Adoption: Sharing the Journey

“Sometimes I forget I am adopted,” exclaims my amazing son as he grabs his backpack to head off to college. I had just let him know that his birthday this year falls on National Adoption Day. “So cool! We will need to do something special this year on my birthday, to celebrate both my birthday and my adoption! See ya, mom!” To Shaun, adoption is as easy as one, two, three, and just a part of everyday life. As anyone who’s been through adoption knows, this is simply not the case much of the time. While adoption helped us complete our family, the process can be exciting, thrilling and scary all at the same time! When another woman is carrying the baby that will become your child, you worry. Was she drinking alcohol? Taking a pain killer? What if she was using illegal drugs?! It can literally lead to countless anxious days and sleepless nights. I understand these concerns as I shared the same worries.

National Adoption Day, started in the United States in 1999, is celebrated each year on the Saturday before Thanksgiving. This year it happens to fall on Shaun’s birthday and reminds me of when we adopted him, many years ago. That time in my life was so powerful, but it was easier for me than it is for others as I was part of MotherToBaby and already knew where to find the answers to my pregnancy exposure questions.

My adoption journey has helped shape who I am today – a genetic counselor and a teratogen information expert who specializes in understanding exposures that can cause birth defects. The non-profit I work for provides this crucial service all across North America and I’m proud that my journey has brought me into a position to ease the minds of other prospective parents starting down the wonderful path of adoption. It reminds me of Austin and Drew, a prospective adoptive couple whom I helped in their adoption journey, “My partner and I did a lot of research as we started exploring adoption. After we started working with an agency, there were lots of questions about prenatal exposures, birth parent medical histories, etc. A lot of the information we found on these topics seemed to be contradictory and some of it was downright scary.”  My job allows me to be on the other end of the line talking to this couple, and others like them, helping fill out intake forms and providing evidence-based answers to some of their questions. “Luckily for us, our adoption agency suggested we reach out to Lori. After our conversation we felt much more at ease, and we felt like we had the information we needed to make informed decisions.”

My own journey has come full circle, utilizing my training to help those going through what I went through years ago. MotherToBaby specialists are here to help you too! As Rory Hall, Executive Director of Adoption Advocates, states, “couples approach the adoption process with so many myths about prenatal exposures and health concerns that might affect a baby. MotherToBaby experts help them approach adoption with relevant, scientific backed information so they can make informed decisions about the children they are hoping to adopt.”

Just before Shaun shuts the door to drive to school, he pauses. Sometimes wise beyond his years, he turns and says, “Mom, adoption is so wonderful because your birth parents gave you up so you could have a better life. Love you!” And just like that, the anxiety, and struggle during the adoption process go back to their place of being a very distant memory. #WorthIt.

More about National Adoption Day

National Adoption Day has been celebrated across the United States since 1999, helping to raise the awareness of the more than 100,000 children who are in foster care each year in the U.S. waiting for permanent families. For more information, see www.nationaladoptionday.org. And when you are going through your adoption journey, and have questions about exposures during pregnancy, contact an expert at MotherToBaby. You can reach us by phone at 866-626-6847 or by text at 855-999-3525.

Originally published 11/3/16, Updated 8/31/2025

Adoption: Sharing the Journey

Having worked as a Teratogen Information Specialist at MotherToBaby for close to 10 years, I have become well versed in the different exposures people commonly ask about. Allergy medications in the spring, sunscreen and bug spray in the summer, and cough and cold medications all winter long. So, when I logged onto our live chat service at mothertobaby.org on a Tuesday morning, I was surprised to see a question that doesn’t come up very often. Natalie, pregnant with her first child, asked: “I’m 24 weeks pregnant and my midwife says I need a RhoGAM shot at my next appointment. What could happen to the baby if I do not get this shot?”

Blood Type Basics

Blood type is hereditary, which means it is passed down from your parents. There are 8 common blood types: A+, A-, B+, B-, O+, O-, AB+, and AB-. If your blood type ends in a minus sign (like A- or O-), you are Rh negative. If it ends in a plus sign (like A+ or B+), you are Rh positive. Most people in the United States are Rh positive, but about 15 out of every 100 people (15%) are Rh negative. A blood test early in pregnancy will tell you your blood type.

What is Rh Incompatibility?

During pregnancy, if a woman who is Rh negative is pregnant with a fetus that is Rh positive, a condition called Rh incompatibility can happen. Rh incompatibility becomes an issue if any of the Rh positive red blood cells from the fetus get into the mom’s Rh negative bloodstream. This is most likely to occur during a miscarriage, certain prenatal tests (like amniocentesis or CVS), a fall, labor and delivery, or if the placenta separates from the wall of the uterus. When this happens, the mom’s immune system might treat the fetus’ red blood cells as something that shouldn’t be in the body (like an infection) and start making antibodies against them. In most cases, these antibodies will not negatively affect the current pregnancy, but they might affect future pregnancies.

When Antibodies Attack

Once the mom’s body makes anti-Rh antibodies, they stay in her system for life. If she becomes pregnant again with another Rh positive fetus, the antibodies can cross the placenta and attack the fetus’ red blood cells. This can lead to a condition called hemolytic disease of the fetus and newborn (HDFN). Without enough red blood cells, the fetus cannot carry enough oxygen during development and complications such as jaundice (yellowing of skin and eyes), hemolytic anemic (low red blood cell count), hydrops fetalis (fluid buildup in the baby), high bilirubin levels, kernicterus (brain damage from the bilirubin), and even death can occur.

RhoGAM to the Rescue

Fortunately, there is a way to lower the chance of HDFN: The RhoGAM shot. Typically given around 28 weeks of pregnancy (and again within 72 hours of birth if the baby is confirmed to be Rh positive), RhoGAM is an antibody that helps stop the Rh negative mom from making antibodies that could attack a future fetus’ red blood cells and cause HDFN. Before RhoGAM was available, thousands of babies died from the condition every year. Nowadays, the chance of HDFN is less than 0.1% when the shot is given, making RhoGAM a remarkable intervention.

Protecting Your Future Babies

After sharing this information with Natalie, I summarized our conversation with a quick recap. Since she is Rh negative, her midwife was recommending a RhoGAM shot at 28 weeks to prevent the development of antibodies that could negatively affect a future pregnancy. An increased risk for miscarriage or birth defects is not expected since the shot is given later in pregnancy and Natalie is past the “critical period” for those outcomes to occur. Pregnancy complications, like preterm delivery and low birth weight, have not been reported in the available studies examining the use of RhoGAM in pregnancy. Natalie felt reassured after receiving this information and decided to proceed with the RhoGAM shot at her next midwife appointment.

If you have questions about the RhoGAM shot or any other exposures in pregnancy, please feel free to reach out to MotherToBaby by phone, chat, text, or email to receive evidence-based information that can help you make an informed decision.

References:

  • Bowman J. Thirty-five years of Rh prophylaxis. Transfusion. 2003;43(12):1661-1666. doi:10.1111/j.0041-1132.2003.00632.x

Adoption: Sharing the Journey

Mental health conditions are real health issues that deserve appropriate and individualized medical care. Making informed healthcare decisions requires that women and their healthcare providers be aware of the available safety information for each specific medication they might be considering. We encourage pregnant women and those planning a pregnancy to have open conversations with their healthcare providers to carefully weigh any potential increased risks of medications, as well as the risks of untreated or undertreated mental health conditions.

SSRIs – including commonly prescribed medications such as Zoloft (sertraline), Lexapro (escitalopram), Prozac (fluoxetine), Paxil (paroxetine), and others – are among the most well-studied medications used in pregnancy. Decades of research have shown that SSRIs, when used appropriately and under the care of a healthcare provider, can be part of an effective treatment plan for managing mental health conditions before, during, and after pregnancy, and can contribute to better outcomes for women and their babies.

As always, MotherToBaby and the Organization of Teratology Information Specialists (OTIS) stand with women and their healthcare teams by providing up-to-date, evidence-based information on the use of medications and other exposures during pregnancy and while breastfeeding.

MotherToBaby offers free, expert-reviewed fact sheets on SSRIs and other medications, as well as on conditions such as depression, anxiety, and stress. You can find many of our mental health resources here: https://mothertobaby.org/pregnancy-breastfeeding-exposures/mental-health/. Individuals can also reach out to a MotherToBaby specialist via phone, live chat, text, or email to receive personalized, confidential support.

Adoption: Sharing the Journey

By LauraAnne Hirschler, BS, OMS4 with help from Casey Rosen-Carole, MD, MPH, MSEd, FABM and Rogelio Perez-D’Gregorio, MD, MS

As an infant, I received the gift of life in the form of a liver transplant. Growing up, I remember taking a multitude of medications that just became part of my daily life. As the years went on, my immune system became stronger, the transplant check-ups became farther and farther in between. As the years went by, I found myself taking an extremely low dose of one immunosuppressant called tacrolimus. Inspired by my personal journey as a transplant patient, I went to medical school with a passion to care for patients as my healthcare providers had cared for me. During my training as a physician, I began to become interested in how the medicines that a person needs to take can impact pregnancy and breastfeeding.

With this interest in women’s health, I pursued a rotation in Breastfeeding and Lactation Medicine. I worked alongside an amazing team of lactation specialists to help patients achieve their breastfeeding goals. I reviewed the medications that new moms were prescribed to make sure that they would address the medical needs of the mom and also have the lowest risk of impacting their developing baby. With a desire for a family of my own, I wanted to learn more about taking tacrolimus while breastfeeding. I saw firsthand how beneficial breastfeeding was and wondered if taking this medication multiple times per day would pose any risk for my developing baby. Would I ever be able to breastfeed?

Tacrolimus (Prograf®, Envarsus®,  Astagraf®) is a medicine used by people who have had a transplant, like liver, kidney, or heart transplants. It helps prevent the body from rejecting the new organ. It’s usually taken as a pill, but it can also be taken as an IV, as a liquid, or applied to the skin for conditions like eczema.

I found that research studies have shown promising evidence that breastfeeding while taking tacrolimus is most likely not of concern for breastfed children. One study looked at a mom who took tacrolimus twice a day. After one dose, scientists checked her breast milk and found a very small amount of tacrolimus in the milk. The amount was much lower than what is given directly to babies who need the medication.

One study involved a breastfeeding heart transplant patient who took tacrolimus throughout her pregnancy and after birth. When her baby turned one month old, tacrolimus blood levels were measured in both mom and baby. This baby’s tacrolimus levels were extremely low.

Another study examined three exclusively breastfed infants and one partially breastfed infant whose mothers took oral tacrolimus. Researchers measured tacrolimus amounts in these infants between age of 15-27 days of life. None of the babies had detectable tacrolimus levels in their blood. 

One of the largest studies was performed by the National Transplantation Pregnancy Registry. It looked at 68 mothers who had liver or kidney transplants. The study followed 83 babies, some for as long as 16 years. None of the babies had medical problems related to their mother’s use of tacrolimus.

Tacrolimus is also used in cream form for conditions like eczema. The good news is that the risk of this cream affecting a breastfeeding baby is very low because only a small amount of the cream enters the mom’s body. However, if the cream is applied to the nipple, it should be cleaned off before the baby nurses. If a topical nipple treatment is needed, some experts recommend pimecrolimus cream over tacrolimus because it does not contain paraffin. Other treatments such as hydrocortisone ointments are better studied and are usually used first.

Breastfeeding while taking tacrolimus has been shown to be a low risk for breastfed babies. Since breast milk has many health benefits for babies, healthcare providers recommend moms who are taking tacrolimus breastfeed their babies. As with any health condition, a discussion with your healthcare provider is needed to weigh risks and benefits to determine the right choice for your family.

After learning more about the safety of breastfeeding while taking tacrolimus, I feel empowered and encouraged to breastfeed my future children, especially since breastmilk is so healthy and nourishing for babies.

References/Resources

Adoption: Sharing the Journey

By Lynn Martinez, Teratogen Information Specialist, MotherToBaby Utah

“O.K., so I can’t look at pizza the same way. Saltine crackers seem to be my go-to snack for sustenance and don’t even SAY the word ‘curry!’ Oh no, I said it… Please excuse me while I hurl,” said Nicole, 34, who’s pregnant with her second child.

For many of the moms I counseled as a teratogen information specialist with the international non-profit, MotherToBaby, this is part of the reality of becoming a mom – nausea and vomiting of pregnancy (NVP). Yes, it’s a real diagnosis. “Please help me! Can I take something to help this nausea?” is usually the caller’s desperate question following her description of how she’d rather swim with sharks than accidentally catching a whiff of chicken tikka masala.

Nausea and vomiting of pregnancy (NVP) affects most pregnant women, whether it’s their first pregnancy or a subsequent one. For nearly a third it can be serious enough to disrupt their usual lives and routines. In the past, it has too often been discounted, but now more health care providers are willing to take it seriously and treat their patients. One of the drugs I get asked about more and more often recently is ondansetron, or Zofran, as it’s more commonly known.

Ondansetron is FDA-approved for use with nausea and vomiting in non-pregnant patients, but has been found to be effective for and used increasingly to treat NVP. Early studies demonstrated no increased fetal risk with its use. Two later studies found very small associations with oral clefting (cleft lip and or palate). Oral clefting defects are very common, so associations with exposures are more likely to be coincidental. These studies have not conclusively shown ondansetron to cause clefting or any other defect. More recent research continues to be reassuring. Therefore, it is unlikely the drug needs to be avoided during pregnancy

Other drugs to treat NVP have also been shown not to be a problem for the baby. The combination of doxylamine and vitamin B6 has been used for many years and is effective for many women. This combination is now available in the newly-marketed Diclegis. Ginger, whether in its raw form or in tablets, also works well for some expectant moms.

“So there are options?” exclaimed Nicole. “Thank goodness! Is it appropriate to ask my older child to work with daddy to get me some medication for nausea this Mother’s Day – instead of flowers?” she giggled.

For some women the nausea and vomiting subside greatly after the first trimester, but for those who need extra support with some treatment, encourage the moms-to-be in your life to consult their health care providers for options. And, whatever you do, do not, I REPEAT, do NOT show up with a potpourri basket for mom coupled with freshly-made Panang curry this Mother’s Day.

Lynn Martinez is a retired Teratogen Information Specialist. Lynn has traveled around the Utah educating doctors, nurse midwives, pharmacists and others over the past three decades.

Adoption: Sharing the Journey
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