Deciding whether to pursue a potential match for an adoptive placement is no game. Nevertheless, the game Twenty Questions provides a good strategy for prospective adoptive couples to assess an offered situation. Asking 20 relevant questions is crucial when such a life-altering decision about a family’s future must be made.

Since legal, financial, and emotional consequences stem from a match, prudent couples need to approach a match with their heads and not their hearts. Using one’s head requires pertinent questions to be asked to obtain information to make a rational, considered opinion as to whether to pursue a specific opportunity. More information is needed than a due date and the baby’s gender.

The following 20 questions provide essential information to be taken into account about any match opportunity:

1. Where will the baby be born?

The location of the baby’s birth determines the nature of the adoption which will be pursued. If the prospective adoptive couple lives in State A, but the baby will be born in State B, the case will be an interstate adoption. Out-of-state travel with the attending costs (gas? plane tickets? hotel?) and logistical issues (method of travel? time off from work? etc.) is required. Interstate adoption cases cost more because processing through the Interstate Compact on the Placement of Children is required. Until ICPC clearance is obtained, it is illegal for the prospective adoptive parents to take the child out of state and back to their home. Therefore, at least one of the prospective adoptive parents would need to remain with the child in the child’s state until ICPC clearance is received.

2. What method of delivery is expected?

If a scheduled procedure (induction or cesarean section) is anticipated, planning is easier, particularly if travel will be required. If the birth mother will be allowed to spontaneously go into labor, prospective adoptive parents will have to place their lives on hold and be ready at a moment’s notice to be present for the baby’s placement. Last minute travel may wreak havoc on work schedules, child care plans, and travel arrangements.

3. How will the birth mother’s medical expenses be covered?

Adopting a child is expensive. If medical expenses must be paid, in addition to legal fees and costs, then the adoption will be even more expensive. Birth mothers may qualify for pregnancy Medicaid coverage, and their eligibility for this coverage is not affected by the fact that an adoptive placement is planned. Pregnancy Medicaid covers the birth mother’s prenatal care, postpartum care, hospitalization for labor and delivery, and the baby’s hospital bill. When such coverage is in place, adoptive couples would not have to shoulder such expenses. If the birth mother has private insurance coverage, the prospective adoptive parents may be asked to pay copays and deductibles not covered by the birth mother’s insurance. The amount of medical expenses which the adoptive couple must pay is a crucial factor as to whether the situation is within their budget.

4.  What hospital arrangements are anticipated?

Factoring into travel plans and attendant expenses is when the adoptive couple will be expected to be at the hospital. The birth mother may wish for them to be at the hospital at the time of the baby’s birth. The ability to do so may be hindered by the couple’s distance from the hospital. The birth mother may want the hospital to provide the couple with a bonding room so they may bond with and learn to care for the child while the baby is in the hospital. For interstate cases, spending time with the baby in the hospital prior to discharge will lengthen the time the couple has to remain out of state from their home. If the adoptive couple has other children, they may not be allowed to have those children with them on the maternity floor or in the bonding room. Where will the children stay, and who will watch them?

5. How long has the birth mother been considering an adoptive placement?

Even if a woman states she has decided on a placement, minds can change, especially when the emotions and hormones of pregnancy come into play. If a birth mother has not been considering the option for long or she contacts a placement resource in the heat of having just learned of an unplanned pregnancy, risks exist that a change of mind could occur. Although not a guarantee of a positive outcome, birth mothers who have considered the option for a while are more likely to follow through with that decision than birth mothers who rush into a decision. A failed placement is devastating emotionally and financially, so learning how invested the birth mother is in her adoption plan is wise.

6.  Why is the birth mother making a placement?

The likelihood of the birth mother carrying through with her plan to place may depend on why she is making the placement. If she is too young to parent, physically/mentally not able to parent, or the victim of rape, the odds are favorable that she will indeed make a placement since these factors will not change. If the birth mother is making a placement because she broke up with the birth father, what happens if she and the birth father kiss and make up? If the birth mother is making a placement due to financial concerns, what happens if she finds a better-paying job that would allow her to parent? Where the reason underlying the need to make a placement can change, the birth mother’s decision about wanting to make the placement may change as well.

7.  What is the biological family’s position on placement of the baby?

Legally, the birth mother and the birth father may be the only ones who need to consent to the adoption. However, the birth parents live in the real world and may be influenced or pressured by family members to choose one option over another. When those who are closest to you in the world, or who financially support, you oppose your decision, those circumstances are a possible recipe for a change of mind about a placement. For example, a young birth father may not care anything about raising a baby at that point in his life; however, if his mother longs to be a grandmother, she may exert financial or emotional pressure to convince her son to oppose an adoptive placement. Family opposition is a red flag indicating a risk in a match situation.

8.  What revocation period, if any, applies to the execution of a consent by a birth parent?

Risk may still exist even if a consent is signed by a birth parent. Some states allow a window of opportunity or a revocation period following execution of a consent. Prospective adoptive couples need to be aware of any such time frames and determine if they are up to the emotional roller coaster of having a baby placed with them that may be taken back during a revocation period.

9.  Is ICWA implicated?

The federal Indian Child Welfare Act complicates cases where the child to be adopted is eligible to be a tribe member. Although ICWA, as the law is familiarly called, has been held unconstitutional by one federal court, the law is currently still in effect. Where applicable, the law may require more stringent procedures such as executing a consent in court and possible interaction with a federally recognized Native American Indian tribe. These procedures add to the cost of a case, as well as adding more emotional roller coaster riding for the adoptive couple.

10. What money must we pay and when?

Being able to cover the cost of the case when required is important for a prospective adoptive couple to proceed with a situation. Adoption resources will commonly require a payment at the time of match. Other resources require a full payment of a flat fee or balance due at the time of placement. If these financial requirements are not feasible for a couple, then they may have to pass on the match. Even if a couple is able to cover the anticipated costs, for planning purposes, they need to be aware of what must be available (in case funds need to be transferred, for example) at specific times in the case.

11.  What money is at risk?

If money is paid prior to a baby’s placement, a prudent question to ask is, “What money may be lost if the situation falls through?” Non-refundable payments cannot be recouped; the loss of such amount may impede a prospective adoptive couple’s ability to pursue future situations. Knowing what amounts, a couple may be out of money and without a baby. This is crucial to assessing the desirability of a match situation.

12.  What prenatal care has the birth mother received?

No such creature as regular prenatal care exists in the world of adoption. Most pregnancies are unplanned, so prenatal care begins late at best. Even when prenatal care begins, it may be irregular due to logistical issues such as lack of transportation, lack of child care, etc. Knowing what efforts the birth mother has made to obtain prenatal care to the current point of her pregnancy gives the prospective adoptive couple an idea of the birth mother’s desire to receive care and the effort she is willing to exert to obtain it. Hesitance or refusal to seek prenatal care may be an indication of substance abuse.

13.  Has there been any substance use or abuse by the birth mother?

Even if the birth mother has not received any prenatal care, the adoption resource can and should ask the birth mother about her use of alcohol, nicotine, and drugs (illegal or prescription) while pregnant. Of course, the answers given are self-reported; the birth mother may or may not be truthful in her answers. Court records are public, so adoption resources are able to review such records to see if there is any court history to indicate use or abuse of a substance might be a concern. For example, if the birth mother has had DUI cases, consumption of alcohol is a good possibility. If she’s been charged with drug possession, then illegal drug use is likely. Social media posts might also be checked. Is the birth mother pictured drinking a beer or smoking a cigarette? Substance use or abuse may cause harm to a fetus, and prospective adoptive couples need to be aware of this possible risk before deciding to proceed.

14.  Does the birth mother have any mental health issues?

The answer to this question may impact the baby’s future health if the condition can be inherited. A birth mother’s poor mental health may impair her ability to properly care for herself during the pregnancy and might lead her to take medications for a psychiatric condition which are harmful to the fetus. Mental health conditions might also affect a birth mother’s competence to execute a consent to the adoption.

15.  Will the birth mother require assistance with living expenses?

Some states allow prospective adoptive couples to assist a birth mother financially during the pregnancy and usual postpartum period. For example, if she is confined to bed rest while pregnant, she may not be able to work and pay for food, etc. The payment of living expenses makes a case more expensive because such amounts are over and above the legal fees and costs. This question allows a couple to assess the economic viability of pursuing the match and take it under consideration.

16. What family medical history is known?

Information about the medical history of the birth parents and their families is important for taking into account possible health conditions the child may have. If there is a strong history of asthma, then the adoptive couple needs to be aware they might be raising a child with this condition. Even if the information is as innocuous as many biological family members wear glasses, it is still important for the couple to plan for this likelihood in their child as he grows up. Conversely, to this question, it is also important for a couple to understand what is NOT known. If a birth father is unidentified, then no medical history will be known about either him or his family.

17.  Has a birth father been identified?

If a birth father is identified and located then medical history on him and his family may be available. The emphasis is on the word “may.” If the alleged birth father denies paternity, then he is unlikely to desire to give the adoption resource his medical history. It is also possible that the identity of the birth father is not certain. If the birth mother says that there are two possible biological fathers of her child, then the case is more complicated in that the racial background and medical history of the child’s family is uncertain. Moreover, the case is likely to be more expensive if more than one possible father must be legally dealt with to effect an adoption.

18.  If the birth father is known, what is his position on the intended adoption?

A father who denies paternity or does not desire to parent his child is less scary for an adoptive couple to deal with than one who acknowledges paternity and may or may not want to parent. A cooperative birth father makes for less emotional roller coaster riding for a prospective adoptive couple and will result in a case that costs less than a contested, or possibly contested, one.

19. How will the birth father’s rights be terminated?

A birth father may be on board with the birth mother’s placement plan and willingly sign a consent. Prospective adoptive parents like those cases because there is tangible evidence of the birth father’s agreement. The situation is a bit scarier when the birth father refuses to sign. He may not want to sign simply because he does not trust lawyers or because he is mad at the birth mother for breaking up with him. In those cases, the birth father may not sign on a dotted line, but other termination options exist. Prospective adoptive parents need to be aware of what must be done to legally cut the birth father out of the picture. Some options require more emotional roller coaster riding than others. Options can be more expensive if additional attorney time is needed or if a birth father must be served and a waiting period must elapse to see if he will respond.

20. What contact does the birth mother desire?

The birth mother may want to have a pre-birth meeting with a couple to give herself peace of mind and confirm her decision. She thinks a couple looks good on paper, but she may want to meet them personally to make sure. Pre-birth meetings can be nerve-wracking for adoptive couples who feel that they are auditioning for a part as the parents of the birth mother’s child. The birth mother may want contact with the couple and/or child following placement. A couple must be willing to abide by the amount of contact a birth mother is seeking if they want to take that match. If a couple says they are willing to let the birth mother see the child once a year, then they will have to abide by that agreement. Is what the birth mother is requesting something you can do? Would you be comfortable with continued contact given the birth mother’s situation? If she has issues with criminal history or drug use, would you still want to have personal contact with her?

In the traditional game of Twenty Questions, only “yes” and “no” answers can be given. For couples faced with a match prospect, they need to ask open-ended questions and gather as much information as they can to assess the desirability and feasibility of proceeding. While more than 20 questions are certain to be asked during the course of a placement, the 20 listed here are a great start at letting a prospective adoptive couple figure out if what they are offered is a situation they should pursue.

Are you considering placing a child for adoption? Not sure what to do next? First, know that you are not alone. Visit or call 1-800-ADOPT-98 to speak to one of our Options Counselors to get compassionate, nonjudgmental support. We are here to assist you in any way we can.