[Ann Fleming]

You raise a very important question. I can't emphasize enough how important it is to carefully consider a referral before accepting it. In an international adoption, with few exceptions, you do not have the knowledge of your intended child's prenatal experience, as you would if you had carried the child yourself. You do not have knowledge of your intended child's genetic makeup nor his/her birthparents' medical history. You must consider the medical information you have been provided, even if it is sparse. Find a physician, preferably one specializing in international adoption, and have him/her review any medical information and/or video you have. If you cannot find a specialist in your area, you might want to contact the International Adoption Clinic at the University of Minnesota. Another resource is Dr. Jerri Jenista, a physician and herself an adoptive mom in Michigan. I cannot recall the contact information for either the IAC or Dr. Jenista off the top of my head, but when I needed them to consider our second daughter's referral, I plugged the information I've given you into my web browser and was able to get correct telephone numbers pretty easily. Another excellent resource is a chapter devoted to the referral in the book Launching a Baby's Adoption.

I also wanted to comment on Rowan's post asking why adoptive parents do not simply accept the first child referred, as parents giving birth to a child do. First of all, it is a fallacy that parents giving birth accept the child they are carrying sight unseen. This is one of the ways in which adoption, especially closed and/or international adoptions, differs most significantly from the birth experience. A family expecting a biological child in the U.S. has access to prenatal care including genetic testing which can determine a host of anomalies. Some families, knowing what their resources are, make the very difficult decision to terminate pregnancies in which the health of the child is in question. Furthermore, a woman carrying a child knows what her child's prenatal experience is, including nutrition and exposure to drugs and alcohol. A family adopting a child in a closed or international adoption must accept that the level of prenatal care their child and his/her birthmother has had access to may be substandard or nonexistent. The birth experience itself may have been at home (as were both of our daughters' births), and may have been traumatic without this information being provided when the child comes into institutional care. Adoptive families need to consider the information they have been given very, very carefully -- because it is so much less information than they would have if they were giving birth, and because information about the prenatal and birth experience can be so important to an overall understanding of a child's health picture.

I will close with a sad but illustrative story. We accepted our first daughter as our first referral, and were so happy to have been referred a healthy infant with only mild concerns related to prematurity and low birthweight. She is now a happy, healthy, almost six-year-old. Our second daughter's adoption was very different. She was not our first referral. Our first referral was for a beautiful little girl who had suffered a significant stroke prior to arriving in institutional care. Her orphanage, an excellent one, had ordered a CT scan and we had access to these results. We spent a frantic 24 hours forwarding all the medical information we had to Dr. Jenista as well as to specialists locally and to our family's general practitioner. All the physicians consulted concurred that the little girl had substantial loss of brain function and would need extensive intervention, possibly 24 hour care for the rest of her life. Because both adults in our family must work to maintain healthcare coverage for the family, we knew that we would not have an at-home parent to offer this child and might possibly experience gaps in insurance coverage during her childhood. We decided we needed to decline her referral. It was grueling, and we still retain a picture of this little girl and consider her to be "our child" in some way. We went on to accept our second referral, also for a little girl who had a stroke prenatally, but with much less significant long-term issues. She is now our beautiful, healthy, almost-two-year-old daughter, with speech therapy and physical therapy going very well. I stay in touch with our India program specialist and saw her this past weekend. I asked about our first referral. She is now almost two, and she has only brainstem function. She cannot see, cannot hear, and has only involuntary muscle movement. She often appears to the observer to be in pain and makes involuntary sounds, much like that of a person who has experienced a severe brain injury. No amount of intervention will change this picture. The orphanage director, after having cared for this child for two years including daily access to physicians and physical therapy, has made the difficult decision not to treat the next infection this child experiences, in other words, to let nature take it's course, providing pain management for her as she declines and eventually dies. I am confident, having seen the orphanage, that she has suffered as little as possible during her first two years, and that she will not suffer during whatever her final illness will be. I offer my love and support across 8500 miles to the caregivers who have fought for her thus far and who must now lose a child. Should we have accepted this referral? I wonder whom it would have helped. This severely impaired child would have been in a vegetative state in a home without 24 hour access to doctors and possibly without appropriate pain management, and the beautiful child who became our second daughter might have remained in an institution as a result. Please show appropriate respect for the difficult and often heartwrenching decisions both birth and adoptive parents make on a daily basis, if you plan to continue to post to this list. Thank you.