Postpartum Mood and Anxiety Disorders in The Adoption Community
November is National Adoption Month. This month we choose to bring awareness to the intricacies of adoption and the impact on Birth Parent(s), Adopted Individual(s) and Adoptive Parent(s). Postpartum Mood and Anxiety Disorders impact all members of the Adoption Community in similar and different ways. The article has research that shares statistics and findings that may not reflect the experience of an Adopted Individual(s), Birth Parent(s) or Adopted Parent(s). Adoption is full of dimension and unfortunately not all voices and perspectives are highlighted in the research. As you read this article, embrace curiosity about each unique dimension of adoption, specifically being aware of the lack of research and support for transracial adoptions and families in the adoption community who are people of color.
Adoptive Parent(s)
Just as a Birthing Person should be screened for Postpartum Mood and Anxiety Disorders so should an adoptive parent(s). The diagnostic rate of PMAD’s reflects a similar rate of Postpartum Depression for a Birthing Person (1 in 7 Moms and 1 in 10 Dads). Rarely are Adoptive Parents screened for PMADs because of the societal assumption that only birthing people are impacted by PMADs. The impact of low screening creates an unsaid assumption with the Adoptive Parent(s) that they are supposed to “be okay” and not struggle in this period. Many Adoptive Parent(s) fear that if they share with their adoption agency that they are struggling that they could be perceived as not bonded to the baby and then the adoption could be at risk. Secrecy and silence increases the weighted toll of PMAD’s on the Adoptive Parent(s).
The reality is that Adoptive Parent(s) are impacted to adjustment to parenthood like any Birthing Person. They experience lack of sleep, career changes, adjustment to meeting an infant’s needs, etc. Adoptive Parent(s) also may have dimensional feelings around their journey to adoption as a family building option. These feelings may arise or exacerbate as they process and grieve the non-biological connection. Seeking counseling during the adoption process is shown to help Adoptive Parent(s) grieve factors like infertility, loss and integrate the new family culture they will have through adoption. Many Adoptive Parent(s) report feelings of grief, sorrow and even guilt when thinking about their child’s Birth Parent(s) experience of grief and trauma in the separation post placement.
Adoptive Parent(s) deserve and need support like all Birthing People and should build a community of Adoptive Parent(s) that understand the complexities of the Adoption Process. Processionals and Adoptive Parent(s) should understand risk factors of PMAD’s including and not limited to infertility, miscarriage, loss, previous birth trauma as well as their own individual conceptualization of their identity as an Adoptive Parent. Adoptive Parent(s) Families should be given boundaries and education surrounding the Adopted Individual and Birth Parent(s) story in order to preserve and protect the Integrity of Birth Parents and Adopted Individuals. It is the responsibility of the Adoptive Parent(s) to determine how they need support from their family in their adoption process and they should articulate boundaries and needs clearly to their family and friends so healthy support can be honored.
Birth Parent(s)
A Birth Parent has the hormonal and biological tendencies to experience a Perinatal Mood or Anxiety Disorder within the same statistical likelihood as a Birthing Person who made the decision to parent a child. Due to financial constraints, social supports, traumatic memories and barriers to healthcare resources, Birth Parent(s) may not receive the healthcare follow up that is needed for Birthing People. The impact of lack of care and social stigma of being a Birth Parent creates a barrier for PMAD Screening. When Birth Parent(s) do seek health care resources providers may not know to screen them for PMAD’s because they aren’t currently parenting although the screening recommendations are the same. Birth Parents may not want follow up services from the Hospital or Adoption Agency due to grief, avoidance, and a desire to distance themselves from painful memories. Birth Parent(s) experience additional dynamics of guilt, shame, overwhelm, as well as the stress intertwined in the actual adoption process. Birth Parent(s) experience hormonal swings, lactation as well as a physical craving that the body has to be with the child.
Birth Parent(s) may experience lack of support in their decision to place their child for adoption and are also experiencing the impact of the current life stressor(s) in how and why they chose to make the choice to place their child for adoption. Birth Parent(s) experience an exposure of sharing their adoption experience in workplaces, school settings and experience the stress of difficult conversations of people who saw them pregnant and now not currently parenting. Birth Parent(s) experience a myriad of grief anniversaries and may have a difficult time processing and accepting their own identity as a Birth Parent. Birth Parent(s) may be met with unmet expectations from the Adoption Agency or Adoptive Parent(s) in regards to Post Adoption Agreements.
During their pregnancy, Expectant Parent(s) who are considering an adoption plan should be educated about PMAD’s and how adoption is not a mitigation to PMAD’s or general mental health concerns and adoption may exacerbate it. It’s also important that any Expectant Parent who is considering adoption understands their rights as a person considering adoption as an option for their baby. Working with an ethical adoption agency or ethical attorney is crucial for the emotional safety of the Birth Parent(s) and the Adoptive Individual. Expectant Parent(s)/Birth Parents should be supported in building a community of other Birth Parent(s) or Expectant Parent(s) who are considering adoption. Mental Health and Health Care resources of providers that understand the intricacies of adoption should be accessible throughout the adoption plan and post placement. Many times Birth Parent(s) specifically the Birthing Person are curious about the Pharmacological support during pregnancy but feel concerned about the impact of the medications on the baby and may experience fears of negative perception of the Adoptive Parent(s). Birth Parent(s) should be guided through pharmacological support just as any Birthing Person.
Birth Parent(s) should be able to experience their birth as their mind and body need. They should have full autonomy of their birth plan and have wishes and desires met during and post birth. Hospital Social Workers, Nurses and the Midwife/Doctor should be aware of the Expectant Parents adoption plan, birth plan and should use accurate adoption language in all settings with the Birth Parent(s) in order to allow them an opportunity to feel comfortable and empowered in their birth process.
When and If a Birth Parent decides to explore family building with the intention of parenting they should be supported as they process possible fertility challenges as well as any emotions that may surface with pregnancy, birth and parenting. Making an adoption plan is not a one time moment of grief and this experience will integrate with the Birth Parent(s) throughout the lifespan. Holding space for the normalcy of the complex emotions that Birth Parent(s) experience allows for healing and support throughout the lifespan.
Adopted Individuals
Adopted Individuals experience a higher likelihood of struggling in identity integration. Identity Integration across the lifespan is noted during but not limited to adolescent/teen years, during family building, pregnancy and parenthood. Adopted Individuals should be screened for PMAD’s with awareness that they may experience heightened feelings of complex emotions surrounding lack of medical information about their Birth Parent(s) pregnancy or medical history. Complex emotions about their identity may have existed passively before and may exasperate during their fertility/parenthood experience.
Adopted Individuals who had an adoption-positive culture in their family noted that they had families that utilized accurate adoption language and offered intentionality in the Adopted Individuals racial and cultural identity. Adopted Individuals report higher levels of identity integration and conceptualization of self worth when they have/had access to a relationship with their Birth Parent(s) and had transparency in their adoption story.
As Adopted Individuals incorporate their identity of becoming parents they may have additional questions or emotions that may arise about their own Birth Parent(s) or Adoptive Parent(s). Adopted Individuals deserve a safe space for processing these questions without judgment. Identity integration is crucial in the formation of their parenting journey and meeting with other Adopted Individuals or Birth Parents may offer a space of understanding even if it’s a person not connected to their adoption journey. Many Adopted Individuals may desire to find their Birth Parent(s) during this season of family building and may begin their journey with DNA, seeking adoption records or even asking more questions of their own self worth or identity. Adopted Individuals should be supported in their identity journey and should have a space to process expectations. If expectations are unmet with access to medical information or to their Birth Parent(s), Adopted Individuals may experience feelings of rejection, abandonment, shame and possible disillusionment around their adoption story. As they integrate their fertility and parenting journey they should be supported in exploring their emotions and feelings and providers should have awareness of the increased risk factors of PMADS due to the complexity of the Adopted Individual’s Identity.
Each member of the Adoption Community Deserves screening, connection and community in their journey and integration of adoption into their parenting journey. May we offer curiosity and respect as they integrate the joy and pain of adoption into their lives.
Author’s Note:
I would like to express my gratitude towards each Birth Parent, Adopted Individual and Adoptive Parent who has allowed me the opportunity to walk with them as they integrate their experience of adoption into their identity.
If you’d like additional information on accurate adoption language and joy and pain in the Adoption Community you can read here.
Emily Morehead, MA, LPC-S, PMH-C
Clinically I specialize in working with Perinatal Mental Health.I work with relationships (traditional and non traditional) that are hoping to build a stronger foundation in their relationship utilizing The Gottman Method. I am currently a student at The University of Michigan’s Sexual Health Certificate Program and am working towards certification to be a Sex Therapist. I am a passionate advocate for supporting individuals and/or couples who are hoping to explore and nurture their relationship with sexuality.
I have a background in working with individuals and couples who are hoping to build their family and struggling with fertility, adoption and/or different roads to parenthood.I enjoy working with Birth Parent(s) and Adopted Individual(s). I specialize in working with individuals and couples with reproductive challenges and enjoy supporting each person on their journey in Birthing and Parenthood.
I am a former board member of Postpartum Support International – Texas Chapter. My partner Braden and I have the honor of parenting two amazing children. I am the co-owner of The Couch Therapy a Psychotherapy Practice Located in Allen & Colleyville Texas as well as online.
https://www.instagram.com/the_couch_therapy/
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https://www.tiktok.com/@thecouchtherapytx
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Child Welfare Information Gateway. (2019). Helping your adopted child or youth maintain important relationships with family. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau.
Child Welfare Information Gateway. (2019). The impact of adoption. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau.
Dean, C., Dean, N. R., White, A., & Liu, W. Z. (1995). An adoption study comparing the prevalence of psychiatric illness in women who have adoptive and natural children compared with women who have adoptive children only. Journal of Affective Disorders, 34(1), 55–60.
Foli, K. J., South, S. C., Lim, E., & Jarnecke, A. (2016). Post-adoption depression: Parental classes of depressive symptoms across time. Journal of Affective Disorders, 200, 293-302. doi: 10.1016/j.jad.2016.01.049
Foli KJ, South SC, Lim E, Hebdon M. Longitudinal Course of Risk for Parental Postadoption Depression. J Obstet Gynecol Neonatal Nurs. 2016 Mar-Apr;45(2):210-26. doi: 10.1016/j.jogn.2015.12.011. Epub 2016 Feb 11. PMID: 26874267; PMCID: PMC4789094.
Foli KJ, South SC, Lim E. Rates and predictors of depression in adoptive mothers: moving toward theory. ANS Adv Nurs Sci. 2012 Jan-Mar;35(1):51-63. doi: 10.1097/ANS.0b013e318244553e. PMID: 22293610.
Madden, E. E., Ryan, S., Aguiniga, D. M., Killian, M., & Romanchik, B. (2018). The Relationship Between Time and Birth Mother Satisfaction With Relinquishment. Families in Society, 99(2), 170-183. https://doi.org/10.1177/1044389418768489
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Keywords: adoption, adoptive parents, birth parents, parenthood, postpartum, mental health, adopted individuals, grief, trauma, hormonal changes, support, expectant parents