Adopting: Sound Choices, Strong Families

By Patricia Irwin Johnston
ISBN: 978-0-944934-34-0
LCCN: 2007033077
Hardcover, 544 pages
Price: $26.95

Adopting: Sound Choices, Strong Families

Adopting is a 2010 Mom’s Choice Awards® Gold Recipient in adult books in Adoption, and Winner of the 2009 Benjamin Franklin Award as best new book in the Self Help genre!

Is Adoption the Right Option for Your Family? Get the answers and information you need in this new resource from Perspectives Press!

Feeling “family-challenged”?

If you’ve been struggling with infertility issues, are a single person or a partner in a same-sex family, chances are adoption has come up in your thinking about a means of building your family. Perhaps you’ve thought a little, perhaps a lot. Ultimately, the key question that you need to answer is both simple and complex:

Is the adoption option right for you and your family?

Important questions about the steps to take–or not–toward building or adding to your family deserve informative and compassionate answers, and that’s precisely what you’ll find in this latest adoption guide from renowned authority and educator Patricia Irwin Johnston, MS.

Adopting: Sound Choices Strong Families offers expert guidance, insight and key understanding about adoption as a genuine, practical means for growing a family–perhaps even yours.

Written to help prospective adoptive parents like you make smarter, more thoughtful decisions about adopting a child, this guide will challenge you and move you step-by-step through the process of adoption through the lens of the deeply personal and emotional obstacles everyone feels during this decision-making process.

Adopting: Sound Choices, Strong Families is not a “how-to” guide to finding an adoption agency or managing the paper trail.

The author, wife of an adopted person and parent herself to three children who joined the Johnston family through adoption, poses and then helps you address the difficult questions that must be examined before you can make any realistic decisions about adoption, including how to

  • Regain a sense of control over your life
  • Decide whether you’re genuinely open to the idea of adoption
  • Understand the central issues of attachment and adoptive family life
  • Feel confident in your decision to pursue–or not–adoption as a viable option
  • Make informed decisions about the details of the adoption process
  • Embrace your decision to adopt with practical support and information
  • Navigate the first months after placement with realistic expectation and information
  • Move forward into adoptive family life prepared to address challenges and find resources for yourself and your child.

You won’t find any sugary, sentimental or rose-colored views here!

Built on the foundation of two earlier books, Adopting after Infertility and Launching a Baby’s AdoptionAdopting Sound Choices, Strong Families offers many tools, vignettes, Q&A, as well as the frank and honest commentary for which Johnston is well known. She tells it to you “how it’s been, like it is, and how it’s likely to be” from someone who’s been there, done that for nearly 30 years as a leading member of the adoption community.

Whether you come to this resource with enthusiasm, ambivalence, or even strong reluctance, it’s by tackling the touch and personal questions upfront that you will be prepared to make the very best decisions possible as you embark–or not–on the journey to family-building through adoption.

Make Adopting: Sound Choices, Strong Families a first step in that journey. Order your copy today!

Adopting: Sound Choices, Strong Families  is now available in Kindle ebook reader format on and in nearly all other ebook formats on

New and Notable on another front…! Adopting’s author, Pat Johnston, served as the adoption coordinator and consultant on Healthvue’s new DVD sets “Infertility Explained: The Complete, Authoritative Guide to Everything You Need to Know on Your Journey to Parenthood”  and “Adoption Explained: The Complete, Authoritative Guide to Everything You Need to Know on Your Journey to Adoptive Parenthood” each as two-disc DVD productions providing an authoritative resource for over six-million clinically infertile couples of child-bearing age in the United States, helping them to make informed choices and achieve greater confidence in their decisions made in consultation with healthcare practitioners. to learn more about this audo-visual resource.

About the Author: Patricia Irwin Johnston, M.S.

Pat Johnston is Perspective Press’ original publisher. She has been writing and speaking and advocating about infertility and adoption issues for  30 years, beginning as a long-term volunteer in Indiana coalition building and with RESOLVE (for which she chaired the national board of directors for three years) and including several years on the national board of Adoptive Families of America. An innovative thinker, in 1979 Pat and two partners (Carol Hallenbeck, RN and reproductive endocrinologist Dr. William R. Keye, Jr., who was later president of the American Society for Reproductive Medicine) conceived of and planned what they later discovered had been the first consumer symposium on infertility held anywhere in the world! It became the model for the RESOLVE/Serono symposia series.

She was a regular columnist (“Growing Up Adopted: 0-2″) for Adoptive Families magazine for over five years (ending in 2000.) Pat is an on-line expert for INCIID’s Exploring Adoption and Expecting by Adoption and Parenting in Adoption bulletin boards. As well, she is a frequent contributor to many other boards, magazines and newsletters. Her books include Understanding Infertility: Insights for Family and FriendsTaking Charge of Infertility, (Adopting after InfertilityLaunching a Baby’s Adoption which are both being replaced by 2008′s  Adopting: Sound Choices, Strong Families), and Adoption Is a Family Affair! What Relatives and Friends Must Know and editing the poetry anthologyPerspectives on a Grafted Tree: Thoughts for those Touched by Adoption.

Pat has been given several awards during her years in the iinfertility and adoption communities, including the 2007 Angel in Adoption Award from Congresswoman Julia Carson and the Congressional Coalition on Adoption; the 2006 Robert Todd Duncan award from Butler University’s Alumni Association to an alum whose personal or professional achievements bring honor to the University; a 2005 JCICS “110% Award” for above-and-beyond commitment to JCICS; and a 2004 Kaleidoscope Best of the Best Award (Consumer Watchdogs) from As Simple as That.

Additionally, she received the 1992 Friend of Adoption award from the Adoptive Parents Committee of New York and New Jersey; in 1991 Resolve, Inc, named its annual volunteer service award to a chapter volunteer in her honor; she received a 1989 Adoption Activist Award from the North American Council on Adoptable Children.

Pat and her husband, Dave, are the second generation of their family to extend it beyond infertility through the adoption of their three children, who are now adults. Her grandmother was a birthparent. Her niece is now adopting. Pat Johnston’s decision-making and special-issue-exploration workshops for consumers and her in-service trainings for allied professionals are routinely praised for their friendly, inspiring, and gently provocative nature. Frequent topics (as one hour sessions or mixed and matched for half and full day sessions) include the following list. The list, however, is not exhaustive and Pat customizes her presentations for each audience. Be sure to ask about other topics.

Infertility: Issues and Decisions

    Life at the Crossroads
    Taking Charge of Infertility
    Making Good Decisions
    Creating a Balance
    For Men:What to Do when You Can’t “Fix It”
    Fostering Effective Communication between Partners
    Dealing with Family and Friends
    Coping with the Holidays
    Choosing the Right Professionals
    Doctor/Patient Relationships
    Where Do We Go from Here?–Evaluating Options
    When Is Enough, Enough?–Knowing When to Stop
    Ethics and Choices
    Why Childfree is not Childless

   The Quasi-Adoption Options: Donor Insemination, Surrogacy, Egg and Embryo Adoption

    Is Adoption for You?–Making the Decision
    Is Adoption for You?–Making the Commitment
    Tough Adoption Choices–Making a “Match”, Openness, Artificial Twinning, and more
    Parenting after Infertility

Parenting in Adoption

Making Ethical Choices in Choosing a Route to Adoption

Expecting by Adoption: A Little Bit “Pregnant.”

Launching a Baby’s Adoption

The Dance of Attachment

Promoting Attachment through the Senses

Getting Real: Understanding Entitlement in Adoptive Families

Growing Your Family–Entitlement, Attachment and More

Getting the Words Right–Using Respectful Adoption Language

Eggs, Cabbages Patches, Airplanes and Social Workers–What Kids Think and When

Children’s Developing Understanding of Adoption

Sex Education and The Adoption-Built Family

Conspicuous Families–Parenting across Racial Lines

Embracing Difference

Opening Ourselves to New Issues

Bringing Family and Friends Aboard

Promoting Understanding in the World Outside

Maintaining a Marriage while Growing a Family


And, for profressionals, The Family-Challenged Client in the 21st Century is a title encompassing a variety of topics pulled together in a half or full day workshop on dealing with today’s changing issues with a new generation of clients which is custom written for each workshop sponsor. Pat offers insights into what makes each generation so different with which to work, provides tools for engaging them, and presents materials professionals can use to help each client make his or her best decisions.

For detailed descriptions of the above topics, a copy of Pat’s vita,  or to contact Pat Johnston about speaking for your organization, e-mail Pat:


Table of Contents for  Adopting: Sound Choices, Strong Families


Part One: Acknowledging and Unraveling Challenges to Family Byuilding

Chapter 1: Beware the Dragon

Chapter 2: Confronting Dragons

Chapter 3: The Plan

Part Two: Life Inside Adoption: An Overview

Chapter 4: The Culture of Adoption

Chapter 5: As a Family Grows

Chapter 6: Special Issues along the Way

Chapter 7: Ethics: Assuring a Firm Foundation

Part Three: Embracing Adoption and Making Sound Choices

Chapter 8: The Plan, Revisited

Chapter 9: Which Child?

Chapter 10: Openness

Chapter 11: Finding Your Path and Your Guide

Chapter 12: Approval (and Preparation!)

Part Four: The Real Thing

Chapter 13: Anticipation (and Adoption Expectancy)

Chapter 14: Planning for a Happy Homecoming

Chapter 15: Adjustments in the First Year Together

Chapter 16: Adoption in the Big Wide World


Reviews for  Adopting: Sound Choices, Strong Families

May 19, 2008

This book is perfect if you’re seeking answers and if you’re open-minded to hearing about different ideas in adoption. Personally, I am seeking answers and am open to gleaning advice anywhere I can take it, therefore, I thought this book was extremely helpful. I’d recommend it to anyone starting the process or anyone who is emotionally bumping into walls in the process. It is a strong, solid book–well-written and very thorough. You may not agree with every bit of advice, but for me, the mark of a good book is one where I walk away having underlined a few things. And my handwriting dots the margins throughout the whole book.

snipped from a review in “Found Poetry” on the blog  Stirrup Queens and Sperm Palace Jesters


March 17, 2008…Patricia Irwin Johnston’s seminal book Adoption: Sound Choices, Strong Families provides sound advice and thoughtful analysis of adoption as a way to building a family – from coping with infertility and deciding to adopt, through the ups and downs of the adoption process, and into the realities of raising your family. While her focus is on people considering adoption, this well-written, fascinating discourse would be beneficial to anyone involved in adoption, including professionals working in the field of adoption and adoptive families.Pat Johnston, a well known adoption publisher and advocate, has long been a force in adoption education. Her lengthy discourse on adoption proves her to be an able and thoughtful writer, as well. Based on an in-depth knowledge of adoption history, theory, and practice, plus years of interaction with all members of the adoption triad, this is a book that is sure to engross anyone interested in adoption. Sometimes controversial, oftentimes wise, your understanding of building families through adoption will be greatly enhanced by consideration of the important issues raised in this seminal, wide-ranging tome.One of the unusual features of the book, Adopting, is that it is extremely helpful for all types of adoption: private, direct, agency, foster-adopt and public; inside the United States and International; babies, toddlers and older child adoption; and same or different race/culture. The breadth and depth of this book is tremendous; it ranges from a discussion of infertility, the realities of adoption and whether it is the right option for you; through the emotional journey and practicalities of the adoption process; and into many aspects of being an adoptive family. Bonding, your child’s health, emotional journeys, pitfalls, history of adoption, adoption ethics, media and public views of adoption, school concerns, raising confident children, race, and many other key issues are just some of the important topics covered in Adopting. Highly recommended, this is a book that is sure to be referred to by both adoption professionals and adoptive parents for years to come.

Reviewed by Alison Martin


March, 2008 In Adopting: Sound Choices, Strong Families (Perspectives Press; $26.95), her newest addition to adoption literature, Patricia Irwin Johnston tackles the tough questions prospective parents must ask before deciding whether adoption is right for them.This informative, densely packed book guides those who are married, single, gay, or lesbian through four distinct phases of thinking about adoption. The first is about resolving personal issues, including infertility, before deciding to adopt. The second is about understanding that raising a family formed by adoption is inherently different from raising a biological family. The third is about making educated choices about the type of adoption to pursue. The final phase is understanding what will happen during the adoption process and after the child arrives.Adopting: Sound Choices, Strong Families is not a how-to guide for adoption, but it compiles the wisdom Johnston has accumulated in her 30 years of experience. With real-life vignettes and ample resources in each chapter, the book is a must-read for those who are just beginning to think about adoption, or who are in the early stages of the process. It will help parents navigate the emotional and practical aspects of an adoption, and help them understand that adoption is a lifelong issue for children, parents, and extended family alike.

Reviewed by Sue Gainor, who serves on the national board of Families for Russian and Ukrainian Adoption (FRUA) for the March/April Issue of Adoptive Families magazine. _________________________________________________________________ 


1/2008… From infertile heterosexual couples to same-sex couples to single parents–anyone who has struggled wit barriers to family-building faces similar losses and similar decisions about their next steps. But what should those next steps be, and is adoption the best way to go? Adopting: Sound Choices, Strong Families was written to help those who find themselves “family-challenged,” as it explores the adoption process within the context of deeply personal and emotional obstacles and encourages readers to actively address, examine and puzzle out the process before adoptive parenthood begins.Adopting: Sound Choices, Strong Families is not a “how to” guide for the adoption process, It does not specifically detail the nuts and bolts topics such as which adoption agencies to contact or what paperwork is required. Rather, its goal is to serve as an experienced, compassionate guide through the hard questions that must be addressed and examined before any realisitic decisions about adoption can be made. It also provides support and practical advice that readers will need after they make their own decisions about adoption. This is a book that explores the process of adopting asn an emotional journey that begins with [a family challenge] and takes the reader through the decision making, preparation and experience of adopting. This book does a great job of looking at the deeper issues and acknowledging the complexity of feelings and experience that are all part of adoption today. If you are not infertile or if you are a single parent, don’t be put off by the focus on couples communication and the grief of infertility in the first section; the other sections are well worth the read.Pat is a good writer and well organized as she addresses the issues faced by adopting families. No one speaks more clearly or directly to and for this group.Required reading for waiting Pact families.

Reviewed by Beth Hall Fall/Winter 2008 Pact’s Point of View Pact an Adoption Alliance Oakland, CA


9/2007… Pat Johnston has the unique ability to understand the feelings of a person struggling with infertility and has once again shown why she is the authority on infertility and adoption resources. Adopting: Sound Choices, Strong Families is a wonderful tool that will help many people trying to make the transition from the emotional burdens of infertility to adoption. I would recommend this book for my infertility patients, regardless of where they are in the treatment process

Jeffrey L. Deaton, M.D. Reproductive Endocrinologist Premier Fertility Center, North Carolina


9/2007… Having placed my son for adoption almost a decade ago, only through Adopting: Sound Choices, Strong Families have I come to know and respect the dragons faced by my son’s adoptive parents. Underlying this book is a great how-to guide for communication in marriages and partnerships, whether the issue faced is infertility or who cleans what when! Through Pat Johnston’s insight, expertise, and personal experience in the fields of adoption and infertility, she brings knowledge and understanding to a diverse audience of readers from infertile couples and singles to their children, to supportive family members and friends, to parents considering placement and birthparents who stand on the other side of the adoption process, to the media and general public. Certainly, a “must read.” 

Courtney Lewis Birthmother and Adoption Advocate


I couldn’t be more thrilled with Pat Johnston’s latest book Adopting: Sound Choices, Strong Families.  There is a tremendous need for such a comprehensive work addressing all family compositions and every avenue of adoption.  Her chapters on attachment and transitioning are extremely relevant and applicable and should be required reading for any family considering adoption (as well as those formed by birth).  Pat’s voice educates and entertains simultaneously.  Her new book is a must read for adoption workers, families and those who support them.

Kathie G. Stocker Adoption Social Worker, Adoptive Parent NACAC state rep and board member of Northwest Adoptive Families Association (NAFA)_________________________________________________________________ 

8/2007…As I finished reading Pat Johnston’s new book—Adopting Sound Choices, Strong Families— I felt as if I had just found the ”Adoptipedia”. Johnston leaves no rock unturned as she takes readers through a journey which begins long before people even know or realize that they may have an adoption journey. She examines every single issue mentioned in adoption literature; I found each page filled with valuable information for those individuals considering adoption. This well integrated piece of work is a ”must read” for anyone thinking about adopting; it should be mandatory reading for all professionals who work within the adoption arena. Johnston illuminates issues well beyond those typically addressed in pre-adoptive training. This will become a handbook for those exploring adoption and for those working with them. I highly recommend this book!

Gregory C. Keck ,Ph.D. Founder/Director of the Attachment & Bonding Center of Ohio

Co-author of Adopting the Hurt Child and Parenting the Hurt Child


The world of adoption has changed dramatically over the last few years, making this update to Pat Johnston’s previous books an  essential tool.Adopting: Sound Choices, Strong Families will become one of the classic resources for the adoption community. 

Mark T. McDermott, Esq. Adoptive Parent, Adoption Attorney Past president of the American Academy of Adoption Attorneys


I have been recommending Pat Johnston’s Adopting after Infertility for 15 years. In truth, I have almost insisted that prospective adopting parents read what I have considered to be the adoption Bible.

I didn’t think it was possible to improve upon Adopting after Infertility, but Pat has done it again.  Adopting: Sound Choices, Strong Families has incorporated the wisdom of her prior books and expanded them to include updated material and current adoption professionals’ thinking on virtually every imaginable aspect of adoption.

This is the quintessential book for those considering adoption and those who are already adoptive families.  It is also a must-read for those facing any genetic or gestational loss, as she guides singles and couples through the grief process, helping them to make wise and considered family building choices.Thorough and clear, this book is simply excellent.  I will be buying it, gifting it, lending it and reading it for many years to come.

Carole LieberWilkins, M.A.

Marriage and Family Therapist


Touched both personally and professionally by adoption for over three decades, Pat Johnston brings to her newest work, Adopting: Sound Choices, Strong Families, wise direction and thorough advice gained from such incredible life experiences.  With solid insight, Pat guides her readers through the early stages of exploring and learning about adoption through to preparation for a child’s arrival and the early months that follow, touching the emotional, relational and practical aspects of the journey.  She fills each and every chapter with valuable information for families considering adoption and for the professionals that guide them in their journey of family building.  This book will be a great addition to any agency’s pre-adoption suggested reading. I highly recommend this tremendous resource!   

Jayne Schooler adoption educator and author/co-author of The Whole Life Adoption Book and Telling the Truth to Your Adopted and Foster Child. _________________________________________________________________

Pat Johnston’s book Adopting: Sound Choices, Strong Families is a thoughtfully written book that addresses a myriad of unique issues likely to be encountered by families preparing to embark on their adoption journey. Richly illustrated by poignant and sometimes humorous vignettes it delves into the complex aspects of adoptive parenting in a style that is compassionate and child focused. Married couples, same gender couples and singles hoping to build their family through adoption will find Pat’s practical “how-tos” and sound advice invaluable. This comprehensive book is my number one choice for families and professionals seeking to broaden their knowledge of adoption.

Jane M. Page, LCSW Clinical Director of Adoption The Cradle, Evanston Illinois




Book Excerpt: Beware the Dragon!

Chapter 1 from Adopting: Sound Choices, Strong Families


Once upon a time there lived a princess so beautiful both inside and out that every man in her parents’ realm longed to marry her. After many months of grueling challenges, a noble, kind, and handsome prince won her hand, and they were married.As they left the palace of her parents to make their own way in the world, the young people were given the blessings of the monarchs, who presented them with a carefully drawn map. On it were plotted the roads and the rivers, the mountains and the mansions, the forests and the fields, the towns and the trading posts of their known world. It was a beautiful map, complete in every way…for as far as it went, that is.All around the edge of the map, beyond the blue of the wide sea and the purple of the impenetrable mountains, were printed warnings in bold red ink, “DANGER! Here there be dragons!”

Most of us spent many childhood days curled in warm laps listening as a parent read even more sexist versions of stories much like this one. Surrounding us was the firm shape of a parent who kept us safe and secure. The fairy tales gave way to more realistic stories, but the themes remained substantially the same: for those who are good, noble and true, for those who try their best, the dangerous unknown is only a fairy tale. Those who try hard will succeed.

And so, like the fairy tale princes and princesses of our childhoods, our expectations about love and family building were idealistic and simplistic. Two people fall in love. They commit to one another. They establish a firm foundation on which to build a secure home. They have children.

In biology class, in family living, in health and sex education there were drawings and diagrams, and warnings about the dangers of premarital sex. These classes offered several messages for Gen Xers and Millennials who are reading this, my third infertility/adoption decision-making book. The first message was about the demons of sexually transmitted diseases, and in particular AIDS. The second was the one familiar to earlier generations: our bodies are time bombs set to go off. If we engage in sex, we will get pregnant! Beware of that dragon, for sure!

Social studies sent a third message to those of us who did not find a partner with whom to parent as well as to those of us who were not heterosexual. It was that growing tolerance in society would soon open family building opportunities for us as well.

Ah, and then there was the comforting final message: People of the second and third birth control generations, you have as long as you want to become parents! Go ahead and delay marriage and parenthood. Get all of your financial, educational and career ducks in a row; take time finding just the right partner before parenting. There’s always time.

You listened, and here you are?young-marrieds or married-agains, without a partner or with a same gender partner?facing a dragon guarding the entrance to parenthood.

When this dragon rears its head, many tend first to play ostrich, burying their heads in the sand and pretending not to see. For months and even years we may deny the possibility of a problem. We just haven?t met the right person, we tell ourselves. Or, when we have and we are trying to conceive it’s, well, We’re under so much stress at work. Our timing is off. The travel schedule has gotten in the way. Looking back now and remembering your own denial, you may wonder why it took so long for you to realize that you needed help, why you wasted so much time with the wrong partner, the wrong doctor, why you refused to acknowledge that there was a problem brewing here.

The answer is not so difficult. You were afraid. Somewhere in the back of your mind you sensed that a dragon was lurking there. You hoped to avoid the crisis of facing the dragon by ignoring it.

The Chinese,an ancient and philosophically sophisticated culture, write not with a sound-based alphabet, but with complex word pictures. Interestingly, in Chinese, the written expression of the concept of crisis is said to be drawn by putting together the characters for two other words: danger and opportunity.

Because we sense danger in the face of any crisis, we often put off facing its reality. And so it was with singles, with gay couples, with fertility impaired heterosexual couples. To acknowledge a barrier to becoming a parent was to face imminent danger. Though at first we might not have been able to clearly identify precisely what it was that we feared, our subconscious sensed the possibility of loss or disappointment ahead and insulated us from pain through denial.

Do you remember that childhood friend who moved away when you were four? The special toy lost irretrievably on the plane to Grandma’s? The cat that ran away? The math test you failed? The first love who dumped you unceremoniously? The college which turned you down? Getting laid off from that great job? Every day we experience losses and disappointments. Some of them are painful, etching themselves on our memories, changing who we consider ourselves to be. Others pass by nearly unnoticed because we have become so accustomed to dealing with them–keys misplaced for a couple of frustrating hours, another lottery ticket with the wrong numbers, forgetting an appointment, missing your train. But every loss–the large and the small–is one of the lessons which contribute to the development of a unique and very personal pattern for how each of us copes with disappointment and loss, a pattern which becomes so familiar, so automatic, that one rarely even recognizes that it has begun and is going on again.

Do you recall, for instance, having found yourself in a situation like the following…

After having spent a day shopping, you arrive at home with your house key in your pocket and your arms loaded with packages only to hear the insistent ringing of your telephone on the other side of the door.

Almost since the invention of the telephone at the dawn of the 20th century, people who have one have had a terrible time allowing a phone to go unanswered, so as a typical person, you struggle with the packages you are juggling in order to fish out a key and then rush inside to answer the phone.

As you put the receiver to your ear, you hear yourself saying, “Hello? Hello?”… to a dial tone (denial).You’re surprised to hear that dial tone, and yet, after ten rings, you knew of course that enough time had passed between the last ring and your picking up the phone?

You begin a litany of “if onlys” (bargaining). …”If only I’d had my key out and ready”… “If only they’d let it ring one more time.”

Feeling frustrated and disappointed about the lost call, you begin to vent a little anger at somebody… “Doggone it! Why are people so impatient? They should have let it ring!” Or, perhaps, “Darn it, won?t I ever learn to keep my keys in my hand!”

You look at the packages strewn in your foyer and, subconsciously you begin a familiar process?your personal process?for coping with (accepting/resolving) a loss.

Remember, all of us have been experiencing losses since infancy. There was the babysitter who talked on the telephone despite your cries for a diaper change or a bottle. The goldfish from the fair died and Daddy helped bury it in the backyard. Your best friend moved clear across the country when his mom was transferred. That really cute girl said no when you asked her to the eighth grade dance. You failed an all important math test. Your favorite uncle died. A lover left.

There are many ways of coping with loss, and after years of experiencing losses large and small, each of us develops a personal pattern for doing so. Some people are more comfortable than others in accepting loss as normal and natural?as a part of their fate. They may shrug this lost phone call off with an ?Oh well, if it is important, they?ll call back? and go about the business of putting away the groceries. Others feel more comfortable with a substitution. Such a person may pick up the phone and call a friend. “Hi, did you just call? No? Yeah, well, I missed a call just as I got in from shopping and I thought it might have been you? So what’re ya doin?”…

Still others cope with loss more aggressively by seeking to avoid future losses of a similar kind and assuming as much control as possible over every situation. If this is what you most commonly do, your reaction to an accumulation of lost phone calls may inspire you to explore the option of adding voice mail or caller ID to your phone service or send you out shopping for an answering machine.

Those whose family building is challenged by infertility or their marital status or their sexual orientation experience multiple losses, each with its own degree of significance. Taking the time right now to determine how it is that you (and your partner, if you have one) cope with loss is an important step toward deciding what family building alternative is right for you. But first you must acknowledge the series of losses built into your experience. Over many years of thinking about it, reading about it, talking with hundreds of couples about it, I have come to see six distinct areas of significant loss , many of which encompass several other related losses. The following sections address each of those areas. Losses Accompanying Challenged Family Building * Control over many aspects of life * Individual genetic continuity, linking past and future * The joint conception of a child with a beloved life partner * The physical satisfactions of pregnancy and birth * The emotional gratifications of pregnancy and birth * The opportunity to parent

The Loss of Control

Perhaps most clearly and immediately felt by those who experience family building challenges is the loss of control over numerous aspects of their lives.

Today?s adults, who came to sexual maturity and selected partners after the birth control revolution precipitated by the wide availability of the birth control pill in the mid sixties, have always had the distinct expectation that they would be able to control their family planning. Unfortunately, because infertility was not discussed as they grew up, this expectation included not just the expectation that they would be able to avoid pregnancy when they so desired, but that they would be able to achieve pregnancy when they so desired. Losing control of a part of life which one?s peers take so completely for granted is devastating and, for many people, precipitates a humiliating blow to self esteem.

Treating infertility demands that couples give up even more control. Control of their sexual privacy and spontaneity, for example, is forfeited to a medical team which asks them to chart their intercourse, supply semen samples, appear within hours after intercourse for a post-coital test, etc. Control of their calendars is given over to treatment.

Couples often comment that with infertility they feel that they have lost control of every aspect of their lives. What type or size car to buy depends on whether or not it will be carrying children. Accepting a new job or a promotion can become dependent on how travel impacts the treatment program, whether or not the new company has excellent health care benefits which cover infertility treatments, as well as whether or not the new employee?s coverage for infertility treatment would be excluded because it was defined by the insurance company as a pre-existing condition. Continuing education may be put on hold when a woman expects that any day she will become pregnant, so that finishing a term might be difficult or impossible. Whether to buy a house in the suburbs with sidewalks for Big Wheels and excellent schools, or a condo in the city close to work and cultural events is controlled by infertility. Social calendars may be driven by the menstrual cycle. Even the most private of decisions–how much time to spend in a hot tub, how much coffee to drink, how many miles to run each week, whether to buy briefs or boxer shorts–can be controlled by the infertility experience.

Singles and gay couples, most already feeling the sting of discrimination, have often compensated for much of the rest of their feelings of being “out of control” by taking careful control of as many aspects of their lives as they can. They may have planned and lived out successful careers, own beautifully designed homes in carefully chosen communities, yet they know that the dragon which guards the door to family building is outside their control.

To many individuals for whom being in control is an important part of their ability to feel confident and competent, challenged family building represents a devastating loss, but this is not its only loss.

The Loss of Genetic Continuity

Potentially, challenged fertility means the loss of our individual genetic continuity?our expectation that we will continue the genes of our families in an unbroken blood line from some distant past into a promising future. For those raised in blood-is-thicker-than-water cultures, this loss is significant enough to be avoided at all costs. While some extended families are entirely comfortable with the idea of adopting in order to carry a family into the future, others believe strongly that the family blood line cannot be grafted onto. Why we feel this way is not as important as is the fact that we acknowledge that we do. When the potential for this loss is felt powerfully– sometimes re-enforced by repeated conceptions which end in miscarriage–alternatives such as donor insemination which allow a woman to use her own eggs and to be pregnant, or traditional surrogacy which provides a man with the opportunity to carry on his genetic material, or gestational surrogacy which allow both partners to use their own genetic material can sometimes be more attractive than traditional adoption. However, as we’ll discuss later, for individuals for whom loss of genetic continuity is central and powerful, pursuing family building alternatives which allow the other partner to retain genetic continuity at the loss of one?s own can be devastating to the relationship.

The Loss of a Jointly Conceived Child

Our earliest dreams about parenting included the expectation of our parenting a jointly conceived child. Gay and lesbian partners perhaps face this loss earlier than heterosexuals do. In choosing a life partner all of us do at least a little fantasizing about what our children might be like. Will he have her intellect and his sense of humor? Grandpa?s red hair and Aunt Wilma?s athletic prowess? Gosh, think of the medical expenses if she inherits both her mother’s crossed eye and her father’s terrible overbite! This child who represents the blending of both the best and the worst of our most intimate selves also represents for many a kind of ultimate bonding of partner to partner. In giving our genes to one another for blending, we offer our most vulnerable, intimate and valuable sense of ourselves?a gift that is perhaps the most precious we can offer. How more vulnerable can we be to another, how much more trusting, than to agree to give 23 of our unique chromosomes in exchange for 23 of our partner?s to make a new 46 chromosome human being? Losing that dream and so feeling forced to consider alternatives such as donor insemination, hiring a surrogate mother, adopting, etc. can be painful indeed for those for whom this expectation was particularly important.

Pregnancy and Birth: Lost Physical and Emotional Expectations

Another challenging loss to deal with is that of the physical satisfaction of successful pregnancy and birth experiences. Though many people see the loss of a pregnancy as belonging entirely to women, this is not so. True enough, the physical changes and challenges of pregnancy and birth are experienced by women alone, but producing a child, as any counselor of pregnant teens will verify, is the ultimate rite of passage for both men and women?the final mark of having reached adulthood. You’re grown up now, and your parents aren?t in charge anymore. Beyond that, the physical ability to impregnate a woman or to carry and birth a child represents the ultimate expression of maleness or femaleness?our bodies at work doing what they were built to do. For many people, losing such capacities challenges their feelings about their maturity or their sexuality or both about their competence as adult men and women. It is their own discomfort with, and fear of, this loss which generates from outsiders the tasteless humor which relates infertility to sexuality in comments such as, “Do you need a little help there? Happy to offer my services!” or “Let me show you how it’s done.” or “Hey, all Steve has to do is look at me and I’m pregnant–must be in the water!’

Some do succeed in becoming pregnant–sometimes over and over again–but these pregnancies result in repeated miscarriages and neo-natal deaths. Trying to block out the unhelpful platitudes from well-meaning others (”Perhaps it was God’s will.”…”Don’t worry, there will be another.”…”At least you know that you can get pregnant!”) can be a struggle like no other.

And there’s more. Over the last several decades, a substantial element of our society, fearful of the impact of massive changes in family structure (and there certainly have been some), has mystified the experience of birth to an exaggerated extent. In search of the perfect “bonding” experience, couples carefully choose specific kinds of childbirth preparation ? they attend classes together, read books, practice breathing, and so on. They expect to experience a magical closeness in spousal relationships, an irreplaceable wonder in sharing the birth experience, an expected instant eye-to-eye bonding between parents and child (a kind of magical superglue without which many fear that families will disintegrate). Hospitals marketing to the expectations of these couples, compete with one another to provide birthing rooms with the perfect equipment (birthing beds, chairs, tanks), the perfect atmosphere (music, guests allowed, champagne afterwards), and the perfect preparation (Lamaze classes, classes for siblings-to-be).

This set of expectations about the emotional gratifications of a shared pregnancy, prepared childbirth, and breast-feeding experience, though far too often unrealistic, is widely held. To risk losing such an experience is much more significant to today’s would-be parents than it would have been to their parents and grandparents–whose mothers gave birth anesthetized in sterile operating rooms while fathers paced in waiting rooms outside, who often didn’t see and hold their children until hours after their births, who bottle fed formula to their infants, and who bonded with their kids!

The Loss of the Parenting Experience

Finally, to be permanently family-challenged threatens the opportunity to parent, which is a major developmental goal for most adults. The psychologist Eric Erickson identified a series of developmental milestones humans work toward throughout their life span. In adulthood, Erickson wrote, the major goals are regenerativity and parenting. To be infertile, single and partnerless, or homosexual on the surface threatens our ability to achieve that goal, so that for many, challenged family-building represents a devastating blow.

Erickson and others have clearly demonstrated that it is possible for individuals achieve this developmental goal and to satisfy the need for nurturing without becoming parents. Many adults find other ways of redirecting or rechanneling their need to nurture–through interaction with nieces and nephews and family friends; by choosing work which brings them in frequent contact with children; by volunteering as religious class teachers, scout leaders, or for a group such as Big Brothers/Big Sisters; by substituting pets for children; by becoming active in non-child centered volunteer work; by nurturing the earth through nature hobbies such as gardening, etc. This is not to imply that lists of possible redirections like these are seen as equivalent substitutions, or as realistic direct replacements for the lifelong experience of parenting a child jointly conceived and birthed with a much loved partner. While some adults can and do actively choose to meet their developmental needs to nurture without becoming parents, for those who have made the choice to become parents and have then been thwarted by family building challenges, the choice to redirect that energy is difficult.

For readers of this book – people who are considering adopting – reactions about this particular loss (parenting) are the most important of all. Adoption provides the opportunity to avoid this loss and this one alone. Singles and couples who adopt will become parents, but in doing so they will give up even more control to the process of adoption: they will forfeit their genetic continuity, they will lose the jointly conceived child of their dreams, and they will be deprived of the emotional and physical expectations of pregnancy.

It is these potential and realized losses which tore at your gut during those days or weeks or months when you tried to deny the challenges you faced. These losses were the danger lurking in the crisis, and they were difficult to face. Now you are asking yourself to examine adoption?one of the potential opportunities which is a part of the crisis. Facing your feelings about infertility?s losses can help you to decide if adoption is right for you.

So unless the loss of the opportunity to parent strikes you as the one loss you would most like to prevent–the one you would find most devastating–adoption may not be for you. The truth is that adoption is not a good choice for everybody!

Addressing the Crisis of Challenged Family Building

When I was a child we had a toy?a child-sized plastic figure with a clownish face filled with air and weighted on the bottom with beans or sand. Its purpose was to be punched, and to rise from the blow grinning, waiting to be punched again. It has often seemed to me that as my husband and I experienced infertility we were like a pair of those punching bag toys placed on a conveyor belt moving through a system punctuated by swing arm gates. As we moved along that conveyor belt from doctor to lab to bed, to doctor to hospital to bed, to doctor to pharmacy to bed, to doctor to counselor to agency to attorney, and on and on, we found that the belt began to speed out of control (rather like the conveyor belt in the candy factory where Lucy and Ethel scrambled to fill boxes that rushed by).

Grinning madly (stiff upper lip, and all that) we were knocked askew by alternating swing arm gates?the doctor, the lab, the hospital, etc. and sent separately reeling to cope with new information, new alternatives. Occasionally in swinging upright again from a blow we would bump against each other and provide one another with a momentary steadiness. But each time we were hit again, we went our own separate ways?alone.

There are several ways that people commonly deal with crisis, but victimhood is the least helpful. Spending significant amounts of time allowing yourself to become the victim of the crisis, floundering in a sea of despair as you are overwhelmed by waves of decisions that must be made is often undergirded by a sense of damaged self esteem. Infertile heterosexual couples, gay or lesbian couples, partnerless adults may all harbor the fear that family building challenges are a punishment of some sort or a message that they wouldn?t be good parents anyway. Some fertility-impaired people react by believing that they are somehow less competent than they were before infertility was discovered. If their reproductive systems aren?t working, they somehow illogically reason, then maybe they shouldn?t trust their judgment, either. (Maybe Uncle Charlie was right; we’re just trying too hard. Perhaps Mom?s manicurist?s cousin?s doctor in Podunk is better than the reproductive endocrinologist at the medical center. Maybe my neighbor who thinks adoption is a sad substitute for real parenting because nobody could ever really love somebody else’s reject isn’t so far off base!)

Feeling neither confident nor competent, victims become unwilling and unable to make decisions. They begin to abdicate more and more control to others, losing their power. The partnerless may date desperately or not date at all, putting aside any thoughts that time is passing quickly. Infertile people may move robotically from treatment to treatment, never looking at alternatives such as adoption or collaborative reproduction. Caught up in the panic of the situation, such people tend to make decisions only when they must be made, struggling forward from crisis to crisis. Those who allow themselves to become victims drift into a childless future they do not want because they haven?t been able to make the decisions that might have helped them consider choices available to them. Victims will fall into a dropped-into-their-laps adoption because someone they saw as competent told them it was the next logical step, and, unprepared for the challenging differences in adoptive parenting, will struggle for years with a feeling that things aren?t quite right, that this didn?t work either.

I worry about victims, because when one operates by crisis management there is little opportunity for reflection. Victims stumble forward on that conveyor belt carried by a panicky momentum much like that we felt as out-of-control young runners about to skin our knees again. I worry because family-challenged people operating in such a mode tend to act out of desperation. With self-conscious laughter, they tell you that they would do anything to have a baby?even drink poison! Sadly, many really would. They sense that the surrogacy service or the adoption lawyer made it just a little too easy (and yet too expensive) for them to skip ahead of more ?traditional? clients. They beg for one more cycle of a drug their doctor has decided isn?t working. They borrow money for yet another in a long string of unsuccessful IVF attempts. They risk it all on a not-quite-legal adoption. They juggle two or more potential adoptions or an adoption and a high risk pregnancy at the same time. Obsessively driven toward the goal of bringing a baby home to a waiting nursery, they have thought very little beyond arrival day.

I worry about these would-be parents, because by allowing themselves to become victims of the challenge to their family building dreams, by allowing themselves to avoid thinking about the ramifications of their crisis management style, they almost guarantee that they won’t effectively deal with their losses. And, that years later those losses will reappear as reopened wounds when new and different losses set a grief reaction in motion – for example, losses of jobs, divorce, death of a parent or close friend or spouse, their adopted child’s recognition of loss as a part of his adoption experience.

I worry because the self-absorption of people operating as victims won?t allow them to feel compassion for others–for birthparents, for people dealing with secondary infertility, for the confused and panicked parents of quads or quints conceived on fertility drugs or in IVF cycles, for couples dealing with an untimely pregnancy, for pregnant infertiles who can’t find a place to ‘fit in’ anymore. For one who has experienced reproductive loss or challenged family building to have lost compassion for those experiencing other types of family-related challenges is particularly ironic.

I worry because for victims there is no joy in living.

There comes a time to stop?to recognize that one has not been in charge and to step off the conveyor belt, regain balance, and look around for a better way. My hope is that the process for decision making offered in the next chapters of this book can become a tool to help couples and singles make that pause for reexamination happen, offering them practical ways to regain control of their lives again, helping them to look far enough beyond the danger represented by the dragon to see the opportunity lying just ahead.

Many significant beginnings and endings in our lives are marked by rituals that publicly mark the transition and invite the support?either in celebration or in mourning?of others. Weddings, funerals, christenings, baby showers, bar mitzvahs, graduations, going-away parties are examples of transitional rituals. Psychologists and sociologists are increasingly noting that transitions which are not accompanied by ritual–divorce, loss of a job, miscarriage, private changes of direction–are often harder to make, since they lack support.

Many family-challenged people are finding it important to create and participate in private or public rituals which acknowledge the progress of their lives. Infertility support groups across the county have put together periodically repeated mourning ceremonies for miscarried or unconceived children. Such ceremonies offer the opportunity for couples and their supportive family and friends to experience a release similar to that in a traditional funeral service.

Several years ago Bonnie and Lawrence Baron of San Diego wrote about their personally composed ceremony in which they formally ended treatment and moved on. Their ceremony was firmly rooted in their Judaic tradition and included elements of several ceremonies and prayers, as well as some nonreligious readings and music.

Mike and Jean Carter of North Carolina, authors of Sweet Grapes: How to Stop Being Infertile and Start Living Again (Perspectives Press, Inc., 1989, rev. 1998), note in their book and in their presentations the formal way in which they marked their choice to live a childfree lifestyle.

Wendy and Rob Williams of Ontario, Canada, created a poignant and very personal ceremony for saying goodbye to the child whose adoption was not completed because his birthmother changed her mind several weeks after placement.

In many ways the structure of the decision making format which will follow encourages the opportunity for using or developing rituals, whether formal or informal. You may wish to explore with your partner the idea of participating in appropriate transitional rituals yourselves as you mark your journey.

In “The Picnic,” one of the wonderful short stories in her collection The Miracle Seekers: An Anthology of Infertility/Mary Martin Mason tells the story of Jill and Dan, frozen in time and unable to move beyond the miscarriage of Gerald, the baby they had waited for so long. In an awkward attempt to help, Dan takes Jill on a picnic along the raw Rhode Island shore. With her sketch pads and charcoal in hand, Jill makes her way to an ancient cemetery to do some rubbings. Dan finds her later, weeping over a one hundred year old tombstone that bears the names of a couple and their five sons–each of whom was named Josephus, each of whom died in infancy.

Here, Jill comes to see that what is preventing her from moving on is the fact that no one–not her mother-in-law, not her friends, not herhusband–has allowed her to experience her grief openly, to mourn the loss of her son, to say goodbye in a formal way to the baby who was not to be. And so, together, Dan and Jill say goodbye to Gerald by burying a baby rattle which Jill has brought with them in the earth above the babies Josephus.

All significant endings and beginnings are indeed crises, fraught with the fear that is a part of facing the unknown. The Chinese concept of crisis consisting of both danger and opportunity is an important one for us to keep in mind as we do the hard work of making good decisions. Many years ago I clipped from a church bulletin a wonderful quote that speaks to this. It was attributed to Merle Shain.

“There are only two ways to approach life–as a victim or as a gallant fighter–and you must decide if you want to act or react… a lot of people forget that.”

But not you, the reader of this book! You?ll remember and decide!