Thursday, April 29, 2010

Troubled Adoptions: Why? What to do?

In recent weeks there has been a fair amount of attention given to troubled adoptions. This has, in turn, been unsettling to individuals with infertility who ultimately are considering adoption as an option for future parenthood. The media's attention to the mid-April return to Russia of 7 year old Artem Saveliev by his Tennessee adoptive mother has ballooned beyond this one situation to a host of articles and TV coverage on "adoptions gone sour." The formal term for the ending of a legal adoption is "disruption," but the stories behind these unanticipated family sorrows are causing many readers to think more carefully about the possible risks associated with adoption. So why might an adoption become problematic? And when it does, what resources do adoptive parents have?

Let's look first at the "why?" factors that can contribute to troubles after the adoption. Whether an adoption is domestic or international, the prenatal care of the developing fetus often is unknown. Alcohol or substance use, poor nutrition, low maternal age and other risk factors may be present in the mothers whose babies are placed for adoption. Life after birth of the baby may include institutional care that is substandard or routinized, with little opportunity for the interpersonal warmth and cuddling that can be so important to building future trusting relationships. For older children or sibling groups, there may be a history of foster home placements or institutional care where those children have, at best, needed to fend for themselves and, at worst, have experienced abuse and emotional rejection. A child's records that are available to prospective adoptive parents may not include this kind of information, and the reports from the examining physician may focus exclusively on obvious health problems. This sets up the possibility that an adoptive parent, eager to provide welcoming arms and a loving heart, may be unaware of the extent of physical and mental health difficulties experienced by a child. Given that the agency adoption process itself can take several years, the conditions in which the child has lived are important for adoptive parents to understand, as there will be more empathy for whatever adjustment difficulties occur post-adoption.

So now, let's consider the "what to do?" question. This is not only for adoptive parents who are experiencing troubles, it also is for prospective adoptive parents who want to know what their options are if their child's adjustment to their home is painful or filled with trauma. This is where the services of the adoption agency need to be evaluated. Is the agency one that offers workshops for prospective parents in which they cover both the joys of adoption and the potential problems? Do such workshops include information about predictable problems (sleep disruption, night terrors, food hoarding, testing behaviors, etc.) that children of different ages might demonstrate as part of the normal adjustment to a new home? Are prospective parents given an opportunity to meet with adoptive parents who have experienced adjustment difficulties, learning from them various ways they coped? And, most importantly, does the agency make itself available for adoptive parents to return for counseling around difficulties that arise after the adoption?

Clearly an agency that addresses possible troubles up front is helping prospective parents to anticipate the special needs that their children may have and to ask themselves if they are "up" for this possible challenge. This is a time when prospective parents need to assess whether they see adoption as "second best" or as a "second choice." Second best is worrisome, in that it presents a sense of disappointment and the belief that having a birthchild is preferred as a route to parenthood. Second choice identifies that the adults had hoped for, and tried for, a birthchild, but when that option was not promising, were sufficiently committed to becoming parents that they turned to adoption as their next (and second) choice.

Since all children at one time or another present unanticipated challenges for their parents, those adults with a second best perspective may be most likely to point to the adoption as the root of the child's difficulties, whereas second choice parents may direct their commitment to parenthood into problem solving strategies. Clearly a problem solving approach is most likely to enable parents to reach out for counseling, for support services, and for mental health treatment. And here is where prospective adoptive parents can do some important homework. Does the agency with which you are working offer that counseling? If not, does it provide referrals to agencies and services that are familiar with childhood adjustment problems and dynamics that families may use in response to these problems?

Clearly prospective adoptive parents are aching to hold a child in their arms and to provide the love and comfort that will nurture this new family member. At the same time, they are hopeful that this child will enable them to feel more fulfilled as adults, opening new experiences to them as they finally join the ranks of their siblings, friends and co-workers who are parents. Yet it is important for adoptive parents to realize that they will need to have a special sensitivity to an adopted child around everyday issues such as "tell me how I was born," assuaging grand-parental misgivings and apprehensions, appreciating how differences in skin color or facial features between the child and parents may present issues (both within the family and in community/school relationships), and deciding how to help their child feel a connection to the country of his/her birth.

So, much as troubled adoptions have been in the news lately, this actually presents an important opportunity to help prospective adoptive parents weigh quite carefully the circumstances under which adoption feels possible, the kinds of questions to ask as you consider what agency to work with, the importance of talking with adoptive parents about how they have weathered hard times in child rearing, and the availability of support services in your community for children and families experiencing adjustment problems. Entering into parenthood requires that each of us ask ourselves how ready we are for this new chapter in our lives; and contemplating adoption requires even more introspection and self awareness about the unique opportunities and possible challenges that adoption can bring into the lives of families. Feel free to share your experiences, both in anticipation and in reminiscing about your own adoptions!

Thursday, April 22, 2010

Celebrate Infertility Awareness Week: April 24-May 1

So, you may be asking, "What's to celebrate?" Infertility is not an experience anyone wants to have, it is something people hope to put behind them as quickly as possible, and it tends to be a somewhat carefully guarded secret for many couples.

So when a week is proclaimed in honor of infertility, this tends to jolt us a bit and provoke some questions in our own minds about how we fit into this week of public awareness. I find myself reminiscing (and not at all warmly) on my early days/months/years of infertility. Given that my children are now young adults, I'm recalling the mid 1970's when infertility was misunderstood on many levels, not very successfully treated, and generally "in the closet" for many affected couples. From that context, I imagine that many people would say that there have been massive medical breakthroughs and successes. This is true, particularly for couples who can afford to pay for medical tests, treatments, and choices (including donor eggs/sperm, adoption, or a gestational surrogate). But, in spite of medical progress, there are areas that have not experienced as much success, and it is especially these areas that will benefit from our voices during Infertility Awareness Week:

  • Lack of insurance coverage for diagnosis and treatment: This is a significant concern for individuals and couples who want to explore what options are available for becoming birthparents. Insurance companies are reluctant to explore this potential black hole, and yet infertility is a significant concern for 12% of couples in the U.S. population of childbearing age. Even more pressing for some couples is being uninsured altogether, which interrupts their efforts to understand more fully what may be contributing to their inability to conceive or to carry a pregnancy to term.

  • Lack of attention to the emotional impact of infertility. On the shelves of most book stores we can find a handful of books on infertility, but almost every book focuses on the medical aspects, with perhaps a cursory mention of the stress and anxiety that accompany the inability to conceive or to have a healthy pregnancy. The absence of the emotional factor has significant ramifications: physicians focus solely on the physiological, and their patients have no validation for the emotional challenges they find themselves confronting month by month as pregnancy eludes them. In addition, too few infertility clinics have therapists on staff to help patients with the mental health fallout from their infertility diagnosis and treatment. Of course it has been this emotional component that compelled me to write When You're NOT Expecting, in which I focus specifically on strategies for coping with the emotional challenges of infertility.

  • Lack of awareness of the full range of populations trying to pursue birth parenthood. In the eighties, nineties and the early years of the 21st century, most infertility support groups were composed of married, middle class Caucasian women, with male partners occasionally accompanying their wives. The populations now trying to pursue parenthood also include people of color, same sex couples and single men and women. Creating face-to-face environments and on-line communities that welcome all would-be-parents is an evolving process. In my book I make a conscious effort to include the voices of these less visible prospective parents, since their emotional struggles are important to recognize as valid.

  • Lack of sensitivity by some ob-gyns, urologists and infertility clinics to unmarried patients and same sex couples hoping to conceive. Beyond the local "invisibility" of these would-be parents, we may find that specialized infertility services can be insensitive to some patients, either unintentionally or, perhaps, in an effort to attract "typical" clients. These insensitivities can include social history forms asking for the name of a "spouse/husband/wife;" reluctance to have the same sex partner in the examining room; obvious awkwardness of the health care professional when interacting with unmarried patients and same sex couples; and, potentially, an unwillingness to accept input on testing/treatment from the couple (an example here would include a lesbian who requests that her partner's egg be fertilized with donor sperm before being implanted in her uterus).

The above are only the most compelling of the issues that deserve attention from the media, from insurance companies, from health care professionals and from infertile people who may have had a restricted view of people affected by infertility.

So, when you find yourself asking "What's this awareness week all about?" recall the issues above, add some of your own, and consider ways that you might be able to advocate on behalf of under-served folks who, like you, share the hope of some day becoming parents.

Thursday, April 15, 2010

Infertility gardens

As I'm looking out at the glorious spring weather, filled with sunshine and bursting blossoms, my thoughts of infertility take a slightly different turn today. I find myself thinking of the ways that the healing balm of nature has calmed sadness and grief of friends and clients experiencing infertility. For those of us tempted to seek solace on the internet, by reading articles and books, through comfort food, or just seeking some solitude, there's yet another option: creating a garden.

First, I will confess that I do not have a green thumb. Nor do I have any experience designing green spaces. But I do love to walk and hike in natural surroundings, especially in the spring. I have many acquaintances who have shared with me the comfort they have received by designing, planting and nurturing special gardens in their back yards and on their apartment building roofs. Perhaps you can identify with some of these scenarios (I will be changing all names and some identifying information to protect the privacy of my acquaintances).

Janice and her husband Bob experienced three miscarriages over the course of two years. After grieving these losses, they wanted to move forward emotionally, but they did not want to forget the hopes and dreams for these children who would never be born to them. So they decided one winter to spend time designing a back yard garden to plant in the spring. They planned their garden with three sections, each one unique in colors and plantings. Poring over seed catalogs during the winter, they planted some seeds in small pots indoors and purchased others in local greenhouses during the spring. Once the threat of frost was over, they devoted several weekends to tilling the soil, planting the bulbs, seeds and sprouting blooms, and applying fertilizer and mulch. Janice, still hoping for a healthy pregnancy, kept herself at a distance from the fertilizer, as she offered suggestions to Bob. Both of them found the garden to be a source of pleasure and calm during the warm months of spring and summer, and as they weeded and watered, they found their own relationship strengthening as they were able to talk openly about their diminishing grief and their continuing hopes for parenthood.

It had been four months since the funeral for Missy and Joe's stillborn son, Jason. The baby's body had been cremated, and they had been unable to decide where to place the ashes, which remained in an urn at the undertaker's. Both were anguished at their inability to find a resting place for Jason's ashes. In conversations with their minister, they eventually decided to plant a back yard garden and to scatter the ashes there. Having reached that decision, they enlisted the help of loving friends and family to offer suggestions about plantings, manual help with tilling and fertilizing, and especially cherishing a hammock that could be hung between trees nearby with a clear and shaded view of Jason's garden. When the time came to scatter Jason's ashes, their minister joined them and their loved ones for a small dedication of this garden planted in his memory.

When Carla had a miscarriage, she collected the remains and took them to her doctor. He indicated that he would send a small sample for genetic and other tests, and Carla decided to bury the rest of the remains in a rose garden in her back yard. She and her partner Kelly buried the material in a shoebox. To their horror, two days later they found that a mole had tried to burrow into the shoebox, disrupting both the garden and their peace of mind. They responded by placing the shoebox into an airtight metal box, which they reburied without further incident. Both now feel that this pregnancy loss has been softened by the presence of the surrounding beauty of the nearby roses.

Susan and Jared were reluctant to plant a back yard garden in their baby's memory, since they expected to move into a different neighborhood within a few years. It would be too difficult to have invested the emotional energy in planting flowers and bulbs, only to leave that garden behind when another family purchased their home. Instead, they decided to plant a tree, with a bench nearby, in a favorite park where they often spent time. Beneath the tree was a rock with their daughter's name and birth date engraved on it. They both derived comfort from this memorial tree, as well as from seeing other people pausing on the nearby bench to read, rest, or enjoy the natural beauty around them.

After two failed adoption attempts, Sandra and Jeff were in a quandary about whether or not to continue to pursue adoption as a path to parenthood. They lived on a dairy farm with gardens in which they grew fruits and vegetables. One day a friend of Sandra asked if she could bring children from her day care center on a field trip to the farm. As they discussed this plan, Sandra suggested that the children might enjoy a chance to create their lunch from the gardens: some gazpacho, a salad and some strawberry shortcake for dessert. The lunch was such a resounding success that the children begged to be allowed to come back again. Future visits included the chance to milk a cow, to feed baby goats, to cuddle newborn kittens and to romp in the fields. As time passed, Sandra and Jeff found themselves enjoying these short term fun experiences so much that they decided to remain childfree, but to nourish their contacts with several day care centers whose children relished the opportunity to visit their farm in all seasons of the year.

Karen and Chris had buried their stillborn daughter Nora in a cemetery plot near that of her grandparents. When spring came, they realized that the ground was untended near the grave, and they decided to plant bulbs that would bloom annually, as well as wildflowers that would bloom throughout the spring and summer months. They found that the flowers and plantings had a calming effect on them during what they had feared would be tearful visits to Nora's grave site.

Infertility and sadness are intertwined. Yet the beauty of nature can be a cushion against grief associated with the losses of infertility. As the scenarios above suggest, our own creativity in using the bounty of blooms and bulbs to create a garden can be a different approach to healing from sadness. A green-thumbed friend said to me recently, "Gardening tills the soul." In these days of spring, consider whether some plantings could offer comfort to you or a loved one struggling with infertility or pregnancy loss.

Thursday, April 8, 2010

Apprehension as Mother's Day Approaches?

In my informal inquiries of individuals and couples diagnosed with infertility, Mother's Day tends to top the list as the holiday that evokes the strongest emotional reaction. So this year I decided to jump into the holiday fray early enough so that we can think ahead about this particular holiday. With Mother's Day falling this year on Sunday, May 9, hopefully a month's lead time will enable you to think through the unique meaning this particular holiday has for you this year. And, beyond that, it may be possible to help others be more sensitive to the impact of this day on families without mothers.

In my own early years of infertility, I focused on Mother's Day as I always had. I sent flowers to my mother, made a long distance call to tell her how much she meant to me, reminded my younger brothers to be sure to connect with her, and went on about my life. In other words, Mother's Day was about MY mother.

But several years of infertility changed all that. More and more I saw myself as yearning for motherhood, rather than being able to celebrate it. A spontaneous plan for dinner out on Mother's Day met with crowded restaurants filled with happy families. My infertile friends turned tearful as they told of attending religious services where mothers in the congregation were honored, either in the sermon, or by being asked to stand for recognition, or by being offered a flower or a corsage. Others told about excitement of friends, siblings or co-workers whose families were planning special festivities. More and more my friends and I felt like bystanders, still honoring our own mothers on that holiday, but wishing so much that we too could be the mothers in the limelight.

I think of my friends and my many clients over the years as the source of creative conversations about how to approach Mother's Day. Many of us chose different pathways through and around this holiday, with the approach differing as the years progressed. I'll share with you my recollections and (since, after all, we have a month to think about all this) encourage you to weigh in with your own thoughts on this holiday and the celebrations associated with it.

Many women simply decide to focus on their own mothers and grandmothers, choosing not to frame this holiday as being about them. This requires a certain amount of tone-deafness as our own peers anticipate their family celebrations, but we already have learned to tune out heavily maternal conversations to a certain extent. And some of our friends and co-workers have become sensitive enough to know what topics to avoid in our presence.

I've known several groups of women and their partners, drawn together by their infertility, who have planned potluck dinners on Mother's Day, thereby avoiding the restaurant scene and symbolically declaring that "we care about honoring one another on this day when the rest of the community thinks of us as invisible." Others have looked forward to the solitude of a movie theater, a walk in the country, planting flowers in the back yard, or seeking some other form of enjoyment "far from the maddening crowd," so to speak.

And then there was the year that I decided to approach the religious leaders in my community, many of whom had evoked misery in my friends' and clients' hearts by their selective honoring of mothers in their congregations. Luckily for me, many of these clergy met once a month for lunch, and I asked if I might join them. I introduced myself as an infertile woman and said that I hoped we could talk together about how Mother's Day in their places of worship could be approached with sensitivity for families without a mother. This made it possible for them first to say what their practices had been on Mother's Day, acknowledging how blind they had been that their efforts to honor mothers might also have hurt families without mothers. We moved from that to a group conversation about how they could approach this holiday with greater sensitivity. I'm happy to say there was no resistance, they tried hard to be creative, and they ended up inviting me back for one more lunch (happily this was only February!), so they could have time individually to think about how they would re-shape Mother's Day that year.

Ultimately that effort led to more inclusive sermons on Mother's Day, with many clergy reminding their congregations that families come in many shapes and sizes, that not all families include mothers, and that families who have experienced the loss of a mother, the loss of a pregnancy, or infertility hope to feel emotionally safe when they come to worship, including on Mother's Day.

Needless to say, Mother's Day services in my community were changed forever, but several other changes grew from that lunch (where, I will admit, my knees were shaking a bit!). Clergy, sometimes the first person sought out after an infertility diagnosis, became much more aware of local infertility counselors and support groups. They also were willing to be panel participants in our regional conferences, where "loss of faith" or "spiritual betrayal" were topics of well-attended workshops.

So, whether you anticipate Mother's Day this year from an individual perspective, a couple perspective, a larger gathering of sensitive folks, or some way to spread the word about keeping visibility for families without mothers, please feel free to share your thoughts (and your actions!) with readers of this blog. I hope to hear from you!