‘Look after me too’: A qualitative exploration of the transition into adoptive motherhood

Adoptive parent experience

Despite the substantial amount of research into adoption, little is known about the emotional and psychological impact of transitioning to parenthood from the perspective of the adopters (Meakings, et al., 2018; Selwyn, et al., 2006). This is likely to be significant as adoption disruption has been linked to parental factors at time of transition, such as adopters’ unrealistic expectations, idealised view of adopted children, help-seeking behaviour and motivation to adopt (Goldberg, 2009; Palacios, et al., 2019; Randall, 2013; Rushton and Dance, 2004; Selwyn, Wijedasa and Meakings, 2014).

Although the prevalence of adoption breakdown is low, approximately 3% in England and Wales (Selwyn, Wijedasa and Meakings, 2014), this encouraging figure should be seen in the wider context where adoptive parents struggle with their child’s challenging behaviour and poor emotion regulation from the onset of placement (Palacios, at al., 2019; Selwyn, Wijedasa and Meakings, 2014).

These difficulties have been highlighted in several studies from around the world. In the USA, for example, Foli and colleagues (2010, 2017b) explored the prevalence of post-adoption depression and warned that unrealistic expectations of self and others heighten the risk of it developing after child placement (Foli, 2010; Foli, et al., 2017a; Foli, Lim and South, 2017b). The prevalence of post-adoption depression six weeks after child placement is comparable to that of post-partum depression (McKay, Ross and Goldberg, 2010; Senecky, et al., 2009). In Canada, Daniluk and Hurtig-Mitchell (2003) interviewed 39 couples who had adopted a child within the previous two years. Parents found the transition stressful, with three factors contributing to stress: accepting infertility and deciding to adopt; psychologically surviving the uncertainties of the adoption process; and coming ‘full circle’ by adapting to adoptive parenthood.

In the UK, Selwyn and colleagues (2006) conducted a longitudinal study exploring the costs and outcomes of non-infant adoptions, specifically involving children placed at the age of three to 11 years. The authors scrutinised 130 children and carers (both adopters and foster carers) over 11 years, reviewing life changes and financial and emotional costs, as well as outcomes for both child and carers. They highlighted the need for improved post-adoption services, particularly those offering emotional support to adoptive parents/carers. A later UK study by Dance and Farmer (2014) recorded the reflections of 27 adoptive parents as they progressed from application to adoption placement and concurred with others by highlighting the physically draining aspects of the process and the value of connecting with already established adoptive parents as a means of support.

More recently, UK researchers have emphasised the love felt by new adopters towards their child and the success of family adjustment, with expectations being more than met (Adoption UK, 2019; Lewis, 2018; Meakings, et al., 2018; Tasker and Wood, 2016). If problems do arise, they centre around different inter-generational parenting styles, a sense of continued uncertainty in the parental role (Tasker and Wood, 2016) and a lack of authority and support for well-being (Lewis, 2018).

A longer time period has been used in two further studies. The Wales Adoption Study (Meakings, et al., 2018) surveyed 96 adoptive families at four months post-placement and 40 of them at nine months. The findings offered a comprehensive exploration of the support needs of adoptive families, particularly the value of short-term financial help, assistance with securing the adoption order and the need to be informed about the stages of the legal proceedings. A further large study, The Adoption Barometer survey by Adoption UK (2019), captured the experiences of adoptive families across the UK via an online survey of 3500 parents. It showed that half of new adopters found the early months so challenging they wondered if they could continue. Moreover, 54% of parents experienced stress, anxiety or post-adoption depression symptoms during the early weeks. In addition, social isolation thereafter was a continuing concern. Advice from social workers to keep family at a distance deepened this sense of isolation and loneliness.

From this literature review, it can be seen that much of the research on adoption tends to focus on specific events within the transition, such as ‘matching’, ‘introduction’ and support needs, with the emotional and psychological impact on parents discussed as a secondary issue. This study adds to the literature by exploring parents' transition to adoptive parenthood over a lengthy period – from point of decision to adopt through to 12 months post-placement – and pays particular attention to their emotional and psychological well-being.

Participants

The participants comprised nine white, heterosexual adoptive mothers who used an online support group often used by adoptive parents who are facing difficulties. They had formally adopted 14 children, with one of those adoptions completed at least a year ago. No fathers, members of the LGBTQ+ or BAME community were represented. Inclusion criteria were: sufficient fluency in English, UK residence and adoption in the UK through public, private or international agencies. Eight families had adopted through the local authority and one via a private agency. Eight children were below the age of 24 months when placed, younger than the current average age of around three years in the UK (CoramBAAF, 2019). The remaining six were aged between three and five. In eight of the families, the adopted children’s ethnicity resembled that of their adoptive parents and seven mothers described themselves as married, with one identifying herself as divorced and another single.

Procedure

Ethical approval (University of Sussex Sciences & Technology C-REC, ref ER/CK377/4) was granted prior to recruitment via three local authority adoption agencies and online support groups. Participants were selected on a first-come, first-served basis with consideration given to the number of children and their ages, as well as the presence of birth children in the family, in order to enhance the representation of different family structures. Each participant received an information sheet prior to interview, including details of data management arrangements. If more than one child had been adopted, parents were asked to speak about the most recent.

Genograms

The genograms of the nine families are laid out below (Figure 1).

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Figure 1.

APEx: Participant genograms.

Data collection and analysis

Semi-structured interviews were conducted between April and June 2019. They focused on retrospective and current adopter experiences and how the family had evolved from pre-placement to its current situation. As the focus of the article is on the transition to adoptive motherhood, content relating to this was extricated from the wider interview transcripts. Interviews were recorded and transcribed verbatim and pseudonyms are used for names, locations and identifiable organisations.

Reflexive Thematic Analysis, as described by Braun and Clarke (2006, 2019), was used to analyse the material as it facilitates the identification of themes both within and across data. The analysis followed the RTA method and comprised repeated reading of transcripts, the generation of descriptive and meaning-based codes across the whole dataset, reviewing each transcript and checking against the created themes and refining theme names and definitions. Themes were developed based on the level of impact not only within each individual narrative but also across the individual transition period as well as across the wider group narratives.

Reality not living up to expectation

For eight of the nine mothers, expectations about what adopting a child would be like, how the process would unfold and how the family would function differed from the reality of their experiences. They reported an optimistic, somewhat fantasised view of parenthood and ‘glossed over’ the hurdles they needed to overcome. For those seeking to adopt a second child, familiarity with the process reduced this lack of realism and boosted their confidence. In Kate’s words:

I just assumed I’d be having a four-year-old child. I had a six-year-old and had she been four, I'd have known what four-year-olds entailed. I always thought that’s what I could be getting … I just thought as soon as that child comes through to me, she’s going to be the most fabulous girl, fabulous boy, whatever, and they’ll merge straight into my family and it’s going to be great.

But such expectations neglected factors like uncertainty about the adoption process, the child’s past experiences and the special demands of parenting a child from care. For all but one mother, there was a discrepancy between the child they expected and his or her presentation once in the family: the child profile and information provided by those who knew the child, such as social workers and foster carers, did not mirror the individual they were seeing and parenting. To quote Angie:

Other mothers spoke of ‘rose-tinted’ expectations with reality being ‘completely different from what they envisaged’ and ‘not within the realms of normal parenting’. The experience of delayed or regressive behaviour, child hostility or violence and challenges to parent–child attachment were unforeseen aspects of their adoption journey.

Interviewees who expressed the most distress were mothers whose prior expectations were mostly unmet and whose high level of uncertainty endured beyond child placement. One summarised her experience as feeling ‘completely unprepared for the intensity’ of her child’s behaviour, often struggling to relate and bond with one child while ‘surviving’ the often dysregulated, aggressive and violent behaviour of the other. To quote Angie again:

It was horrendous … I felt claustrophobic and wanted to escape most of the time … I was desperate for anybody else to be in the house, so I didn’t have to manage this on my own … I didn’t feel safe often … I had been through a trauma.

In contrast, two mothers did not experience large discrepancies between expectations and reality and did not report great emotional distress. On referring to a friend who had adopted, Tracey stated:

So, to summarise, the analysis of this theme showed variation in the contrast between mothers’ expectation and reality and that those for whom the gap was smallest reported less emotional distress throughout the transition period.

Uncertainty and powerlessness

Feelings of uncertainty and powerlessness were frequently expressed in the interviews, particularly about the length of the process and perceptions of authority within child selection and eventual adoption approval. Angie highlighted these features in her complaint about the process timeframe and her lack of power to influence it:

You find a child, oh no you haven’t, we’re going to go to matching panel, or no we’re not. There are just so many variables. At least with pregnancy you know you are going to have a baby at the end of it and it’ll be around this date. But in adoption you can’t even put a date on it … you just don’t know when to get excited.

Mary’s experience reflects the power imbalance experienced by all the mothers throughout the process. This was also evident after placement when birth parents contested the adoption, leaving one mother to say, ‘We had no idea that might be a possibility.’ The powerlessness and uncertainty mothers felt reflects the realities of the situation, namely that children's services and/or birth parents remain very powerful.

Emotional and physical fatigue

All the mothers spoke of emotional and physical fatigue throughout the adoptive process. For seven of them, the toll of fertility treatment was a precursor to their decision to adopt. Interestingly, fatigue was not reported during the assessment and matching stages, but more once approval had been granted and the parent and child were united in a phase called ‘introductions’. In Kate’s words:

While the emotional intensity of this period produced mixed feelings among the mothers, physical demands were reported by all. The adherence to statutory requirements meant that they lacked sleep and a lot of travel was involved, often with early starts and late finishes. Days were spent in unfamiliar locations while attempting to bond with an unfamiliar child. This was Helen’s experience:

As soon as I saw him, I wanted him to be my baby … but he has gone from his foster home to being with me, he didn’t sleep, I can’t tell you how tired I was. I went to bed at 4.30 in the afternoon, I cried at going to bed at 4.30pm but he was asleep, so I was going to go to sleep. He hardly slept; I couldn’t leave him for any period of time … I couldn’t return to work.

For these mothers, the behaviour and characteristics of their newly placed child were unexpected and their frustration was exacerbated by the fact that statutory bodies continued to maintain a parental responsibility during this time, and monitor the situation to assess the progress of the placement. Under such pressure, mothers hid their distress, fearing the child would be removed if they acknowledged their difficulties, a response that could only further increase their physical emotional exhaustion.

Uniqueness, difference and isolation

For seven mothers, the adoption process was new to them and those around them. Uncertainty about the process, along with recollections of previous pregnancy complications, led them to withhold information about the decision to adopt or the progress of the application from others. This was Sarah’s experience:

Every mother spoke of the unique position of beginning their parenting journey with a child who had started his or her life within another family and the sense of ‘missing information’ about them. The task of looking after a child while developing a meaningful mother–child relationship recognisable both within the family and the wider community was a challenge.

All but one of them spoke of the time commitment of appointments and continued monitoring by statutory services post-placement. To quote Helen:

At a time when most new biological mothers are given space to recover, bond and lean on family for support, adoptive mothers continue to be assessed and monitored. Access to tailored support appeared non-existent in the majority of cases and in all the adoptions physical contact with family and friends was discouraged in the initial weeks. This was Kate’s experience:

Many mothers struggled with the lack of personal contact with close family, suggesting they needed hands-on support to help manage day-to-day tasks. However, they complied with instructions from social workers to delay or avoid such contact in order to promote positive attachment. Knowing whom to share information with, how much to share and when proved to be a challenge throughout the transition period and beyond.

Across the narratives there was a sense of isolation from other new mothers and a lack of the understanding and support afforded to biological mothers. They reported a pressure to be seen to cope, be ‘perfect’ or a ‘wonder woman’. To quote Kate again:

Feelings of isolation, difference and fear were shared by the six mothers who struggled the most, one commenting, ‘I wish I’d been told that it’s okay not to be okay.’ They wanted social workers to provide reassurance that if they felt they were not coping very well, they could admit it and be told, ‘It’s fine and your child won’t be taken away.’ Six mothers also felt isolated by their friends and by their family’s misunderstanding and ignorance about their situation. In Angie’s words:

[T]he first six or nine months were horrendous, and there was almost the feeling of ‘Well, you wanted this, now you have to get on with it’ or ‘you know, it’s just a tantrum and you just put him in his bedroom’, and no you don’t. When you are faced with that complete lack of understanding it’s easier to just say everything is fine because it’s too emotionally difficult to try and explain it to somebody and then still not receive the support you need from them. This is when we shut down a little really.

Loss, love and ambivalence

The theme of loss, love and ambivalence captures the evolving nature of relationships during the adoptive parent journey. Like most adopters around the world (Schmidt, 2010), all nine mothers had attempted to become biological parents. Most had experienced unsuccessful fertility treatments before considering adoption as a means of creating a family life.

These experiences left many with a strong sense of loss concerning life expectation and control of life choices, a prolonged sense of stress associated with a risk of developing mental health symptoms linked to anxiety and depression (Schmidt, 2010; Verhaak, et al., 2007). Interestingly, only two mothers referred explicitly to the emotional impact of this loss and in both instances, it endured, even post-adoption. For Molly: ‘I don’t dwell on it but sometimes something will come out of nowhere, like on the telly, you know like a scan and it’ll make me go [physically retract and sigh].’

More common was reference to the physical and/or financial toll of fertility treatment. Each mother began her adoption story by referencing her fertility or infertility status, perhaps suggesting that this loss is an important aspect not only related to her motivation to adopt but also her identity as an adoptive mother.

Another loss which seemed apparent to the researcher but was not explicitly acknowledged by most of the mothers was that associated with the fantasised child. Each mother held strong views of either what their adoptive child would be like or how their post-adoption family would function. In all but one case, these expectations or fantasies were not realised and a loss of the ‘idealised child’ was experienced (Hugger, 2009).

Despite stems of affection developing throughout initial meetings, the challenges of day-to-day life and the need to abandon previously held fantasies resulted in mothers finding it difficult to bond and attune to their child. For four of them, the first year after placement was filled with ambivalence. Angie again:

[At the beginning] I’d given him my heart … I felt there was a connection … [but when he was placed] there was a major communication breakdown … I’d go into survival mode … love was gradual.

While loss and ambivalence touched each mother’s story in some way, love was threaded throughout: love held for the fantasised child, love at first sight for the real child and/or the development of love over time. Despite the challenges throughout the process, five mothers experienced a positive connection – a love, a sense of togetherness with their new child.

Others also felt ‘instant’ and ‘powerful’ connections, describing a sense of belonging and ownership: ‘He is mine.’ Perhaps it was the feeling of having ‘a lot of love to give’ and belief – ‘I was meant to be a mother’ – that motivated mothers throughout the adoption process. But for some, the reward came from an immediate strong connection, a love at first sight, leading Alexia to experience a type of Winnicottian ‘maternal preoccupation’ (Holloway, 2012) more commonly associated with biological motherhood.

These extracts encapsulate the complexities and transient nature of relationships during this transitional period. Adoptive mothers explicitly or implicitly referred to the desire to develop a connection with their new child/ren, while perhaps overlooking the child’s own sense of mourning or loss connected to the adoption. Their narratives depict a transitional experience shaped by unanticipated challenges, a sense of uncertainty and powerlessness and lack of parental autonomy, leading many to suffer distress and poor mental health in what should be a primarily joyful life change.