BIRTHING VOICES OF LOSS AND LOVE:
EXPLORING THE EMBODIMENT PROCESS OF BIRTHMOTHERS AND THE
POTENTIAL BENEFITS OF DOULA SUPPORT
Susanna Claire Snyder
B.A. Florida State University, 2006
A thesis submitted to the
University of Colorado Denver
in partial fulfillment
of the requirements for the degree of
Master of the Arts
Department of Anthropology
This thesis for the Master of the Arts
Susanna Claire Snyder
has been approved
Snyder, Susanna Claire (M.A. Medical Anthropology)
Birthing Voices of Loss and Love: Exploring the Embodiment Process of
Birthmothers and the Potential Benefits of Doula Support
Thesis directed by Associate Professor John Brett
This project utilizes an in-depth approach to explore the embodiment process
of birthmothers in the adoption process and lay a foundation for future research into
whether the provision of doulas for birthmothers may improve the birthmother
experience. To engage these questions, this project uses targeted life history
interviews to elicit data from three birthmothers who used doulas for their
relinquishment births. I explore how these women contest accepted definitions of
motherhood while attempting empowerment in a social and political climate that
while improving, still largely lacks understanding of the roles and rights of these
women. These interviews provide a holistic representation of birthmothers in
contemporary contexts that challenges the accepted damaged birthmother stereotypes
and make a compelling argument for further examination of how doulas can assist
this vulnerable population.
By using Scheper-Hughess and Locks three body approach, the analysis
examines the birthmother experience on an individual, social and political level.
Individually, these women struggle with dis/connecting with the fetus and child and
reforming non/mother identities; socially, these women absorb and resist societal
constructions of sexuality and motherhood; and politically, these womens
experiences reveal the changing landscape of adoption practices and the
commodification of adoption in the U.S. Furthermore, in understanding this
embodiment, it is clear that a lack of structural and sometimes social support exists
for this population. By examining the social support these women received formally
from doulas and informally from others, I propose that more systematic forms of
support such as doulas may increase birthmother empowerment through educating
and nurturing these women during their pregnancy, labor and post-partum periods.
Additionally, in giving a voice to the seldom-heard birthmother, this research
explores how holistic models of birthmother care can reduce adoption stigmatization
and increase birthmother empowerment.
This abstract accurately represents the candidates thesis. I recommend its
I dedicate this thesis to my sister Kelly whose unconditional love and support helped
me to believe in myself. She was an amazing friend, sister and role model, and I
could not have written this thesis without her.
My thanks to my advisor, John Brett, who helped me develop this project, who
supported me throughout the process and who reminded me that its okay to cry when
doing research. I also wish to thank Sarah Horton and Jean Scandlyn, members of my
committee whose insights and assistance proved invaluable. I also wish to
acknowledge all the doulas who helped me find my participants, especially Tammy
Brannen-Smith. Thank you to my family and friends for their patience and belief in
me. Finally, thank you to all of my participants for sharing their experiences with
their words, tears and laughter.
TABLE OF CONTENTS
1. INTRODUCTION....................................................... 1
2. METHODS............................................................ 6
Research Design.......................................... 6
Data Collection.......................................... 7
The Interviews........................................... 8
Data Analysis............................................ 9
Research Scope.......................................... 10
3. THE INDIVIDUAL BODY: CHALLENGING MOTHERHOOD....................... 11
The Individual Body Framework........................... 11
Connecting and Disconnecting: Ambiguity in ^
Pregnancy and Relinquishment..........................
Navigating Loss......................................... 15
Re-Forming an Identity as a Non/Mother and Contesting the ^
Stereotype of Damaged Birthmothers..................
4. THE SOCIAL BODY: SLUTS AND BAD MOTHERS............................ 24
The Social Body Revealed through Stigma................. 24
Unmarried, Adolescent and Relinquishing................. 26
Im gonna pretend were married and whatever..... 36
Screw you guys, Im not a bad person............ 30
5. THE BODY POLITIC: ADOPTION BODIES TRANSFORMED..................... 36
The Body Politic Enacted through Law....................... 37
Adoption Then and Now................................ 38
State by State....................................... 44
6. SOCIAL SUPPORT....................................................... 48
Social Support Framework................................... 48
The Patchwork Quilt of Informal Birthmother Support...... 52
The Birthmothers and Their Doulas.......................... 55
7. CONCLUSION........................................................... 63
A. COMIRB Protocol Approval......................................... 67
B. COMIRB Continuing Review Approval................................ 68
C. Question Guide................................................... 68
D. Scripts for Doulas............................................... 72
E. Scripts for Participants......................................... 75
F. Resource Guide Provided to Participants.......................... 77
LIST OF FIGURES
6.1 Social Support Chart
The thing is.. .1 dont want her to ever think that I dont love her and
that I didnt want her... .which I know is hard. I mean, I have a friend
in junior high that her mom gave her up for adoption, and until she met
her birthmomthis was a closed adoption, you know that was popular
with my parents age groupshe was always thinking well, my mom
didnt want me, like, I was a mistake. The thing is that the whole
situation may have been a mistake.. .it wasnt supposed to happen.
But, I kept her for a reason, and I gave birth for a reason, and I found
her a good family for a reasonbecause I love her, and I care for her,
and I want her to have the best life possible. (Laura, 20 year old
birthmother and study participant)
Birthmothers1 are the least understood and most-stigmatized participants in
the [adoption] process (Evan B. Donaldson Adoption Institute 2006:4). While
several seminal studies have attempted to give a voice to these marginalized women,
birthmothers are still largely underrepresented in the research literature, and though
adoption is becoming more accepted in American society, the role of birthmothers in
public discourse surrounding adoption remains noticeably absent (Evan B. Donaldson
Adoption Institute 1997). Consequently, researchers and the public have accepted and
participated in the perpetuation of false stereotypes of birthmothers that fail to
holistically and accurately depict the birthmother experience (Gritter 2005). Lauras
expression of love for her daughter fills a gap in this literature that has often been
glossed over by social scientists and ignored by the general public. Her experience
reveals the seldom studied and often misunderstood negotiation of loss and love that
birthmothers encounter during their embodiment process. The loss of a child
inevitably impacts a mother, but the majority of the literature fails to equally explore
how birthmothers may honor their experience of pregnancy and childbirth, love the
relinquished child without reservations and come to integrate this loss as part of a
new non/mother identity. To relinquish a child is to experience a loss. This is beyond
1 Though various terms have been used to describe women who choose to relinquish a child for
adoption (biological mother, natural mother, life mother), these terms are, like all language,
historically constructed and emotionally charged (Carp 1998: xiii). Recently, the adoption community
has designated birthmother as the preferred term to describe the mother who gives birth to a child
who is adopted; this term will be used for this project (Pavao 1998).
question and well-supported in the literature, but what the literature has yet to do is to
take an even-handed approach to the birthmother experience that operates outside of
the pathology paradigm, where unbecoming a mother...is variously regarded as
unnatural (Aloi 2005:58). As a discipline, anthropologists have traditionally been
interested in cross-cultural variations in kinship systems and how this ordering of
family reveals deep-seated ideologies, yet an alternative kinship system present
in our own culture has somehow escaped our critical gaze (Modell 2002). In turning
this gaze inward, an anthropological perspective can reveal how cultural
constructions of motherhood as a biological reduction rather than a social process
may bias research and negatively impact birthmothers who strongly identify as loving
and caring for their relinquished child (Mander 1995).
The above quote also illustrates how birthmother experiences may be
changing for the better. While closed adoption models were popular (i.e. mandated)
in previous decades, the structural forces surrounding adoption now allow for more
birthmother involvement. The accepted construct of birthmothers as emotionally
damaged due to their relinquishment may have been accurate at one point given the
history of adoption practices in the U.S., which traditionally neglected the rights of
birthmothers. Now, these women are almost always provided with the choice to
open their adoption process, removing the secrecy and subsequent question of
whether the relinquished child knows her birthmother cares for her (Pertman 2000;
Modell 2002). In this new, more respectful model of adoption, birthmothers who
express satisfaction with their adoption experience may not only be redefining
cultural norms regarding kinship but may also be a product of shifting adoption
practices. Still, despite dramatic changes in womens health laws that include the
legalization of abortion, access to contraception and birthmothers more active
involvement in developing an open/closed adoption model, scholars have failed to
critically re-examine this model of birthmothers as inherently damaged.
Previous research on birthmothers has framed their experiences as traumatic
and has sought to determine the long-term negative impacts of relinquishment on
women. These studies have determined that birthmothers are at increased risk of
depression, damaged self-esteem, persistent guilt, shame, and self-
loathing over giving away their child; persistent loneliness or
sadness; difficulty with intimacy, attachment or emotional closeness;
lack of trust; anger; severe headaches or physical illness that cannot be
expressed or diagnosed; and occasionally PTSD characterized by
extreme anxiety, panic attacks, flashbacks and nightmares (Fessler
While this unfortunate list of potential ailments may undeniably be a reality for many
birthmothers, it may also be limited in scope. First, it does not address the changes in
U.S. adoption practices, including the increasing use of open adoption models which
has been shown to improve outcomes for birthmothers. Secondly, many of the studies
on birthmothers fail to address the fallacy of a framework that is designed to
illuminate negative outcomes. These previous birthmother research foci are reflective
of American cultural constructions of kinship that posit the real, true, blood, by birth
[relationship] can never be severed, whatever its legal position (Schneider 1980:24).
Birthmothers challenge this model of blood and motherhood in that they attempt to
remove the natural connection between a mother and child; as more alternative
family forms emerge and become accepted, these assumptions about birthmothers as
damaged due to relinquishment must be reexamined.
This thesis is an in-depth, exploratory project that seeks to update and modify
the existing birthmother model by eliciting, analyzing and contextualizing the
embodiment processes of this new generation of birthmothers. I ask how do these
women construct their identities as birthmothers? In using Scheper-Hughess and
Locks (1987) three body theory, I explore the birthmothers phenomenological
experience of the individual body, situated in the symbolic, social body and
influenced by the body politic. This process of embodiment is understood through the
a multi-layered examination of the three bodies within a cultural context: the
individual body, i.e. the phenomenological lived experience of the body-self; the
social body which involves the representational use of the body as a natural symbol
with which to think about nature, society and culture; and the body politic, or the
regulation, surveillance and control of bodies (7). From the individual experience to
the structural level, this framework allows for a comprehensive analysis of how
individuals construct identities and how these identities reflect the culture in which
This analysis then informed my second, more applied research question, how
are birthmothers supported by informal sources of social support (i.e. family and
friends) and how may they benefit from the formal support of a doula? Social support
has been proven to improve physical, emotional and social health outcomes, and
literature on birthmother grief has suggested that social support may be a mitigating
factor in this process (Hodnett et al. 2007). A doula, or "a trained and experienced
professional who provides continuous physical, emotional and informational support
to the mother before, during and just after birth, is trained specifically to provide
formal social support to pregnant and laboring women (Doula Organization of North
America 2008:NP). Numerous studies have demonstrated the quantitative (reduced
cesarean section rates and shorter labors) and qualitative benefits (increased
confidence and perceived control in labor environments) of doulas for laboring
women, especially in vulnerable populations such as recent immigrants and
adolescents (Breedlove 2005; Hans 2006; Hazard et al. 2008; Hodnett et al. 2007;
Kayne et al. 2001). In providing emotional, informational and physical support and
advocacy, doulas could be uniquely suited to assist birthmothers in their
In-depth interviews with three women who relinquished a child for adoption
and used a doula revealed that personal, socio-cultural and political constructs
combine into an intricate constellation of forces that influence the birthmothers
experience. The difficulties the birthmothers encountered reflect the ambiguity
surrounding the roles and rights of birthmothers at all three levels. The birthmothers
lack a model for understanding their own, individual identity constructionasking
themselves are they mothers, or are they not? Society is unsure of how to treat them
and may sometimes stigmatize them for their failure to fulfill traditional female roles,
and the structure of American adoption reveals further ambiguity regarding how we
have treated and continue to treat birthmothers. This stressful time is thus
compounded by social pressures that reveal underlying cultural values regarding
motherhood and femininity. The positive outcomes associated with social support
combined with the individual, social and political experiences of birthmother
embodiment contribute to the argument that birthmothers should have a strong
support system, especially in the novel process of birth and relinquishment.
This research project has opened new threads of inquiry against largely
negative stereotypes around birthmothers by acknowledging the difficulties
associated with this decision and exploring the identity construction of birthmothers
as a product of cultural and historical processes. The three-body theory examines the
body as a "physical and symbolic artifact, as both naturally and culturally produced,
and as securely anchored in a historical moment (Scheper-Hughes and Lock 1987:7).
By exploring the birthmother experience within this frame, we can illuminate the
social construction of adoption and motherhood, track its transformation, and in
giving birthmothers a voice, challenge traditional tropes of motherhood. Additionally,
the hypothesis that the provision of doulas could improve the experience of
birthmothers initially interested me in this research project, and though the data
presented here on doula support for birthmothers is neither generalizable nor
conclusive, it provides a foundation for future research into the benefits of providing
doulas for this vulnerable population.
To explore the theoretically based embodiment process of birthmothers and
the application of doula support for this vulnerable population, I utilize the three-body
approach and social support to structure my literature review and analysis. After
introducing my methods in Chapter 2, Chapter 3 explores the lived experience of
birthmothers in their individual body, an analysis that reveals a complicated
negotiation of connecting/disconnecting, loss and identity construction that while
difficult also resulted in some positive outcomes. Chapter 4 discusses the embodiment
of the social body, where symbolic constructs of motherhood and womanhood are
placed on birthmothers whose disobedience of these traditional roles results in
stigmatization from numerous sources. In Chapter 5, the focus shifts to the power of
the body politic in regulating womens bodies, but a lack of data from participants
experiences resulted in an analysis of how these adoption bodies have been
transformed by sweeping cultural changes (Evan B. Donaldson Adoption
Institute 2006:7). Finally, Chapter 6 introduces social support theory and the
participants experiences with informal social support systems and ultimately their
relationships and the benefits of their relationships with their doulas. In my
conclusion, I discuss future implications of this research and potential avenues for
further study of this underrepresented population.
To explore the experiences of birthmothers who have used a doula, I utilized a
retrospective, targeted life history approach with three birthmothers who relinquished
a child for adoption and used a doula for their relinquishment birth. Since this very
specific subpopulation is difficult to access and research with them has yet to be
performed, this project was exploratory and used a qualitative approach which
allowed me to examine the experiences of the birthmothers in great depth rather
than breadth (FHI 2002:57). So, while this format does not allow for broad
generalizations, it does allow me to explore a phenomenon in great detaila research
methodology that is largely lacking in the birthmother literature. As Mander (1995)
points out in her seminal work on the birthmother experience, qualitative research
permits a holistic picture of the phenomenon to emerge, which demonstrates the
interrelatedness and interdependence of various differing facets of an event (12).
This holistic picture was critical considering the lack of research in this specific area,
my theoretical frameworkwhich explores the different levels of experienceand
my attempt to understand how these levels interact in the embodiment process.
Additionally, existing literature on birthmothers has generally depicted these women
as damaged due to their relinquishment experiences. Many of these studies relied on
survey formats that list potential problems that resulted from relinquishment or
used probing questions that focused on negative aspects of adoption, but a more open-
ended qualitative approach allows participants to express their feelings without
preexisting expectations of the phenomenon or setting under study (Patton 1994:44).
My research method for this topic is also unique in that it is marked by an
emic, or insider, perspective. As a birthmother who relinquished approximately eight
years prior to the first interview, this research was inspired by my own experience,
and thus, like Rapps study of amniocentesis (1999), I am necessarily (and partly)
positioned within the phenomena I seek to understand (14). Since I informed my
participants of my birthmother status prior to the interview2, this helped me to
establish rapport, but my insider perspective also inevitably influenced my approach
to and analysis of the data. In acknowledging my situated knowledge as a
birthmother, I argue, like Haraway (1988) that the only way to find a larger vision is
to be somewhere in particular (590). By locating myself within this research project
2 One participant, Vicki, must not have fully read my initial email to her since she was surprised when
I mentioned my own birthmother status during the course of the interview.
as an anthropologist as well as a birthmother, I attempted to enrich the data gathered
from the participants and strengthen my analysis by bringing forth the voice of the
often silenced birthmother.
Due to the small population of birthmothers who have used doulas, I chose to
recruit the participants through a priori, purposive sampling which allowed me to
select participants for their ability to provide rich information (FHI 2002:59). I
additionally used criterion-based sampling so my participants met some
predetermined condition of importance (Patton 2002:238), which was being over 18,
having relinquished a child in the last ten years and used a doula for their
relinquishment birth. By selecting birthmothers who used a doula, this criterion-based
sample allowed me to more extensively focus on my predetermined condition of
importance in my research question, the birthmothers use of doulas (FHI 2002).
To recruit this sample, I utilized my preexisting contacts within the Denver
doula community to see if they had attended births where the client had relinquished.
I sent an IRB approved email to doulas I knew, doulas I found on the internet and
through the Colorado Doula Association listserv. When doulas responded to this
email, I provided them with IRB-approved scripts that I requested they send in an
email or use as a rough guide in a phone conversation with their former clients who
met my sampling criteria. Due to confidentiality and privacy concerns, the doulas did
not provide me with any of the participants contact information; instead the former
client and potential participant then directly contacted me through email or by phone,
per the instructions in the script provided to the participating and interested doulas.
I received several responses to my doula inquiries, but most of the doulas
were unable to contact these clients or sent out the emails to former clients to no
avail. Two doulas contacted me and had former clients reach out to me. One of these
was a doula who was also an adoption counselor. Two of the birthmothers
participated as a result of this doulas engagement with my research. My third
participant was the daughter of a doula who responded to my inquiries since she
became a doula after her daughters relinquishment birth in which a doula was
present. Coincidentally, this third participant also used the same adoption agency
where the doula/adoption counselor worked but did not use that doula for her birth.
Once the potential participants contacted me, I sent them a lengthier email
describing what their participation entailed.3 After they agreed to participate based on
that email, I confirmed that they were 18 years old and scheduled an interview at a
place of their choosing. I interviewed participants at a park, a Barnes and Noble cafe
and at one participants house. At the beginning of each interview, I obtained consent
3 A fourth participant contacted me but, after agreeing to be in the study, stopped responding to further
inquiry from me to schedule an interview.
and informed the participants that they were allowed to stop the interview at any time
if they were uncomfortable. After following this protocol, I audio recorded these
interviews and transcribed them in their entirety, using pseudonyms to protect
participants and their friends and family members identities.
To obtain a holistic and nuanced account of the participants experiences as
birthmothers, I utilized a targeted life history approach. The life history approach
represents any historical account by the individual of his/her life in whole or in part,
in written or oral form, that has been elicited or prompted by another person; the life
history model provides a useful tool for revealing inner expression as directed by the
participant (Amos and Wisniewski 1995:125). Josselson (1993) contends that life and
story are two inextricable parts of the same phenomenon rather than two discrete
units, so in looking at life stories, we are able to get a sense of ones inner life
because as Geertz (1986) points out, we do not have the ability to enact some
magical intrusion into the consciousness of others (373). Rather, we must examine
how their expressionsrepresentations, objectifications, discourses, performances,
whatever can provide us insight into the lived experience of individuals; life
histories provide an arena for the participant to enact any or all of these expressions
To focus the interview on their birthmother experience as it was affected by a
doula, I concentrated on the part: the pregnancy of the birthmother and surrounding
events, which makes this a targeted life history narrative, or the history and
sequencing of specific behaviors of research interest (Schensul et al. 1999:138). So,
the data portion of each interview began with this elicitation question:
Please share with me your adoption story, from conception to present
day, and how you feel that process was affected by having a doula
present during your pregnancy, childbirth, the post-partum period and
in the time since then as youve processed your experience of
This life history approach allowed the research participant to tell her own
story as she had experienced and interpreted it, where my questions emerge[d] from
the immediate context and are asked in the natural course of things (FHI 2002:64;
Atkinson 1998). Since eliciting narratives, as Bruner (1986) describes, reveals both
structures of meaning and structures of power, this approach was well-suited to my
three body framework which speaks to the process of embodiment through
interpretive, symbolic and political economic theories. The structure of meaning
provided by the targeted life histories of the participants helped to tease out the
individual body, or the phenomenological lived experience of the body self, as well
as the social bodys construction as they felt their bodies existed in a symbolic
context. Additionally, the life history approach provides an appropriate template to
speak to structures of power in the body politic in that it emphasizes the experience
and requirements of the individualhow the person copes with society rather than
how society copes with streams of individuals (Mandelbaum 1973:177). In eliciting
a life story, researchers reveal the interface between the individuals life experience
and the social and cultural forces in which the individual lives, so for my theoretical
framework and the exploratory nature of this research, the targeted life history
provided a means of revealing the interface between participants perceptions of
themselves, societys perception of them and how they interfaced with political and
economic structures (Josselson 1993).
While very helpful and informative, I foresaw that the targeted life history
approach might result in dissimilar data across interviews and could potentially focus
on aspects of their experience that, while relevant, may not have spoken to my
research questions. To augment my data and protect against this potential problem, I
utilized a second interviewing strategy after the targeted life history. I asked the
participants a list of probing, open-ended questions to ensure that the data I gathered
spoke to my research questions (Appendix C). In using this directed approach to my
research design, I was able to gather data relevant to my theoretical framework of the
three bodies and social support. Many of the questions were addressed during the
course of each participants self-guided narrative of their life history, but when they
were not, this allowed me to guarantee that I had comparable data for all of the
The final data gathering technique developed over the course of my interviews
and was not originally intended as an elicitation tool. After listening to the
participants life histories and asking probing questions, I would conclude the
interview. Since I am a birthmother myself and the participants do not know many, if
any, other birthmothers, I asked them if they had any questions for me. The brief
narration of my own story in response to their inquiries inevitably developed into a
dialogue about the comparisons between our experiences. These informal
conversations drew out intricacies in the birthmothers perceptions of themselves and
the adoption process and provided rich data that supplemented the other two
For my data analysis I used a primarily inductive approach that was guided by
a priori codes. Due to my theoretical structure which addresses multiple levels of
embodiment and the additional application of social support, it was essential that I
analyze the data across these layers, so I used what Miles and Huberman (1994) refer
to as start codes. This initial ordering of my data allowed me to gather data and do
preliminary data organization according to this comprehensive theoretical framework
(LeComte and Schensul 1999). After transcribing the interviews in a word processing
program, I first read them many times to familiarize myself with the data and then
used a closed coding format to sort the transcripts into four broad categories: the
individual body, the social body, the body politic and social support.
Within the four a priori codes, I used an inductive approach to determine how
the birthmothers described these different bodies and how and from whom they
received social support, especially from doulas. In immersing myself in these a
priori codes, I expanded the existing codes as new themes emerged, bridging the
relationships between coding units and surfacing unforeseen categories of analysis
(Miles and Huberman 1994:62). The interpretive approach was used to uncover
patterns of human activity, action and meaning and to better understand the
phenomenological perspective of the individual body (Berg 2001:239). To determine
the codes that related to the social body, the body politic and social support, I used a
more social anthropological approach to identify and explain the ways people use or
operate in a particular setting; how they come to understand things; account for, take
action, and generally manage their day-to-day life (Berg 2001:239). This second
stage of inferential, open coding revealed the themes presented in each chapter
according to the initial, start codes.
This research design was intended to be exploratory and allow me great depth
in exploring the birthmother phenomenon. By focusing the research on the
experiences of the three participants who met the research criteria, I was able to
intensively explore this gap in the literature though not able to make generalizations
based on the data. Additionally, a second aim of the project was to determine how
doula support may improve the experiences of birthmothers in the adoption process,
but research into this addition to adoption models has yet to be explored. Thus, this
project represents a first step toward building a body of literature on the entirety of
the birthmother experience and the role of doula support in the adoption process.
THE INDIVIDUAL BODY: CHALLENGING MOTHERHOOD
In Scheper-Hughess and Locks (1987) discussion of the individual body,
they argue that we lack a precise vocabulary with which to deal with mind-body-
society interactions and so are left suspended in hyphens (10); this suspension is
evident in birthmothers phenomenological experiences of motherhood and
relinquishment, their feelings of connection and disconnection. Birthmothers force us
to question Western societys construction of motherhood as a primarily biological
product, rather than a social process, since birthmothers must form a maternal identity
that challenges the traditional tropes of motherhood. This process involves a
complicated negotiation of attaching and detaching from the fetus prenatally and the
child in the post-partum period, navigating an unrecognized loss and forming a new
non/mother identity. The participants experiences illustrate the struggle to
incorporate an identity as a mother who is not a parent, where they undergo a
transformation of the self that, while fraught with difficulties, is in some ways
The Individual Body Framework
In the individual body concept, Scheper-Hughes and Lock (1987) provide a
model for understanding how Western cultures construct the body. Under the
influence of Cartesian dualism, Western cultures categorize phenomena surrounding
the body into discrete polarities, where body opposes mind, spirit remains separate
from matter and symbolic and material identities operate independently of each other.
Rather than viewing these human experiences as a holistic amalgamation of a
self/body, Western cultures separate these processes and elevate the mind above the
body. In this paradigm, we create oppositions in reason and passion, culture and
nature and ultimately male and female; the body becomes the embodied
representation of this dualism that has penetrated so deeply.. .that we have come to
regard it as natural and inevitable (Goody 1977:64).
This dualism affects the experience of motherhood in Western culture. Instead
of viewing motherhood as a socially constructed result of a biological process where
traditional dualities must be merged, biological reductionism creates a narrow
construction of motherhood that imparts the role of mother to someone based
primarily on the physical act of reproduction (Wegar 1997:77). A phenomenological
approach recognizes these cultural influences but also attempts to situate the
experience of a person and their consciousness within the body rather than objectify
individuals as a neutral embodiment of symbolic values (Jackson 1983:329). In this
framework, pregnancy and childbirth are biological, bodily processes that are
experienced individually within the body and also intersubjectively where the the
self emerges within social relationships (Horton 2009:22). Still, separating lived
experiences from cultural constructions of the self is understandably problematic, so
it is helpful to engage some aspects of the cultural construction of motherhood.
The American kinship system places precedent on the biogenetic connection
between a mother and her offspring as an an objective fact of nature, but
motheringthough affected by hormonal responses in the immediate post-partum
periodis in many cultures, regarded as a social process (Schneider 1980:24). This
can be seen in the many cultures whose definitions of parenting extend beyond
biological kinship: in many African cultures, it is common for maternal uncles to
assume the role of father for their sisters children (Radcliffe-Browne 1950); in
cultures in Oceania, women with many children may be viewed as selfish for not
adopting out children to infertile relatives (Leon 2002); and, in many agrarian and
gathering cultures, it is common for the community to utilize a multiple mothering
model where a few women assume responsibility for all of the communitys children
(Ambert 1994). This cross-cultural variation in adoption and parenting models
reflects different socio-economic patterns between cultures and reveals how all
constructions of parenthood or motherhood are products of a cultural system of
beliefs. In Western ideology, binary dualism and biological reductionism are cultural
constructions that do not reflect absolute truths regarding the role or legitimacy of
motherhood, and thus, the birthmothers act of relinquishment and subsequent
non/mother role challenges and reveals the contradictions of these ideologies (Leon
2002; Wegar 2000). Due to both the embedded dualistic ideology and the
phenomenological experience of the self, birthmothers may experience a connection
to the fetus or child but also struggle to remove their maternal feelings since though
they are blood mothers, they are no longer parents (Mander 1995; Wegar 2000;
Pietsch 2002). In thinking in dualities, as Scheper-Hughes and Lock (1987) assert we
do, our perceptions of ourselves are challenged by phenomena that defy these
categories. The participants formation of a non/mother identity illustrates the
limitations of these dualities.
In exploring the participants lived experiences of pregnancy, childbirth and
relinquishment, patterns exist that illuminate how each participant dis/connected with
both the fetus and their identity as non/mothers. The participants in this study
experienced the dis/connection in several ways that did not represent a simple
before/after, connect/disconnect process. Instead they vacillated between feelings of
attachment and detachment. Whether connecting to the fetus in utero, once bom or
after relinquishment, these participants all vocalized their bittersweet experience of
feeling a connection to their relinquished child. Conversely, all of the participants
made intentional efforts to remove these feelings. In removing these feelings the
participants all reported the difficulty of navigating the loss of a relinquished child
with whom they had shared nine months of their lives. Because these women are
experiencing pregnancy and motherhood outside of a normal model, they are both
resisting and embodying these cultural constructions of motherhood. Thus, the
birthmothers phenomenological experience of motherhood represents a unique
model where they must navigate the liminal space between biologically accepted and
socially contested motherhood.
Connecting and Disconnecting: Ambiguity in Pregnancy and Relinquishment
I walked in there, and he was soooooo cute. And, so I ended
up holding him and I fed him and I cried and stuff. So it was
pretty neat [Vicki]
Despite feeling that they must remove maternal feelings, the participants,
like birthmothers from other studies, did not feel that they could separate themselves
from their bodies and thus the fetus (Mander 1995; Romanchik 1995). The
birthmothers in this study experienced an intimate but controlled bond prenatally, a
strong initial post-partum attachment, complicated by the knowledge they were
relinquishing and intensified in the immediate separation period. The dis/connect
during each stage was variable, but the attempts to distance themselves were
apparent, as was their inability to completely do so. Generally, this feeling of
connection began once they made the decision to carry the pregnancy to term and
began to imagine the fetus as a person. Relational feminists, who argue that men and
women are fundamentally different yet still equal, have legitimized this connection,
arguing that [WJomens reproductive experiences and traditional role as nurturer,
influence their capacity for connection (Cahn 2002:194; Laufer-Ukeles 2008). Thus,
in the experience of even an unwanted pregnancy, these women are sharing a body, a
uniquely female phenomenon thatwhile not universally experienced with women
who are going to raise their childrenis still an enormously influential experience.
Though I argue that biological reductionism in childbirth delegitimizes the social
experience of motherhood, the act of sharing a body with a fetus is a biological
occurrence that may impart an indelible connection between a mother and a child;
under the optimal conditions, this physical closeness may be transformed into an
emotional closeness between the birthmother and the fetus (Cahn 2002; Pietsch
Scholars have found (Mander 1995; Freundlich 2001) that many birthmothers
attempt to deny a connection throughout the entire process, but though the
birthmothers in this study attempted to mediate their attachment, nonetheless, they
experienced an intimate prenatal connection with the fetus. All of the participants felt
an intense closeness with the fetus despite knowing they were going to relinquish.
Vicki, who decided to carry to term after seeing an ultrasound of the baby at four
months, was awed by her pregnancy and her birth:
In a way, I loved being pregnant, it was so cool.. .in the first months
when you can feel him moving around in there. It was just so much
fun. It was so amazing.. .The whole fact that you have a human in
there. Growing inside you. And then BAM there he is. Its just, I dont
know the whole thing is just crazy. Such an awesome experience.
Laura also felt a closeness to her daughter while the fetus was in utero. After
briefly considering an abortion, she explained deciding to carry the fetus to term by
thinking of the fetus inside of her as her little brother or sister. She vividly
remembered her mother being pregnant with her younger siblings and sharing in that
process. Though framing the fetus as a sibling rather than a son or daughter may have
been an attempt at detachment, it also allowed her to reframe the fetus as an already
manifest child. After this shift, she began forming a relationship with the fetus,
exploring her maternal feelings and taking advantage of the time she had with the
child before relinquishing:
It was awesome. It was a great experience. I loved being pregnant. I
LOVED it. I would sit there on the lifeguard stand and I would just
have my big old belly and I would watch her flip and flop.. .And you
think about it and some people could be grossed out about it but thats
a child in there and shes her own little person now. And she probably
was. We would play games. I would poke her and she would kick me
back. It was just a lot of fun.
While Laura felt she was already forming a relationship with the fetus from
the moment she decided to carry to term, Elizabeth struggled more with her
pregnancy and avoided making a decision till she was seven months along. This
delaying of the choice to deliver and relinquish caused some early ambivalence that
evolved into more maternal feelings that she viewed as a decision to accept the child
into her reality:
At the beginning, I didnt connect at all with it. But sometimes I knew
that he was there and I was pregnant and it was a baby but I dont
think I ever at first, in the first couple months, I really decided that I
wanted this to be a part of my life. But then as I thought about it I was
like I cant do this to a human you know... at first I didnt do anything
to like make him feel comfortable and okay about it but as time went
on I definitely felt more towards him and stuff. And after I gave birth.
It was like very different. Like him not being there is like crazy.
Definitely missed it.
In this complicated prenatal period, the birthmother, as seen in these excerpts,
begins to form a maternal identity. As Rubin (1984) and Fowles (2007) argue, the
beginning of developing a sense of the self as a mother occurs while the fetus is in
utero, and while these scholars discuss this occurrence as it affects maternal-infant
attachment post-partum, for birthmothers, this attachment alters their identity as
non/mothers. Subsequently, this burgeoning identity is made problematic by the
impending separation from the infant and social relinquishment of their newly formed
maternal identity. The birthmothers attempted to resist prenatal maternal attachment,
knowing their time with the fetus is the most time they will have with their offspring.
An especially fascinating example of this dis/connection can be seen in the
participants use of pronouns and proper names when referring to the relinquished
child. Despite each participant knowing the given name of their relinquished child,
they used it in narrating their stories prior to deciding to carry the fetus to term.
Once their narrative passed the point of that decision, the participants used gendered
pronouns and my/the baby. With one exception, the participants only used the childs
given name when they discussed the adoptive parents and their role. For example, the
first time Elizabeth used her sons name, she was discussing when she handed him to
the adoptive mother for the first time. The intimacy and detachment associated with
these forms of speech appeared unconscious, but in other ways, the participants were
aware of this intentional mediation of their attachment. Laura described this process,
saying, I tried to kind of convince myself to put myself in this mind frame that Im
kind of like a surrogate. Still, as seen in the excerpts above, they developed some
attachment, which is a positive indicator for post-partum bonding (Fowles 2007).
What happens when prenatal bonding occurs and the maternal identification of the
self developswithout a social assumption of the full maternal role? For
birthmothers this involves a complicated navigation of loss that, while not necessarily
a biological mandate, is still palpable and difficult (Leon 2002).
Many women choosing to parent report missing the intimacy with the fetus
during the prenatal period, but this arguably can be exacerbated in relinquishment
when the babys birth is not necessarily the celebrated next step into motherhood but
the symbolic disconnection that marks the beginning of a birthmothers
relinquishment, a more final disconnection (Fridh et al. 1988). Their most intimate
moments of motherhood have ended once the child is bom and soon they will transfer
the symbolic role of mother onto someone else and be forced to face the reality of the
impending loss (Freundlich 2001). For the participants in this study, they did not
make an effort to remove their maternal feelings; rather, their experience of the
relinquishment period is marked by attempts to cope with the ambiguity of this
liminal space. This difficult transition in the immediate post-partum period was
marked by intense emotional turbulence that presented differently at different times
for the participants.
Though Vicki expressed being confident in her decision and considers herself
a strong, dependable and independent person who enjoyed the wonder of
pregnancy, her emotions in the immediate postpartum period shocked her.
Throughout her pregnancy, she felt certain that relinquishment was the best choice for
herself and her son since she grew up in the whole poor thing. She explains that it
was not that she hated her life.. .BUT its not a fun environment to grow up in; she
didnt want to do that, have a baby to do that too. She had regular
counseling/information meetings with the adoption agency and an active role in
selecting the adoptive family. She described selecting them as, If s just like
something inside you saysyes, its them. Despite all of these positive indicators
the support of a flexible agency, the certainty that she had selected the right family
and confidence in her choice to not raise a child in the same situation that she was
raised inVicki felt the weight of her choice immediately after her son was bom:
After I had him or whatever. I was just so overwhelmed with emotion.
I just started crying. It was just crazy. I was just so... Ahhh. And you
know.. .1 was just so overwhelmed. I couldnt even look at him at first.
I just couldnt. I was just so tom up about it. I didnt think it was going
to be that hard. As soon as he just popped out it was like this is for
real. This is really happening. Im not going to keep him. It just all hit
me at once. And so. I just couldnt even look at him. I didnt want to
look at him. I didnt want to touch him. Because it FREAKED me out.
I was like this is going to be hard on me. I cant do it, right?
Laura experienced the same critical moment, but for her, it came when her
daughter went home with the adoptive parents. The moment when her daughter was
first bom intensified the attachment rather than the feeling of loss like Vicki. Though
she enjoyed her pregnancy and bonded with the fetus, she also acknowledges that she,
like birthmothers in other studies, attempted to kind of detach herself during her
pregnancy and told herself, This is my baby but theyre the parents. After she
delivered the baby naturally on the bathroom floor of the hospital, the midwife laid
the baby on her chest and let Laura cut the umbilical cord. When the child looked up
at her, all sense of detachment left and despite thinking of herself as a surrogate. She
recounts, In that moment, it was just like this is my baby. You know, she loves me
and I love her. It was just awesome. She also talks about how important it was for
the adoptive mother to respect her personal experience of childbirth and motherhood,
articulating the ambiguity of how she felt despite trying to imagine herself as their
If she had come in and been like let me see my baby. I wouldve been
like. Back off. This is my child. I just went through 16 hours of labor
with her. Dont. You know. Dont come in here and do that.
Instead the adoptive mother let her enjoy that period of attachment before the
separation, but, after three days in the hospital with the baby, the adoptive parents
came with a car-seat and a special outfit in which to take their new daughter home.
The reality of the relinquishment darkened the joy she had so recently experienced
once the separation was immediately imminent. Rather than watching the new family
walk out of the hospital room, Laura climbed into the shower where she reevaluated
her maternal identity without a child. She described this moment of separation and
isolation through tears:
I knew that as soon as I got out of the shower it was just going to be
me again. She was going to be gone. I had been with her for nine
months, every day. Like nonstop. So just to have her gone. Like 100%
you know I was like. It was just really hard.
In these experiences, these women are acutely experiencing the loss of not only the
child but the feeling of pregnancy, their closest moments with the child soon to be
relinquished. The loss in these moments is an acute experience of separation from a
partner; the us is now reduced to one. Elizabeth even directly addressed this
feeling in non-relinquishing mothers: Everyone talks about even after they have a
baby and keep their baby that they go to depression because the baby isnt like in
their stomach anymore, and its just weird. Elizabeth expanded on this saying that
while that was a natural emotion for all post-partum women, going home without a
baby.. .made it even worse. They went home with a baby and my email address, and I
went home with nothing. And it was very hard.
Separation between mother and newborn has been studied by various
psychiatrists and biologists, and from a phenomenological perspective, there exists an
intersection between the biological, emotional and social factors that influence
feelings of maternal attachment and separation anxiety. Feldman et al. (1999)
researched the impact of infant separation in mothers who chose to raise their
children and found that that the primary maternal preoccupation complex, referring
to thoughts, worries, and anxieties regarding infant safety, would increase among
mothers who experienced initial separation [but] in those mothers who experienced
prolonged separation and potential loss of the infant there would be diminished signs
of attachment (931). They attributed this anxiety and subsequent diminishing
attachment to biological, social and behavioral factors that relate to evolutionary
processes and emotional responses to loss. In relating this research to birthmothers, I
argue that these women are experiencing the primary maternal preoccupation but
that this is complicated by the impending separation, leading to an immediate
intensification of the attachment period.
This period of intensification is marked by withdrawal and a feeling of
unreality where birthmothers enter a liminal period where they must struggle with
reentering a social environment as a non/mother who has recently given birth; they
must renegotiate an identity where they are neither parent or childless. Vicki left the
hospital the day before Mothers Day and said that sucked. People wished her
Happy Mothers Day with obvious discomfort, even sarcasm. She admitted that, I
definitely grieved a lot. Laura experienced weeks where she didnt want to leave bed
but mediated this loss by choosing to breastfeedsomething not many birthmothers
choose to do. Motivated initially by the health benefits of breastfeeding for infants,
she acknowledged that this was something I can give her. I gave her life, but I can
also give her nourishment. Additionally, this non-traditional choice allowed her to
remain engaged in a relationship by regularly pumping and delivering her breast milk
to the adoptive family; she admitted that besides wanting the baby to have the
advantage of being breastfed, It was kind of a little excuse to go see her twice a
week for the first couple months. When she delivered her pumped milk, she would
hold her daughter and interact with the family, but when Laura lost a few days worth
of breast milk while out of town with her family, she reports,
I was devastated.... That was. I guess. My. Kind of detachment.
Because I was like. You know. I can give her so much but... I can
[pause] depend on it. You know. And so. Slowly, I stopped
For Laura, this marked the beginning of the more tangible separation and the
beginning of a coping and recovery period. Elizabeth also felt that the going home
was the hardest part, but her separation was also mediated by a very open adoption
where she began regularly seeing the adoptive family.
Additionally, all of the participants reported increased grief and conflict in
seeing their peers with children they chose to raise. Vicki avoided telling peers with
children or older co-workers who had children at a young age that she had
relinquished because she felt that they have struggled and will judge her for not
choosing to struggle to raise a child in a difficult situation. Laura and Elizabeth
both reported feeling pain at seeing their friends raise children shortly after they had
gotten pregnant. Elizabeth said of a friend who had a child a year after Elizabeth, I
was like, if it happened a year later I could have kept Bryson. I just really miss him.
Laura said it is especially hard to see people get excited for her friends who are
having babies; she wondered, Why werent people excited for me? She argued that
people keeping a child despite being unprepared to be a parent feel that, If Im going
to give birth to this baby, then Im going to keep it. She said, Theyre not selfless
enough to be like Im giving a life, in that they are relinquishing their child to a
family that chooses to adopt. In seeing alternative routes represented in their friends
lives, the participants were confronted with the re-imagination of the life they chose
not to lead.
From a symbolic anthropological perspective, this conflict is understandable;
there is no ritual to mark this moment in a birthmothers lifethe ambiguous
movement between pregnancy, relinquishment and post-relinquishment identity
construction. Instead, these women must navigate a prolonged liminal period of
simultaneous attachment and separation in which they feel conflicted about their
maternal role. If as Turner (1995) contends, ritual reveals group values at the deepest
levels, then the lack of ritual or even social acknowledgment of this process reveals
how society struggles to address the dualities between the biological and social
construction of motherhood and adoption and how to acknowledge this loss (6).
Furthermore, Turner argues that in ritual, societies can resolve dualities so that
opposition is overcome and transcended in unity, so without ritual, it is difficult for
birthmothers to resolve the duality between the biological process of pregnancy and
childbirth that typically marks entry into motherhood and the social process of
relinquishment that purports to remove the role of mother (93). Instead in navigating
this on their own without a prescribed process, the participants come to their own
unique conclusions, such as Laura, who said, I guess Im not technically a mother. I
mean Im a mother Im just not a parent I guess. Its just that line of where is
Re-Forming an Identity as a Non/Mother and Contesting the Stereotype of Damaged
In their long-term readjustment, all of the participants continue to work
through their grief in personalized ways, identifying as non/mothers in ways that
reflect societys lack of a template for dealing with this category-defying role. Also,
their experiences in navigating this new identity proved in some ways empowering
though much of the existing literature fails to explore this phenomenon. The
participants in this study had relinquished only recentlyfive months to two years
prior to the interviewand thus were still in an earlier period where the immediate
intensity had lessened but the grief was still viscerally present at times. Though broad
generalizations of the data are problematic due to the small sample size, it is worth
noting that the participant who expressed the least incorporation of the experience
into her identity had relinquished most recently, and the participant whose post-
relinquishment period was longest expressed that despite personal and social
difficulties with her birthmother status, Now, its just a part of me.
Vicki, who had relinquished only five months prior to the interview confessed
that, It was really hard, still is. While Vicki acknowledged that talking about the
experience and her feelings ameliorated her grieving, she did not discuss the process
as getting easier. In comparing parenting as an adolescent to relinquishing, Elizabeth,
who had relinquished approximately a year and half before, acknowledged that there
were pros and cons both ways but both are a win/lose situation. She confessed
that there were still nights when she sat up in her bed, unable to sleep for thinking of
her relinquished son but also feels comforted by the fact that she talks to or sees the
adoptive family once a week. She talked about her relationship with her son and the
adoptive mother, whos definitely [her] best friend, expressing great joy and
comfort in their relationship. Finally, Laura, who had relinquished almost two years
before our interview, talked about how her grief intensified around significant dates
such as Mothers Day and her relinquished daughters birthday, but she describes the
long-term processing as improving,
.. .one step forward two steps back and then slowly it started being like
two steps forward one step back. You know and then three steps
forward. And slowly my breakdowns would be less often, and I would
start being happy about it.
These participants are noteworthy in their navigation of the biologically-felt
role as mothers and their socially-relinquished role as a parent. In their prenatal, post-
partum and post-relinquishment periods, they were forced to confront the Cartesian
dualism that informs our epistemology about motherhood, and in the lived experience
of falsely discrete categories, individuals will inevitably be forced to recognize the
limitations of these categories. All of these young women, in turn, were faced with
defining themselves as mothers in novel ways that defied these traditional tropes of
motherhood. In this traditional Western concept of femininity and motherhood,
failure to fulfill social ideals of motherhood is an indicator of a womans moral
irresponsibility, but these women clearly articulated their maternal love for their
relinquished children (Wegar 1997:78). While they did discuss the feeling from
others that they had abdicated their maternal responsibilities, they also felt they
should not be judged by others for this, noting how difficult relinquishing is and how
much they love their children. Despite confidence in their decision to relinquish, the
birthmothers all struggled with feelings of self-worth related to their relinquishment, a
phenomenon well-supported in the literature (Ellison 2003; Fowles 2007; Fessler
To further complicate the formation of a non/mother identity, the participants
also experienced pride in their unselfish decisions and empowerment in working to
include the benefits of the experience into their new non/mother identity. The
majority of birthmother research has highlighted the negative impacts of adoption on
birthmothers in the damaged birthmother model; in this accepted model,
birthmothers are at increased risk for a variety of negative outcomes such as
depression, anxiety, divorce rates, codependent relationships and secondary infertility
(Freundlich 2001; Pertman 2000). The research gathered here challenges this
damaged birthmother model since the participants also experienced empowerment
in their relinquishment experience.
This large body of literature and its contradiction to the outcomes in this study
could be a result of several factors. First, much of the research on birthmothers has
examined the outcomes for women relinquishing in the 1950s through the 1980s,
when adoption was decidedly anti-birthmother, guarded in secrecy and mired in
shame (Wegar 2000; Leon 2002). This research was important at the time since the
myth that birthmothers could move on and forget was rampant. But, since then,
stigma regarding out-of wedlock pregnancies has decreased and practices regarding
open versus closed adoptions have dramatically shifted (Wegar 2000). Studies have
also shown that birthmothers who use open adoption models have improved
outcomes, but long-term studies that emphasize the impacts of new adoption models
on birthmothers have yet to be conducted (Freundlich 2001). Also, since much of the
literature still depicts birthmothers relinquishment as pathological, both in their
unintended pregnancies and post-relinquishment readjustment, this could be a result
of social mores that still pervade our construction of motherhood in Western culture,
in which motherhood is the ultimate ideal of the female role (Wegar 2000; Cahn
2002; Leon 2002). In this model, birthmothers are aberrations that need to be studied
to illuminate deviant behavior; the fact that researchers have sampled birthmothers
in the process of seeking professional help has only confirmed this portrayal of
birthmothers as inherently deviant. An excellent counterpoint to much of this
literature is a study by Neil (2006) who selected birthparents and birth grandparents
randomly without the same selection bias; she found that based on a variety of
external forces, there were three reactions to relinquishmentpositive acceptance,
resignation and anger/resistance. While some variation of positive acceptance and
resignation can be seen in the participants narratives, none of them expressed
Vicki reported less incorporation of the birthmother piece into her identity
than the participants who had a longer period of post-relinquishment readjustment,
but did feel empowered due to her birth experience. After Vicki felt rushed by the
on-call obstetricians, she reported that having a doula there to advocate for her and
assist her in making labor decisions will help her the next time she is pregnant: I feel
like I can stand up for myself, and be like, Well, no. I dont want you to do that. Id
rather do this. She also reported that she is excited [to be pregnant] when the time is
right and cant wait to be pregnant again. She even expressed interest in working
in ultrasound imaging or becoming a doula to be a part of the process that was so
transformative for her, a claim supported by Fessler (2006) who found that many
birthmothers go into helping professions as a result of their relinquishment
Elizabeth reported an increase in self-respect and empowerment due to the
relinquishment experience, though not the birth experience. For her, the major growth
and transformation came after the birth when she held her son and met the adoptive
family, a relationship that has developed into a deep friendship. Before becoming
pregnant, she reports that she was just naive and turned to the birthfather, her
longtime boyfriend, for closure from her parents divorce and struggled growing up
without a strong maternal figure. Fler growth was apparent in her reflection of how
the experience changed her,
I think that this whole thing saved me.. .1 should have found something
that I really enjoyed in life. And I looked to one thing but it wasnt the
best thing, and now, I have such a good outlook on life. Its not just
about one person. You have to go out there and find what you love and
be happy with what you do. And, you know that theres like theres
this huge area. Its not just right here. You have to broaden your focus.
I dont think that other people should make me happy. I should be
happy with what I do in life and stuff.
Elizabeth, though always interested in health professions, specifically
pursuing a career as a physicians assistant, is now considering working in a neonatal
unit in a hospital since this experience had such an impact of her life.
Laura reports similar feelings of empowerment due to her birth and
relinquishment experiences, and these experiences have also influenced her life goals.
She reported, I definitely have to say because my birth experience was so awesome.
Thats what made me want to be a nurse-midwife.. .1 want to be able to provide that
for someone else. She went into her birth incredibly informed and prepared and felt
it was important that she undergo the process naturally, for herself and the baby. She
also described herself as a pushover prior to her pregnancy, the little fighter for
everyone but myself, but her narrative revealed that she very much advocated for her
own wishes for herself and the fetus. She reported that this was out of character but
much easier during pregnancy because she felt, this is my baby and this is my body,
and I am going to be making her into a child. She also reported that she learned how
to be selfless and that she learned a lot about herself. She began incorporating her
new maternal identity early on, and despite the struggles post-relinquishment, she
reports that, Ive gotten to the point where its just a part of my life. If you cant
accept it, dont be around. She has worked to resolve her feelings of both attachment
I kept her for a reason and I gave birth for a reason and I found her a
good family for a reason. Because I love her and I care for her and I
want her to have the best life possible.
The lack of anger/resistance present in the post-relinquishment narratives
reveals the fallacy of the damaged birthmother model. The alternative model
presented here, where relinquishment, while still difficult, may empower rather than
harm birthmothers, represents a marked deviation from other birthmother research. In
addition to the previous hypotheses for this difference in finding, this projects
research design may illuminate the cause of some of these differences. First, this
could be a product of using the ethnographic, life-history approach rather than using a
survey format that asks participants to identify their symptoms rather than to narrate
their adoption story with the details that they deem salient. Second, and quite
importantly, the women in this study were all provided doulas, which could have
improved their long-term readjustment. This hypothesis cannot be fully tested within
this research design, but this study makes a strong argument for a potential patterned
association between doula support and positive birthmother outcomes. Future
research could illuminate if this variable improves psychosocial outcomes for
birthmothers. The value of social support for these women will be discussed at greater
length in Chapter 6.
These birthmother experiences provide a compelling study of how traditional
constructs regarding motherhood can be challenged and how data regarding
birthmothers and their dis/connection to the relinquished child is neither linear nor
predictable in general models regarding adoption and the birthmother experience. The
phenomenological process of navigating loss outside of accepted norms and
incorporating a birthmother identity into ones larger identity is suffused with sadness
and joy, maternal attachment and the anxiety of separation. In this liminal space
where birthmothers are biological mothers but not social mothers, a unique role is
formulated that involves being a mother who is not a parent.
THE SOCIAL BODY: SLUTS AND BAD MOTHERS
The perspective of the social body holds that the body is a natural symbol
where cultural constructions of and about the body are useful in sustaining particular
views of society and social relations (Scheper-Hughes and Lock 1987:19). In this
framework, the body is both a template for and subject to cultural beliefs. In
discussing the individual body, I presented the argument that birthmothers stand at
the crossroads of the biological reductionist view of motherhood and the supposed
natural connection of a mother to a fetus; they must simultaneously navigate the
connection with the fetus and the bifurcation of their own identities as mothers. In
exploring the data through the social body lens, I ask: how and why are birthmothers
stigmatized? How do the stigmatizing experiences of birthmothers reveal ideologies
surrounding womens sexuality and motherhood, and how do birthmothers receive
and respond to the stigmatized identity placed upon them?
A particularly important aspect of the social body is how perceptions of the
body reveal constructions of normativity, as the natural body serves to embody
societal health and illness, harmony and discord. In the normative construction of
Western motherhood, a mother is a twenty- to thirty-something, married female who
anxiously and lovingly awaits the birth of her child with Botticellian graceone
mother, one father, one act of copulation yields a family (Scheper-Hughes and Lock
1987:19). This is the harmonious pregnant body, but an adolescent, unmarried mother
planning to relinquish upsets this image and is thus subject to social action to correct
the aberrant behavior. In exploring the stigma associated with non-marital and
adolescent pregnancy as well as the stigma of relinquishment, the participants
narratives illustrate how society reacts to women who threaten the traditional
idealization of family and motherhood. Additionally, the participants, in failing to
conform to these standards of female sexuality and motherhood, had to learn how to
manage stigma and cope with the negative feedback, resisting the social construction
of their reproductive bodies as aberrant.
The Social Body Revealed through Stigma
Scheper-Hughes and Lock (1987) explore the social body through symbolic
and structural theory. They argue that the body is a powerful symbol that is good to
think withthus, we view our social and physical environment as analogous to our
bodies, and in turn, our embodied selves are affected by our social and physical
environment. The body, a rich symbol, becomes imbued with the cultural realities of
our surroundings. Cultural norms regarding reproduction, an especially symbol-laden
process, are especially revealing of a societys kinship system (Scheper-Hughes and
Lock 1987). Since Western patriarchal ideology views the body and the feminine as
fully realized in motherhood, people who threaten this image are viewed as social
deviants that need to be reined in (Wegar 2000; Tolman 1994; Ellison 2003; Cahn
2002). Women, in embodying societys ideologies, are deeply affected by the
rhetoric of what it means to be a good and worthy woman, mother and wife in
which maternity as civic duty constructs conceptions of self (Ellison 2003:323,325;
Malson and Swann 2003). In evaluating the discourse surrounding unintended,
teenage pregnancy and adoption and the experiences of the participants, it is useful to
utilize the concept of stigma as it is created at a social level and experienced on an
Several disciplines have explored the concepts of stigma and deviance as a
cognitive product, a form of social control and behavioral process. As a cognitive
product, stigma theorists explore how when encountering another person, individuals
identify similarities and differences. The socialization process then enters in since,
according to ones cultural beliefs, the viewer of the other person will then
hierarchically order the similarities and differences and consequently typify the
other (Ainley and Crosby 1986). If the type of person violates cultural norms, the
process of stigmatization may occur. Stigmatized qualities are those that violate
norms, or a shared belief that persons ought to behave in a certain way in certain
circumstances (Stafford and Scott 1986:81). For these stigmatized qualities or norm
violations, such as disability or adolescent pregnancy, these qualities assume a
master status that eclipses most of the other qualities a person possesses, leading to
a stereotype (Ainley et al. 1986). With stigmatizing stereotypes, others will then enact
sociocultural behaviors, such as social isolation, in an attempt to both maintain their
own protected normal status and illustrate to the other that their behavior is not
socially sanctioned (Becker and Arnold 1986). But, while stigmatization is a
universal process, the identification and prioritization of stigmatizing qualities is
culturally-bound, so stigma is not only a reflection of culture.. .it is a cultural
process (Ainley et al. 1986:12). As Goffman (1963) contends, the stigma, or
discrediting attribute is established by a society as a means of categorizing persons
and the complement of attributes felt to be ordinary and natural for members of each
category (5). In this framework, the stigmatization process provides a powerful tool
for revealing the social body of stigmatized individuals who will naturally embrace
and reject, absorb and deny the stigmatization placed upon them for these qualities
(Ainley et al. 1986). In embodying how society feels bodies should behave,
birthmothers struggle with stigmatization since their social bodies challenge the
natural bodies of mothers in the timing of their pregnancy and their choice to
The participants in this study, all of whom conceived the relinquished child
before their nineteenth birthdays, experienced the triple burden of unintended, non-
marital, and adolescent pregnancy, all compounded by adopting away their child in a
strongly pronatalist society (Ellison 2003:331). Teasing out the source of the
experienced stigmatization (unintended/non-marital pregnancy, adolescent pregnancy
or choice to relinquish) is difficult and may be perceived by the stigmatized
individual to be for adolescent pregnancy when it is actually for unmarried
pregnancy, or vice versa. However, all of the participants reported stigmatization for
at least one of these norm violations.
Unmarried, Adolescent and Relinquishing
Stigma scholars allow for the mutable nature of stigma over time, and this is
apparent in the increased tolerance for out-of wedlock pregnancies and the increasing
visibility of adoption in the public sphere (Ainley et al. 1986; Goffman 1963; Wegar
2000; Pertman 2000). Still, stigmas persist tenaciously, and the public perception of
the participants in this study is affected by powerful cultural norms that restrict
female and adolescent sexuality as well as the dominant North American ideology
that defines a real family as the nuclear family unit of a heterosexual couple and
their biological children (Ainley et al. 1986:5; Wegar 2000:363; Diamond and
Savin-Williams 2009). These ideologies are then placed onto the participants
construction since womens bodies have long been sites of extensive biopolitical
contestation [of] morality and rationality, the underpinnings of the stigmatizing
process (Ellison 2003:339). To explore the stigmas of non-marital/adolescent
pregnancy and relinquishment associated with the participants, I will discuss how the
stigma is presented in the literature, how the participants experiences reveal the
prevalence of each stigma, suggest reasons why the stigma is still prevalent and show
how the participants respond to these stigmas.
Im gonna pretend we re married and whatever...
Since most pregnant adolescents are also experiencing unintended/non-marital
pregnancies, the literature on this population mostly lumps these stigmas together as
one, especially unintended/non-marital. For the purposes of this research project, I am
combining the stigmas associated with these norm violations since the participants
were largely unsure of which norm violation was the source of their stigmatization,
but I will attempt to specify one or the other where it is possible.
In regards to unintended/non-marital pregnancy, Ellison (2003) asserts that
48% of women will experience an unplanned pregnancy, but discourse surrounding
intention silences this phenomenon.4 For married women, their marital status allows
them to pass, but unmarried women are then especially vulnerable to
stigmatization. Her research on womens experiences of unintentional pregnancies
revealed that unmarried, pregnant women experienced isolation and fear, especially in
being typified as easy or loose. Additionally, this embarrassment may not only
be due to violations of sexual norms but due to the perception that out-of-wedlock
pregnancy is irresponsible (Yardley 2008). While the decoupling of childbirth
from marriage is becoming more commonplace and accepted, stigma still exists
among certain subpopulations of Americans as seen in the still high levels of
embarrassment regarding out of wedlock pregnancy reported by people who identify
as White and more highly educated persons (Mollbum 2009:122).
Besides experiencing stigma associated with a non-marital pregnancy,
additional stigma is placed on adolescents who become pregnant (Wiemann et al.
2005; Mollbum 2009). Like non-marital pregnancy, adolescents engagement in
sexual activity is becoming more accepted, but stigma, especially for adolescents who
get caught by getting pregnant, is still prevalent (Mollbum 2009). In the past, this
prohibition against teenage pregnancy has been motivated by statistics that show
higher maternal and infant morbidity and mortality associated with teenage
pregnancy, a suggested correlation to future social and economic disadvantage and
ensuing high costs to society. While this data clearly confirms that teenage mothers
and infants of teenage mother face additional health and socio-economic risks, this
research has been misconstrued by careless and sometimes biased research that has
been both moralistically driven and narrow in its analysis of why these women and
their infants have poorer outcomes (Furstenberg 1991:127). Researchers seeking to
expose the fallacies of these arguments do not deny that teenage childbearing has
adverse effects on adolescent mothers who are not adequately prepared to assume
the economic, social and psychological responsibilities of child care and
childrearing; still, they feel these out of context statistics combined with moralistic
debates has led to the assumption that teenagers are biologically incapable of
producing healthy infants, and if already disadvantaged persons delay childbearing,
they will produce children who as adults would be well prepared to compete in the
new global economy (Luker 1996:41). These exaggerated claims fail to
contextualize which teenagers are more likely to get pregnant (lower socioeconomic
status), what resources are available to them (limited) and how societys disapproval
4 The majority of the literature uses non-marital pregnancy to describe pregnancy out of wedlock and
fails to acknowledge differences between women who will act as single parents or who will parent
with their partner. As norms regarding family shift, more adults are choosing to abstain from marriage
while engaging in a domestic partnership outside of these legal definitions, so the experiences of single
or soon to be single mothers and mothers who have chosen to abstain from marriage may be quite
of them affects their access to these resources and ability to gain marketable skills
The body of literature surrounding teenage pregnancy both reveals and
perpetuates the conflicting portrayals of teenage mothers as deviants, victims or
simply babies having babies and consequently society is left with conflicting
cultural beliefs about whether these women should be condemned and punished, or
cared for and rehabilitated (Luker 1996:37). This illustration of cultural norms can
help us understand how the participants embody cultural perceptions of adolescent,
non-marital pregnancy. The participants, who were all from small communities in
largely rural, more conservative areas in northern Colorado where this stigmatization
may be more intense, struggled with how these stereotypes were placed upon them.
The participants accounts surrounding their stigmatization reflect that some members
of society still subscribe to the belief that these women should be, at least socially,
condemned and punished due to common stereotypes that pregnant adolescents are
sexually promiscuous and/or irresponsible.
Elizabeth, when talking about her experiences in high school during and after
her pregnancy, struggled with continuing to attend classes due to this stereotyping:
People would talk during class and say, like, mean stuff. Like, if we were debating
in government, about people, girls being sluts and stuff. Though teachers attempted
to mediate these thinly veiled insults to Elizabeth, she said, [I]t still doesnt take the
pain away. Its so hard listening to all the kids saying nasty stuff. This socially
enacted, unofficial sanction against pre-marital sex resulted in Elizabeth limiting her
time at school, sometimes leaving school early and finishing her class work outside of
this uncomfortable social situation. Still, over a year later, she says, people talk
about me, like shes easy. While she felt that other people in her school were
having sex, the stigmatization that she experienced reflects how pregnancy can
become a physical symbol that marks an unmarried person as easy, at least because
they got caught. This experience supports Brediss (1975) finding that among
adolescents, perceptions of pre-marital sex may be more accepted unless a peer
becomes pregnant; girls engaged in sexual activity still viewed unwed mothers as
falling beyond their own moral worlds (484). This scarlet letter disguised as baby
bump marks the unmarried adolescent and makes her vulnerable to social sanctions.
The stigma of unmarried, adolescent pregnancy was also apparent in Lauras
story. In her high school, like Elizabeth, she remembers, Everyone was super
judgmental and just really hateful towards the whole thing. Outside of this high
school culture, Laura also felt the social isolation. At one point, this community
stigmatization, due to being what she assumed was 18 and pregnant, became so
intense that Laura attempted to lessen the social stigma attached to the discrediting
attribute of a non-marital, adolescent pregnancy since she would just get the nastiest
looks from older ladies:
So, I just went to J.C. Penney and bought one of those fake diamond
rings and wore it on my finger, and it just. Everybody would assume
that my husband was in Iraq or away on business. Or something like
that. All the time I would get, Oh are you and your husband so excited
for the baby, and I would be like, Yup. Im not even gonna bother
Goffman (1963) calls this passing, where instead of managing social relationships
according to the discrediting attribute, the individual is able to manage information in
regard to their discrediting attribute. In wearing a status symbol, Laura was able to
negate one of her stigmas, and it worked. She noted, The day that I put it on.
Everybodys...the way that everybody looked at me and talked to me was a 360 [sic],
which was kind of ridiculous. But. Whatever. In this example, despite being young
and pregnant, Laura is able to manage the stigma of being young and pregnant by
hiding the violation of marital pregnancy norms. These are called life transition
norms, or the timing and ordering of life transitions (Mollbum 2009). While being
a pregnant adolescent may be a violation of the age timing, being pregnant out of
wedlock violates a second timing norm against pregnancy before marriage
(Mollbum 2009:124). Lauras altered experience of pregnancy once she donned the
faux engagement ring illustrates how by even alleviating the stigma of one norm
violation, she increased her social acceptance. While Laura felt relieved at her ability
to pass, Goffman (1963) cautions against the potential complications of attempting to
pass, noting that even without socially imparted stigma, individuals attempting to
pass will still embody the shame of their stigma. Lauras experience of this
stigmatization, the nasty looks, and her concealment of her stigma reveal both some
agency in fighting stigma but also the potential incorporation of public perceptions
into ones identity.
The socially stigmatizing actions taken by either peers or adults could be due
to disapproval of adolescent pregnancy, non-marital pregnancy, or even for acting
irresponsibly by failing to use contraception rather than for engaging in sexual
activity outside of marriage or adulthood. Regardless, it is reasonable to assume that
some, if not all, of this stigmatization is due to the participants failing to conform to
gendered expectations for young women, especially in regards to sexuality; this
assumption is supported by the finding that nearly 80% of all U.S. adults believe
teenage sex is always or almost always wrong, a stigma that has disproportionately
affected females (Diamond and Savin-Williams 2009:479). Since stigmatization
reflects the culture, the social structure and the historical period within which stigma
exists and though norms regarding sexuality have shifted and continue to shift, the
experiences of these participants reveals that, in some communities, cultural norms
still regard the behavior of the participants as deviant (Becker and Arnold 1986:55).
For the participants, the obvious display (i.e. pregnancy) of sexual deviance from
pregnancy timing norms (adolescent and unmarried) marks them as objects of scorn
that threaten cultural standards of young female behavior.
In illuminating the social body, these womens experiences of stigmatization
for their out-of-wedlock, adolescent pregnancy reveals the rich symbolism that
society imparts upon young girls bodies, where crushing conventions of femininity
maintain cultural standards of normative and deviant female behavior (Tolman
1994:325). While society responds to some stigmas with legal sanctions and in the
past out-of-wedlock pregnancies have been subject to legal sanctions (Carp 1998),
these womens accounts of stigmatization reveal the still present, though unofficial,
sanctions against womens sexuality outside of approved settings such as adulthood
and marriage and how constructions of deviance vary within and between cultures or
subpopulations. Vicki, whose non-marital, adolescent status was not discussed in this
section, reflects the variation within cultures. Her family, friends and social network
did not judge her for the timing of her pregnancy; instead her experience of
stigmatization was primarily associated with her choice to relinquishsomething all
of the participants confronted.
Screw you guys, Im not a bad person
Besides the more readily discussed and studied stigmas regarding female
sexuality, birthmothers must confront the additional stigma of relinquishment in a
society where the image of a mother is of the natural one who recognizes and
appreciates her interdependence with her children, what Leon (2002) calls the myth
of the maternal instinct (Cahn 2002:197; 654). This romanticizing of the maternal
state is regarded as the ultimate expression of femininity; thus, the choice to
relinquish represents a marked deviation from motherhood in Western culture. Leon
(2002) believes that stigma as a stressor for birthmothers may be underestimated
(656). This stigma associated with relinquishment is apparent in a variety of studies
that have examined perceptions of adoption in the U.S. as well as the excessive
amount of problem-oriented studies on adoption that have pathologized adoptive
parents as less capable or less accepted by communities than birthparents, adoptees as
psychologically scarred, and birthmothers as irresponsible women who either blithely
forget their child or experience long-lasting, incurable trauma.
While it is important to note that the veil of secrecy that kept adoption stories
in dark closets has in many ways been lifted, there still exists an undertone that
adoption is second best to the traditional, Western model of a nuclear, biological
family (Wegar 2000). This has been revealed in multiple ways. A national
representative sample of adoption beliefs in the American public shows that
Americans are divided over whether it is better for pregnant teenagers to place their
babies for adoption or raise them themselves, and though the majority of American
support birthparents decisions, one in four disapproves and feels that this decision is
irresponsible, uncaring and selfish (Evan B. Donaldson Adoption Institute 1997: ii).
This disapproving group is over-represented among less-educated groups and racial
minorities. Other studies have revealed that though public sentiment regarding
adoption tends toon the surfacebe in support of adoption, further analysis reveals
that even those who support adoption, harbored doubts about the institution. These
doubts include a belief that adoptees have increased behavioral risks, birthmothers are
callous and adoptive parents are unable to parent as effectively as birthparents (Fisher
2003a: 159; Evan B. Donaldson Adoption Institute 1997). In everyday life, the false
acceptance of adoption becomes visible with language such as, Oh they have two
children and then they adopted a son.
This bias against adoption is also found in and perpetuated by news and
academic sources. Content analysis of textbooks and readers in family research found
that little attention was devoted to adoption and that the coverage provided was
predominately negative, stressing the potential problems of adoption about twice as
often as its probable successes and rewards (Fisher 2003a: 154). This misguided
approach is hypothesized to operate under the preconception that biological ties
supersede social ties when forming a family structure leading to a view by some that
adoption is a problematic family form rather than the successful alternate family
form that it is(Fisher 2003b: 159). Additionally, academic research regarding
adoption has been criticized for being problem-oriented and having a dearth of
research on positive adoption outcomes (Wegar 2000:364; 365). In popular
information sources, Karel (2006) analyzed 292 news stories covering adoption and
found similar results with more problematic than positive depictions, and
birthparents, when depicted (only 47% of the time) were portrayed as solely
negative over twice as much as solely positive, with a focus on the rare but
sensationalized stories about birthparent reclamationa statistically rare occurrence
(Pertman 2000). In fact, 90% of adoptions are reportedly successful, but the media
sensationalizes and over represents the rare problem adoptions (Karel 2006). The
cyclical nature of discourse makes determining the source of adoption bias difficult,
but the negative, biased and problem-focused research as well as sensational stories
will continue to dominate the media and academic literature and thus influence public
opinion unless an even-handed approach is taken to exploring the social dimensions
In interviewing participants, the stigmatization due to relinquishment was one
of the strongest and most emotional themes for each participant. From many
sourcesstrangers during pregnancy, acquaintances post-relinquishment, intimate
family membersall of the participants had to, at some point, defend their choice as
one based in love and responsibility, but since this attempt to sever the blood bond
contradicts the America kinship system, these arguments were often met with
skepticism (Schneider 1980). Vicki has experienced outright stigmatization from her
aunt and peers and a difficult distancing from her father. While Elizabeth and Laura
had unconditional support from family members they encountered adoption stigma
from outside sources. Even with large amounts of support, the instances of extreme
social isolation and judgment seemed to stand out in participants narratives,
illustrating the power of the one-in-four Americans who disapprove of birthmothers
choices (Evan B. Donaldson Adoption Institute 1997:ii).
Within intimate family environments, two of the three participants were
supported. Vicki was the exception. While her mother supported her, both her father
and the birthfather urged her to have an abortion. Though they attempted to be
supportive through the process, she confesses that her dad is still, weirded out by the
whole thing. She also has an aunt who refuses to speak to her, who is mad and
tells Vicki shes a bad person. With such a tense family environment, Vicki, who
was already living with the birthfathers mother, found comfort and support from the
birthfathers mother who was supportive of the decision to relinquish. Laura, who
was living with her Catholic parents when she learned she was pregnant, received a
lot of support in her decision to relinquish, and Elizabeth, who was already close with
her father (her legal guardian) and her sister, received equal support saying,
Whenever I had a bad day.. .they were just there for me to lean on.
The majority of stigmatization was shown from community members and
casual acquaintances. Vicki, who works a minimum wage job with several women
who chose to parent at a young age, was confronted by a lot of peers who said things
like, I did it, you could do it. She was heavily criticized by other young mothers
that told her she was a bad mom and that it didnt matter what your living situation
was, he would still love you and care about you. Vicki who was motivated to
relinquish due to her desire to not raise her child in the whole poor thing, quickly
tired of trying to explain that thats not the point. Since then, she has stopped telling
people about her relinquishment and often thinks to herself, Screw you guys, Im not
a bad person. The ensuing internalization of the shame of her relinquishment has
forced her to confront her reasons for relinquishing and lament, No one looks at you
like, Oh you really love this baby, thats why youre giving him a good family. Go
you! Based on other participants experiences of support in unlikely places, it could
be that other individuals in these communities could or would be supportive of her
decision, but because of the trauma of a few dissenting persons who placed the bad
mother stigma onto Vicki, she has chosen to conceal her birthmother status. Becker
and Arnold (1986) caution the reader about the cost of concealing, contending that
even if the individual succeeds in concealing the past, a sense of stigma is kept alive
by the knowledge of cultural beliefs about such behaviors as well as by the need to be
secretive (Goffman 1963; 50). Whether revealed or concealed, stigma is likely to be
internalized and can foster feelings of shame or lack of self-worth; this could be a
contributing factor to some of the negative psychological consequences in the
birthmother literature. Additionally, the inscription of socio-cultural values on
individual persons illustrates how the participants may come to embody this social
body in either struggling with the hurt or attempting to reject the norm, saying to
themselves, as Vicki did, Screw you guys. Im not a bad person (Goffman 1963;
Ainley et al. 1986).
Laura, who experienced a large amount of stigmatization for her young, out-
of-wedlock pregnancy, also experienced some overt stigmatization from community
members as well as more quiet discomfort from her peers due to her decision to
relinquish. One of the most impassioned anecdotes that Laura relayed was one
involving a couple, specifically the father, who had hired her as a live-in nanny.
Apparently, the father had known a young girl who had relinquished a child for
adoption and had a very negative experience. The birthmother he knew had entered
into an open adoption contract that was disregarded after relinquishment, and since
open adoption contracts are not enforceable in most states, the girl he knew had no
legal recourse. This instance, potentially combined with some of the sensationalism
reported in media accounts, colored his perception of adoption. Laura discovered his
bias after he performed a background check on her and discovered a three-day
hospital stay. He questioned her about it, and she honestly replied that she had
relinquished a child. She was shocked by his response:
He got really mad at me. One day and just yelled at me, Youll never
ever see your baby again. They say that its going to be an open
adoption. But theyll back out on you. Thats how it always works.
You think you know how all of this works, well let me tell you.
Goffman (1963), in discussing the potential impacts of stigmatization, allows for the
possibility that individuals can be empowered in their stigmatization. That by being
marginalized, they may find and begin to nurture their differentness as a source of
power and even increased self-esteem. This process became clear in Lauras response
to her employers rude judgment of her decision:
And I just looked at him. And I was like you dont fucking know my
life. And I was like you dont know what happened you dont know
how I feel about it. Dont even think you are allowed to talk to me like
that... .1 ended up quitting.. .so it was just ridiculous. I mean after that.
I started being more open about it.
In response to this man, imparting judgment based on an experience of adoption that
he had witnessed, she found a voice. After this experience, she became more open in
discussing her birthmother status with others and, in some ways, embraced this
differentness as a source of strength.
When considering Laura and Vickis different individual reactions to
stigmatization, it is helpful to look at the collective power of Vickis multiple
encounters with young mothers and Lauras more isolated incident of stigmatization.
Additionally, Vicki had relinquished only five months prior to our interview whereas
Laura had relinquished almost two years prior to our interview. Becker and Arnold
(1986) discuss this process; As the stigma is integrated into identity...it may move
from the foreground and can become more normalized to the individual and thus less
potent in identity formation (51). Vickis still new identification as a birthmother may
contribute to her discomfort with disclosure, but it may also be an appropriate
response to her social situationwhere the young, single mothers she knows view
adoption as the callous choice.
Laura also experienced and expressed a separate, more subtle stigmatization
that, rather than indicating overt stigmatization due to distaste with relinquishment,
reflects societys discomfort and unfamiliarity with adoption. In watching other
friends have babies once she relinquished, Laura felt the sting of the silence
surrounding her pregnancy and birth. She remembers, Everyone was so supportive
and excited for [her pregnant friend] because she was keeping it, and I had a really
hard time because I was like, Why werent people excited for me?! In an honest
conversation with one of her friends, Laura expressed this disappointment, to which
her girlfriend responded, Laura, you werent keeping it. People didnt know how to
react. Nobody knew what to say to you because you werent keeping her. Laura
expressed that she still wanted to be supported, and her friend responded, What you
want and what you can expect from people are different. While Lauras friends
observations are wise and reasonable, the disenfranchised experience of a birthmother
is evident in her hurt at feeling as if her friends failed to support and understand her
experienceespecially as one that could be celebrated.
Finally, Elizabeths experience of birthmother stigmatization reflects the
struggle with disclosing her choice to relinquish. The ambivalence she feels towards
sharing her birthmother status reveals how while she is attempting to integrate this
piece into her identity, she is also fearful since she has received negative feedback in
the past regarding both her choice to relinquish and her adolescent pregnancy. In
discussing how others treated her and her choice to relinquish, she contemplates:
I guess the fact that its easy that I dont have to take care of Bryson
and be with him 24/7 and wake up with him at night and stuff like that.
And not do financial stuff. But I am all night all the time thinking
about him thinking if hes ok and stuff. I think its a win-lose situation.
I dont think that either way would have been easy you know. Pros and
cons both ways. Whether you do adoption or keep the baby or
When I asked Elizabeth why or when she would potentially share her birthmother
status, she shook her head and made a distasteful face. She expressed that she didnt
want to disclose, but it was difficult not to since whenever she met potential new
friends, they would ask her, Are you a virgin? I asked why she thought this
happened, and she responded, I guess its just what our society is now. Were faced
with sex everywhere. Despite being faced with sex everywhere in her small town,
she was still called a slut and easy making her comfort with her relationship with
her son difficult to navigate. The feeling that she made the right choice makes her feel
that, I just need to be open with it and tell everyone that I have a baby and hes still
in my life. Yet, she counters, Its definitely a turn-off for people.. .they just leave.
They dont care to know what happened they just, like, you know, whatever, you
must be a slut. Though still struggling with her birthmother status, Elizabeth, like
Laura, also feels strengthened in her decision, saying before her pregnancy, I was
just naive.. .now I understand what I want in life. I just want to be happy. I dont
think that other people should make me happy. Elizabeths responses here are
another indicator of how the isolation of stigmatization can bring inner strength to
individuals, as a blessing in disguise (Goffman 1963:11). Still, despite some
positive outcomes, it is imperative to avoid valorizing birthmothers and/or promoting
stigmatization as a necessary process to self-empowerment. The pain of
stigmatization in these narratives is still palpable.
In exploring the construction of the social body, we can see how
stigmatization reveals and perpetuates ideologies surrounding sexuality and
motherhood, in which young girls who become pregnant are sluts and women who
choose to relinquish are bad mothers. Birthmothers experiences of stigmatization
illustrate how being an unmarried, pregnant adolescent and/or relinquishing their
children for adoption violates norms. Thus, birthmothers are subject to social action
that demonstrates the violation of the norm. Additionally, the embodiment of the
social body of birthmothers is not a uniform experience as displayed in the variations
in participants responses to the stigmatization they experienced. While they all
confront the consequences of norm deviation, how they chose to submit to or resist, to
embody or displace, feel shame or empowerment was based on each participants
unique family dynamic, community interaction and already-established conceptions
of the self. Since historically, stigmatized persons occupy ambiguous, multivalent
terrains the social reaction to stigmatized qualities or phenomena and embodiment of
social sanctions due to stigmatization will vary accordingly, and similar to combining
dualities of biological and social motherhood, understanding this process can
deconstruct the fallacy of Western ideologies surrounding these phenomena.
THE BODY POLITIC: ADOPTION BODIES TRANSFORMED
The body politic framework posited by Scheper-Hughes and Lock (1987)
provides a means of deconstructing how the body may be viewed as an artifact of
social and political control (6). Drawing heavily from the work of Foucault, the body
politic perspective is primarily concerned with the regulation, surveillance and
control of bodies as a protection against threats to social organization and a means of
producing docile bodiesthe kinds that societies need to maintain the current social
organization. In the previous chapter, I discussed stigma as revealing the social body
since it helps us understand the way societies view the body as a symbol, but the
institutionalization of stigma, or a systematic attempt to rein in deviance, reveals the
body politic. Though many societies practice adoption in an informal way that is
based in social contracts between families, the U.S. system of adoption operates
under formal, legal models, which are subject to cultural beliefs. These culturally
influenced legal practices determine how the we treat the bodies of birthmothers,
adoptees and adoptive parents and how these processes systematically attempt to
Understanding the body politic through participants stories was difficult
because little emerged on this topic. When I questioned them about their experiences
with the legal and financial aspects of the adoption process, I received brief answers
and shrugs. All of the participants reported feeling like their rights were respected,
their various decisions supported and that the agency provided them information on
all available choices. As Laura described it we didnt settle [on an agency] cause
they were just awesome. While this may be indicative of the discourse surrounding
social institutions that disciplines individuals from questioning the institutions
practices, this also led me to ask why the participants may have had such positive
experiences considering the plethora of data on egregious cases of coercion and
systematic stigmatization in adoption practices (Foucault 1984b). In reviewing the
literature, I discovered two things: adoption practices have evolved dramatically since
most birthmother data was collected from women relinquishing in the 1950s through
the 1970s, and while the period between the end of World War II and before Roe v.
Wade was certainly the dark age of adoption, the samples for these studies often came
from women who self-selected into studies through already existing support groups.
Also of importance in understanding the participants experiences of the body politic,
state-by-state variations in adoption provide different laws that safeguard
birthmothers rights, and Coloradowhere all of the participants relinquishedhas
some of the most strictly regulated practices.
The participants stories, contextualized in the history of adoption as a social
and economic process, together with an analysis of current adoption laws provide a
means of exploring the body politic of adoption. The history of adoption in America
illustrates how legal logistics, laissez faire economic principles and cultural
perceptions of out-of-wedlock pregnancy and infertile couples have intersected in a
manner that has caused adoption policy to evolve rather haphazardly (Evan B.
Donaldson Adoption Institute 2006:7). The experiences of the participants in this
study show how the sweeping cultural changes, illustrated in and affected by
reproductive health laws, have impacted adoption practices and ultimately improved
the birthmother experience (Evan B. Donaldson Adoption Institute 2006:7). The
participants experiences, framed in a historical context, show how previous
institutionalized practices regarding adoption have, in many ways, been transformed,
and in highlighting the current variations between state policies, the potential benefits
of regulating what effectively remains the only unregulated business in America
The Body Politic Enacted through Law
The study of the body politic is a study of power and control. Throughout
history, womens bodies have been subject to institutional acts of overt and covert
manipulation and control. The patriarchal system has traditionally used the male body
as prototype, and therefore the female body is inherently defective and dangerously
under the influence of nature, which due to its unpredictability, was itself regarded as
in need of constant manipulation by man (Davis-Floyd 2001:2). This ideology has
led to the use of laws and medical technology to control the bodies of women,
whichespecially in reproductionreflect the natural and undisciplined body
(Davis-Floyd 2001; Wendland 2007). Thus, through structural constraints, the body
politic has sought to control the female body by placing it in organic communication
with the social body (whose regulated fecundity it was supposed to ensure), the
family sphere (of which it had to be a substantial and functional element), and the life
of children (which it produced and had to guarantee by virtue of a biological-moral
responsibility lasting through the entire period of the childrens education (Foucault
Birthmothers represent a deviant form of the controlled female body in failing
to regulate their own fecundity according to the social body which approves of
reproduction within financially stable, heterosexual marriages and also in their failure
to fulfill their biological-moral responsibility to the children they have produced.
The body politics response to this norm violation has been to conceal birthmothers
deviance with falsified birth records which includes erasure from public documents.
This silencing of the birthmothers role in a childs life in conjunction with social
prohibitions against discussing adoption has resulted in the perpetuation of facile
stereotypes, such as the ones explored in the social body, that still haunt all members
of the birth triad (Pertman 2000). In addition to the legal practices of the body politic,
the power of the market has also contributed to the body politic of adoption in which
market forces have influenced the regulation, or lack thereof, of the adoption business
and made vulnerable the couples seeking to adopt as well as the women choosing to
relinquish (Evan B. Donaldson Adoption Institute 2007; Freundlich 2000).
Traditionally, birthmothers have occupied a socially and financially
disadvantaged position, but changes in reproductive health laws and shifts in
childbearing decisions have led to a shifting power dynamic where birthmothers have
something which other Americans badly want (Pertman 2000:34). The simple
economic laws of supply and demand in a free market economy are giving rise to
birthmothers who are demanding more involvement in the childs life, i.e. open
adoptions, and adoptee rights and the womens rights movements are illuminating the
fallacies of secrecy. In this rapidly shifting environment, adoptive parents have been
forced to accommodate the new and growing surge in open adoption models, and
many are finding fault with the stereotypes that sensationalize birthmothers as either
uncaring in their relinquishment or fickle in the seldom-realized, but often depicted,
rescinded relinquishment (Pertman 2000; Gritter 2000). Still, though birthmothers are
in possession of a valued commodity according to economic principles, their position
is complicated by their social marginalization, so their position in this market also
leaves them vulnerable to exploitation. To further complicate this market framework,
while the laissez faire approach to adoption has increased their visibility and allowed
birthmothers to exert more agency in some ways, the free market principle combined
with lack of federal oversight in this classic states rights issue has allowed the
adoption business to become big business where some states allow adoption
facilitators to realize substantial fees for services rendered (Freundlich 2000:12). A
brief analysis of adoption history as it relates to the body politic allows us to
facilitate an insurrection of subjugated knowledges, revealing that birthmothers
throughout the twentieth century suffered the regulation of their reproductive and
maternal rights according to misguided belief that adoption must be forced into the
same mold as normal (defined as biological, same-race, heterosexual) family
formation (Sawicki 1991:16; Pertman 2000:186). By eschewing the false ideal of a
traditional family, adoption is becoming a model in which birthmothers, as seen
with the participants here, can be involved and respected.
Adoption Then and Now
Its really tragic. We were not told any of our rights. We were not told
we had the right to keep our own baby... We werent told that we
could get child support from fathers. We werent told that we could
apply for welfare.. .All of our rights were abused. Ignored and abused.
The rights people take for granted today, we were denied. We didnt
know because we were young and we trusted our parents, and we
trusted authority. [Teenage birthmother ca. 1965 (Fessler 2006:161)]
I met [the adoption counselor] and she was just great. She explained
everything with me and gave me all kinds of different adoption stuff.
And, If, you know, I wanted to keep the baby then she was telling me
all the help I could get. [Vicki, birthmother 2010]
The excerpts above illustrate the dramatic shift in birthmother treatment in the
U.S. At the height of the adoption phenomenon in 1970, there were 89,000 extra-
familial, infant, domestic adoptions and the first excerpt reflects the standard
treatment of most birthmothers during that time period (Evan B. Donaldson Adoption
Institute 2007; Melosh 2006; Fessler 2006). Since then, adoption rates have shown a
precipitous decline and, though no national statistics are gathered for domestic
adoptions, the Evan B. Donaldson Adoption Institute (2007) reports that an
estimated 13-14,000 adoptions of this kind occurred in 2006. Todays birthmother
experiences appear to be more similar to the second quote from one of the
participants, but no generalizable studies have been done with recently-relinquishing
mothers. How did adoption professionals build, establish and legitimize the 1950-
1970 adoption model, and why and how has it changed so dramatically?
In order to understand how the body politic of birthmothers is constructed by
society and embodied by birthmothers, it is helpful to construct what Foucault
(1984a) called a genealogy of power, where we can look at power in a certain area
and depict its wavering course, locate its moments of strength and weaknesses and
define its oscillating reign (87). In mapping the genealogy of power in adoption, the
changes in the worth ascribed to children and the rights given to birthmothers
illustrate the shifting perceptions and restrictions placed on adoption. Prior to 1900,
infants as adoptees were not desired as a solution to infertility (Freundlich 2000;
Melosh 2006). Instead, the mostly informal adoption models operated outside of legal
channels and emphasized adoption as a solution to labor concerns. In this model,
older children were adopted out from urban areas where the Industrial Revolution and
ensuing urbanization left many children without one or both parents, and so these
orphans were sent to rural, agricultural communities in the Midwest (Gish 1999).
This farming out of child labor reflects how structural influences produce the kind of
bodies societies need (Foucault 1984a; 91). This surplus of abandoned or financially
burdensome children was sent to areas where their bodies could produce and
contribute to a larger system.
At the beginning of the twentieth century, children were imbued with a new
emotional worth (Freundlich 2000:4). For children to be accommodated to the
shifting ideologies of society, their value changed from a labor value to a
sentimental value, a distinct and key condition of kinship in American culture
(Schneider 1980). As a result, infant adoption became more actively practiced for
children whose parents could not care for them (Freundlich 2000:4). Additionally, as
the number of out-of-wedlock pregnancies increased after World War II, illegitimacy
was acknowledged to be a growing social problem in desperate need of a solution
(Fessler 2006). Social workers who had previously worked to keep infants with their
biological kin began advocating for stranger adoptions, a practice that had formerly
been viewed as the less than ideal choice (Melosh 2006). Though governmental
regulation lagged behind the rapidly growing popularity of adoption in the middle of
the twentieth century, extra-familial adoption became enacted through legal practices
that were cloaked in secrecy due to a belief that the second chance that adoption
provided for infertile couples and fallen women was best granted by concealing the
past (Melosh 2006). The issuing of false birth certificates and the sealing of original
birth certificates was veiled in good intentions in that it removed the literal
illegitimate stamp from adoptees bom to unwed mothers and allowed them to claim
kinship to adoptive families for inheritance and other legal purposes, but this practice
effectively removed the legal and emotional ties of the birthmother, erasing her from
the public record. While again, this was argued to allow a birthmother a fresh start
as well, this operated under the now-refuted myth that it was best and possible for
birthmothers to forget and move on (Pertman 2000).
Adoption stories from this era reveal how secrecy permeated each level of
adoption: some adoptive mothers left town or put pillows under their shirts to pass
off the adopted child as their biological kin; adoptees were often never told of their
adopted status; and many birthmothers were hidden away in Crittenton Homes, a
nationwide charter of homes that housed unwed pregnant women, advised them to
use aliases and notoriously coerced them into relinquishing their children and then
returning to their normal lives as if nothing happened (Fessler 2006; Pertman 2000).
The birthmother narratives from this period are heart-wrenching tales of hopelessness
and loss. The stigma associated with unwed mothers at this time was intense and the
ensuing legal practices that denied their existence worsened things; as one
You walked out of the hospital with whatever memories you had and
the stretch marks on your body, thats it. There was no piece of paper.
Nothing. It was as if it never happened. (Fessler 2006:176).
In denying the existence of birthmothers, socially and legally, their process and
purpose were denied a place in societys construction of families, and their stories and
experiences became sealed in legal documents, buried under the advice of persons
who told them to just go on with your life (Fessler 2006:128). In this process, the
body politic institutionalized the stigma of out-of-wedlock pregnancy and attempted
to conceal this deviance. This conspiracy of silence allowed society to maintain the
typical nuclear family prototype and regulate the fecundity of women who were
deemed unfit to parent by denying that they ever did (Cahn 2002; Ellison 2003). The
closed adoption model reflects the ideology of a society that sought to hold on to
traditional cultural norms regarding womens sexuality, but changes in reproductive
laws and shifting perceptions of womens sexuality opened the adoption model to
more possibilities that include increasing birthmothers rights.
The womens rights movements of the 1960s-1970s, in combination with
more convenient and reliable methods of contraception, vastly expanded womens
reproductive choices (Melosh 2006; Evan B. Donaldson Adoption Institute 2006).
Socially, the stigma of women engaging in pre-marital sex was dramatically lessened,
and out-of-wedlock pregnancy and subsequent single parenting became viable
options for women who experienced what was previously a scarlet letter of shame
(Melosh 2006; Pertman 2000). Legally, Roe v. Wade also allowed women the choice
to abort a fetus. The previous adoption mandate, that single women must relinquish in
order to maintain their reputation or parent and suffer the consequences, began to
crumble. In 1973, 19.3% of never-married Caucasian women who experienced a
pregnancy placed a child for adoption, but by 1995, this number had dropped to 1.7%
(Evan B. Donaldson Adoption Institute 2006). Conversely, as baby boomers and later
generations have entered their reproductive periods, they have chosen to delay
marriage and pregnancy, resulting in higher rates of infertility (Pertman 2000;
Freundlich 2000). In the 1950s, the number of parents seeking infants was nearly
proportionate to the number of relinquished infants, but currently, the inverse
relationship between the supply and demand for adoption has led to nearly five times
the number of parents seeking to adopt than there are available children.
Since adoption operates as part of our free market economy, adoption as a
business has developed a supply issue, leaving birthmothers and adoptive parents
increasingly vulnerable to entrepreneurs looking to capitalize on an emerging market.
Due to demand, the cost of adoption has increased to an average of $20,000-$30,000
per adoption (Freundlich 2000). These increasing costs with little regulation raise
acute ethical concerns and are complicated by social and economic power relations
(Freundlich 2000; Evan B. Donaldson Adoption Institute 2006). This burgeoning
adoption market represents a commodification of the fetus, which in turn
commodifies the birthmothers body. In this commodification, the social action of
transferring a child from one set of parents to another is reduced to a market exchange
that in turn transforms parenthood into something that can be bought and sold (Marx
1977). Freundlich, for example, (2000) argues that rising costs are associated with not
only a supply issue but also to the growing belief that everything in our country is
a commodity that can be packaged, marketed and sold at a profit, and the ability of an
increasing number of affluent young adults who are willing to pay whatever is
required to satisfy their desire to become parents (11). In this commodification of the
fetus, the birthmothers body and ultimately parenthood, more adoption agencies and
independent lawyers are offering financial incentives to birthmothers including
scholarships and costs of living; though this reimbursement could be a heartfelt
offer, it also provides an inducement to get wavering women to give up their
children (Pertman 2000:38). Additionally, couples seeking to adopt are sometimes
encouraged to provide under-the-table financial incentives with the explicit message
that this will make it more difficult for a birthmother to change her mind once the
child is bom. These gray market adoptions reflect the free market principles in
which commodifying bodies (fetuses and birthmothers) and relationships
(parenthood) is now big business, and under a neoliberal economic policy, this
business functions best with little to no regulation.
Proponents and opponents of the current laissez-faire approach to adoption
differ in their opinions of which party this model benefits or harms. In a business
model, the adoptive parents are the paying customer and thus afforded the most
power, but others argue that birthmothers are carrying the desired commodity so
are able to advocate for more rights (Freundlich 2000:31; Pertman 2000). The reality
is it likely benefits and harms both parties in different, myriad ways, and although the
birthmothers are the suppliers of the desired commodity, they nonetheless hold much
less social and economic capital than adoptive parents who are generally affluent
given the high cost of adoption (Freundlich 2000; Evan B. Donaldson Adoption
Institute 2007). For example, one website entitled, Birthmothers Choice provides
resources to women considering relinquishing a child for adoption. The information
is provided to potential birthmothers in the form of sample questions that
birthmothers may ask such as, I dont have anywhere to live? Can you help me?
The site responds that Yes! If your state permits, we will help you. Just call us!
[paraphrase] (Reachsource Adoption 2010). The posing of this question reveals the
power dynamic in which birthmothers, while having a desired commodity, may also
be in an incredibly vulnerable position when considering relinquishment; the fetus
inside of them, in the commodification of bodies, may be the most financially
valuable thing they have to offer.
As distasteful as the idea of a fetus or a child as a commodity may be, this
supply problem has also led to increased birthmother involvement in designing an
adoption plan. Pertman (2000) interviewed several adoption agencies that reported
allowing open adoptions in direct response to birthmother requests and their inability
to recruit enough birthmothers without allowing this option. Since almost all
birthmothers who are offered open adoption models end up choosing them, this is
dramatically altering the standards of adoption in the U.S (Evan B. Donaldson
Adoption Institute 2006). Another reason for this increase in birthmother involvement
is the advocacy by Concerned United Birthparents (CUB). The stigma literature
discusses the potential for stigmatized individuals to bond over their shared deviance
and organize to advance rights for their community, and CUB is an example of this
phenomenon (Goffrnan 1963). CUB was formed in 1976 and is composed primarily
of women who relinquished during the era of the adoption mandate and suffered
under the previous models of secrecy (Modell 2002). Their efforts to enact legislation
and bring birthmothers out of the closet, a term they have used, has improved the
information provided to birthmothers when considering adoption
The changing social attitudes regarding pre-marital sex, access to
contraception, the legalization of abortion, free market economic principles and the
advocacy work of previously disenfranchised birthmothers have all increased the
rights afforded birthmothers in the adoption process. (Pertman 2000). This is apparent
in the experiences of the participants who report that their experiences with the
adoption agency were positive.5 They stated that the agency they used informed them
of their choices, provided them with resources should they consider parenting and
counseled them on their decision. Two of the three participants reported that they
shopped around for agencies, and one participant noted that many of the agencies
she visited pushed a pro-life agenda and didnt have any moral support or [help
with] decision making. This coercive phenomenon is still prevalent among many
adoption agencies, but it is important to note that the participants had access to a
market of agencies and thus a choice to give their business to the agency that suited
them best. The participants chose this agency because it provided a lot of
informational and emotional support to them without a political agenda, something
that was seldom provided for the birthmothers of the previous eras, so while the
experiences of the participants reflect a specific agencys practices, their experiences
illustrate that birthmothers today have more options than ever before (Fessler 2006).
The open adoption phenomenon may be the most radical shift in adoption
options for birthmothers. Brown et al. (2007) report that approximately 25-35% of
birthmothers are now choosing entirely open adoptions, meaning all aspects of the
adoption are open to birthmothers, adoptive parents and adoptees, and almost no
women choosing adoption today [seek] anonymity or express a desire for no ongoing
information or contact (Evan B. Donaldson Adoption Institute 2007:5). The open
adoption model is removing the veil of secrecy and no longer attempting to force the
adoption model into a normative, nuclear family model. All of the participants in this
study used an open adoption model that ranged from receiving regular pictures and
phone calls from the adoptive family to almost daily phone conversations with
adoptive mothers and weekly visits with the adopted child and parents. Their positive
experiences are representative of many studies that report higher satisfaction rates and
5 In discussing the positive experiences of the participants, it is necessary to note that due to sampling
difficulty in finding birthmothers who used doulas, the participants all used the same adoption agency,
and so their experiences may not be representative of all agency experiences.
increased grief-resolution in birthmothers who have ongoing contact with adoptive
families (Christian et al. 1997). As Vicki reported, I hate wondering. And dont
want to be like I wonder how hes doing today. Laura reported similar feelings
saying, It was a lot easier to know that she would know that I loved her; Laura was
allowed to bring her child her breast milk post-partum and maintains contact through
emails and phone calls. Similarly, Vicki has been to the adoptive parents house, but
she reports that people have been shocked by this asking, Youre going to see where
he lives? Youre going to his house? Her response: Yeah and whats your point?
Im not going to steal him...
Elizabeth has a very open adoption arrangement, more so than the average
birthmother. She calls the adoptive mother, definitely my best friend, as seen in
their daily phone conversations and weekly gatherings. She also reported that
outsiders were suspicious of her ongoing contact with the adoptive parents. In the
beginning of the adoption, while Elizabeth was still pregnant, she didnt even want to
select the family, to see their faces. She gave the adoption counselors her criteria:
same-race, active lifestyle, religious, non-television-watching with good morals, and
had them choose a family for her child. Then, the night before she went into labor,
she decided she did want to meet the adoptive parents. After the birth, their
relationship escalated which caused suspicion from the adoptive parents relatives;
to assuage their fears, the adoptive parents brought Elizabeth on an out-of-state
vacation to meet their extended family, to prove that shes cool...not some druggy
that doesnt know what shes doing with her life. These fears, founded in stereotypes
and sensationalized stories and allowed to perpetuate due to the secrecy surrounding
birthmothers and their experiences, illustrate the pervasive belief and the lag between
the changing adoption models and the publics perception of the adoption process.
Still, despite the success and popularity of open adoption models, adoption laws are
not keeping pace with adoption practice. Only 24 states have laws that enforce open
adoption agreements, so if an adoptive family chooses to break contact with a
birthmother in contradiction to their adoption plan, there is no legal recourse for
birthmothers since they have legally relinquished all rights to contact (Page 2011).
Though Colorado does not enforce open adoption contracts, it is one of the states that
enforces greater regulation in adoption, but the variations between the different state
laws make deconstructing the body politic problematic.
State by State
Adoption effectively remains the only unregulated business in America, and
each individual state determines the legality of different adoption practices leading to
gross differences between state adoption laws (Freundlich 2000:23). Though, in the
U.S., kinship is defined as biogenetic, it is also marked by what Schneider (1980)
calls enduring, diffuse solidarity, or love which can both be conjugal (husband-
wife) or cognatic (parent-child); the lack of oversight in this alternative kinship form
is contradictory to this concept (61). Though we have given children a sentimental
value, leading to an increase in adoption rates and indicative of the emphasis on
cognatic love in kinship, our institutions have yet to infuse their regulatory practices
with the same values of our kinship system. Rather, states have been allowed to
operate under different adoption paradigms, and some have opted to use a more
market-driven model that prioritizes free enterprise as being in the best interests of
the members of the adoption triad.
Nationally, adoptions are performed by adoption agencies (faith-based, not-
for-profit and for-profit), independent adoption lawyers or facilitators, and with the
growth of the internet, more people seeking to relinquish and adopt are meeting and
arranging adoptions independently of any third party assistance (Pertman 2000). Yet,
each state differs in specifying which parties can perform adoptions (Pertman 2000;
Freundlich 2000). For example, some states like Colorado only allow agency
adoptions in an attempt to more strictly regulate adoptions, but in other states
independent adoptions through lawyers are seen as being more efficient and allowed
to proliferate (Pertman 2000). Also, national laws allow for third-party adoption
parties to charge reasonable costs associated with adoption, but each state differs in
the definition of reasonable costs; some states specify that reasonable costs given
to birthmothers only include medical expenses, but other states include covering costs
of living and transportation for birthmothers. So, what in one state is a legal
birthmother allowance could be baby-buying in another (Pertman 2000). Another
variation between states is the time required to pass before a birthmother can legally
sign away her rights; this period can be as short as 48 hours and as long as six months
This variation between states reflects different models of governing market
activity. Louisiana, for example, has become a nest for adoption lawyers seeking to
capitalize on the business of adoption (Freudlich 2000:12). Louisiana allows
independent lawyers to perform adoptions with little regulation, so while costs are
high, adoptions are performed more quickly and lawyers allowed to realize
substantial fees for services rendered, commonly referred to as gray market
adoptions (Freudlich 2000:12). Birthmothers cannot voluntarily surrender their
rights before five days post-partum and allowable expenses that the birthmother can
receive include medical, legal, mental health, and living expensesall up to 45 days
post-partum (Evan B. Donaldson; Adoption Media N.d.). Because of the flexibility
allowed in Louisiana law, adoptive parents will find birthmothers in other states and
overseas and cover the transportation fees to bring them to Louisiana to ensure a
speedy and efficient adoption. In a state such as this, where regulation is lax,
financial incentives for birthmothers increase, and the potential for for-profit adoption
practices to flourish increases (Freundlich 2000). In this model, adoptive parents
yearning to adopt, and birthparents who generally have lower social and economic
status are both vulnerable to the private enterprise of adoption that leads to more
intense commodification (Evan B. Donaldson Adoption Institute 2007:7).
Conversely, Colorado state laws heavily regulate adoption practices.
Independent lawyers are not allowed to perform adoptions, and instead, all adoption
must be performed by accredited agencies. Only four states mandate that adoptions be
performed by agencies; the idea is to ensure that all parties receive adequate
counseling as well as to minimize the possibility of other service providers operating
as though they are merely running a business in which the product happens to be
children (Pertman 2000:42). With agency adoptions, costs are lower, but the process
takes longer. Besides the sole reliance on agency adoptions, Colorado law also limits
reasonable costs to medical costs, orders counseling to adoptive parents and
birthmothers, provides a decision-making model for birthmothers so they are aware of
their options and extends the time before which a birthmother can relinquish her
rights.6 Though an original form is signed to allow the child to live with the adoptive
parents immediately post-partum, birthparents cannot officially relinquish their rights
for several months. In a state such as Colorado, where adoption is a public process
rather than a private enterprise, commodification is less intense as seen in the
limitations placed on potential incentives provided by agencies and demands that
birthmothers can make.
It is difficult to ascertain if the participants experiences are a direct reflection
of this increased regulation in Colorado or if they illustrate the benefits of their
specific agency, but the agencys practices are strictly regulated by the state. Studies
on the outcomes for birthmothers, adoptive parents and adoptees according to
increased or decreased regulations have yet to be done but could greatly increase our
understanding of the benefits and risks of different adoption models. Laura said, The
one thing I love about Colorado is that they are very pro-mom; she felt that the laws
and the agency protected her best interests and helped her find a model that worked
for her. Elizabeth described the process of increasing communication as a decision
between herself and the adoptive family, which the agency helped facilitate. Elizabeth
also appreciated that they helped her with her decision, playing devils advocate for
each option. Vicki, who didnt have health insurance or any knowledge of where to
6 Paternal notification and relinquishment laws also vary by state and are potentially more problematic.
Mandatory notification of relinquishment has proven to be unconstitutional given the chance that a
birthfather may be difficult or impossible to find. Instead, many states have enacted Putative Father
Registries where men who think they may have fathered a child can register for notification in the
event that their sexual partner intends to relinquish (Pamess 2005). Many states have language in then-
adoption laws that states that locatable unwed fathers are 'entitled' to notification" which includes
information about the Putative Father Registry (Arcaro 2008: 18). This slightly absurd practice has not
been very successful but an alternative solution that equally respects the rights and privacy of both
birthparents and allows for special circumstances (such as being unable to locate the birthfather) has
yet to be found.
go, commented that without the agencys assistance she would have struggled to get
adequate pre-natal care. The large amount of care provided by the agency reflects
strict state standards that while potentially increasing bureaucratic slog for adoptive
parents, have the potential to better safeguard birthmothers rights.
As Sawicki (1991) argues, though the total absence of power is an abstraction,
we are never trapped by power; its always possible to modify its hold, in
determined conditions and following a precise strategy (3). Participants positive
experiences with the adoption process illustrate how the body politic and its power
over members of the adoption triad has been modified within the existing framework.
Though members of the adoption triad and legislative bodies are challenging the
current model, as seen in in the ongoing sealed birth record debate, the financial costs
of adoption and the sometimes gross abuses of the system to procure children, these
participants were not harmed by these potential problems. Instead, theyve benefitted
from the insurrection of subjugated knowledges and, ironically, from the
commodification of the adoption process since their bodies are the producers of this
scarce resource (Sawicki 1991). This is not to suggest that applying laissez faire
principles to adoption is appropriate or ethical; instead, other models could afford
more rights to each member of the triad. This irony speaks to the assertion that
motherhood has been both a source of power and enslavement for women; for
birthmothers in the adoption process, it is apparent from this research that while the
rights newly afforded to them have been hard-won and affected by many larger
structural forces, they are also contingent upon the idea that there are producing a
good that is highly valued in a free market system. Additionally, the lack of federal
oversight and variation between state enforcement of more free market principles
(Louisiana) or greater levels of regulation (Colorado) reveal the ambiguity still
present at a structural level. This structural ambiguity filters down and helps us to
understand how the ambiguities in the previous chapters persisthow the social body
is rewarding mothers with one hand and recriminating with the other, and the
individual bodies of birthmothers are struggling to mediate the space between
connecting and disconnecting with the fetus, the child and their identities as mothers
In the previous three chapters, I explored the embodiment process of
birthmothers in the adoption process. These bodies are intricate processes unto
themselves, but also exist in concert, coalescing into a whole, embodied self. The
individual phenomenological experience of connecting and disconnecting with the
fetus does not occur irrespective of birthmother stigmatization in the social body or
ambiguity in adoption regulation of the body politic. In each of these bodies, I have
discussed the difficulties associated with negotiating a birthmother identity in a
culture that largely lacks an understanding of this phenomenon. While participants
narratives reveal resilience despite the challenges they have faced in their
relinquishment experiences, they also reveal, especially in the individual and social
bodies, the stress associated with this process. How can we use this information to
improve conditions for birthmothers?
Shifting from my theoretical framework, this chapter focuses on the
application of a potential intervention for birthmothersthe provision of doulas. Due
to the abundance of literature on the benefits of social support and doulas, particularly
among vulnerable populations, I asked, does a doula provide additional benefits to
birthmothers, including an improved post-relinquishment experience? The
birthmothers in this study are unique in that they were selected because they had used
a doula for their relinquishment births. To adequately explore the experiences of the
birthmothers in this study, I will discuss the concept and application of social support
theory and how it affects birthmothers. In applying this literature to the participants
experiences, I will analyze the participants existing, informal social support systems
(family, friends and partners) and how the formal support of a doula can complement
and/or supplement both strong and weak social support networks.
Social Support Framework
The study of social support as a theoretical concept and practical application
has fascinated and stymied social and medical scientists. Though the exact process by
which social support functions is unknown, it is clear that under certain conditions,
social support can be both preventive and reactive to stressors that could harm the
mental and physical health of individuals. Some argue that social support is a
metaconstruct that is a higher order theoretical construct consisting of several,
discrete theoretical constructs (Vaux 1988:28). Others argue that social support is not
a theory per se, rather they are concepts that describe the structure, processes and
functions of social relationships (Heaney and Israel 2008:193). This latter, low-level
theory concept of social support seems more useful considering the number of
complexities and inconsistencies that have surfaced in attempts to construct a
universal theory of social support (Cohen and Syme: 1985:20). This lack of a
theoretical and operational definition that is not easily defined or measurable
results in almost anything that infers a social interaction being classified as social
support (Hupcey 1998:1231; 1236). Definitions are varied and include: well-
intentioned action that is given willingly to a person with whom there is a personal
relationship and that produces an immediate or delayed positive response in the
recipient (Logsdon et al. 2004 607); actions intended to be positive, consciously
provided... in an interpersonal context of caring, trust and respect for each persons
right to make his or her own choices. (Heaney and Israel 2008:192); defined as the
resources provided by other persons (Cohen and Syme 1985:4).
For the purposes of this study, I am utilizing the broad, descriptive models
provided by Heaney and Israel (2008) in which social support is defined simply as
aid and assistance exchanged through social relationships and interpersonal
transactions (191). The authors utilize four broad categories of supportive behaviors:
emotional support; instrumental support, or tangible aid; informational support; and
appraisal support, or constructive feedback and affirmation (190); they argue that
these various forms of social support may promote health directly and/or due to a
buffering effect where having enhanced individual or community resources
increases the likelihood that stressors will be handled or coped with in a way that
reduces both short and long-term adverse health consequences (194). Though some
have argued that these effect models are incompatible, Heaney and Israel (2008)
argue that they are not mutually exclusive and propose the model illustrated on page
51 for understanding the multi-causal pathways for social support. I have adapted the
model to include bulleted examples from this project, but the conceptual ideas (in
bold) and the pathways are the same as Heaney and Israel (2008).
In this model, Pathway 3 represents how social support filters and reacts to
stressors such as the stigmatization of birthmothers or potentially feeling
overwhelmed in a hospital birth or the adoption process. Social support can then
produce a number of different pathways to improved physical, mental and social
health outcomes. Pathway 1 represents the direct effect of social support in
ameliorating stressors and enhancing health. In connecting the sources of social
support to the health outcomes for birthmothers, a stressor such as the unfamiliar
territory of the hospital can increase catecholamine production which in labor can
decrease blood flow to the uterus, placenta and fetus causing the fetus to conserve
oxygen and increasing the potential for dangerous fetal heart rate decelerations (via
Pathway 3). When a doula is present, the social support she provides can mitigate
against the secretion of these biologically active amines, so she is able to improve
quantitative birth outcomes (Meyer et al. 2001:60). Pathways 2 and 4 represent how
informational and instrumental support can increase access to community resources
and individuals ability to cope. In accessing these new resources and information, an
individual may be able to achieve a more desirable outcome and increase her sense of
control over a situation. This is clearly seen in the literature on doulas which reports
that doula-supported mothers feel more in-control with their doulas due to either
information or the advocacy provided by the doula (Hodnett et al. 2007; Meyer et al.
2001; Koumouitzes-Douvia and Carr 2006; Kayne et al. 2001). Pathways 2a and 4a
refer to the buffering hypothesis where this access to resources and bolstering of
coping skills provides a buffer against other present or future stressors. In more
informal support systems, family or friends may help a pregnant adolescent find an
adoption agency (Pathway 4) that in turn, sensitively assists her in navigating the
legal process of relinquishment (4A)a potentially stressful process. Finally,
Pathway 5 illustrates the potential for future health behaviors to be affected by social
support. This more tenuous hypothesized pathway posits that, for example,
birthmother support from parents who are forced to confront their daughters
sexuality could lead to discussions about future methods of contraception.
These pathways illustrate the multitude of potential processes of social
support and the difficulties in creating a uniform model. Is it possible to separate the
effects of familial social support from community social support? Can a model
quantify social support? What are the benefits of informal versus formal social
support? Is less social support from more people better than increased social support
from fewer people? How do individual personalities affect social support models? Do
variations exist between cultures, and how do we control for other social forces?
Though social scientists are still grappling with these questions, studies show that the
provision of social support improves physical, mental and social health, regardless of
the complexity or ambiguity in determining causality.
Several studies have examined the potential effects of social support for
birthmothers and posited that a lack of social support makes the already vulnerable
birthmother increasingly vulnerable to long-term emotional health problems (Doka
1989; Mander 1995; Winkler and van Keppel 1984; Romanchik 1995). The
birthmother experiences what Doka (1989) identifies as disenfranchised grief, grief
that is not openly acknowledged, socially accepted or publicly mourned (27).
Kubler-Ross identifies the five stages of grief and expresses that for the full grief
resolution process to occur the griever must fully experience the range of emotions,
but, in the birthmother experience, the social constructs are not in place to facilitate
the healing process (Aloi 2009:28). A few seminal studies on the birthmother
experience reveal a pattern that indicates birthmothers feeling they cannot express
their grief and that their grief is shrouded in a conspiracy of silence due to societys
discomfort or inexperience with birthmothers (Mander 1995:131; Winkler and van
Keppel 1984; DeSimone 1996; Logan 1996). Henney et al. (2007) indicate that
control" in binh
SocUl Networks and Social
Unfamiliar territory (hospital and'or adoption)
Physical. Mental and Social Health
health knowledge and
Figure 6.1: Social Support Chart
[Heaney and Israel 2008:194 (adapted)]
"healthy grieving for birthmothers is best facilitated by having a nonjudgmental and
supportive environment in which to express their feelings, understanding people
supporting them in the process, [and] engaging in ritual to commemorate their loss"
(877). Leon agrees with this and applies it to the birthing experience when he states
that, regardless of women's choices to parent or relinquish their children, they are
"entitled to have the delivery remembered and respected as milestones in their lives"
(1999:129). Winkler and van Keppel (1984) found that the strongest indicators for
psychological maladjustment post-relinquishment revolved around a lack of social
support that was felt as an inability to talk through feelings about relinquishment
(1). One birthmother stated this feeling well saying, It is like somebodys died but
when somebody dies it is different because it is talked about (Mander 1990:63).
Over 78% of the birthmothers in the Winkler and van Keppel (1984) study wanted to
discuss their feelings regarding their relinquishment. Those who reported that they
could discuss their feelings exhibited a more satisfactory adjustment within 12
months post-partum. DeSimone failed to find a strong correlation between social
support and post-relinquishment adjustment, so further research needs to examine this
relationship. Despite the discrepancy between these studies, numerous sources call for
an increased understanding of the birthmother experience and how the community
can better serve this socially marginalized population (O Leary et al. 2005; Evan B.
Donaldson Adoption Institute 2007; DeSimone 1996; Henney et al. 2007).
Even less certain but still of some note is the medical care provided for
birthmothers relinquishing since the birth of the child and the act of separation both
generally occur within the biomedical system. Leon (1999) argues that physicians are
ill-prepared to handle the special circumstances of relinquishment but must become
better equipped; Mander (1995) makes a similar argument with midwives in the
British model of care, and several articles (Aloi 2009; Gilliland 2002; Devaney and
Lavery 1980) discuss the potential role of labor and delivery nurses in providing
social support to mothers but note the difficulty due to busy labor and delivery wards.
The birth experience for birthmothers is understandably bittersweet and difficult, but
Devaney and Lavery (1980) found that after exploring their feelings, most
[birthmothers] want their birth experience to be as rewarding and emotionally
fulfilling as that of married women (377). Unfortunately, due to their young age,
lack of social support and the absence of childbirth education, these women may enter
the hospital with little to no knowledge of the childbirth experience and may be
susceptible to feelings of being overwhelmed, isolated and not in control of their birth
experiences (Devaney and Lavery 1980). The biomedical model does not give
priority to providing the kind of emotional support a birthmother may need during
birth and immediately postpartum, and the female figure as non-medical birth
attendant has not become mainstream though many studies show that it is financially,
physically and psychologically beneficial to the mother (Kayne et al. 2001; Gilliland
The birthmothers in this study benefitted from informal support systems and
their doulas. For all of the participants, these sources of support provided, in varying
capacities, emotional, instrumental, informational and appraisal support. Though the
literature on birthmother support fails to address sources of social support (formal
therapist versus informal family), and although I am specifically interested in formal
social support from doulas, it is critical to first account for the varieties of informal
social support that birthmothers received from family and friends.
The Patchwork Quilt of Informal Birthmother Support
Logsdon et al. (2004) use the patchwork quilt analogy to discuss the diverse
and complicated sources from which adolescent mothers gather and receive informal
social support. This research is important considering the variety of studies that have
illustrated the benefit of social support on pregnant and parenting teens (Wortman and
Conway 1985; Logsdon et al. 2004). While many adolescent mothers receive support
from their parents, the father of the child and their peers, these relationships are
frequently inconsistent and/or unreliable, so adolescent mothers must patch together
a quilt of available social support resources (Logsdon et al. 2004:609). In relating this
framework to the birthmothers in this study, who were 17-20 years old at the time of
relinquishment, I observed the same patchwork phenomenon, but the level of support
provided to each participant greatly varied.
Vicki had fewer sources of informal support than the other participants and
had the most financially strained living situation. Though she benefited from having
an ongoing relationship with the father of the relinquished child, she was estranged,
emotionally and geographically, from her closest family members. Besides the lack of
support, she also experienced negative feedback from her immediate family since her
father did not approve of the decision to relinquish. While she felt if she had
absolutely needed him he would have been there, he didnt want to participate in it
because it would have hurt him even more. Though Vickis mother was supportive,
she lives in another state and was unable to be physically present for the pregnancy,
labor or postpartum period. Still, Vicki found solace in talking to her mother about
relinquishment despite the distance saying, Shes really good about it. How come we
kind of grew up in that situation. She knows what its like. In relating to her
mothers experience of potentially raising a child in what she called, the whole poor
thing, like her mother did for her, she received appraisal support in her decision.
Also, Vicki and her partner lived with her partners mother, and the rest of his family
was supportive as well. Despite these sources of support, Vicki lacked a great deal of
information and instrumental support. Prior to meeting her doula, she had very little
knowledge of pregnancy and childbirth. Instrumentally, she had to use gas cards from
the adoption agency, was kicked off Medicaid postpartum and even drove herself to
the hospital when she was in active labor. The tangible aid she received from
informal support systems was limited but not necessarily reflective of a lack of caring
from those who were able to provide other forms of social support and likely more
reflective of a general lack of resources among her social network.
Lauras social support network was the most robust and cohesive in sources of
support and across the four categories of support. Her mother, stepfather, partner, best
friend and her partners relatives were all involved in and supported her through the
process in different ways. In fact, her mother was so involved with her pregnancy and
enjoyed it so much that she has since become a certified doula specializing in
adoption births. In addition to her doulas presence at the birth, Laura had what she
referred to as a birthing posse, which also included her mother, her best friend and
a midwife with whom she had become close. Laura never mentioned any instrumental
resources she felt were lacking in her relinquishment, and she went into her birth
incredibly informed because her mom researched birthing options and talked to her
about how much the medicine affects the baby and how one thing leads to
another. Because of this information, Laura opted for a natural childbirtha goal
she was very proud to have accomplished. The only potential gaps or difficulties in
her support system arose from the physical absence of her partner who had started
school in another area of the state and was not physically present for the latter part of
her pregnancy, her labor or her postpartum period. While Laura felt that he supported
her intensely during the process, his absence during the most difficult periods of the
relinquishment seems, from an etic perspective, to have further isolated Laura. This
corresponds to Clarks (2002) argument that perinatal women may emically describe
a supportive environment or relationship that from an etic perspective does not appear
to be very supportive
Elizabeths informal social support network, while stronger than Vickis, was
not as strong as Lauras. She was the only participant whose partner was not involved
in the process. Despite having been together for many years, when she informed the
father of the baby she was pregnant, he told her she was lying, and they separated. In
retrospect, she felt that her only regret about the whole experience was that the
birthfather was not involved more, but she did receive support from her immediate
family. Despite this loss, her father, her sister and aunt formed a protective shield
around her and helped her with adoption and childbirth decisions including finding an
adoption agency and making a birth plan (instrumental and informational), and
though her mother was not involved, Elizabeths estrangement from her mother was
already ongoing prior to her pregnancy. Elizabeth also received support from a tight
circle of girlfriends and her swim coach who helped to protect her from the other
students who taunted her during her pregnancy and afterwards (emotional and
instrumental). Elizabeth, like Laura, did not express lacking any instrumental support
and overall expressed great appreciation that her family was always there and she
didnt have to explain [her] self to them. She did express that though she received a
lot of support from her father, she does really miss someone being there emotionally
besides my father, indicating the potential benefits of patchwork support from
The social support provided by these informal networks was critical for the
participants. In interviews with Laura and Elizabeth, they both expressed that, despite
the stigmatization they experienced in their public interactions, the intense support
from those closest to them created the previously-discussed buffer between
themselves and the external stressors from these judgments. Elizabeth discussed the
bad days shed have at school and how her swim coach helped arrange for her to
leave school occasionally (instrumental support) and do work from home around her
family who just knew what I was going through (emotional support). Laura felt that
in the post-relinquishment period, other people didnt get it, but [my partner] got it
because he loved [their daughter] and he went through it too; this emotional and
appraisal support from an empathetic partner allowed her to work through her grief
process. Also, her mother allowed her to stay in bed for two weeks postpartum and
allowed her to have a safe space to grieve. Vicki did not appear to experience this
same buffering effect, which may be due to the more difficult financial situation and
more numerous external factors.
In discussing their feelings with their support network postpartum, all of the
participants had at least one person they felt they could talk with about the experience
of relinquishment and felt that was helpful. Originally, Laura said, I didnt want to
share it with anyone else because it was all I had of her... and I just wanted my story
to be mine; eventually, after seeing a therapist, Laura began opening up and
enjoying sharing her story with others, and her and her now-ex-partner honor each
other on Mothers and Fathers Day. She says she shows pictures of her daughter to
her close family and keeps them updated on her daughters growth. Elizabeth, who is
very close with the adoptive mother, reports talking to the adoptive mother the most,
and when I asked her if that was a struggle being open with the adoptive mother about
some of the difficulties of relinquishing, she responded that while it was at first, she is
now her best friend. Vicki reported that she talks to one of her friends about it and her
mom but did not describe these conversations in detail. In sharing who in their life
provided space for them to discuss their feelings about relinquishment, the
participants appeared to be happy. They identified their confidants as essential to their
lives but did not directly correlate being able to discuss relinquishment with their
The Birthmothers and Their Doulas
Doulas, as trained, non-medical labor companions, are uniquely positioned to
provide social support to birthmothers in addition to these informal social networks.
Literature shows that doulas provide much needed care to women, particularly
vulnerable women like birthmothers and despite variations in types of doulas, care
providers and overall birth experiences, all of the participants reported that their doula
was invaluable in helping them navigate the unfamiliar birth experience. This is
understandable given that historically and cross-culturally, sisters, mothers, female
neighbors and midwives have supported women during childbirth (Hodnett et al.
2007: 2). Traditional imagery of childbirth from ancient and indigenous cultures
usually include at least two women supporting the birthing woman, and a survey of
one hundred twenty-seven indigenous cultures found that all but one utilized the
support of a female companion in labor (Meyer et al. 2001). But with the transition to
hospital births in the mid-twentieth century, this practice was lost in favor of a more
controlled, clinical environment (Davis-Floyd 2001; DONA 2008); childbirth, which
was once a deeply entrenched social event in which women bonded as they shared a
rite of passage, became a biomedical phenomenon devoid of the symbolic and social
aspects that had, throughout human history, imbued this life transition (Meyer et al.
2001:57; Davis Floyd 1993). In this new sterilized labor setting, the pathology of
pregnancy was emphasized, and traditional forms of labor support were eliminated
(Davis-Floyd 2001; 1993). This included excluding family and other support persons
from labor and delivery wards; women were attended only by labor and delivery
nurses whose jobs did not require or often even allow them to fill this vacuous void
(DONA 2008; Gilliland 2002).
The advent of the childbirth movement of the 1960s and 1970s reintroduced
familial support and more natural coping mechanisms into hospital settings.
Childbirth educators began encouraging women to have an outside labor coach
and/or advocate and mothers began requesting more personalized, uninterrupted
care within the biomedical birth models (Gilliland 2002). Female friends and relatives
began to fill this role in a personal, informal way, and it wasnt long before the next
logical step was attending births professionally (Gilliland 2002; 763). Certifying
organizations developed curricula that focus on providing four forms of support that
correspond almost exactly to the four agreed upon forms of social support (Davis-
Floyd 2001; Kayne et al. 2001; Heaney and Israel 2008). First, they provide
emotional support in the form of reassurance, distraction, eye contact, praise and
encouragementthe equivalent of emotional support and appraisal support in social
support models. Second, they provide advice and information about the physical and
mental aspects of birth as well as being familiar with the different medical
interventions and hospital policies that a woman could encounter in her birthor
informational support in the social support model. Third, they provide physical
support in massage techniques, alternative positioning and pressure points applicable
in laborthe instrumental support detailed in the social support model. Finally, they
advocate for the birthing mother in helping her to ask the medical personnel effective
questions and help her to be an active participant in the unexpected decisions that
may need to be made; while this does not fit into the four categories of social support
as neatly, it can be seen as contributing to the individual coping skills by
contributing to problem-solving abilities and perceived control (see chart p. 51).
Traditional doulas are required to meet with mothers once during their pregnancy, be
present for the entire birth and to visit the new mother in the postpartum period, but in
working with vulnerable populations, health promoters have developed a
community-based doula model that involves increased interaction in the prenatal
and postpartum period and a larger education componenta model that could suit
The social support provided by traditional and community-based doulas has
been proven to improve birth outcomes for mothers and infants. The presence of a
trained, non-medical labor support person has been shown to reduce average length of
labor, reduce the number of complications, and reduce the need for interventions such
as pitocin, forceps/vacuum extraction and cesareans that can increase risk for mother
and infant as well as the cost of labor (Hodnett et al. 2007; Chalmers and Wolman
1993). Qualitatively, doula attended mothers self-report higher levels of satisfaction
with their labor experiences and increased confidence in parenting skills (DONA
2008). Additionally, several studies (Wolman et al. 1993; Kayne et al. 2001;
Hans2006) have found that when community-based doulas are provided to socially
high risk mothers they have the potential to increase the mothers positive feelings
about labor, decrease anxiety, increase feelings of control and confidence as a mother
and decrease postpartum depression (Hans 2006:5). These vulnerable populations
include adolescent mothers, Hispanic immigrants, and urban women of low
socioeconomic status (Hans 2006; Breedlove 2005; Hazard et al. 2009).
This body of literature on doulas for vulnerable populations is what initially
led me to investigate whether this model could benefit birthmothers in a similar
capacity. While not conclusive, the data presented here makes a compelling argument
for further research into the potential benefits of doulas for birthmothers. The quality
of the feedback regarding the participants doula support, while well-framed in the
social support model, is, like the model itself, largely descriptive rather than
illuminating causal pathways to positive or negative outcomes. While I can suggest
that some of the positive outcomes reported by the birthmothers may potentially be a
result of either having a doula or other social support, the data do not directly support
this. Nonetheless, in exploring the doula support provided to the participants and how
it correlates to the categories of social support, the potential benefits are obvious.
Before reviewing the experiences of doula support, it is necessary to
contextualize the different participant experiences of doulas since no two births are
exactly alike and no two doulas are exactly alike. Vicki and Elizabeth used the same
doula, Katherine, who was also an adoption counselor at their adoption agency. They
both also utilized medical pain management technology and had obstetricians attend
their births. Vicki experienced the majority of active labor prior to receiving an
epidural and discussed her labor experience at length, expressing her frustration with
her care provider, her love for the nurses and the awesomeness of the experience.
Alternatively, Elizabeth received an epidural very early in her labor and had little
interest in discussing her birth experience at length other than to say, I got the
epidural, and it was easy as cake. On the other hand, Laura used a doula-in-training
who was still attending births to fulfill her certification requirements and was also a
friends older sister; Laura also had, at her request, an un-medicated birth and used a
certified nurse midwife; she reported, I really want to do this on my own and be able
to say I did this on my own. While the adoption counselor/doula that Vicki and
Elizabeth used was not a trained community-based doula, Katherine provided more
intensive care that more closely resembled the community-based doula model of care;
Katherine also, obviously, has extensive experience in adoption process and provided
a dual model of care that incorporated both her experience as an adoption counselor
and as a doula. Lauras doula, Kelly, while not particularly close with Laura, was able
to provide a more personal level of care in that she had known Laura for many years.
Also interesting is the inverse relationship of utilization of doula support, particularly
emotionally, and the strength of informal support networks. The stronger ones
informal support network was the less one relied on ones doula, and conversely, if a
participants informal support network was weaker, she relied more on her doula.
Laura, who had the most intact informal support network, utilized the
emotional support from her doula the least. She had many people to turn to other than
her doula and actively chose not to utilize her doula, Kelly, for her ability to provide
this more personalized support. Laura was interested in using a doula to gain more
informational and instrumental support, saying, she was a lot of help as a doula, and
I respected her in that professionalism aspect but not the personal aspect, which is
what I wanted of her. In the professionalism aspect, Laura commended Kelly for
her knowledge of pain management techniques, especially since she was interested in
and succeeded in having a natural childbirth. Because of Kelly, Laura used a TENS
unit, a small electrical muscle stimulation kit that helps alleviate back pain in labor.
Kelly also practiced massage techniques, accessed pressure points, helped suggest
different positions and coached Laura in her breathing. This very tangible aid was
precisely what Laura wanted and this partitioning of informal from formal support
is supported in some of the literature. Research suggests that formal support, while
providing more instrumental and informational support, fails in providing the
personal connection in informal support systems that creates a stronger bond where
emotional and appraisal support carries more meaning and thus has more protective
and reactive aspects against stressors (Heaney and Israel 2008; Hupcey 1998). Laura,
whose doula let her mom take over during the relinquishment process, had access
to other emotional support systems whereas the other participants support networks
were not necessarily as strong.
Elizabeth had slightly less informal support from family and friends than
Laura but more than Vicki. Again, she used the doula, Katherine, who was also an
adoption counselor and benefitted from the informational support for childbirth and
the emotional support in both childbirth and relinquishment. In being estranged from
her mother, Elizabeth had very little knowledge of childbirth, and since she did not
acknowledge her pregnancy until her seventh month, she very quickly had to make
sense of the pregnancy and childbirth process. She recalled, I didnt understand how
much was behind having a baby... it just wasnt ever a question to me. Devaney and
Lavery (1980) contend that one of the most important aspects of prenatal teaching
[for birthmothers] is preparation for labor and delivery, so Katherines wide range of
knowledge on pregnancy and childbirth was incredibly valuable to Elizabeth in
preparing mentally and emotionally for the experience (377). She recalls Katherine
going to the doctor with her for her first prenatal visit late in her second trimester,
Katherine brought up things that I didnt know about. About birth and
pregnancy and how the whole process works and what happens when
you go into having the baby and stuff. And then she brought questions
up that I could ask the doctor and get informed about that and what
happens if something were to go wrong. Something bad. She was just
like always there emotionally and brought up other questions that I
might have that I didnt realize I had.
Katherine also helped Elizabeth design a birth plan which Elizabeth mentioned
brought her a lot of relief in the fear of potential childbirth complications; Devaney
and Lavery (1980) suggest this as a potential benefit to the disenfranchised
birthmothers in increasing their sense of control and correcting misconceptions
regarding pregnancy and childbirth. This form of information and organization
corresponds to the increasing of perceived control through social support by
providing the individual with increased coping skills and access to resources.
For the actual birth, Elizabeth did not recall the experience as vividly as Laura
and Vicki; this could potentially be due to getting an epidural early on or the fact that
her labor was only about five hours total. In discussing Katherines support during the
actual birth, Elizabeths answers were brief and mostly concerned the informational
piece in that Katherine talked her through it. Instead Elizabeth talked extensively
about the emotional support that Katherine provided to her in the pregnancy and
Im pretty sure I couldnt have done it without her. That sounds stupid,
but she just helped me, like, know what I wanted emotionally and
physically and figure out what I wanted to do, like, with the adoption
and pregnancy. Just everything.
The informational and emotional support in the decision-making process were not
discrete categories for Katherine and very clearly provided an empowering sense in
that Katherine provided Elizabeth with information about many options and allowed
Elizabeth to decide. While not part of her doula duties, Katherine provided Elizabeth
with a number of different adoption models in the closed to open spectrum, and
Elizabeth felt strengthened in being able to control the level of openness with the
adoptive family. Elizabeths experience with Katherine post-relinquishment was also
very positive. Elizabeth said Katherine was easy to contact, talked about anything
and wouldnt pass judgment. Because of this ongoing support, Elizabeth felt
Katherine helped a lot with the grief and everything. This level of support and its
benefits make an argument for doulas attending adoptions to utilize a community-
based doula model. While Laura obviously benefitted from the more professional
support, Elizabeth and Laura, who lacked more of the personalized support in their
informal support structures and both had Katherine as their doula, appreciated the
more engaged doula approach that Katherine provided.
Vicki, who appeared to have the least support through her informal network,
benefited the most from having Katherine support her during her relinquishment
process. Vicki also expressed that she felt more overwhelmed and pressured by her
care providers which the other two participants did not encounter. Her experience is
discussed here at greater length since her perception of doula support illustrates the
increased importance of a doula for females whose existing support system is less
able or available to offer support and the value of doulas in some biomedical birth
Vicki, like Elizabeth, had very little knowledge of pregnancy and childbirth,
so when she met with Katherine during her pregnancy,
I had a bunch of questions for her.. .because I had no idea what the
heck I was doing and didnt know anything. So she was there
explaining throughout the whole thing, this is what your baby looks
like now and this is what you should be doing and blah, blah, blah.
In lacking informal support from other women who have had children, Vicki relied
heavily on Katherine for this information and seemed to benefit the most from this
informational support in the prenatal period. Still, for all women and especially
women who plan to relinquish, they are likely to feel a great deal of anxiety when
[they] arrive at the hospital, and Vicki felt overwhelmed in the fast-paced hospital
setting (Devaney and Lavery 1980:377). After having to drive herself to the hospital
while her partner was at work, Vicki was able to call Katherine who dropped
everything and came, which was really cool; here, Katherine was able to fill the void
of Vickis informal support system, and Vicki was thankful for this because once she
was in the delivery room, the doctors offered Vicki a number of drugs. She
remembers her confusion:
I was like, I dont even know what that stuff does and what are the
effects on the baby.. .they just wouldnt explain anything.. .the doctors
dont want to explain anything. They were just like do you want this or
that? What do you want? We need to know now.
In this environment, Katherine was able to offer both informational support and the
advocacy that doulas are trained to provide. While not making decisions for Vicki,
she answered Vickis questions about the drugs when the doctors would not or could
not explain the benefits or the risks of the different drugs, and if she was unfamiliar
with a particular intervention, she would have the doctor explain it to her and relay
that information to Vicki. If Vicki was still unsure of which avenue to pursue,
Katherine would offer her opinion based on information she already knew about
Vicki; for example, Vicki wanted to avoid any drugs that affected the baby, so when
the doctors offered Vicki unfamiliar narcotics, Katherine reminded Vicki that these
drugs would cross the placenta.
Besides some confusion, Vicki also expressed a sense of losing control since
the doctors were so rushed on everything. They wouldnt really give me a chance to
think. To explain anything. But, Katherines questions and continuous support
empowered Laura who was able to follow the birth plan that she and Katherine had
designed based on Lauras desires and Katherines knowledge. In sharing the
knowledge of Vickis birth plan, Katherine was able to vocalize things for Vicki who
was preoccupied with her birth experience. Vicki said, [Katherine] already knew
what I wanted versus the doctors who she felt were very persistent and trying to get
it all done super quick. Vicki took note of this advocacy piece when I asked her what
she thought about other women having doulas or having one in the future:
I definitely think everyone should have one. Just especially like if you
dont know what youre getting yourself into, to have someone stand
in for you and be like look, look here doctor. Here is what is going to
happen. Youre going to slow your roll.
Vicki also appreciated Katherines instrumental support such as massage
techniques, pushing techniques and all that great stuff. Since she was feeling the
majority of her contractions in her lower back, Katherine used tennis balls to rub that
area and included Vickis partner, who was all flustered and I dont know what to
do, by teaching him how to physically assist Vicki through her labor experience.
Katherine also helped Vickis partner provide more emotional support for Vicki since
they began to argue a lot while she was pregnant. Vicki felt that Katherine provided
Vickis partner with perspective considering the weight of what Vicki was
experiencing saying, you need to give her...listen to her.. .go with it. Vicki said this
mediating force that Katherine provided made them a lot stronger, but was only one
piece of the emotional support that Katherine provided.
Besides supporting Vickis and her partners relationship, Katherine also
supported Vicki in her relinquishment experience. Since Katherine was also an
adoption counselor, she was uniquely suited to assist Vicki in the emotional process,
but community-based doula models operate similarly with specialized training and
increased involvement. Vicki, who had relinquished several months before our
interview, had heard from Katherine a couple weeks ago. She was checking in on
me.. .after all this time. Since Vicki definitely grieved a lot and said it was really
hard, still is, she confided in her doula,
Katherine was there, still is. Just to talk to, which was great. I mean
talking to [my partner] about it is different than talking to someone
who deals with it. She doulas all the time for other women. She just
knows the whole.. .she knows what its like. It was really nice to talk
to her about it. It helped a lot. It made me feel so much better. You
know?.. .Being able to talk to her. Her giving me input. Just listening
and being there was awesome.
Vicki obviously greatly benefitted from the emotional support of being able to talk
through her feelings of relinquishment as other birthmother research has suggested
(Mander 1995; Winkler and van Keppel 1984), but for Vicki, a doula who was also
an adoption counselor provided unique and appreciated insight. Mothering the
mother is a phrase often used by doulas and this characterizes Vickis experience
with Katherine. Vicki describes Katherine and all doulas as, very caring...they are
there for support. Repeatedly, at different points during the interview, Vicki extolled
the support Katherine provided: Without her, there is no way I couldve done it; I
couldnt imagine doing it without her; 1 honestly dont know what I wouldve done
The benefit of social support on health outcomes is indisputable, and while the
mechanism by which this occurs may be contested, the stories of these birthmothers
augment the argument that birthmothers can receive additional value from social
support due to their increased vulnerability. For some birthmothers who have an
already-existing social support system, the benefits of the more formal support of a
doula may be limited, but in Lauras experience, there were still many advantages to
having a doula. Additionally, for birthmothers who have a less intact support system,
the ways in which a doula can support these women increase. Elizabeth and
especially Vicki received advantages from not only the less personalized aspects of
care like labor positioning and knowledge of pain medications but also the increased
support in decision-making, advocacy and talking through feelings of relinquishment.
Though the limitations of this research model prevent generalizations, it is
quite noteworthy that the data presented throughout this project contradicts the
majority of the literature regarding birthmothers that regularly presents a litany of
psychological problems as a direct result of relinquishment. While determining
causation for the seemingly improved post-relinquishment experiences of the
participants (compared to other studies) is problematic, the positive experience of
birthmothers using doulas begs further research to determine if doula support could
be a low-cost intervention that improves birthmother experiences and supplements
already existing social support systems.
A societys kinship system reflects underlying ideologies that can illuminate
broader realms of thought since the way people think about kinship will affect other
ideas about the relatedness between human beings (Strathem 1992:15). In seeking to
understand how a biological process becomes one of the fundamental building blocks
of social organization, kinship allows us to discover how societies connect and
understand the relationship between nature and culture (Strathem 1992). These two
domains, united in unique ways within each societys kinship system, provide
powerful tools for understanding how societies organize themselves and for
comprehending the naturalness all that organization entails (Schneider 1980). In
exploring the experiences of birthmothers who have used doulas, this project helps to
understand how birthmothers construct identity based on these cultural norms that are
a result of our societys construction of the relationship between nature and culture. In
challenging the trope of motherhood in our kinship system, the study of birthmothers
and their experiences can show how this model of nature and culture operated
historically, continues to operate and is in many ways going through a transformation
that must acknowledge and accommodate alternative kinship systems. Though
adoption as an informal institution has been in existence since the colonization of
America and as a formal institution since the early 1900s, its recent emergence as a
valid, yet different, family form rather than a secret arrangement that was intended to
masquerade as a traditional nuclear family represents a marked shift in the way
adoption has been performed and received within our culture (Carp 1998; Perrtman
2000; Modell 2002). The increasing popularity and acceptance of assistive
reproductive technologies, same-sex unions and other tests to the nuclear family
prototype have forced kinship studies to focus on the practice and process of kin
relationships in this dynamic time (Levine 2008:377). With this revolution in
domestic life, the practice of adoption and the process of becoming a birthmother
have undergone dramatic transformations but a cultural emphasis on biogenetic
connection...as a basis for conferring irrevocable kinship still persists and in some
ways negatively impacts birthmothers (Levine 2008:377;385).
The research presented here reveals how the birthmother experience is
changing and mostly improving in Americas new adoption climate but also how
some negative stereotypes persist. While the birthmother experience of the 1950s-
1970s left an unfortunate and traumatic legacy, the experiences of those women and
the outcomes associated with relinquishment are different from the birthmothers of
the present, burgeoning open adoption era. The birthmother experience, as explored
here, is still fraught with difficulties such as reforming non/mother identities and
dealing with still-present stigmatization, but research into open adoption models as
well as the research presented here has shown decidedly optimistic results. For many
birthmothers in America, it is getting better. Rather than feeling as if they were
coerced or treated unfairly, as birthmothers from previous generations report, the
participants reported that the most difficult aspects of relinquishment were their
internal struggle from the experience of dis/connecting and their social stigmatization.
Thus, things are improving dramatically at the level of the body politic, and the
participants narratives reveal that cultural norms regarding kinship are no longer
being institutionalized as absolute truths that marginalize persons who defy them.
Still, these norms exist within the social and individual bodies, so it is important to
further explore the experiences of birthmothers as well as actively engage the
adoption community to identify future areas of improvement for birthmother support
The enormous body of literature on the benefits of doula support combined
with the very preliminary results presented here on doula support for birthmothers
provides an excellent platform from which to pursue further study into this simple
and low cost addition to holistic birthmother care. This project was not designed to
discover specific outcomes associated with doula support such as a direct relationship
to the grief process post-relinquishment, but the participants enthusiasm for their
doulas clearly shows that doulas have the potential to help birthmothers during this
incredibly vulnerable time. These data prove that this field of study is worth further
inquiry. Future research may explore comparative results between birthmothers who
have been provided doulas and birthmothers who have not, how community-based
adoption doulas versus traditionally trained doulas may have different results and
how doulas can improve short-term and long-term physical and mental health
outcomes specifically for relinquishing women. Additionally, since very limited
research has examined the actual birth experiences of women relinquishing, we
cannot yet determine how fast-paced, biomedical birth environments could potentially
further disenfranchise this already-disenfranchised population. Doulas can assist
women in providing a holistic model of care for birthmothers in their pregnancy,
labor and post-partum period.
Also, while the participants in this study had positive encounters with the
institution of adoption, the data presented here on the plethora of routes available for
those pursuing adoption could provide insight into which adoption models provide
birthmothers with the most rights. No study has yet examined the different
experiences of birthmothers in independent adoptions, agency adoptions and lawyer-
led adoptions. The positive experiences of the birthmothers in this study may indicate
the benefits of the adoption agency model that includes increased regulation rather
than a private enterprise model seen in states such as Louisiana. Birthmother
coercion, while not the epidemic it once was, is still actively practiced by many Crisis
Pregnancy Centers that operate under pro-life agendas (Joyce 2009). Increased
awareness of how these models are allowed to operate, how the members of the
adoption triad are treated in each and how this affects the long-term adjustment of
these groups could help regulatory bodies determine and implement healthier
adoption models, since, as seen through the three body framework, reproduction and
adoption are individual experiences, situated in the social structure and regulated by
Methodologically, the depth of the research presented here is also a testament
to the power of an emic perspective when engaging a vulnerable, hard to reach
population. As a birthmother, I was able to develop a rapport with the participants
that allowed them to narrate their stories without fear of stigmatization, a well-
founded fear given their experiences with community encounters. Additionally, some
of the most engaged parts of the interview came as a result of the end of the
interviews where I allowed the participants to ask me questions about my experience.
Having relinquished approximately eight years before the interviews, at least six
years before the participants, they were very curious to hear my perspective having
had more time to reflect on my choice. They were also interested in my adoption
model. Having used an adoption lawyer in a much more closed model than the
participants used, they used my story as a further discussion of their own experiences
in comparison to my experience. Their engagement and the ensuing dialogues during
this period elicited some of the most provocative data.
Ultimately, the goal of this project was to give a voice to this seldom heard
population. Since birthmothers have largely been neglected in the literature and the
publics imagination, many people have little knowledge of who birthmothers are,
how they perceive their loss and how they feel about their relinquished child. Since
the participants reported some of the most difficulty with the social stigmatization
part of their relinquishment, these stories may hopefully speak to those who would
negatively judge a person choosing to relinquish. In sharing these narratives, I hope to
part the veil of secrecy surrounding the birthmother experience. Though this sample
was limited and the results not generalizable, the interviews were successful in
helping to present a holistic picture of the birthmother experience, from an individual
to a structural level. This research represents a contribution not only to the public
portrayal of birthmothers but also to the academic fields understanding of
birthmother identity since many studies in this area are still biased. By allowing these
women to narrate their relinquishment experiences without inserting negative bias
based on the assumption that birthmothers inevitably develop some pathology as a
result of relinquishment, this research shows the depth, though not breadth, of how
relinquishment affects a person. Despite numerous studies that explore birthmother
trauma, these womens stories show that relinquishing does not always result in long-
term emotional distress.
The many positive responses of the participants illustrate the changes in the
adoption experience and the importance of removing bias from research designs in an
attempt to more accurately reveal the process of relinquishment. The life histories of
the participants would seem to suggest that birthmother experiences are far more
complex than usually depicted in the media or the research literature. The experiences
of these women and other current birthmothers are worth further exploration. I hope
the stories these women so graciously shared may shed light on future avenues of
study and provide insight into the embodiment process as well as potential ways to
further improve the birthmother experience through increased social support.
COMIRB Protocol Approval
UMwaxa wearers* Hose*
Dvrrm TWMn trMkal Cooar
Certificate of Approval
COMRB Protocol 104)481 Initial Appfccation
Battling Voices of Grief: Exploring the Role of Doutas in the Adoption Process
Al COMIRB Approved Iftvesligatoni must comply wdi the foiowng
For the duration of your protocol, any change ai the experimental design/consent and/or assent form must be approved
by toe COMIRB before implementation at the changes.
Use only a copy of tie COMIRB signed and dated Consent and/or Assent Form. The investigator beats toe reaponstetty
tor obtaining from al subjects Informed Consent" as approved by the COMIRB. The COMIRB REQUIRES toat toe
subject be given a copy of the consent andlor assent form Consent and/or assent forms must todude the name and
telephone number of the investigator.
Provide non-Engksh speaking subjects with a certified translation of the approved Consent andlor Assent Form in the
subjects Brst language
. The invesbgator also bears the reaponsibiity tor informing toe COMIRB tovnectalely of any Unanbcipaled Problems that
are inexpected and related to the study in accordance with COMIRB Potcy and Procedures.
Obtain COtMfB approval tor al advertisements, questionnaires and surveys before use.
Federal regulations require a Contrxsng Review to renew approval of this project within a 12-monto period from toe last
approval date unless otherwise inctcated to toe review cycle listed below. If you have a restricted/high risk protocol,
apec*c detais wA be ouBtoed to this letter. Non-compiance unto Conbnung Review w* tesuK to toe terminaion of tots
You be sect a Cocttoung Review reminder 75 days prior to the expiration date Any ques&ons regarding Ns COMIRB
action can be referred to toe Coordinator at 303-724-1055 or UCHSC Box F-490.
Application for Protocol Review, v. 05/14/10
Attachment F Expedited Review
Consent, v. 05/14/10
DooLt Email Scnpt
Doola Phone Scnpt
Researcher Email Scnpt (1)
COMIRB Continuing Review Approval
UWmKj 0 Comes. t
1 Wi 117* Race. Ma s
Atfn. Csmw H9tl
303 724 1055 Ptwwj
uwvonxr of Coicraeo hotook
Dow HCOTi kMU Center
vwml AMMMoi loaa crar
tie CNwwn Heww
Certificate of Approval
1^* - J - ----- - ... - ..---- I
hvutigitor: Susanna Snyder
COMPS Protocol 10*0481 Continuing Review
Birthing Voices of Grief. Exploring the Role of Doutas in toe Adoption Prooess
Al COMtRS Approved Inwitigaton must comply w#i fietotownog:
For the duration of your protood. any change in toe experimental designfeonseot and/or assent form must be approved fry toe COtiBRS
before impteiimitahmi of toe changes.
Use orty a copy of toe COM RSsqpied and dated Consent aod/gr Assent Form. The invesbgator bears toe rtsponsbiey tor obtaming
from all subjects Informed Consent" as approved by toe COIMR8. The COMRB REQURES toat tie subject be given a copy of toe
consent andfor assent form. Consent and/or assent forms must include toe name and telephone number of the investigator.
Provide non-English speeding subjects with a certified frmsIPion of toe approved Consent andfor Assent Form in the subject's
The investigator also bears toe responstoftty ter irdorming toe COMIRB immediate!) of any Unanticipated Problems that are
unexpected and related to toe study in accordance wito COIffitS Pcicy and Procedures.
Obtain COMIRB approval ter ai advertisements, questionnaires and surveys before use.
Federal regulations require a Cordinuing Review to renew approval of tors project within a 12-month period from the last approval
date unless otoerwtse indicated in toe review cycle Isted below. ffyou have a restocted/tegh risfc protocol, specific detaiswd be
in tors letter. Non-compliance with Continuing Review wii resufi in the termination of this study.
You wi be sent a Continuing Review reminder 7S days prior to toe expiration date. Any questions regarding (Ns COMIRB action can be
reterredto toe Coordmator at 303-724-1055 or UCHSC Box F-40G.
Principal Investigator: Susanna Snyder
Title: Birthing Voices of Grief: exploring the role of doulas in the adoption process
Date: May 2, 2010
Interview will have been set up with participant by phone or email.
Participants will have received a copy of the consent form to review prior to
meeting. We will go over any questions participants have about the form, and
if participants are satisfied with the consent form, they will sign.
Show participants the recording mechanism, to familiarize them with it.
o Can stop at any time (reiterate from consent form) and either terminate
their involvement in the study or reschedule if they are interested in
continuing but need time.
o lam using specific language. Are they comfortable with the terms Im
using (birthmother, relinquish, the child v. your child, son, daughter,
etc)? It is possible to negotiate new terms at beginning or any time
during interview, if the participant feels uncomfortable with any of
o They are also invited to ask to stop recording or have something
stricken from the record if they change their mind about disclosing
somethingeither at that moment or even later after the interview has
ended, they can contact me.
o Im interested in hearing their story. I may ask them to clarify or
expand on some aspect of their narrative within the course of the
interview, but mostly I hope to be an active listener.
o At the end, I may ask additional questions that come up during the
interview or that I would like them to address more at length.
If they havent addressed it in an email, ask how theyd like me to identify
myself in future correspondences, either by phone or through email.
TARGETED LIFE HISTORY: elicitation question
Please share with me your adoption story, from conception to present day, and how
you feel that process was affected by having a doula present during your pregnancy,
childbirth, the post-partum period and in the time since then as youve processed your
experience of relinquishment.
SAMPLE PROBING QUESTIONS
If not addressed or not addressed at length during the course of the life history, the
following questions are examples of additional probing questions that will be used to
elicit some additional data on adoption, doulas and the post-relinquishment process as
it was affected by having a doula.
1. What made you choose adoption?
2. Was it closed/open/some variation between the two?
a. What made you want that?
b. What kind of contact have you had with the adoptive family since
3. Did you use an agency/lawyer, etc?
4. Was the birthfather involved?
5. Why did you choose that family?
6. Was your family present for the adoption and/or supportive?
7. Did you have another form of support? Friends, birthfathers family, adoptive
8. Did you feel comfortable with the adoption process? The legal aspects, your
rights, etc? If you could change anything about the legal process what would it
9. Did you feel comfortable sharing that you were relinquishing the child while
you were pregnant? Why or why not?
10. Did you feel that you were treated differently during prenatal care/labor
because of your relinquishment status?
11. Since relinquishment, how/when/to who have you chosen to disclose your
birthmother status? Why or why not?
12. After the child was bom, what agreements had been made? Did you feel that
you were able to express your wishes for the actual act of relinquishment?
Were you satisfied with this process?
13. Post-partum, after paperwork etc, what was your relationship with the
1. How did you find out about doulas?
2. Did the adoptive parents provide you with a doula? The adoption agency?
Were they supportive of this extra expense?
3. What made you choose to use a doula?
4. What was your involvement with your doula? (how many prenatal visits?
Present for how much of the birth? How much communication post-partum?)
5. How do you think having a doula changed your birth and relinquishment
6. Did having a doula change any other aspects of your life?
7. What roles did the doula perform for you (educator, advocate, etc) and which
of these do you think was the most important?
8. Did having a doula impact your prenatal care? Relationship with provider?
9. Did having a doula impact your birth experience? Relationship with provider?
10. Did having a doula impact your post-partum experience? Relationship with
11. Did having a doula impact your relinquishment process (i.e. paperwork,
saying goodbye, meeting with the family, etc?)
12. Did having a doula impact your relationship with your lawyer?
13. Did having a doula impact your relationship with your adoptive family?
14. Did having a doula impact your personal relationships? Family, partner?
1. After you relinquished, how did you feel?
a. How long did that last? Has it lessened? Intensified? Remained the
b. Do you think having a doula affected that at all?
2. How do you feel now about having used a doula? Would you use one again?
How do you think it helped or hurt?
3. What did you do immediately after relinquishing the child? School/work?
What do you do now?
4. Have any subsequent decisions been made/changed because of your
5. How have relationships (partners/family members/friends/children) been/not
been affected by your decision to relinquish?
6. Do you presently have any children? Plans to have any children? Would/did
you use a doula for another birth?
7. Shortly after you relinquished your child, how did you feel those around you
a. Who were you able to talk to about relinquishing?
b. What do you wish you could have shared?
c. What would have been the ideal support situation for you in this time?
8. Currently, do you feel like you can talk about your feelings surrounding
relinquishment with anyone? Who?
Scripts for Doulas
Doulas Initial Email Script:
Below is an email/phone script to be used by doulas to contact prior clients who meet
my sampling criteria. This is to be sent only to personal email addresses. No business
email addresses will be used. Also, below is the one-week follow-up email.
I have been contacted by University of Colorado Denver graduate student, Susanna
Snyder, who is doing a research project on the role of doulas in the adoption process,
to see how the presence of a doula affects the adoption/birth experience of
Susanna is also a doula-in-training as well as a fellow birthmother who used a doula
when she relinquished her daughter for adoption seven years ago.
Susanna is interested in interviewing people who have relinquished a child in the last
ten years and used a doula. She would like to talk to you about your experience of
pregnancy, birth, immediate post-partum period and current feelings about these
periods of your life as they may have been affected by your doula. She wants to give
voice to birthmothers and hopes to identify things that may help birthmothers to feel
more supported and have more positive birth and relinquishment experiences. Her
study would begin in June 2010.
If youre interested in learning more about Susannas project, have any questions or
concerns, or would like to hear more about her adoption experience, please contact
her directly. Her email address is: firstname.lastname@example.org. She can be reached by
phone at: (850) 545-8093.
Thank you in advance for your consideration! I would like to contact you in a week
for a follow-up email to see if you are considering this. If you would prefer me to not
contact you again, just let me know!
I contacted you a week ago to see if youd be interested in being interviewed by
University of Colorado Denver graduate student, Susanna Snyder. If you have already
contacted her, please disregard this message. If you havent, I was wondering if youd
considered this offer any further and would be interested in contacting her. She knows
that these can be emotional, trigger subjects and understands if you are not interested
in speaking with her. If you are interested, Susanna looks forward to hearing from
you. Again, her contact information is:
Thanks again for your time!
Doulas Phone Script:
Below is a guideline script to be used by doulas to contact prior clients who meet my
sampling criteria and may not have given the doula a personal email address.
[Note to Doula: Please note below that this is a rough script and your personal
relationship with the client will dictate how you strictly/loosely you use the below
dialogue. In using the telephone to contact these women, I am primarily concerned
with protecting their birthmother status, especially if they have not disclosed it with
other people who have access to their phone line. Precautions for this are included in
the script, so please be cognizant of them. Thank you again!]
If receive a voicemail message:
Hi [name of potential participant]. This is [name of contacting doulado not include
that you are a doula or the nature of your relationship]. I was calling because I have a
research opportunity [OR someone whod like to speak with you]. You can reach me
at [Doulas number and/or email address]. If you have time, Id love to hear from
you. Hope everything is well!
If potential participant answers:
Greetings etc. Is this an appropriate time to talk? I want to talk to you about a
research project with birthmothers and understand if you dont have time or need to
call me back later when you have time/privacy to talk?
Now isn7 a good time:
Schedule a time to talk. Use below script for the next conversation
Now isn 7 a good time and the participant isn 7 interested in future contact:
Well thanks so much for your time! Hope everything is well.
Giving information to participant:
Now is a good time, you have scheduled a time when the participant can talk or when
the participant calls you back after receiving your voicemail:
I have been contacted by University of Colorado Denver graduate student, Susanna
Snyder, who is doing a research project on the role of doulas in the adoption process,
to see how the presence of a doula affects the adoption/birth experience of
Susanna is also a doula-in-training as well as a fellow birthmother who used a doula
when she relinquished her daughter for adoption seven years ago.
Susanna is interested in interviewing people who have relinquished a child in the last
ten years and used a doula. She would like to talk to you about your experience of
pregnancy, birth, immediate post-partum period and current feelings about these
periods of your life as they may have been affected by your doula. She wants to give
voice to birthmothers and hopes to identify things that may help birthmothers to feel
more supported and have more positive birth and relinquishment experiences. Her
study would begin in June 2010.
If youre interested in learning more about Susannas project, have any questions or
concerns, or would like to hear more about her adoption experience, please contact
her directly. Her email address is: email@example.com. She can be reached by
phone at: (850) 545-8093.
Thank you in advance for your consideration.
Scripts to Participants
Researcher Email Script One:
Hi__________________. Its lovely to hear from you. Thank you so much for your
interest in the project. Id like to provide you with some additional background
information on my project, so you can see if you are still interested in possibly
I am a graduate student at the University of Colorado Denver, studying medical
anthropology. I am primarily interested in birthing and adoption practices in the U.S.
I developed this interest after relinquishing a child for adoption when I was 18 years
old and have continued to do research in this area in the seven years since then. For
my Masters thesis, I would like to speak with women who have relinquished a child
for adoption in the last ten years and who used a doula for that pregnancy, birth and
post-partum period. I am interested in finding out how the presence of a doula during
that time affected womens experiences of relinquishment.
The project is conducted as an interview that could be broken up over a couple of
meetings, at a place of your choosing. I will ask some broad, guiding questions about
your adoption story from conception to the present and how having a doula affected
your birth/adoption story. This interview will be audio-recorded and transcribed by
me, the primary researcher. I will also take notes during the interview. This data will
then be used to inform my thesis in the form of life-histories, or a narrative of your
experience. I will send you a copy of your individual life history as well as a copy of
my completed thesis. Though the hope is for my thesis to inform an article for
publication and the material may be presented at conferences, your real name will not
be used for any publication or presentation.
Based on the information above, please let me know if you have any additional
questions, and/or if you think you have the time and desire to be a participant in this
project. In that email, Id also like to know your preferred method of contact.
Additionally, I want to make sure I protect your birthmother status if youve chosen
not to disclose it to others in your life, so if youd like me to identify myself in any
other way, use another email address or anything else to ensure your comfort and
privacy, please let me know. I am happy to accommodate you. I will default to using
this email address, and if youd prefer me to contact you by phone, I will only
identify myself by name (no identifying things about my study or my research
Besides participating in the project, if youd like to hear about my experience or just
talk, feel free to contact me off the record.
I really appreciate your time and consideration of sharing this sensitive topic with me.
Please feel free to contact me with any additional questions, concerns. I look forward
to hearing back from you either way.
Email to potential participant two:
Below is the follow up email to participants who have responded yes to the
recruitment emails and expressed their interest in participating.
Hi__________. Thank you so much for your response. I want to first respond to your
Based on your response, it sounds like you are interested in participating in my
project. I am really excited for the possibility to work with you, but before we can
move forward, I need to ensure that you and your privacy are protected. I am
attaching an electronic copy of the consent form, so you can read this thoroughly
before we meet. We will read through it again at our interview, but I want to make
sure if you have any concerns about the process, that they are addressed. I am also
attaching a rough question guide so you can get a sense of the kinds of things I am
interested in. This is by no means a formal interview, so these questions may or may
not be answered in the course of you sharing your story nor are they limitations on
what is relevant. If something is relevant that is not on this list, I invite you to share it
anyways. Finally, I am also attaching a short intake form to help me get to know you
a little bit prior to our first meeting. The last form is optional.
At your earliest convenience, please call me at (850) 545-8093, so we can schedule a
time to meet. I am excited to work with you on this project and appreciate your
willingness to share your story with me.
Resource Guide Provided to Participants
The material we are talking about may be a trigger for emotional or psychological
issues directly or indirectly related to your experiences of relinquishment. If youd
like to speak to someone or get additional support to deal with any of these things,
you may contact any of the below contacts for assistance.
Name: Julie Anne Kelty, M.A.C.P. (Denver)
Field: Professional Counselor, Therapist
Specific Interests: Adoption Issues, Adolescent, Peer Relations, Family Issues,
Contact Information: Phone (720) 314-0157; Email adoptees firstname.lastname@example.org
Name: Rebecca K. Wilson, MSW, LCSW, EMDR2 (Denver)
Field: Social Work
Specific Interests: Anxiety, Depression, Trauma, Womens Issues,
Contact Information: (720) 514-3425
Name: Adoptees In Search (Denver)
Field: Support for all members of the adoption triad
Contact Information: (303) 232-6302
Name: Concerned United Birthparents (Wheat Ridge)
Field: CUB is a national organization serving those touched by adoption and others
who are concerned about adoption issues. Although our focus is on birthparents,
long the forgotten people of the adoption community, we welcome adoptees,
adoptive parents, and professionals. We find that we all have much to learn from each
other and that sharing our feelings and experiences benefits all of us.
Contact Information: Phone: (303) 263-1860; Toll-Free: (800) 822-2777;
Site Name: Life Mothers
Brief Description: Offering support, resources, and compassion to all birthmoms.
Founded by, Skye Hardwick, Skye is Lifemom to Emily & Mom to Isaiah. She is a
writer for Adoption Today Magazine as well as other involvements in the adoption
Site Name: Birth Mother Support Group Forum
Brief Description: Join our group if you are a birthmother, birthmother to be or
pregnant and considering releasing your baby through adoption...Connect with
birthmothers of all ages, in all kinds of circumstances; from teens, to girls in college
and even women who already have children at home.
Carol Schaefer, The Other Mother (Soho Press 1991)
In 1965, as a pregnant, unmarried 19-year-old member of an image-conscious,
Catholic, southern family, Schaefer found herself unusually hemmed in. In this
emotional memoir she describes the harsh conditions imposed on hershe was sent in
secrecy to a home for unwed mothers where she gave birth and atoned for her "sin"
by relinquishing her newborn son. Although Schaefer married and had two more
children, her longing for reunion with her first child did not abate. On his 18th
birthday, she began the arduous, frustrating process of making contact with her first
bom, named Jack, and his adoptive family in the Los Angeles area, finally arranging
a successful meeting that involved the birth father as well. This wrenching account,
covering a range of adoption issues, is a moving testament to the bonding power of
Heather Carlini, Birthmother Trauma (Morning Side Press 1997)
Some birth mothers go into a prolonged mourning period that can last for years
following the relinquishment of a dhild to adoption. This book offers a seven stage
recovery program to help birth mothers work through the mourning state.
-Amazon.com product review
Merry Bloch Jones, Birthmothers: Women Who Have Relinquished Children for
Adoption Tell Their Stories (Chicago Review Press 1993)
In a well-written, compelling narrative, Jones tells the poignant stories of over 70
birthmothers whose babies have been adopted. These adoptions took place from the
1950s until the 1980s, and the mothers came from a variety of backgrounds. Their
stories add much to the anecdotal study of adoption and unwanted pregnancies,
particularly their reflections on society's attitudes. Although this compelling book
adds much to our anecdotal knowledge, the author's conclusions must be interpreted
with caution, especially because relatively few birthmothers were interviewed (a
nonrandom sample from the approximately six million birthmothers in the United
States) and they cover so many eras and backgrounds. Jones acknowledges that the
book is about some not all, birthmothers. Recommended for public and
-Kay Brodie, Chesapeake Coll., Wye Mills, Md.
Copyright 1993 Reed Business Information, Inc.
Adoption Media, LLC
n.d. State Adoption Laws, http://laws.adoption.com/statutes/state-adoption-
laws.html. accessed March 3, 2011.
Ainley, Stephen C., and Lerita Coleman, Gaylene Becker
1986 Stigma Reconsidered. In The Dilemma of Difference: A
Multidisciplinary View of Stigma. Stephen C. Ainley, Gaylene Becker, Lerita
M. Coleman, eds. Pp. 1-13. New York: Plenum Press.
Ainlay, Stephen C., Faye Crosby
1986 Stigma, Justice and the Dilemma of Difference. In The Dilemma of
Difference: A Multidisciplinary View of Stigma. Stephen C. Ainley, Gaylene
Becker, Lerita M. Coleman, eds. Pp. 16-37. New York: Plenum Press.
2009 Nursing the disenfranchised: women who have relinquished an infant
for adoption. Journal of Psychiatric and Mental Health Nursing 16: 27-31.
Amos, H.J. and Richard Wisniewski
1995 Life History and Narrative. Washington D.C.: Faimer Press.
Arcaro, Timothy L.
2008 No More Secret Adoptions: Providing Unwed Biological Fathers with
Actual Notice of the Florida Putative Registry. Capital University Law
Review 37: 449-NP.
1994 An international perspective on parenting: social change and social
constructs. Journal of Marriage and Family 56(3): 529-543.
1998 The Life Story Interview. In Qualitative Research Methods Series 44.
Sage Publications: CA
Becker, Gaylene, and Regina Arnold
1986 Stigma as a Social and Cultural Construct. In The Dilemma of
Difference: A Multidisciplinary View of Stigma. Stephen C. Ainley, Gaylene
Becker, Lerita M. Coleman, eds. Pp. 39-57. New York: Plenum Press.
2001 Qualitative Research Methods. Boston: Allyn and Bacon.
2005 Perceptions of Social Support from Pregnant and Parenting Teens Using
Community Based Doulas. Journal of Perinatal Education 14(3): 15-22.
1975 Marginal Deviants: Teenage Girls Experience Community Response to
Premarital Sex and Pregnancy. Social Problems 22(4): 480-493.
Brown, Donna and Scott Ryan, Janet Therese Pushkal
2007 Initial Validation of the Open Adoption Scale: Measuring the Influence
of Adoption Myths on Attitudes Toward Open Adoption. Adoption Quarterly
Bruner, Edward M.
1986 Experience and Its Expressions. In The Anthropology of Experience.
Victor Turner and Edward Bruner, eds. Pp. 3-32. Champaign, IL: The
University of Illinois Press.
2002 Birthing Relationships. Wis. Womens Law Journal 164: 163-198.
Carp, Wayne E.
1998 Family Matters: Secrecy and Disclosure in the History of
Adoption.Cambridge: Harvard Press.
Chalmers, B. and Wolman, W.
1993 Social Support in Labor: a selective review. Journal of Psychosomatic
Obstetrics and Gynecology 14: 1-15.
Christian, Cinda L. and Ruth G. McRoy, Harold D. Grotevant, Chalandra M. Bryant
1997 Grief Resolution of Birthmothers in Confidential, Time-limited
Mediated, Ongoing Mediated and Fully Disclosed Adoptions. Adoption
Quarterly 1(2): 35-58.
2001 La Familia: methodological issues in the assessment of perinatal social
support for Mexicana living in the United States. Social Science and Medicine
Cohen, Sheldon and S. Leonard Syme
1985 Issues in the Study and Application of Social Support. In Social Support
and Health. Eds S. Cohen and S.L. Syme. Pp. 3-20. San Francisco:Academic
1993 The Technocratic Model of Birth. In Feminist Theory in the Study of
Folklore.Tower Hollis S, Pershing L, Young M.J, eds. Pps. 297-326.
Champaign, IL: University of Illinois Press.
2001 The Technocratic, Humanistic, and Holistic Paradigms of Childbirth.
International Journal of Gynecology and Obstetrics. 75(1): S5-S23.
De Simone, Michael
1996 Birth Mother Loss: Contributing Factors to Unresolved Grief.
Clinical Social Work Journal 24(1): 65-76.
Devaney, Susan Wuest and Sharon Farrell Lavery
1980 Nursing Care for the Relinquishing Mother. Journal of Obstetric and
Gynecologic Nursing 9(60): 375-378.
Diamond, Lisa M., and Ritch C. Savin-Williams
2009 Adolescent Sexuality. In Handbook of Adolescent Psychology. Richard
M. Lemer and Laurence Steinberg, eds. Pp. 479-523. New York: Wiley and
Doula Organization of North America (DONA)
2008 Position Paper: The Birth Doulas Contribution to Modem Maternity
Care. Electronic document.
http://www.dona.org/publications/position paper birth.php. accessed April
Ellison, Marcia A.
2003 Authoritative Knowledge and Single Womens Unintentional
Pregnancies, Abortions, Adoption and Single Motherhood: Social Stigma and
Structural Violence. Medical Anthropology Quarterly 17(3): 322-347.
Evan B. Donaldson Adoption Institute
1997 Benchmark Adoption Survey: Report on the Findings. Princeton Survey
Resarch Associates. Washington D.C.
2007 Safeguarding the Rights and Well-Being of Birthparents in the
Process.http://www.adoptioninstitute.org/r>ublications/2006 11 Birthparent S
tudy _All.pdf, accessed March 1, 2011.
Family Health International
2002 Qualitative Methods: A Field Guide for Applied Research in Sexual and
Reproductive Health. Priscilla R. Lion eLalet al. eds. New York: Family
Feldman, Ruth and Aron Weller, James F. Leckman, Jacob Kuint, Arthur Eldelman
1999 The Nature of the Mothers Tie to Her Infant: Maternal Bonding under
Conditions of Proximity, Separation and Potential Loss. Journal of Child
Psychology and Psychiatry 40 (6): 929-939.
2007 The Girls Who Went Away: The Hidden History of Women Who
Surrendered Children for Adoption in the Decades Before Roe v. Wade. New
Fisher, Allen P.
2003a A Critique of the Portrayal of Adoption in College Textbooks and
Readers on Families, 1998-2001. Family Relations 52(2): 154-160.
2003b Still Not Quite as Good as Having Your Own? Toward a Sociology
of Adoption. Annual Review of Sociaology 29: 335-361.
1979 The History of Sexuality, vol 1. Harmondsworth: Penguin.
1984a Nietzsche, Genealogy, History. In The Foucault Reader. Paul
Rabinow, ed. Pp. 76-100. New York: Pantheon Books.
1984b Panopticism. In The Foucault Reader. Paul Rabinow, ed. Pp. 206-213.
New York: Pantheon Books.
Fowles, Eileen R.
2007 Relationship among Prenatal Maternal Attachment Presence of
Postnatal Depressive Symptoms and Maternal Role Attainment. Journal for
Specialists in Pediatric Nursing 1(2): 75-82
2000 The Market Forces in Adoption, vol 2: Adoption and Ethics Series.
Washington D.C.: Child Welfare League of America.
2001 The Impact of Adoption on Members of the Triad. Adoption and Ethics,
Volume 3. Annapolis Junction, Maryland: Child Welfare League of America.
Fridh, Gerd, and Telle Kopare, Fannie Gaston-Johansson, Kristine Turner Norvell
1988 Factors Associated with More Intense Labor Pain. Research in Nursing
and Health 11: 117-124.
Furstenberg, Frank F. (Jr.)
1991 As the Pendulum Swings: Teenage Childbearing and Social
Concem.Family Relations 40: 127-138.
1986 Making Experiences, Authoring Selves. In The Anthropology of
Experience. Victor Turner and Edward Bruner, eds. Pp. 373-380. Champaign,
IL: The University of Illinois Press.
1999 Rescuing the Waifs and Strays of the City: The Western Emigration
Program of the Childrens Aid Society. Journal of Social History 33(1): 121-
1963 Stigma: Notes on the management of spoiled identity. Englewood
Cliffs, New Jersey: Prentice Hall.
1977 The Domestication of the Savage Mind. Cambridge: Cambridge
Gritter, James L.
2005 Lifegivers: Framing the Birthparent Experience in Open Adoption.
Washington D.C.: Child Welfare League of America.
2006 Doula Support for Young Mothers: A Randomized Trial. Final Report.
Maternal and Child Health Bureau Research Program, HRSA, DHHS. R40
1988 Situated Knowledges: The Science Question in Feminism and the
Privilege of Partial Perspective. Feminist Studies 14(3): 575-599.
Hazard, C.J. and L.C. Callister, A. Birkhead, L. Nichols
2009 Hispanic Labor Friends Initiative: supporting vulnerable women.
American Journal of Maternal and Child Nursing 34(2): 115-121.
Heaney, Catherine A., and Barbara A. Israel
2008 Social Networks and Social Support. In Health Behavior and Health
Education: Theory, Research and Practice (4th ed.). Eds. Karen Glanz, Barbara
K. Rimer and K. Viswanath. Pp 189-210. Danvers, MA: Jossey-Bass.
Hodnett, ED, with Gates, S., Hofmeyr, G.J., and Sakala, C.
2007 Continuous support for women during childbirth (Cochrane Review).
Cochrane Database of Systematic Reviews 3:1-72.
Henney S, Ayers-Lopez S, McRoy RG, Grotevant HD
2007 Evolution and Resolution: Birthmothers' experience of grief and loss at
different levels of adoption openness. Journal of Social and Personal
2009 A Mothers Heart is Weighed Down with Stones: A Phenomenological
Approach to the Experience of Transnational Motherhood. Culture, Medicine
and Psychiatry 33: 21-40.
Hupcey, Judith E.
1998 Clarifying the Social Support Theory-Research Linkage. Journal of
Advanced Nursing 27: 1231-1241.
1983 Knowledge of the Body. Man, New Series 18(2): 327-345.
Josselson, Ruthellen, and Amia Lieblich
1993 The Narrative Study of Lives, Vol. 1. Sage Publications: CA.
2009 Shotgun Adoption. The Nation, September 14:
http://www.thenation.com/article/shotgun-adoption, accessed May 21,2011.
Karel, Amanda I.
2006 Covering Adoption: General Depiction in Broadcast News. Family
Relations 55: 487-498.
Kayne, M.A., Greulich, M.B., Albers, L. L.
2001 Doulas: An Alternative Yet Complementary Addition to Care During
Childbirth. Clinical Obstetrics and Gynecology 44(4): 692-703.
2008 Selective Recognition Of Gender Difference In The Law: Revaluing
The Caretaker Role. Harvard Journal of Law and Gender 1: 1-66.
LeCompte, Margaret D., and Jean J. Schensul
1999 Analyzing and Interpreting Ethnographic Data, vol 5: Ethnographers
Toolkit. Walnut Creek, CA: Alta Mira.
Leon, Irving G.
1999. The Role of Obstetric Caregiver in Adoption. Elsevier Science 6(4):
2002 Adoption Losses: Naturally Occurring or Socially Constructed? Child
Development 73(2): 652-663.
Levine, Nancy E.
2008 Alternative Kinship, Marriage and Reproduction. Annual Review of
Anthropology 37: 375-389.
1996 Birth Mothers and their Mental Health: Uncharted Territory. British
Journal of Social Work 26: 609-625.
Logsdon, M. Cynthia and Patricia Gagne, Tara Hughes, Jennifer Patterson, Vivian
2004 Social Support During Adolescent Pregnancy: Piecing Together a Quilt.
Journal of Obstetric, Gynecologic and Neonatal Nursing 34(5): 606-614.
1996 Dubious Conceptions: The Politics of Teenage Pregnancy. Cambridge,
MA: Harvard University Press.
Malson, Helen and Catherine Swann
2003 Reproducing Womans Body: Reflections on the (Dis)place(ments) of
Reproduction for (Post)Modem Women. Journal of Gender Studies 12(3):
1973 The Study of Life History: Gandhi. Current Anthropology 14(3): 177-
1995 The Care of the Mother Grieving a Baby Relinquished for Adoption.
Aldershot, Hants: Avebury.
1976 Capital, vol 1. London: Penguin Books.
2006 Strangers and Kin: The American Way of Adoption. Cambridge:
Harvard University Press.
Meyer, Bruce A. and Jane A. Amnold, Debra Pascali-Bonaro
2001 Social Support by Doulas During Labor and the Early Postpartum
Period. Hospital Physician. 57-65.
Miles, Matthew B., and A. Michael Huberman
1994 Qualitative Data Analysis: An Expanded Sourcebook (2nd edition).
Newbury Park: Sage Publications.
2002 A Sealed and Secret Kinship: The Culture of Policies and Practices in
American Adoption. New York: Berghahn Books.
2009 Norms about Nonmarital Pregnancy and Willingness to Provide
Resources to Unwed Parents. Journal of Marriage and Family 71: 122-134.
2006 Coming to Terms with the Loss of a Child: The Feelings of Birth
Parents and Grandparents About Adoption and Post-Adoption Contact.
Adoption Quarterly 10(1): 1-23.
2011 Should Adoption Be a Reproductive Right? Huffington Post.
repr b 858404.html. accessed May 10, 2011
Pamess, Jeffrey A.
2005 Adoption Notices to Genetic Fathers: No to Scarlet Letters, Yes to
Good Faith Cooperation. Cumberland Law Review 36: 63-81.
Patton, Michael Q.
1990 Qualitative Evaluation and Research Methods, 2nd edition. Newbury
Park: Sage Publications.
Pavao, Joyce Maguire
1998 The Family of Adoption. Boston: Beacon Press.
2000 Adoption Nation: How the Adoption Revolution is Transforming
America. New York: Basic Books.
2002 Possession: A Feminist Phenomenological And Poststructuralist
Analysis Of Illegitimate Pregnancy, Pregnant Embodiment And Adoption.
Womens Health and Urban Life 1(1): 1-10.
1950 African Systems of Kinship and Marriage. Cambridge: Oxford
1999 Testing Women, Testing the Fetus: The Social Impact of Amniocentesis
of America. New York: Routledge.
2010 What Can Birthmothers Choice Offer You?
http://birthmotherschoice.com/birthmothers.html, accessed May 21, 2011.
1995 Birthparent Grief. Electronic Document.
www.adopting.org/birthmother grief.html. Accessed May 3, 2011.
1984 Thinking Sex: Notes for a Radical Theory of the Politics of Sexuality.
In Pleasure and Danger: Exploring Female Sexuality. Ed. Carole S. Vance.
Pp. 267-319. London, UK: Routledge.
1991 Disciplining Foucault: Feminism, Power and the Body. New York:
Schensul, S.L., and J.J. Schensul, M.D. LeCompte
1999 Essential Ethnographic Methods, vol 2: Ethnographers Toolkit. Walnut
Creek, CA: Alta Mira.
Schneider, David M.
1980 American Kinship: A Cultural Account. 2nd edition. Chicago:
University of Chicago Press.
1986 Stigma and Western Culture: a historical approach. In The Dilemma of
Difference: A Multidisciplinary View of Stigma. Stephen C. Ainley, Gaylene
Becker, Lerita M. Coleman, eds. Pp. 59-76. New York: Plenum Press.
Stafford, Mark C., Richard R. Scott
1986 Stigma, Deviance and Social Control. In The Dilemma of Difference: A
Multidisciplinary View of Stigma. Stephen C. Ainley, Gaylene Becker, Lerita
M. Coleman, eds. Pp. 77-91. New York: Plenum Press.
1992 Reproducing the Future: Essays on Anthropology, Kinship and the New
Reproductive Technologies. Manchester: Manchester University Press.
Tolman, Deborah L.
1994 Doing Desire: Adolescent Girls Struggles for/with Sexuality. Gender
and Society. 8(3): 324-342.
1995[ 1969] The Ritual Process: Structure and Anti-Structure. London:
Routledge and Kegan Paul.
1988 Social Support: Theory, Research and Intervention. New York: Praeger
1997 In Search of Bad Mothers: Social Constructions of Birth and Adoptive
Motherhood. Womens Stidues International Forum 20 (31): 77-86.
2000 Adoption, Family Ideology and Social Stigma: Bias in Community
Attitudes, Adoption Research and Practice. Family Relations 49(4): 363-370.
2007 The Vanishing Mother: Cesarean Section and "Evidence-Based
Obstetrics. Medical Anthropology Quarterly 21(2): 218-233.
Wiemann, Constance M., and Vaughn Rickert, Abbey Berenson, Robert Volk
2005 Are Pregnant Adolescents Stigmatized by Pregnancy. Journal of
Adolescent Health 36(4): 352el-352e7.
Winkler, Robin and Margaret van Keppel
1984 Relinquishing Mothers in Adoption: Their Long-Term Adjustment.
Melbourne: Institute of Family Studies.
2008 Teenage Mothers Experiences of Stigma. Journal of Youth Studies
Wolman, W. L., Chalmers, B., Hofmeyr, G. J., & Nikodem, V. C.
1993 Postpartum depression and companionship in the clinical birth
environment: A randomized, controlled study. American Journal of
Obstetrics and Gynecology 168: 1388-1393.
Wortman, Camille B. and Terry L. Conway
1985 The Role of Social Support in Adaptation and Recovery from Physical
Illness. In Social Support and Health. Eds. Sheldon Cohen and S. Leonard
Syme. Pp. 281-302. Orlando, FL: Academic Press, Inc.