Are you considering adopting a baby? On today's show we talk about the legal and medical risk factors you need to consider. We talk with Amy Wallas Fox about the legal risk factors in infant adoption. Ms. Fox is an attorney partner of Claiborne Fox Bradley Goldman, a North Carolina and Georgia law firm and a fellow in the American Academy of Adoption and Assisted Reproduction Attorneys. We talk with Dr. Lisa Prock, MD, MPH, about the medical risk factors in infant adoption. Dr. Prock is the Director of the Developmental Medicine Center and Associate Chief in the Division of Developmental Medicine at Boston Children's Hospital and Harvard Medical School.
In this episode, we cover:
This podcast is produced by www.CreatingaFamily.org. We are a national non-profit with the mission to strengthen and inspire adoptive, foster & kinship parents and the professionals who support them. Creating a Family brings you the following trauma-informed, expert-based content:
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Please leave us a rating or review RateThisPodcast.com/creatingafamily
Are you considering adopting a baby? On today's show we talk about the legal and medical risk factors you need to consider. We talk with Amy Wallas Fox about the legal risk factors in infant adoption. Ms. Fox is an attorney partner of Claiborne Fox Bradley Goldman, a North Carolina and Georgia law firm and a fellow in the American Academy of Adoption and Assisted Reproduction Attorneys. We talk with Dr. Lisa Prock, MD, MPH, about the medical risk factors in infant adoption. Dr. Prock is the Director of the Developmental Medicine Center and Associate Chief in the Division of Developmental Medicine at Boston Children's Hospital and Harvard Medical School.
In this episode, we cover:
This podcast is produced by www.CreatingaFamily.org. We are a national non-profit with the mission to strengthen and inspire adoptive, foster & kinship parents and the professionals who support them. Creating a Family brings you the following trauma-informed, expert-based content:
Please leave us a rating or review RateThisPodcast.com/creatingafamily
Please leave us a rating or review RateThisPodcast.com/creatingafamily
Please pardon the errors, this is an automatic transcription.
0:00
Welcome to Creating a Family talk about adoption and foster care. I'm Dawn Davenport. I am both the host of this show as well as the director of the nonprofit creating a family.org. Today we're going to be talking about a topic that a lot of people are interested in and that is the legal and medical risks in infant adoption. We will be talking with Amy Wallace Fox, she is an attorney partner at Claiborne Fox Bradley Golden, which is a North Carolina and Georgia Law Firm. She practices exclusively in the area of adoption and assisted reproduction law. And she is a fellow in the American Academy of adoption and assisted reproduction attorneys. We will also be talking in the second half of the show with Dr. Lisa Prock. She is both an MD. But she also has her master's in public health. She is the Director of developmental medicine center, and Associate Chief of the Division of Developmental medicine at Boston Children's Hospital, Hospital and Harvard Medical School. Welcome both of you to Creating a Family. I am looking forward to talking with you. We're going to start with the legal risk factors in infant adoption. So Amy, that will be you that we will be discussing this with it to begin with. And then we'll move to the medical risk factors. So how can a I'm just trying to find the basics from what people are wondering and looking for? How can adoptive hopeful adoptive parents find a baby to adopt in the US? That seems to be the question that everyone when they're first beginning in the world of adoptions, the wonders? Sure,
1:37
well, there are several different avenues for that, of course, there is agency adoption, where you find you sign up with an adoption agency, who would then assist with the matching process. There are attorney facilitated, which tend to be what we call independent adoption, meaning not agency adoption. There can also be assistance from adoption consultants, adoption facilitators, adoption advertisers, and then some people are finding their own match by doing their own advertising
2:16
and finding an expectant parent who may be considering adoption that way. The what is the difference? There is a lot of confusion, the difference between adopting through an agency adopting through an attorney or difference between a facilitator and adoption consultant.
2:32
Well, legally speaking, the biggest difference between agency and non agency or often called independent is when a an expectant mom delivers the baby is consenting to the adoption in an agency adoption. She's typically relinquishing her rights to the agency. And then at a later point, the agency is completing the legal transfer of the child to the adopting parents in an independent adoption without that agency component, then in many states, she is allowed to actually consent to the adoption directly to the adopting parents. So there would be no intermediary in that case, holding legal custody. As far as the facilitator and consultant I do think those terms get used sometimes interchangeably, but my experience is that the consultant tends to offer a wider range of services, such as perhaps help with the profiles help with finding a home study agency, kind of assistance throughout the entire process, support in that way. And then with the consultants that I'm aware of, most of them actually receive mostly agency, potential opportunities that they then present to their clients. So they at the consultancies are actually working with various adoption agencies. So if you are signed up with a consultant, you may hear about a possible adoption opportunity from more than one agency facilitator and my mind tends to be more just kind of matching up the birth mom with the family and not really staying in the case or providing other services. It is also worthy to know that in some states, facilitators are not allowed or not allowed to be paid. So you want to be careful with that. And making sure that whatever services you're signing up for is legal for you in your state.
4:48
Good, very good point. We often hear that the term adoption friendly state and I should add that that's probably not probably it is very adoptive. Parents centric that term. But is there a state that is better than others in which to find an expectant mom who may be wanting to place her child for adoption?
5:11
I think it depends on your on your viewpoint. As you mentioned, a lot of times when people say that they are meaning, you know, friendly to the prospective adoptive parents, not necessarily the birth parents. So, the main thing that I hear with that is just the states where the revocation period is shorter or that there isn't one. So every state has their own set of laws on adoption. So that's another thing you have to be aware of, you know, when you are dealing with multiple states, but in some states, such as Florida, is one that comes to mind, just because the birth mom does have to wait 48 hours before signing the adoption documents following delivery of the baby. But at that point, once she signs, then she does not have the right to change her mind. In many other states, there is some period of time for them. And those vary from you know, as little as you know, no time or one day, three days, four days all the way up to as much as 45 days that I've heard of there may be some even a bit, a bit longer
6:26
revocation period. So, there is a period of time that parents of birth parents or parents at that point, have before they are allowed to consent to sign the papers that relinquish their parental rights. And then there may be and usually in most states is some period of time after they signed the pay the papers relinquishing their parental rights, that they can revoke that consent. Am I correct that they're kind of two time periods, is that right?
6:52
That's right. And in some states, there is there are both so there may be a waiting period before they can sign and then a revocation period in which they could change their mind. In other states, there may be a waiting period, like I'm in Florida with the 48 hours and then no revocation. In other states like North Carolina, there is no waiting period technically, but then there is a seven day revocation period. I will say that sometimes, too. There are conditions on the revocation period. So it's not always just for any reason, no reason it is here in North Carolina, the seven days the the birth mom does not have to prove anything, she merely has to say I'm changing my mind sign the form that says that in the the child will be returned to her during that time. But there are some states one that I believe is the case is New York, where it is a longer time, I believe it's 45 days, again, I'm not a New York attorney. But my understanding is that even though it is that long of a time, the birth mom would actually have to prove a best interest standard if she is to actually get the child back. So that would be for many birth parents much more challenging, also needing to hire legal counsel possibly to even have a chance at that. So it's not always just about the days it's also about, are there conditions required in revoking?
8:21
All right. Okay. And so a fear that many adoptive parents have going in is is it possible for the birth family to get the child back after an adoption is completed?
8:36
It would be very rare. I mean, there would be an appeal period. And then some states would have time periods after which it's not possible no matter what, but typically, unless there's some, you know, proving of fraud duress or something that was done improperly it would not be possible.
9:00
Okay. And that brings up the issue of the the legal issue with birth father's birth father's can and so we have to separate those birth fathers who are identified and those who are unidentified. So what are some of the legal issues with both identified and then birth father's unidentified birth father's?
9:23
Right. So when you're talking about issues, I think typically then you're you're thinking about where the birth father's not consenting. So I mean, there are some cases where he and the birth mom are on the same exact page with the plan, and they're both consenting so that would be the best case scenario for the legal issues with the birth father, there would not be one in that case. Otherwise, the biggest things are, you know, someone who is known and identified and not on board with the adoption plan. I mean, that can really be the and of the adoption plan, just depending on what his role has been, typically the more involved that he's been with, you know, communicating with the birth mom assisting her financially, if he's not on board with the adoption plan, it is going to be very difficult or maybe impossible for it to happen. He is
10:21
a parent has the right to parent, and just as much as the, as the mother has the right to parent.
10:28
Yeah, if he has been acting as a parent, you know, acting as a parent and, and going about, you know, showing that he wants to parent again, every state law is going to be a little bit different. And sometimes there is a bit of a gray area, you know, like, well, you know, he only provided one thing for me or he hasn't been consistent. So I mean, those types of things are sometimes things that would eventually get to a court to a judge, if the mother is still trying to push forward with the adoption plan, you know, without his consent, so just depending on his, you know, status, and whether, you know, what sorts of things has he done, there would also be a major difference, if they are married versus not married, if they're married, you need his consent, or for him to be completely unresponsive. But if they're unmarried, he would not necessarily have the same status. What about for
11:22
an unidentified birth father, that's the the expected Mom, it's it doesn't know who the dad is, or doesn't identify him.
11:31
Right? In that case, again, it's going to vary state by state. But in many states, they would end up needing to check to see first of all, is there a putative father registry. So this is a registry that a man can sign if he thinks he may have fathered a child and he does it with the mother's name. In that case, if he has registered, then he would get notification of the adoption, even if she hadn't identified him. So that's a way that he can actually protect himself. Otherwise, typically, there would be a publication, maybe both, it just depends, again, on the state law to publish notice to unknown or unidentified birth fathers. And sometimes that does have to contain the birth, mother's name or initials, or some identifying features to be able to, you know, for some man to who's possibly reading this to actually know who they're talking about. So that would be the things that we would have to do with an identify. As far as other issues. I think, of course, medically, you know, if you don't have any information about him, that could be problematic down the road, or just the lack of information.
12:45
So it's possible to adopt with a an identifier, FF birthfather, has not been identified.
12:52
It is however, it does sometimes depend on what the situation is, in some states, for example, North Carolina does not allow her to just declined to name him. That's different from not knowing who he is. If you don't know, you don't know. And that's fine here. You know, we take we take care of it with the publication, but some states actually do allow her to say I know who it is. And I don't want to say, but North Carolina is not one of those states, there are states that say she has a privacy interest in being able to not name even when the person is known.
13:30
That if that just differs by state law. Exactly. Right. Have you enjoyed what you've heard so far today, we are so excited to offer you even more expert based content, such as this, thanks to a donation from the jockey being family foundation that allows us to bring you 12 free online courses. And this is these courses are on our online Parent Training Center. And you can access them by this link Bitly, slash j, b, f support, that's bi T dot L y slash JP deaf support. And some of the topics there's 12 of them there, you get a certificate of completion, when you complete the course, an example of one of the courses is parenting a child with prenatal exposure, directly relevant to what we talked about today. So check it out at Bitly slash JBf support all right, how does the Indian Child Welfare Act impact legal risk and adoption?
14:35
So the Indian Child Welfare Act is a federal law that is supposed to be protecting children of Native American ancestry who actually would be raised in an in a Native American family, but for you know, the adoption, it was primarily put into place for the involuntary removal so meaning In the state welfare, office DSS defects whatever your state calls it, taking children away, however, it, it does still include voluntary placements. So the biggest thing about that is to make sure that those questions have been asked of the birth parents, as far as are they registered in a federally recognized tribe? Or are they eligible to be registered. And then also, a few states have what they call mini ICWA, we call it the Indian Child Welfare Act, some states actually have an additional law at the state level that makes it even more, you know, difficult or challenging, or maybe even not possible to adopt a child who does fall into that category. So you just want to make sure there's no surprise there with finding out later once things have have moved along. And in some cases, it is still possible to adopt the child, of course, with the mother, you know, voluntarily wanting to do it. But there are some specific and extra steps that have to be taken with the mother going to court and sometimes notifying tribes, and it really depends on the situation. And, you know, and what's going on. So you have to be careful about that. With Indian Child Welfare Act.
16:26
It's both that
16:27
she is either registered or eligible to be registered with the tribe. Is that correct?
16:33
I believe. So. Yes. I mean, because she could then register even sort of while things are going on, if she's, if she's eligible. So,
16:43
okay, so something to be aware of at the beginning. And knowing that it's a, it can be a very big legal risk factor. If the mom or the What about the Father, if the father is a member of a tribe,
16:58
it would depend on if they're married, or what his status is, there were there have been some cases about various fathers where the Native American status was not enough to actually, you know, remove the child from the voluntary placement if he is not considered a illegal parent. But the actual just wanted to pull it up the definition for Indian child is a member of the Indian tribe are eligible for membership and the biological child of a member. So the parent would actually have to be a member, but it's just that, you know, if they're eligible, I think, you know, it could be that that's something they, you know, try to do quickly if they are trying to maybe, you know, invalidate the adoption or something like that. So, okay, you would want to get an attorney very knowledgeable about that. There are a couple specific ones nationally, that are that are experts, for sure.
17:57
One of the the things that a lot of people who are beginning to consider adoption, don't realize is that an expectant mom cannot consent to adoption until after birth. I think that's right for every state that mom has to consent after the birth. And even though there has been an adoption, what we call it an adoption match, meaning that an agency or an attorney has connected an expectant mom. And it's with an adoptive family, they have talked a bit shared pictures they've met, they've done whatever, but the mom still has the right to change her mind. And that's hard for parents sometimes to adopt prospective adoptive parents because they have in their mind that this has become their child when in fact, it really isn't. It is still the moms child until she consents to the adoption and signs of paper terminating her parental rights. So what are some of the red flags that you've seen with expectant moms, that they may not go through the adoption after birth?
19:02
One of the biggest ones that I've seen is just her support, especially from her own family. So if she's saying that she's gonna go through with it, and her own family, especially her mother is not supportive of it. That is a huge red flag just because you know, anyone can think about your own parents, if they're not approving of what you're doing, especially if she's relying on them for support financially or in other ways. Same, you know, non supportive birth father, you know, especially if they are still in a relationship again, we talked about that a little bit with the legal risk, definitely a red flag, if there's a domestic violence type of situation with them, and even if she has tried to leave him or did leave, it can be a red flag just because, you know, those dynamics can sometimes lead to her caving in or, you know, allowing his will to prevail in a certain sense. So that is another thing, difficulty in communication with her kind of being unwilling to provide medical records is another one, of course, kind of over reaching on needing financial help, or just requesting kind of unnecessary expenses. So that's something that we didn't really talk about yet. But actually, I had thought about with your question earlier about adoption friendly state kind of coming from a different angle, other than just the revocation time, you know, there are states that do and don't allow living expenses to be paid. So I guess sort of either way, could be considered friendly. Usually, it's considered more friendly, if it is allowed for parents to pay expenses, but you still have to be careful about that, that it's not being abused, which could be considered obviously a red flag, if she's, you know, trying to get more than she actually needs. Or perhaps even Of course, fraudulently taking money from more than one family would be a big red flag
21:08
as to living expenses that are just to fill in. Depending on the state law, prospective adoptive parents can pay, recognized, approved living experience Spence's of the expectant mom, depending on the state law, some allow some don't have a specification of what is included or not. But I think what you're saying is that a expectant mom, who is pushing that limit, and seems to be asking repeatedly for additional monies might be a red flag that she does not she's gonna make the decision to parent.
21:44
Right, right, either make the decision to parent or you know, it's not common, but in rare cases, you know, taking money from more than one source, which you know, would lead her to either parent or have to choose someone to place the baby with and could definitely get her and everyone involved into a bad place with that. So definitely something to look out for.
22:08
Okay, well, thank you so much, Amy Wallace Fox for talking with us about the legal risks and infinite option. Hey, everyone, have a favor to ask. Please let your friends know about this podcast. Word of mouth is probably the best way to help us get content like this into the hands of your friends. It also helps us obviously, most people find out about podcast through others. So please be that other please let your friends and families know about the creating a family.org podcast. Now we want to turn to Dr. Proc. Again. She is an MD as well as a Master's of Public Health. And she is the director of the developmental Medicine Center as well as the Associate Chief of the Division of Developmental medicine at Boston Children's Hospital and Harvard Medical School. Welcome, Dr. Brock. I want to now turn to the medical risks and infant adoption. And I think the one that is certainly coming it's on the top of most people's mind, most adoptive parents minds at the beginning is the risk of prenatal exposure to alcohol as well as drugs. So what are the most dangerous drugs are Terada? genic? Are drugs of those that have the greatest impact on the fetus? And then the subsequent long term impacts on the child? And what are some of the more dangerous substances or drugs?
23:36
Thank you, Don. I'm glad you're starting off with an easily answered question here. Sarcasm?
23:42
Yeah, yeah, I wrote insert eye roll.
23:46
Many, many people in studies have tried to answer this question over the past decades. And I think for example, with prospective parents, it's always hard to hear about a child that you may have joining your family being exposed to anything in utero. So I try to think about them as big red flags, things that we may not know. And things that I would worry less about, of course, the environment a child lives in. Other factors that might lead to later developmental issues are something to consider as well. I think we'll talk more about that. But with respect to the substance that probably has the most concerns for children long term is really alcohol. And we have very good evidence of significant effects long term, cognitively developmental abilities, ability to learn mental health concerns, as well as you mentioned on transgenic so causing birth defects or other concerns, I would put high level of alcohol use in the highest risk category with all substances that we're going to talk about today. There's a gray zone So how much is safe? You know, we don't always know. What are the effects? Well, it really depends what's the dose? How often is it being used? And then there are things that we don't know how resilient is the child, there are genetic factors that we can't test for that may predict long term resilience, or vulnerability for children. So I put alcohol on that biggest area of concern. Just a second, before we move on, let
25:29
me ask one question with alcohol. Does it matter when in the pregnancy, I think that sometimes we hear well, the expectant mom did drink heavily. And in the first month, I mean, the first three months, the first trimester, or maybe she didn't then and then she was in jail or something, and whatever. And then she did drink. So does the timing in the pregnancy matter?
25:55
Good question. I think each substance is a little bit different. But for alcohol specifically? Well, for all substances, the less exposure in any period of time during pregnancy, when someone is not using is very helpful. So I'll put that out there. So although I don't like incarceration, for women who are pregnant, it can be relatively protected for the fetus. So not using a substance being in treatment, always better than not. With alcohol, we generally see more likely structural brain problems, or changes in facial features. If children are exposed alcohol earlier in the pregnancy. Where is later in pregnancy, it can affect more executive functioning and developmental abilities. Now, from an experimental perspective, or working with animals, we can parse out first trimester, second trimester, third trimester, most individuals don't use only in the first trimester, or don't use for the first two, and then using the third trimester. So I would look at the less exposure, the better and yesterday is a differential impact for some substances, alcohol, particularly. And I think we'll talk maybe more about alcohol later in terms of what the facial features and specific outcomes are.
27:15
Yeah, we will. Well, we will go ahead and talk about it now. But in summary, the less the better, obviously. And I think the reality of from what you're saying is that generally, if somebody is abusing alcohol, it's likely that it's not going to be just in one month in the pregnancy, if I'm hearing you correctly. So
27:36
I think that's correct. I think for most people in the world are aware that use of alcohol during pregnancy is not ideal. It's not recommended. So I view a birth mother who's using alcohol as likely to have an alcohol use disorder, and probably unlikely to stop. So unless treatments involved in the treatment program are incarcerated, I would presume it will continue. And I don't think people will start using in the third trimester if they have not used an artificial distinction is what I'm saying.
28:06
So the impacts are going to be the facial dysmorphology the facial features might not be present, because they're only going to happen if the fetus was exposed during a very short time in the pregnancy, but the brain damage can still result if I'm hearing you correctly, regardless and in so the child can be impacted regardless of whether or not they have the standard facial features from a fetal alcohol spectrum disorder. Okay, that
28:36
is correct. We used to talk about classic fetal alcohol syndrome, which is identified by known alcohol use growth challenges, specific facial features and long term neurodevelopmental issues. But that's really been expanded to be fetal alcohol spectrum disorder. And as you said, there are some individuals who may have facial features but minimal neurologic outcomes. There are people who may have typical facial features that don't look like a classic child exposed to alcohol, but do have significant neurodevelopmental outcome challenge, right, and it's easy to project before birth or even before adolescence when children have a chance to demonstrate their skills.
29:14
Alright, so now let's move on to opiates or opioids, either prescription or non prescription. What are the long term and short term impacts for children who've been exposed prenatally to opioids?
29:30
Yeah, so I'm going to lump these all together as opiates. So both prescription opiates, Oxycontin, the things that are some of the challenges with our opioid epidemic in the United States at the moment, but heroin or methadone, which is used to treat people to help address their substance use concerns and it's sometimes even used in infants to address their withdrawal or will have the same mechanism between the various opiates, the dose that you're taking, and the length of time that it works in your body do have different outcomes in terms of the likelihood of a child having withdrawal for a substance. So, in other words, fentanyl, which is a relatively commonly used opiate, at the current time, is actually something that has a very quick onset of action, a real quick high for people. And so someone during pregnancy may use fentanyl and have a really significant high but it also comes down really quickly. If a mother's primarily be been using fentanyl during pregnancy. After birth, a child is less likely to have an extended withdrawal period in the newborn period. If they're using fentanyl. On the other hand, if methadone is what's being used, and has a much longer half life, so it is more likely that there will be withdrawal in the newborn period. So any of the opiates may lead to withdrawal in the newborn period. And what that looks like is something that's described clinically, we see evidence of jitteriness, challenges eating, sleeping, having bowel movements may not be able to sleep. And that is generally what leads us to begin treatment for withdrawal in the newborn period with respect to long term outcomes, although opiates are never recommended for use, unless really medically indicated, we don't see a big spectrum of long term outcomes from opiate exposures in children who are prenatally exposed. The studies that have been able to be done looking at this question are often confounded by continued use with adults who are also using opiates. Or often people who use opiates or other substances have pre existing mental health concerns. And the best studies that have been done looking at long term effects of opiates show that children may have a slider glute great greater risk of development or behavioral challenges if they're exposed to opiates in utero, but it's nothing like what I described earlier in terms of alcohol. So the main issue short term for all these opiates are withdrawal and newborn period, which can be treated and is relatively contained to that period of time. Long effects are not clear in terms of developmental and behavioral issues. And there's not a specific syndrome that we look for in a physical exam after opioid exposure.
32:41
And I think one of the other confusing things is that so often, children have been duly exposed, meaning that the birth mom is not only using an opioid, but she's also drinking. And so it's hard to say you don't know whether the child has only been exposed to a opioid, because she may well have also been the infant may also have been exposed to alcohol.
33:09
Right? I think it's a really good point. So Polly, we would call it poly substance exposure, using more than one thing is really the norm. I think what I often say when reviewing records is, although the report may be yes, I've used heroin and fentanyl and methamphetamine and cocaine, but I never touch alcohol. I don't know that. Perhaps if someone is using a fair amount of substances, they're always they're always aware of what they're using, and they may not recall. So I think you have to say probably substance exposure can happen. And I think we look for other signs about for example, pre pregnancy use is the best predictor of use during a pregnancy. So if someone had an alcohol use concern previously, or a child previously diagnosed with fetal alcohol spectrum disorder, or fetal alcohol syndrome, I would be quite concerned about the next pregnancy also being at risk for alcohol exposure.
34:09
So one of the looking at what the mom's lifestyle was prior to getting pregnant is probably the best indicator. Not that not that women don't change when they become pregnant. Not that they don't then make better choices. But if somebody is struggling with substance abuse, or alcohol abuse, prior to pregnancy, your risk are fairly high that that infant will have been exposed prenatally.
34:35
Yes, that's true. And I think I don't want to be all negative here. I do think that there are women who make choices when they find out they're pregnant, and really get into treatment and it is a very strong motivating factor. But yes, the research suggests the best predictor especially for alcohol is significant alcohol use pre pregnancy predicts use during pregnancy, whether that's reported or not.
34:58
Now we've talked about adequate substances, drugs used for medical treatment of substance abuse. He mentioned methadone methadone. What about Suboxone?
35:09
Suboxone is a different class of medication, which is also used to treat withdrawal from opiates in general, it also can have a profile of withdrawal in the newborn period, it tends to be less because it's not an active opiate, it blocks receptors. That is a little bit different. And it is not known at this point to have long term negative side effects the use of Suboxone per se, it is something we've only been using for a few decades. So we don't have great research on women who are using Suboxone. But if you were asked to make a choice as a pregnant woman, is it better than I'm on a stable treatment with methadone or Suboxone? Or that you continue using substances as you can get them on the street? I would always choose methadone or Suboxone.
36:02
But if for no other reason number one, you know, it's not laced with something. But also because it's a steady dosage, you know what you're getting?
36:10
Right? It's very predictable. And you're right. We haven't talked about that. But people may purchase something on the street. And there have been a number of studies that have been done that look at if you think you're purchasing heroin, well, it may be laced with other things, fentanyl, or methamphetamine. And even if you're smoking marijuana, it may be laced with other things. So that's often something that we find on, let's say, urine, normal conium drug tests, and someone truly thought they were purchasing something, but it was laced with something else.
36:45
Alright, let's then talk about, we've talked about the opioids, but we still see in certain parts of the country, methamphetamines or are still higher use even in opioids. So what's the impact of methamphetamines on the baby both the short term as well as the long term impacts?
37:03
Yes, I think we don't have great long term studies of methamphetamines at the current time, and methamphetamines I would say is one substance that is extremely addictive. And my biggest concern with a birth mother who is using methamphetamines is that it may be the primary driver of seeking substances at all costs. And it may, unlike some of the other substances where I'm not so worried about lack of adequate nutrition, the lifestyle that often goes along with seeking meth can also lead to really significant poor nutrition. So in the new in the newborn period, babies can show signs of withdrawal from methamphetamine, it may look like a combination of exposure to other substances, some children are extremely reactive, very jittery, can't sleep, or looking a little bit more like withdrawal from opiates. Over time. The information that we have so far suggests that methamphetamine use in humans exposed does not necessarily cause cognitive issues, reduced IQ or developmental problems, it really tends to impact one's ability to regulate everything, their attention, their sleep, their focus, and their memory. So we're often seeing children who are more likely to meet criteria for ADHD Attention Deficit Hyperactivity Disorder, or have emotional vulnerabilities like depression or anxiety. But there's a lot more we don't know, animal studies have been very clear that methamphetamine prenatally in animal models can really impact your ability to regulate yourself. And that's what we're actually seeing in human studies as well.
38:56
So self regulation, would that include executive functioning issues, ability to organize, plan, predict? General make generalizations things like that are primarily just regulation issues? Yeah,
39:07
absolutely. So a lot of people have executive functioning vulnerabilities without prenatal substance exposure, but with methamphetamines and cocaine isn't on your list. But I would add that as another one that cocaine exposure often contributes to later challenges with executive functioning difficulties organizing yourself to get something done, get out of the house in the morning, get your work to school and bring it home and do it and return
39:30
it in that way, and cocaine would also include crack cocaine.
39:36
Yes, cocaine, whether inhaled or smoked. Yes.
39:40
So in either in either case, it's similar. It sounds like to meth that it. It doesn't necessarily reduce IQ per se, but it reduces the the child and later the adults because we have to remember, the brain dysfunctions caused by prenatal exposure you don't outgrow so you It impacts things such as regulation, executive function and things such as that.
40:06
Right, I just want to maybe emphasize that I was using cocaine to describe the executive functioning vulnerabilities which we do see with cocaine exposure. We've got good studies for that. I think Methamphetamine is cocaine plus in terms of more mood regulation problems as well, the anxiety, depression, and the challenges with sleeping in addition to the executive functioning challenges.
40:28
And with meth, as you pointed out, which is such a good point, the lifestyle of someone who is addicted to meth, also, then it factors into a prenatal care, nutrition, risk, fat, risky situations that will not put themselves in, which would also have an impact on the on the fetus and subsequent baby.
40:49
Yes, correct. All right.
40:53
Let me pause for a moment to tell you about one of our partners. Spence Chapman is a licensed accredited nonprofit organization that has more than 100 years of experience providing adoption services, and pre adoption support. Spent shaping provides domestic and international home studies, both for New York as well as New Jersey families adopting through skilled shapings placement programs, as well as for families adopting with other agencies or attorneys. Regardless of the path, you ultimately choose to grow your family spin shape and is able to provide pre adoption support. So I think we've talked about this. But if a mom stops using alcohol or drugs, when she finds that she's pregnant, will the baby be spared the worst of these impacts?
41:42
I think the earlier she stops, the better, although there's really no safe window, and there's no appropriate amount of something to use. But I like to think about the fact that even outside of the realm of foster care and adoption, about 50% of pregnancies in the United States are unplanned. So there may be a fair number of birth mothers who are using substances. But once you realize you're pregnant, which often happens by the end of the first trimester, if you stop using that's much more protective for a child. So the question about how early does exposure do something is really challenging, because it's not ethical to put women into trials where we expose them to this amount of alcohol for this period of time when we know it causes long term concerns, but our epidemiologic evidence shows the earlier you stop, the less you use even earlier in pregnancy, the better.
42:37
And we do have animal studies where we can do those, and they support that and they support. Okay, well, prenatal exposure to alcohol and drugs is not the only medical risk factor for infant adoption. Now, though, it does take up a lot of our brain space when we're considering adoption. What are some of the other medical risk factors? And then we're going to talk about mental health risk factors in at the end, but before that, what are some other medical risk factors that adoptive parents should be aware of?
43:08
Really good question. So during routine prenatal care, pregnant women in the United States are, are screened for exposure to a number of infectious diseases, HIV, syphilis, hepatitis B, hepatitis C. So I would say each of them carry different risk factors and are variably treatable. So in other words, Syphilis is a bacteria that's been around forever, it's easily treated. And it is not something to worry about. If a mother is exposed to syphilis, it's determined during pregnancy. If the baby looks healthy, and she's treated appropriately, that's not one to worry about. HIV is increasingly uncommon. In the United States, although we still see some cases of women with prenatal HIV infection. This is something that we do have protocols to treat the mother during pregnancy, and babies can be treated afterwards. Hepatitis B is something that we see much less in the United States now than we did 40 or 50 years ago, because everyone born after 1991 has had the recommendation of receiving hepatitis B vaccine and is protected typically against hepatitis B. Even if a mother has hepatitis B, we have protocols that can essentially eliminate the possibility of trans I'm saying essentially eliminate because there's because always be one in a bazillion but it's been a very long time since a birth mother has been Hepatitis B positive in the United States and that baby has developed Hepatitis B if treated appropriately and treated appropriately is immunized in the newborn period with both an active vaccine and a passive vaccine. So immunoglobulin is given to the baby and a vaccine is started in the newborn period and that Really resists reduces the likelihood that the child will have hepatitis B, hepatitis C is prevalent and maybe one in 30. individuals in the United States, it's much higher, so much higher prevalence in those who use intravenous drugs or are sexually active with those who do. So Hepatitis C is probably the main infectious concern. prospective adoptive parents should be thinking about. If a birth mother is known to have hepatitis C, we don't have routine treatments in pregnancy, or in the newborn period, reduce the infection for a child. If a birth mother has hepatitis C positive, a child that she has has less than 10, probably less than 5% chance of developing hepatitis C infection. And what that can look like is over over time, usually over decades, developing inflammation of the liver, that can lead to perhaps cirrhosis of the liver or even liver failure risk for liver cancer needing a liver transplant. So we really want to treat this early. routinely. children exposed to hepatitis C are monitored for the first at least a year of life, to see if they become negative or positive. If they are hepatitis C positive, they can be monitored. We do have drug treatments that are available. Most hepatologist who treat liver disease would say pediatric Hepatitis C is eminently treatable, it's chronic, it still is an infection. But we can use medications that can reduce the infection and the infection to not being a significant problem.
46:45
What about how heritable? Is there a genetic connection with ADHD Attention Deficit Hyperactivity Disorder? So if if we know our suspect that one or both of the birth parents or birth grandparents or birth aunts, uncles, whatever, have ADHD, what are the risks that the child that you adopt will also have ADHD.
47:12
There are many factors besides genetics that can contribute to ADHD. So for example, premature birth, significant malnutrition, early in life, both contributing to ADHD. So if we look at individuals diagnosed with ADHD, separate from the world of foster care and adoption, about 50% of those children have a parent with ADHD as you move further away, so a grandparent or an aunt and uncle, it's reduced quite a bit, maybe 10 to 15%. ADHD is pretty common. People would say, somewhere between six and 8%, perhaps in the United States, it is partly genetically determined. There are many genes that have been identified as possibly contributing but there's not one thing we can test for to determine Okay, ADHD will be passed on to a child or not. So it is inheritable. It is something to look for, I would say look early, and treat early to, you know, maximize long term outcomes for children,
48:16
and reduce secondary impacts of just not fitting not being able to do the things that people are expecting you to do that type of thing. So recognition early, right.
48:23
I think the other thing that links to what we discussed earlier is that if you think about the profile of parents who are using substances, ADHD alone, increases your risk two or more times of using substances and having challenges with substance use. But if treated appropriately, behaviorally, and medically, the risk of substance use can be brought down to the typical risk of population. I think that's one of the reasons to reduce the secondary comorbidities.
48:51
So now let's move to mental illness. Is there a genetic connection? So in other words, if we know that the birth mom birth father or someone in the direct birth family has a diagnosis of and I'm gonna go through some of the different mental illnesses, how heritable? How likely? Is it? That what risks does the child have these parents that you would be adopting? What risks does that child have? What about and let's do I'll just kind of go through them and in the more common middle illnesses, anxiety or depression, assuming is there a genetic connection there?
49:34
So with all the mental illnesses I think you're going to talk about there is a genetic predisposition, but environmental triggers. And I think if you think about the fact that depression and anxiety are very common in the population, up to perhaps 15% of the population may have either or both. Most families will have someone who's had depression or anxiety, I think multiple family members With significant anxiety concerns, you make it more likely that a child will have anxiety and parental anxiety brings out anxiety and kids. So there's that there's there's a genetic contributor. And then there's the environmental exposure, I think about, are there ways that we can treat these long term and absolutely, with depression and anxiety, we do have some good treatments. But I think that it's often a combination of challenging environment in someone's life, especially if we're thinking about a birth mother who's making an adoption plan. She has significant trauma history and has depression, I'm not sure that that's a genetically driven depression, it may be more triggered by her environment. And similar with anxiety, if you have a lot of trauma, you may have PTSD and a lot of anxiety symptoms. But if you have the same genes, and you didn't have the trauma, you may not have that anxiety.
50:53
Such a good point. How do you tease out what is your anxiety is actually a normal and adaptive behavior, response behavioral response to a life event. And oftentimes, when we're looking at women who are making decisions to place for adoption, there's a lot in their life at that moment that would cause anxiety and depression. So that's such a good point.
51:17
And I think it's not easy to sort out that's the take home is that it is not easy to sort out, especially if there's trauma and other stressors.
51:26
What about some of the more and I hesitate to use the word significant mental health issues? Because I am very appreciative that depression and anxiety are very significant. But what about bipolar? or schizophrenia? Right? What about those? If you have if you're considering adopting a child with a direct link birth parent, or birth grandparent who has bipolar or schizophrenia, what are the chances that your child will have Bipolar schizophrenia?
51:55
Yes, so for both schizophrenia and bipolar disorder, so classic bipolar one with manic episodes and significant depression, the research suggests if one parents as bipolar disorder, schizophrenia, their child is has about 10% chance of having that same disorder. If both parents have schizophrenia, for example, the child's likelihood of having schizophrenia is 40%. So there is a genetic component. But the flip side would be if both parents have schizophrenia, 60% of their children would not have schizophrenia. So it's not a determinant. It's a predictor or a risk factor. And just like I said, with garden variety, depression and anxiety, with both bipolar disorder and schizophrenia, there are thought to be significant environmental triggers. So we've got the best information with schizophrenia, because it's a very clear psychiatric disorder that is more clearly diagnosed and bipolar disorder, in my opinion. But we know that for example, stressors, times of famine, or war, more children develop schizophrenia. Similarly, if you're in a stressful environment, let's say, a challenging home environment, or you're in institutional setting, your likelihood of schizophrenia with the same genetic risk factors is higher. And the flip side is if you're in a stable environment, and don't have other stressors, the likelihood of your genetic predisposition leading to schizophrenia is
53:36
much loved. It is such a it's such a web, isn't it and trying to it's almost impossible to pull. And maybe that's the the take home message here is that it's you can't look at it at the mental health of the birth parents and predict, although there's certainly a genetic component, there is such a strong environmental component as well. Absolutely. My last question is, it doesn't happen as often as people might think. But there is concern if a birth mother or an expectant mom that you're considering that you're considering a match with has not had any prenatal care. Usually there's some type of prenatal care but, but sometimes there was no prenatal care. How much of that should be a concern to adoptive parents.
54:29
I think prenatal care was really created primarily to protect maternal health. As a pediatrician, I know that good prenatal care can be very helpful in ensuring the baby is healthy and thriving. But a baby who's born healthy without prenatal care is still a healthy baby. And I would not worry about what wasn't done for the month of pregnancy. The important thing if a child doesn't have prenatal care, is to make sure all the routine screening done for infectious concerns is done in the newborn. period, which is the standard of care in every hospital I know of in the United States. So I hope the baby's a healthy baby. I think what you said Dawn about it does happen. People have stomach aches, and they go to have a bath, they go to the bathroom and they have a baby, this happens and people come into the emergency room and a child is born. And that may be a child who is extremely healthy, without any prenatal exposure. And a parent who's in denial or for some reason, was unable to access prenatal care. So to me, that's, it's important to look at why there was no prenatal care and make sure the health of the baby is great. But it is not a big worry, from my perspective, when you're talking about long term health of a child.
55:43
That's its health of the pregnancy. Yes, perhaps but in this case, the baby is born. And the we have to look at as to the Why Why was there no prenatal care? All right. Well, thank you very much, Dr. Lisa, for discussing medical risks and infant adoption. And to everyone who is listening. Thank you so much for joining us, and I will see you next week.
Transcribed by https://otter.ai