by Susan Dusza Guerra Leksander, LMFT

updated 2024

Note: I use the term “first parent” to be inclusive of all birthing people who place a child for adoption, including those who do not identify as women at or after the time of birth.

What happens to those of us who give birth and then place our child for adoption? What goes on emotionally, mentally, and physically? Are there any patterns that can be detected? How do we fare over time? What do we need? And what, if anything, can the people in our lives do to help us recover from what many of us experience as the most profound stressor in our lives?

These are some of the questions that the On Your Feet Foundation of Northern California [now called MPower Alliance] set out to answer when they commissioned a research project led by David Brodzinsky, PhD, and Susan Smith, MSSW. The paper, titled “Post-Placement Adjustment and the Needs of Birthmothers Who Place an Infant for Adoption,” was released in late 2013 and documents the results of data collected from 235 first parents across the United States. Of the respondents, two-thirds (69%) were Caucasian, with the other women identifying as either multiracial (10%), African American (8%), Hispanic (7%), Asian (4%), Native American (1%) or Pacific Islander (1%). The study focused on the first parents’ perception of their physical and emotional health, supports and needs during the first year after placement, and at the time of the survey. It also gathered information about the extent and nature of contact with their children’s adoptive parents, and made some interesting correlations between the amount of contact and their ability to recover.

While the study addresses the outcomes and needs of first mothers/parents as a whole, it does not categorize responses and outcomes based on racial identity. However, building on what it teaches, and adding what we know about BIPOC experiences , I hope to raise awareness about what the first parents of adopted BIPOC children might be up against as they try to recover from the trauma of placement.

The results confirm what many first parents already know and have lived through: Our emotional and mental health can be significantly compromised, especially in the first year following placement. As years go by, there is a reduction in reported mental health symptoms, but some may linger. There are very few established resources in place for first parents, and those also tend to dissipate over time. The first parents who are more likely to recover from the trauma of placement are those who had some sort of supportive contact—from their family, friends, mental health professionals and, in some cases, the parent(s) who adopted their child(ren). Finally, the first parents who had the greatest adjustment difficulties were those whose agreements regarding the extent of openness and contact with their children were not honored by the adoptive parents. The actual amount of contact (visits once a year versus once a month, etc.) did not matter as much as first parents’ satisfaction with their expectations being met.

For me, as a mental health professional and a first mother, two of the most concerning pieces of data were that 90 percent of the first parents surveyed reported the presence of mental health symptoms or stressors in the year following placement, but only 27 percent accessed counseling. From the report: “The most common problems in the first year included: depression (71%), anxiety (48%), grief (67%), guilt (64%), diminished self-esteem (55%), sleep problems (51%), and problems with parents/siblings (33%).” Although it is difficult to confirm whether these problems were present before adoption, 80 percent of respondents perceived these issues as directly related to the placement of their child.

Quotes from a 2010 study, also conducted by David Brodzinsky and Catherine Magee, MPH, breathe life into these numbers through the voices of first mothers:

“I went through a very difficult first year after placement. I was very suicidal…I didn’t know I was suicidal…the only thing that kept me alive was knowing that I didn’t want to leave [my child] with questions. I couldn’t leave her that way.”

“Placing a child is like losing a child [to death]. The grief is kind of the same. My husband and I went through a lot that was like we had lost a child.”

“I think that counseling should be a mandated part of adoption. I don’t think you should be able to place a child for adoption without going to counseling before, during and after.”

Many adoption agencies do not offer any sort of counseling services to first parents post-placement. For those who do receive counseling it is often limited to a pre-determined number of sessions. If first parents are lucky, they might have comprehensive health insurance or be able to pay out-of-pocket, but then the task is finding an adoption-competent therapist who can sensitively and skillfully address their needs. At a retreat for first parents that I helped facilitate, a woman from Merced, CA spoke of being unable to find even one therapist in her area who had the experience and training to address her needs.

I want to dig further into the implications for BIPOC first parents. It has been well documented that African-American, Latinx, and Asian/Pacific Islander people are less likely to seek and receive appropriate mental health care due to institutional barriers and stigma. It’s reasonable to extrapolate that, of the 27 percent of survey respondents who reported having received counseling in the first year, very few were BIPOC. While these communities have their own healing traditions and recovery approaches, talk therapy—though not the only model—is one that might be particularly useful for people who have placed a child. For example, an Asian-American woman who would traditionally seek counsel within the family might have hidden her pregnancy. Or a Catholic Latina who would typically speak to a priest may feel too much guilt to seek the help she needs.

To summarize, here is what women of color who have placed a child are up against:

1. Documented presence of clinical symptoms post-adoption that are directly related to placement of the child;
2. Non-existent or time-limited post-placement services;
3. Lack of adoption-competent therapists, especially outside of urban areas;
4. Generalized barriers to seeking treatment (language, lack of culturally competent providers, internalized stigma, mistrust of dominant cultural norms, etc); and
5. Racism in healthcare systems and biased providers who believe that people of color “don’t feel as much pain,” which can translate into emotional suffering being dismissed and the need for mental health referrals being ignored.

What can adoptive parents do? Here are some ideas and suggestions:

1. If you have openness with your child’s first parents, maintain it! The best outcomes were found among first parents whose agreements regarding contact and openness were honored by their children’s adoptive parents.
2. If you have reduced the amount of contact you had agreed upon, seek the help you need to heal the relationship. Contact the adoption agency for mediation and/or seek your own counseling. The worst mental health outcomes were found among first parents whose relationship with their child(ren) had been terminated or reduced by the adoptive parents.
3. If you have a positive relationship with your child’s first parents, know how valuable that can be and continue to work at it. Forty-seven percent of people in the study cited their child(ren)’s adoptive parent(s) as a supportive presence in their first year post-placement. However, that number dwindled over time to 27 percent at the time of the survey.
4. Peer support has been cited as an effective method for healing, but is often hard to find. If you have the monetary means, consider starting a counseling grant fund within your adoption agency and/or financially sponsoring a monthly support group for first parents. Support groups can be peer-led or facilitated by a counselor. Either way, this can be more approachable than individual therapy and provides a space for first/birth parents to be in community. Because an agency can be a triggering place, such sponsorship could cover the cost of space rental, as well as advertising, materials, snacks, transportation costs for low-income women, and even for a facilitator. You can also make donations to organizations that provide support to first/birth parents.
5. Be on the lookout for culturally competent therapists in your area who would be sensitive to the needs of first mothers. Let them know that classes exist for professionals who wish to become more skilled in adoption issues, such as the Training for Adoption Competency (TAC) through the Center for Adoption Support and Education (CASE), the Kinship Center or the Child Welfare League of America.

May this be in service of our own growth, and the well-being of all our children.

Susan Dusza Guerra Leksander, LMFT, is a Latina first mother, transracial domestic adoptee, and licensed psychotherapist who specializes in the adoption and foster care triads, providing treatment and consultations since 2009. At Pact she serves as First/Birth Parent Advocate, Agency Director, and Clinical Director of the Center for Race and Adoption Focused Therapy.