About one-fourth of unrelated domestic adoptions involve infants. For prospective adoptive parents of a newborn, placement typically occurs shortly after birth. In such situations, the hospital is the location where such parents meet the newest member of the family. What can they expect to occur when placement is expected at the hospital?

The most honest answer is that these adoptive parents will receive placement of a newborn. Period. There is no set itinerary or fixed schedule for an infant placement from the hospital. These types of placement require flexibility and the ability to go with the flow. While there are specific events and things which must occur, each case is different and dependent on the specific circumstances.

When prospective adoptive parents are matched with a pregnant birth mother, the big question is when the baby will be born. This question cannot be answered with any scientific certainty. A due date is merely an estimate of when a baby might be born. To highlight that the due date is an estimate, consider the fact that, according to the Perinatal Institute, a UK nonprofit organization, a baby is born on the due date only 4 percent of the time. The term EDC (often seen on ultrasound pictures) is a more accurate description of the date. It stands for Estimated Date of Completion.

So, it is impossible to know in advance when a baby will be born. But what if the delivery is scheduled? Even then, it is not possible to know with certainty when the baby will be born. A cesarean section might be scheduled, but it is possible that the birth mother could go into labor prior to that date. Similarly, depending on health conditions, the procedure may be moved up or even done on an emergency basis based on the medical circumstances at the time. Even a scheduled induction guarantees nothing. A procedure may be scheduled and then delayed due to existing circumstances such as lack of beds in the hospital.

Waiting for a birth mother to go into labor spontaneously can be nerve-wracking for prospective adoptive parents, particularly when travel arrangements are required to get to the hospital. Birth mothers can be told that they have begun to dilate or that they have lost their mucus plug. This may or may not signify impending labor.

The commencement of labor is simply the beginning of the process and a prospective adoptive couple’s hospital experience. Typically, if the couple is matched in advance of birth, the adoption entity will, in conjunction with the birth mother, have come up with a hospital plan. The adoption entity will coordinate with the hospital in advance as to the plan so everyone is aware of what is going on and what the birth mother desires. Key to this process is that a plan is just that. A plan. Things can change necessitating a shift from Plan A to Plan B.

If the prospective adoptive parents are to be at the hospital for the birth, will they be in the delivery room? Obviously, the wishes of the birth mother must be respected. She may want the prospective adoptive mother to be with her or perhaps she wants her own mother, close friend, etc., with her. Much will depend on whether the birth mother has had any contact or relationship with the couple prior to the delivery. For privacy reasons, she may understandably feel uncomfortable with having the prospective adoptive father in the delivery room when she gives birth.

Regardless of what the birth mother or the adoptive parents have arranged, the doctor is ultimately in control of what goes on in the delivery room. Given medical emergencies, complications, etc., it will be the OB-GYN’s call who may be present for the birth. Assuming a routine delivery, OB-GYN’s are generally willing to accede to the wishes of the patient.

Whether the adoptive parents are present at the hospital for the birth or not, the duration of labor is a big question for them. How long must they wait for the baby to make his arrival? Once again, there is no one-size-fits-all answer. The length of labor varies for every woman, and there can be wide variations in its duration. Several variables may impact the length. Generally, labor progresses quicker for women who have previously given birth. Research also shows that older mothers may take longer to deliver.

Once the baby has arrived, everyone wants to know how little one is doing. Is he healthy?  One indication of the baby’s health is the Apgar scores assigned. This testing is a health assessment conducted soon after birth, usually at one and five minutes thereafter. Apgar scoring, introduced by Virginia Apgar, M.D., in 1952, assigns a score of 0, 1, or 2 in five categories: breathing effort, heart rate, muscle tone, reflexes, and skin color. The higher the score, the better the baby is doing. Scores of 7, 8, or 9 are normal; scores below 7 require medical attention. Low scores may be caused by such things as a difficult birth or fluid in the baby’s airway. A perfect 10 is unusual because infants commonly have blue hands and feet following birth.

Getting medical information about the baby is not always a smooth process for prospective adoptive parents. Federal law regulates the disclosure of personal health information (also known as PHI). HIPAA, or the Health Insurance Portability and Accountability Act, signed into law by President Clinton in 1996, requires express written authorization for a covered entity to disclose PHI except in certain circumstances such as in connection with facilitating treatment and payment.

In adoption situations, the adoption entity will obtain a signed medical release form from the birth mother to allow the entity access to information on the health and condition of both mother and baby. Therefore, the information will flow from the medical staff to the adoption entity to the prospective adoptive parents. Nevertheless, if the prospective adoptive parents are interacting with the birth mother during the baby’s hospitalization, they may obtain information through the birth mother. If the prospective adoptive parents are caring for a baby in a bonding room, they will be given specific health information to assist in providing care for the baby.

After the baby’s birth, access to the baby is the key concern for a prospective adoptive couple. Hospitals have policies and procedures in place which address who is authorized access to a baby. Hospital bands are used to establish one’s permission to access a baby. They also serve to identify a patient and to provide medical staff with important health information such as allergies.

Babies are banded following birth with one band being placed on the baby’s ankle and one on the baby’s wrist. The number on the band corresponds to the number on the band issued to the birth mother. The birth mother will also be given a band for the baby. A second band is usually issued as well; the birth mother can direct hospital staff to give the second band to the person of her choosing—her mother, a prospective adoptive parent, etc. With such a band, the adoptive parent is permitted access to the nursery to spend time with the baby. Without such a band, the prospective adoptive parent is like any other hospital visitor. He may see the baby in the room with the mother or look at the baby through a nursery viewing window if one is available and if the birth mother has given permission for her baby to be placed for viewing.

Security is a huge issue for hospitals today. Most maternity units are locked units. Doors permitting access are kept locked; an entry phone is utilized to contact staff on the unit to gain access. Without prior arrangements having been made, the prospective adoptive parents will not be able to freely access the maternity unit. If they are in communication with and known to the birth mother, she can authorize access by directing the maternity unit staff. Otherwise, the adoption entity must coordinate with the appropriate hospital point of contact regarding the adoptive parents gaining access to the maternity unit.

Even if banded and provided with a bonding room, prospective adoptive parents must still comply with hospital procedures regarding security. The baby’s security band will set off an alarm if they try to take the baby off the maternity unit or close to a restricted area such as an elevator. This band is removed prior to discharge.

In recent years, hospitals have begun offering bonding rooms for prospective adoptive parents. If the birth mother has directed an adoptive parent to be banded and wishes a bonding room made available, the hospital can assign a room specifically to the prospective adoptive couple. Using such a room allows new parents the opportunity to spend quality time with the baby to bond and learn to care for him.

Bonding rooms are an offshoot of hospitals embracing the practice of rooming-in, where a baby stays in the mother’s hospital room for care rather than being kept in the nursery. Bonding is the formation of a close relationship especially through frequent or contact association. The benefits of facilitating bonding immediately after birth have been documented. According to Deepak Chopra, M.D., a close mother-infant bond can prevent disease, boost immunity, and enhance IQ in a baby.  Since the adoptive mother has not carried the infant during the gestational period, it is even more crucial that she has as early contact with the baby as possible to begin the crucial bonding process.

An adoptive couple is eager to take their new family member home with them; they want the baby discharged as soon as possible. When will this occur? Again, there is no set time for discharge. The baby must be medically fit for discharge which means that when a pediatrician shows up to do rounds or how long it takes to run a test factor into the answer. A common time for a healthy newborn to be hospitalized is around 48 hours. And things can change at a moment’s notice. If the baby starts running a temperature or experiencing a medical issue, the discharge may be delayed.

When discharge has been authorized, the prospective adoptive couple receives discharge training. The hospital staff will provide basic information regarding safety, feeding, umbilical cord care, positioning for sleep to avoid sudden infant death syndrome, etc. The timing of a follow-up appointment with a pediatrician following discharge will also be discussed. The discharge training gives adoptive parents the opportunity to ask questions or address concerns about infant care. Often, hospitals will provide adoptive parents with pamphlets or materials about caring for the baby as well as give them a gift pack of items to take home—commonly diapers, formula, etc.

The adoption entity facilitates the baby’s discharge. A hospital will require written permission from the birth mother to allow the baby to be discharged to someone other than her. The adoption entity obtains such a release to present at the time of discharge. In connection with the discharge, the adoption entity will also request copies of the baby’s medical records or previously submitted forms for completion by medical staff. The medical records/forms are utilized in the adoption court proceedings and/or included in an Interstate Compact on the Placement of Children packet when an interstate adoption is being handled. Medical records will also be provided for the adoptive couple to give to the pediatrician they will use to care for their new baby.

At last the baby is cleared to leave the hospital with his forever family. Before they leave, medical staff will typically check how the baby is being transported from the hospital. The American Academy of Pediatrics recommends babies be placed in a rear-facing infant carrier. Adoptive parents thus need to be equipped with the proper carrier and versed in how to use it. Practicing how the seats are fastened into place in their vehicle and how straps are tightened to secure the baby is best done by adoptive couples before everyone is all set to leave the hospital.

While receiving placement of a baby from the hospital is a joyous and happy time for an adoptive couple, it is also a time of uncertainty. No set itineraries of when things will happen can be provided, and couples are often left to wing it as events unfold. Babies will come when they are ready to come. Labor will take as long as it needs to take. Access to the baby will need to be worked out. Discharge will occur when everything is in place for that event to occur. Adoptive parents cannot control many things at the hospital; nevertheless, one thing they can control is their expectations for what will occur. It will be a time for flying by the seat of one’s pants. Being flexible is key. And all the uncertainty and twists and turns which occur at the hospital will make for a great story—later.

 

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