a woman becomes a surrogate mother for a couple, not being impregnated with their biological child
  • a couple adopts embryos, so that the woman becomes pregnant with another couple’s biological children

Wow — think of all the factors that might go into play in all of these categories! Bean-counters are used to white parents having white children, and black parents having black children, and bi-racial couples having bi-racial children; but white parents having black children just doesn’t fit into a neat little pigeon-hole! I can see a reason to note racial factors, but sometimes I get the idea that people are pigeon-holed by their race, and rather than it being a help, can be a hindrance. I’ve seen attitudes of fatalism in some people, that, “Oh, well, we just can’t help these mothers and/or babies, because they had this or that risk factor…” I don’t like that! Ok, stopping myself before I go off on a tangent, here!

But, really, when thinking of how much genetics and maternal health goes into things related to pregnancy, birth, and the first year of life, it really does get to be a lot of food for thought. First, is the baby’s genetics, then the gestating mother’s genetics, and finally the gestating mother’s current state of health. When a woman carries a child that is not biologically hers, how much of the child’s biology goes into the pregnancy, and how much of the woman’s biology, and the woman’s health, go into the pregnancy? Is it possible that there are some fetal considerations that go into certain maternal health conditions — like gestational diabetes, preeclampsia, or preterm birth? I can easily see it be so — the mother’s body adapting to the life within, even if not genetically her own. Not genetically her own, but biologically her own, since it was her body gestating the baby?

Ok, I’m making my own brain hurt, trying to think of all the considerations, so I’ll stop rambling now. 🙂

Defiant Birth

I read about this book in the New Zealand College of Midwives’ Journal, and it intrigued me — Defiant Birth: Women Who Resist Medical Eugenics. Essentially, it is a book about women who either give birth after having been pressured to have an abortion because of a fetal anomaly, or refused such testing altogether. While the person writing this review criticized the book for not including any stories of women choosing an abortion, the whole point of the book is one of defying the medical community and giving birth to babies that most women would abort and most doctors would encourage to abort. The whole point of the book, evidenced by the title, is that it is about women who refuse to kill their offspring for medical reasons.

It is my opinion, based on years of being on pro-natural- and pro-home-birth lists, that women who tend towards natural (meaning, unmedicated, not just vaginal birth) and/or home birth tend to avoid prenatal tests and screens, including ultrasounds, which may indicate a problem with the baby before it is born. Also, women who are so strongly pro-life that they would refuse an abortion regardless of the prenatal diagnosis would be more likely to decline any testing. [If any of you know of any research done on this topic, please let me know, because I’d like to know if my opinion is accurate or not.]

The down-side of refusing tests is that if there is a problem (which is, fortunately, rare), then it is not known prior to the birth, so the parents cannot prepare for a child with disabilities or one who needs medical care. Many parents, and it is especially the mothers who write about it, talk about being grateful for knowing of their child’s circumstances prior to the birth. One reason given is that it made the time of pregnancy more special for them, knowing that it would be the bulk of the time they would have with that child. They made more effort to bond with their baby prenatally than they otherwise would have. While it was difficult for them to continue the pregnancy knowing that their baby could die at any moment, and would most likely be stillborn, or die soon after birth, they found joy where they could, and loved their babies as long as they did live. Another reason given is that knowing the condition beforehand gave them the opportunity to better prepare for the baby’s birth (and sometimes immediate death) — either by having a birth plan with specified medical care, a team of specialists to help the baby live, or being able to mentally and emotionally prepare themselves for the grief of losing a child.

The downside of having the tests is that there are false negatives as well as false positives, and if you receive a negative result (that is, that your child is not affected) and at birth you find out that he or she is affected, then you will been given false assurance that everything is normal. If you have a positive result (that your child does have something), then your pregnancy will be much more stressful than it otherwise would have been. While some of that stress may be related to finding out everything about a certain condition, there is undoubtedly stress just in dealing with that condition. One of my friends had a positive result from a screen she had in early pregnancy, and although she chose not to have an amniocentesis to confirm or disprove that potential diagnosis (because of the risk of miscarriage, and the certain knowledge that she would not abort her baby even if he did have something), she did have a more stressful pregnancy with him than with his older brother, because of the worry that the test raised. It was needless worry — the baby was just fine — but it was many months of concern, nonetheless, even though she knew that most of the positives from this screen were false.

While most abortions done for a negative prenatal diagnosis (that is, the baby is said to have a certain condition which will result in his death in utero or soon after death, or will survive with disabilities) are accurate, a small percentage of healthy babies are aborted, or the condition was not as bad as it was thought to be, when the fetus was given an autopsy. If you have been given a difficult diagnosis, and are thinking of having an abortion, please get a second or even a third opinion. While it is rare, I have read of women who have been told that their babies were missing organs (kidneys or even the brain), and after the baby’s abortion or birth, it was discovered that the diagnosis was wrong. Since most of these diagnoses are done by ultrasound, it all depends on the sonographer’s skill and equipment. But even highly-skilled doctors can make mistakes.

I’ve mentioned it before, but I’ll tell it again — a woman on one of my lists was told when she was at or near term that the ultrasound showed her fetus didn’t have Down Syndrome nor have any heart problems (and this was a 90-minute-long Level 3 ultrasound), and the baby died just a couple of weeks later, of the heart problem she supposedly didn’t have, and she also had Downs. The woman said she was glad that the incorrect diagnosis was given, because although she was falsely assured, it at least kept her baby from multiple surgeries which would have done no good, but which she would have been pressured into having her get “just in case.” She would have been pressured into inducing or having a C-section, and the baby’s short life would have been spent in operating rooms and in pain, to no avail. As it was, her entire life was spent in the comfort and safety of her mother’s womb.

Often when such a diagnosis is given, the woman is immediately pressured to have an abortion. Perhaps the word “pressured” is too strong in some cases — it may just be asumed that women will have an abortion (or pre-term induction), rather than carry the baby to term. Here is one such case — the woman had her first ultrasound at 31 weeks, and it was discovered her baby had anencephaly. Immediately after the diagnosis…

My doctor had proceeded to tell us there was a room upstairs to start an induction. She never asked me or had said go home, rest, make an informed decision when you are thinking clearly. I don’t blame her, I had free will, but she now knows how important it is for her to tell patients they have a right to make an informed logical decision regarding inducing early or carrying to term.

The induction didn’t work, and after three days of waiting for contractions to start, she finally decided just to go home and continue the pregnancy, and carry the baby to term.

Our reaction to our son was that of complete awe. He was anencephalic and he was indeed beautiful. He had so many resemblances to our family, it was uncanny. He had my husband’s thin lips, his wonderful cheeks, chin, and nose. His eyes were a bit bulgy, that is due to the orbital bones not forming correctly, but the same deep brown eyes all my children share.

Then there is this story, in which the mother had declined the quad screen because of the level of inaccuracy in it, and wouldn’t have an amnio because of the risk of miscarriage, but she did have an ultrasound, where it was discovered the baby had so many problems, that she just kept hearing them say “and… and… and…” They counseled her to have an abortion, which she naturally refused being very pro-life, but eventually consented to an amniocentesis, because the after-birth care her son got might depend on the answers an amnio would give them. [As an aside, I will point out that when her husband left the room while they were prepping her for the amnio, they pressured her to have an abortion, saying that it was her decision and not her husband’s. As if the only valid “choice” they perceive would be to have an abortion.] The results for the amnio were that the baby did have Down Syndrome, and they counseled her again to abort, because that, combined with his other ailments, meant that he would not live much past birth. When she declined yet again, they offered her a pre-term induction. After it was explained to her that she would be induced before the baby was old enough to live, she said, “That’s the same thing as an abortion,” and told them “no” once more. Good for her! Read the rest of this amazing story here. While her adorable little boy does have Down Syndrome, he defied the prognoses and instead of dying within the first few hours or days of life, is now one year old.

I’m not saying it will be easy to be “defiant” in the face of such pressures. Women “over a certain age” will be strongly pressured and coerced into having tests and screens to see if their babies are affected. All women, regardless of age, will be pressured into having an abortion or pre-term induction if the test results indicate that the baby has a defect. Sometimes even minor, correctable defects like a cleft lip or cleft palate will send some women to an abortionist. But when the baby has a genetic condition or severe heart problems or anencephaly, the pressure to abort will be very strong. It is almost assumed that you will abort — by your doctors, and perhaps your friends and your family — such as what happened to a woman whose blog I happened across. She is currently pregnant with a daughter with congenital diaphragmatic hernia, which may kill her soon after she is born. The woman needed support, and her mom and dad both told her to have an abortion. But she is choosing to let her daughter live as long as possible, and is going to love her as long as possible. I admire her.

If you have been given a poor prenatal diagnosis, you need to consider all your options. There are many support groups, especially on-line, that you can talk to as you go through this. Abortion is not the only answer. Even if you think you cannot raise a child with a disability, there are many families who will adopt special-needs children. Here is one such organization with over 200 families waiting to adopt a child with Down Syndrome. Over on the Real Choice blog, there is a list of websites (below the list of posts, in the right-hand column) that are geared towards helping families when they have been given a negative diagnosis — some are for specific ailments, like Trisomy 13 or Trisomy 18; while others are for all conditions, including being pregnant with cancer, and how to support a friend who has been given a poor prognosis for her baby.