The Unrecognized Developmental Trauma of Early Relinquishment in Adoption

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https://visiblemagazine.com/the-unrecognized-developmental-trauma-of-early-relinquishment-in-adoption/?fbclid=IwAR1nrr4yROt6urG-qQIxSW9PrGdsJEp6UCgQp0lPSvHGXu0pHIpODiXxprE

The Unrecognized Developmental Trauma of Early Relinquishment in Adoption

by Meggin Nam Holtz   
July 23, 2022

Note from Author

Hello readers.  This writing is basically a paper lifted from my Master of Social Work graduate school professional seminar in child trauma.  I hope to disseminate this information widely in various ways, especially due to the recent overturning of to Roe v. Wade, 410 U.S. 113 (1973) and the rising argument that the simple answer to children born to those who did not intend on having them is adoption.  This paper is personal; my positionality is that of a female, an adopted person, adopted in infancy, and a clinical social worker working with the adopted population.  Side note regarding language: I am aware of the ever-changing and evolving use of adoption language.  In this article I chose to use language for clarity, and mean no offense.  If the language is outdated or harmful, please do reach out and let me know.  Thank you for reading.

DISCUSSION

Permanent physical separation between birthing mothers from their babies is commonly referred to as "relinquishment" in the context of adoption. This discussion article will explore developmental effects of relinquishment occurring at birth and in the early days of an infant's life.  Examination of neurological, attachment, and developmentally positive outcomes attained through maintaining physical interactions between mothers and their infants during the first hours and days of infant life sheds light on what is missed if a separation occurs.  Contrary to conventional beliefs and attitudes that a baby will not remember or be affected by early life experiences, the neurological impacts of stress in very early life such as relinquishment should be re-framed, acknowledged, and understood as a form of developmental trauma.

The Issue

In general, there is a misconception in conventional attitudes that young children cannot and will not remember traumas experienced in their first few years of life. It is commonly believed that children "removed at birth may be spared the impact of ACES" (Anthony, Paine & Shelton, 2019) and although adoptions that take place at an earlier age are often associated with better outcomes (Perry, Hambrick & Perry, 2014), adoptees who experience relinquishment at all ages are vastly overrepresented in mental health and substance abuse clinics, are at higher risk for mood disorders, mental health issues, and are four times more likely to commit suicide than non-adoptees (Sunderland, 2019).  Adoptees are an unrecognized marginalized group deserving of specialized services that are currently lacking.  This article strives to debunk the myth that even when placed into the best of circumstances, adoptees separated from their birth mothers in early life face challenges with long lasting developmental, emotional, and behavioral consequences.

A Little History – From 1937 to 1965, the number of adoptions in America grew from 8,000 to over 70,000 due to the fact that newborns, as opposed to older children, became available (Fessler, 2006).  Prior to Roe v. Wade, 410 U.S. 113 (1973), now overturned, doctors often issued orders for birthing mothers surrendering their babies not to see their children (Fessler, 2006).  In some instances, birthing mothers were allowed to hold their babies for moments, and the majority were advised that it was against policy (Fessler, 2006).  In extreme cases birthing mothers were drugged at the time of delivery, awoke post-delivery, and were forbidden to make any contact with their baby out of fear that a bond would be initiated (Fessler, 2006).  Protocol sometimes allowed for brief moments of visitation, followed by the baby being taken by a social worker to a foster care family or facility until they were adopted (Fessler, 2006). Now that Roe v. Wade has been overturned, this article is of utmost prevalence.

In present day there is often no waiting period at all between the actual birth and placing a newborn into the arms of an adoptive family (Finn, Silverstein & Bodie, 2019).  Birthing processes are unique and varied depending on the pre-arrangements and wishes of the birthing mother and adoptive family.  In open adoptions some birth mothers are given the opportunity to pump breast milk for their babies, while in closed adoptions birth mothers have little to no contact with the child or family after giving birth (Finn, Silverstein & Bodie, 2019).  Noteworthy to mention is the overwhelming body of evidence that both birth mothers and adopted children/adults involved in open adoptions fair better in the areas of mental health, well-being, and productivity than those in closed adoptions (Grotevant, McRoy, Wrobel, & Ayers-Lopez, 2013).

Science and Brain Development

Research in animal studies conducted over the past 40 years finds that early life stressors "can alter key neural networks in, and functioning of, the developing brain" (Hambrick, Brawner & Perry, 2019: 2; Bath et al., 2013; Bedrosian et al., 2018).  Because "brain organization occurs most rapidly in the first days to first week of life" (Hambrick et al., 2019: 1), denying a newborn the familiar, regulating milieu associated with smells, tastes, movement, and sounds of its birth mother affects the foundational organization of core regulatory networks that form the backbone of the stress response.

The limbic system, which monitors danger, is developing immediately after birth at a rapid rate in all mammals (Van der Kolk, 2015).  In a healthy environment where a baby feels safety and love, neurons will fire in a manner that creates a brain wired for exploration, play, and cooperation; whereas an environment of neglect inducing fear and feelings of abandonment or being unwanted produces a brain wired to manage abandonment and fear (Van der Kolk, 2015; Perry, 2003).  The use dependent manner and neuroplasticity in early brain development affects the ability to form emotional relationships, which are critical to the outcome and ability to form healthy relationships later in life, and become mentally healthy (Perry, 2001).

The most rapid ex-utero brain growth occurs during the first two months of human life (Hambrick et al., 2019).  Severe early life stressors occurring during the 0-2 month period of life prove to be risk factors for self-regulatory functions such as "sleep, arousal, attention/tracking, primary sensory integration, affect mood/regulation," (Hambrick et al., 2019) and chronic health and behavioral issues.  Because the brain is rapidly organizing in the first days and week of life, particular attention must be paid to the fact that the neurodevelopmental systems organize at unique rates and times; the timing of an early life stressor may provide disproportionately different outcomes (Hambrick et al., 2019).  Impaired bonding between infant and mother such as relinquishment should be viewed as an early life stressor.  The timing, length, and severity of impaired bonding will influence the degree to which the amygdala, limbic system, and long-term programming of hormonal systems affect a developing human's emotions and functioning (Perry, 2001).

Oxytocin

Oxytocin is a nine amino acid peptide paracrine hormone and neurotransmitter system activator that brings about feelings of well-being, anti-stress, lowers pain sensitivity, decreases inflammation, and is a stimulus for both growth and healing (Moberg & Prime, 2013).  Oxytocin has a short half-life, but because it neuromodulates other hormonal systems within the brain, its effects can last long after its release (Buckley, 2015).

Oxytocin is instrumental in the development of use and state dependent functioning (Perry, 2001) as it has the power to wire the brain for both positive and negative associations in the brain (Northwestern University, 2013).  Experiments on mice found that "after a negative social experience the oxytocin triggers anxiety and fear in a new stressful situation" (Northwestern University, 2013: 2) indicating that oxytocin is involved in both the pleasure and stress responses.

In Utero

One can argue that attachment begins in utero.  Utero sets the stage for familiarity, comfort, soothing, and a sense of safety.  In utero the fetus becomes accustomed to ingesting the foods that its mother eats, the movements and rhythms of the mother's gait and life, and the sounds of the mother, other people close to the expecting mother, and all environmental sounds in the mother's life.  At 16 weeks of life, a fetus begins to hear sounds both from the outside world such as music and voices (Gordon, 2013) and the heartbeat of their mother.

One area that is understudied is how the stress of an expectant mother hormonally affects the development of a fetus and newborn.  Exposure to the mother's hormonal stress and other teratogens directly relate to emotional, attachment, cognitive, behavioral, social and physiological issues (Perry et al., 2014).

Birth

Allowing for physiologic and salutogenic childbearing facilitates positive hormonal system outcomes for both women and babies (Buckley, 2015).  In utero babies are swimming, weightless, and impervious to gravity.  As Van der Kolk points out, being mobile, and "able to protect oneself is a critical factor in determining whether or not a horrible experience will leave long-lasting scars" (Van der Kolk, 2015, p.55).  At and during birth infants shift from a floating body in amniotic fluid to immobile, weighted by gravity beings.  Interestingly, higher levels of oxytocin are found in infants who experience vaginal births than cesarean births (Moberg & Prime, 2013) suggesting that a vaginal birth may more "stressful" to the newborn, and possibly better prepare it for the sudden drastic change of environment and immobility of gravity.  Any state of hyperarousal and prolonged trauma fuels the necessity for soothing (Van der Kolk, 2015).

Infant oxytocin production is triggered by the sight, smell, touch, and sounds of the birthmother (Moberg & Prime, 2013).  Research shows that infants have preferences for their own mother's voice and breast milk over other voices and other breast milk when offered a choice (LifeWorksCommunity, 2015), suggesting that infants can sense the difference between caregivers and their biological mothers.  One could assume that the infant feels soothed by the voice of its biological mother. Physical separation at birth can cause disruptions to attachment, reward, and regulation and even infant survival (Buckley, 2015) due to the lack of familiar sounds, smells, and movements of the mother.  Changes to brain development regarding language heard in utero versus post birth placement (relevant in intercountry adoption) have not been studied.

Skin-to-Skin

Benefits of skin-to-skin contact in the first hour or so after birth include peak oxytocin activity, increased contractions reducing postpartum risk of hemorrhage, and vasodilation of the birthing mother's chest which creates natural warming for the baby (Buckley, 2015).  Skin-to-skin contact activates hormones that increase biological bonding, and lower maternal and newborn stress (Buckley, 2015).  "The hour or so after physiologic birth is a sensitive period, when skin-to-skin maternal-newborn interactions foster peak oxytocin activity" (Buckley, 2015: 5).

In animal studies, even brief repetitious separations of mother and offspring detrimentally impact the "stress hormone systems ...with enduring effects including depression-like behaviors in adult offspring and also in separated new mothers" (Buckley, 2015: 9).

Breastfeeding and Breast Milk

The birthmother's breast milk is the best food for her baby as it is uniquely developed specifically for that infant human (Newnham & Milgrom, 2019).  "There is growing evidence that breastfeeding improves the brain development of infants... and can increase a baby's brain growth by 20 to 30 percent" (Bergland, 2013: 1).  Although breast-feeding and the lack thereof is not just an adoption or relinquishment issue, this article will examine the act of breastfeeding and the benefits of breast milk in order to highlight positive developmental results that the child does not receive if a separation occurs.

Oxytocin, both a hormone and neurotransmitter, stimulates breast milk production (Moberg & Prime, 2013).  Maternal and newborn stress decreased by hormonal facilitation of initiation of breastfeeding (Buckley, 2015).  During breastfeeding prolactin levels correlate with protective "maternal adaptations including: reduced anxiety, aggression, and muscular tension; and increased social desirability (conformity), which may help mothers to prioritize infant care" (Buckley, 2015:9).

An infant's Ventral Vagal Complex (VVC) is stimulated by interactions and controls sucking and swallowing, two actions involved in breastfeeding (Van der Kolk, 2015).  When the VVC's functions are "stimulated in an infant, they are accompanied by a sense of pleasure and safety, which helps create the foundation for all future social behavior" (Van der Kolk, 2015: 86) and associates these actions and interactions with reward and pleasure.  Even minutes long routine separation of a birthmother and their newborn during the minutes and hours after birth such as evaluation and bathing "disrupts the babies ability to find the breast and attach" (Lothian, 2005: 44; Righard & Alade, 1990).

Development/Attachment/Bonding

Brazelton and Winnicott studied parent-infant pairs and found them to be interdependent; the newborn and mother were thought of as a unit (Brazelton & Cramer, 2018).  "Scientists believe the most important factor in creating attachment is positive physical contact... optimally (with) the mother" (Perry, 2001).  A baby knows its mothers voice and smell (Newnham & Milgrom, 2019).  This information is acknowledged as important in that it factors in a good base for bonding, attachment, and provides comfort and feelings of safety and security to the newborn (Newnham & Milgrom, 2019).  Some argue that a newborn has no "normal" or known "desirable" state, but as Brazelton demonstrated, babies will recognize and turn to their mother of origin's voice and show preference for their mother's breast milk.  This familiarity, currently uncategorized by modern psychoanalysis, is in itself, a regulating and safe base for the baby, and serves as a protective factor.

A number of these familiars are absent in multiple circumstances outside of the adoption context.  They can be observed briefly in cesarean section birthing practices, premature infants sent to the neonatal intensive care unit (NICU), surrogate circumstances, and in scenarios due to medical, cultural, unforeseen choices, procedures, or conditions.

Movement towards recognizing the importance of mother and infant bonding is evidenced by Minnesota's new "Healthy Start Act" (HF1403/SF1315, 2021), where pregnant inmates have the ability to bond with their babies "during what is recognized as a crucial period when nurturing is particularly important for the development of children" (Gains, 2021).  Further recognition of protective factors such as familiarity between mother of origin and baby could initiate major changes in best practices across the birthing, adoption, and human rights fields.

Adoption Law

The law surrounding the revocation period given to birthing mothers considering relinquishment varies state to state from one week to 30 days (adoption.org, n.d.) although antithetical procedures still exist.  Allowing formation of a bond between mother and baby still invokes fear due to the possibility of a disrupted adoption.  A disrupted adoption is not only a tremendous loss for an adoptive family, it is also a risk to the adoption industry.

Research indicates that open adoptions serve as protective factors to both birth mothers and adoptees, where closed adoptions often prove to be risk factors for both adoptees and the birth mothers (childwelfare.gov, n.d.).  Further studies on open adoption would be instrumental in providing recommendations for best practices in adoption including adopting parental and birthing mother and father wishes surrounding the birth of the baby.

GAPS

Society often does not realize that babies are complex beings with feelings and reactions that activate systems with lifelong human repercussions. Due to this gap in understanding, it is vital that we use current information and give voice to the newborn.

 "High quality research is lacking" in the study of maternity care practices impacting oxytocin effects (Buckley, 2015).  There is a general lack of funding for studies in women's health, birthing practices, breast milk, and long-term studies of relinquishment in adoption outcomes.  Studies currently in existence regarding adoption rely heavily on the adoptive parents second-hand information that could be missing large portions of a child's story, or simply be inaccurate (Anthony, Paine & Shelton, 2019).

Additional studies should be conducted on breast milk, wet-nurses, surrogates, NICU infants, and birth-partner effects on the infant in order to identify promotive versus risk factors. Findings recommend that professionals involved in natal care incorporate and advocate for best practices promoting physiologic birth, immediate skin-to-skin contact between infant and biological mother, and breast-feeding.

Specific long-term studies on adoptees are needed in order to discover and support changes towards best practices.  Additional research on oxytocin's power to wire both for positive and negative responses, and the developmental impacts of those measures could prove to be a link in understanding the overrepresentation of adopted people in substance use treatment centers.

Additional recommendations include that the "potential impact of complex trauma be considered in the deferential diagnosis of other mental health" (Murray & Sullivan, 2017: 221; Lee et. al 2015) as currently "a single disorder does not exist in the DSM-5 to adequately capture trauma's impact on development" (Murray & Sullivan, 2017: 221; Van der Kolk, 2005). Great care must be taken to avoid pathologizing individuals who have experienced relinquishment and separation.  "Adoption-specific adjustment should be included in a comprehensive mental health assessment, even for children adopted from birth or infancy" (Murray & Sullivan, 2017: 219).  In addition, clinicians and providers should be trained in adoption-specific issues, especially if they are working with the adoptee population.

Additional Findings

Although this article originally sought to highlight benefits for the infant when allowed time and physical contact with its birth mother, findings point to undeniable long-lasting benefits  mentally and physically for both infant and mother.  Furthermore, denial of skin-to-skin and prolonged physical contact between mothers and their newborns prove to be risk factors for both parties.

Other areas where mother and child separation occur outside of the adoption context are surrogacy, cesarean section protocol, and the NICU.  Surrogacy is considered a high-risk emotional experience (Tehran, Tashi, Mehran, Eskandari, & Tehrani, 2014).  In surrogacy, after legal parenthood is set forth, the surrogate has no legal rights in relation to the child (conceivabilities.com, 2019).  As of 2019 it was illegal to contract for gestational surrogacy in four states (circlesurrogacy.com, n.d.) and in France (sciencedirect.com, n.d.).  Cesarean sections often call for early separation of newborns and their mothers "depriving (mothers) the opportunity to reduce epinephrine-norepinephrine for herself and her baby through oxytocin elevations with skin-to-skin contact and mutual interactions" (Buckley, 2015: 8).  "Separation of mothers and their healthy newborns, which typically follows cesarean section, may also impact postpartum maternal prolactin levels" (Buckley, 2015: 9).  There is a growing body of understanding regarding the importance of bonding and attachment while an infant is in the NICU (Newnham & Milgrom, 2019).  An important aspect of NICU bonding includes acknowledgement of infant recognition of parental voice and smell (Newnham & Milgrom, 2019) leading to soothing and regulation in all parties.  This knowledge could be further expanded upon in exploring the beneficial aspects of familiarity and comfort provided by birth mothers and fathers.

Social Contract

Are people living up to the social contract created by the intervention of human adoption? It is common knowledge that prior to the adoption of puppies, they must spend 8-10 weeks with their mother.  Removing a puppy prior to this 8-10 week period creates canines that are prone to nervousness and a "tendency to bark and bite.  They are also less likely to accept discipline and may be aggressive to other dogs" (Faricelli, 2019).  Is the widely accepted practice of human infants separation from their mothers a fair social contract for the baby and all parties involved?  It is ethically expected that all beings enter the world with equal opportunities, but if one enters the world with no opportunity to interact with his/her/their familiar secure base from which to explore and learn and grow, the removed child has unfair expectations placed upon them; their "normal" is in fact atypical.

Recommendations

Formal education on childbirth is still a relatively new concept (Hutchinson, 2015).  The information presented in this article should be shared with professionals who work with natal facilities, adoption services, and social workers.  The information should also be shared with pregnant women as a form of protective psychoeducation, so they are more informed of the benefits of prolonged contact with their infants for both themselves and their babies.  This empowering information allows room for educated decisions about post birth procedures.

It is recommended that mothers hold their "babies in skin-to-skin immediately after birth and remain with them in the first hours and days after birth" (Lothian, 2005: 45).  The absence of birthing mother and infant interactions that induce chemical network-forming pathways affecting brain development, attachment, regulation, and sensory integration should be viewed as an early life stressor and developmental trauma exposure that are currently not taken into consideration by mental health and medical fields.

As discussed above, impairment and interference with fetal neuroprotective systems affects the long-term programming of babies hormonal systems.  Disruptions to attachment, reward, and regulation and even infant survival can be related to brain functioning in early life. One hope in these findings is the fact that ongoing neurobiological maturation creates continuing opportunities for recovery (Perry, 2001), and it is recommended that the mental health profession take into account developmental trauma by including relinquishment, adoption, and foster care in the ACES, and by including developmental trauma in the DSM-5.

Policy & Practice Implications

Large-scale implications from changed global perception and recognition of early relinquishment as a form of trauma include the potential to affect multiple areas of policy and practice.  Changes may include updates to adoption reform, pre and post adoption practices, adoption laws, women's health, birthing procedures, funding for research, original birth certificate access, assessment measures, practitioner training, and diagnosis.  Recognition and wider awareness will benefit adoptees, families, practitioners, professionals, and the global community at large.  Understanding the benefits of open adoption may lead to greater access to original birth certificates and a variety of unique family dynamics.  The training and creation of an adoption-informed provider workforce will offer better-informed and attuned mental health services for this marginalized population.  It is recommended that voices from the adoptee population are included in creating these methods.

Acknowledging separation consequences will inform pre and post adoption treatment, pre-adoptive considerations, clinicians, and professionals working with the adoption populations, and allow for critically needed policy changes.  Economical and emotional support for multiple adoptee challenges currently unaddressed by medical health insurance companies, workplaces, and other systemic structures may occur in our country and abroad.

Conclusion

Contrary to conventional beliefs and attitudes that an infant will not remember or be affected by early life experiences, this article finds that keeping a birthing mother and her newborn baby together with physical contact serves as a protective factor against developmental and behavioral issues (Lothian, 2005).  Early relinquishment should be acknowledged as a developmental trauma exposure that may lead to multiple behavioral and social issues that are currently not associated with early life mother and infant separation.  Consequence of this finding could have wide ranging effects on public and professional perception, treatment, and policy.

By giving voice to the infant, we become cognizant that "the first year of life is a time of significant risk for victimization" (Hambrick et al., 2019: 9; Turner et al., 2006) with long lasting consequences.  Through investigation of best circumstances surrounding birthing practices and relinquishment, the benefits of biological mother and child contact are explicitly underappreciated, understudied, and prove vastly beneficial for both the mother and her infant. Recognizing early relinquishment as developmental trauma is radical and immense, yet this knowledge gives us the power and opportunity to facilitate the creation of neurologically more-typical, and ultimately happier humans.

References

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