When Your Patient Has an Adoption Plan: Insights for Hospital Staff

When a woman arrives at the hospital planning to place her baby for adoption — or considering it in real time — hospital staff are often the first point of support. Whether you are a L&D nurse or a social worker, you play a critical role in ensuring her experience is safe, respectful, and rooted in autonomy.

Here’s a breakdown of what the adoption process looks like from her perspective, and how you can best support her during this vulnerable time.

Step 1: Exploring the Option of Adoption

Many women start thinking about adoption before delivery, and have already established a relationship with an adoption agency. Others don’t consider it until they’re in the hospital. Either way, the emotional weight is enormous, and timing varies.

At this stage, she may be:

• Still deciding between parenting and adoption
• Feeling pressure (from family, partner, or circumstances). Some might be pressuring her to place; some might be pressuring her to parent.
• Seeking clarity without judgment

Your role: Provide emotional space and ask open-ended questions. If she hasn’t done so already, connect her with a trusted adoption agency — without assuming a decision has been made.

Step 2: Creating (or Revising) the Adoption Plan

If she chooses to move forward with adoption, she’ll work with her adoption specialist to build a personalized adoption plan. This includes:

• Choosing the adoptive family (if she hasn’t already)
• Deciding on openness and future contact
• Outlining her preferences for time with the baby after birth
• Preparing for the legal process, including reviewing relinquishment documents

Even in the hospital, these decisions can evolve. Some women want time with the baby; others may prefer not to hold or feed the baby. Her preferences should always guide the care team.

Your role: Help facilitate her plan without imposing. Communicate her wishes clearly to the medical team and advocate for trauma-informed care. Remember that until relinquishment, she has the right to make all decisions for the baby.

Step 3: Hospital Stay & Birth Experience

Birth can be a deeply emotional moment for a woman placing her baby for adoption. Many are grieving even as they feel at peace with their choice. Others feel conflicted, confused, or numb.

Supportive hospital policies should include:

• Respecting her birth plan
• Offering privacy and emotional support
• Allowing her to change her mind without pressure
• Ensuring the adoptive family’s involvement (if desired) aligns with her wishes

Your role: Be her advocate. Coordinate between her, the adoptive family, and the agency to ensure the experience honors her needs first and foremost.

Step 4: Signing Relinquishment Documents

After birth (at least 48 hours later, per Texas law), she may be presented with paperwork to legally terminate parental rights.

This must be:

• Voluntary
• Informed
• Free from pressure or incentives
• Unmedicated, with no narcotic administered within the 4 hours prior

An adoption agency or attorney should oversee this process, not the hospital staff.

Your role: Ensure she is not rushed or coerced. If she is emotional, ask her how she’s feeling about her plan. She might be crying because this is the hardest decision a parent could make. Or she might be thinking she wants to parent but is afraid to say so. By asking that question, she can let you know how she’s feeling without a more judgmental question such as “You know you don’t have to do this?”

If she does say she’s not sure about adoption anymore, ask to let the hospital social worker know so she can advocate for her.

Step 5: Post-Placement Support

Placing a baby for adoption is not a one-time event – it’s a lifelong emotional journey. After she leaves the hospital, grief and healing often intensify.

Ethical agencies – including Adoption Advocates – provide:

• Ongoing grief counseling
• Legal representation for the expectant/birth parents
• Guidance navigating open adoption relationships
• Financial assistance for up to 6 weeks after delivery

Your role: Encourage her to participate in grief counseling through her adoption agency. Refer her to trusted, ethical organizations that may provide additional support and resources through the post-partum period.

One Last Thought

Hospital staff, especially social workers, are the bridge between clinical care and emotional support for women choosing adoption. Your compassion and awareness can make the difference between a traumatic experience and one that is grounded in dignity and care. When in doubt, lead with empathy, honor her autonomy, and advocate for her rights.