Adoption Medicine: Tips For Raising A Happy and Healthy Adopted Child Transcript

Episode 12 Podcast > Full Transcript

Nicole Witt, Greeting:
Hi, listeners, welcome back to Adopting! The Podcast. As always, I'm so excited to be your host for this journey. I'm Nicole Witt, Executive Director of The Adoption Consultancy where we guide pre-adoptive parents, step by step, through their adoption journey.

In Adopting! The Podcast, we're going to focus on the issues, questions and concerns you have as you get started in your adoption journey. So, this is for people just considering, brand new to, or early in the process, who are trying to get their questions answered and figure out their best path forward, as well as learn about what to expect and how the process works.

Nicole Witt, Intro:
In some previous episodes, we've tried to shed light on and demystify some of the big fears of pre-adoptive parents. Today, we continue in that vein. Of course, the ultimate concern of all parents to be is having a healthy baby. No one, of course, has complete control over that. And with adoption, you have even less control, which leads to a lot of second guessing and fear.

Today, like I said, we're going to shed light on some myths and give you some of the information and resources you need to make informed decisions about what medical situations you are and are not accepting of.

To walk us through that, I'm absolutely thrilled to welcome a very special guest. Over the years, I have referred many clients to her for her medical expertise in the world of adoption. And I'm honored that she's on the podcast today to share her knowledge with all of us. So, please join me in giving a very warm welcome to Dr. Melissa Goldstein. She's with Carnegie Hill Pediatrics in New York City.

Dr. Goldstein received her B.S. from my alma mater, Cornell University, and her MD from Weill Cornell Medical College. After completing her pediatric residency, Dr. Goldstein moved to Russia to work as a general pediatrician. In this position, she spent a great deal of time performing pre-adoption evaluations of Russian orphans.

When Dr. Goldstein returned to the US, she joined International Pediatric Health Services in New York City with Dr. Jane Aronson. In this office, she provided general pediatric care for adopted children. Dr. Goldstein is now with Carnegie Hill Pediatrics and has been for nearly 15 years.

In this practice, she dedicates much of her pediatric practice to helping families navigate the challenging steps of adopting, practicing adoption medicine and offering pre- and post-adoption medical counseling.

Dr. Goldstein screens preliminary videos and photographs, reviews expectant mother OB reports and analyzes records pertaining to children being considered for adoption. She has expert knowledge about health issues unique to adoptees.

Nicole Witt:
Thank you so very much for spending some of your valuable time with us today, Dr. Goldstein.

Dr. Melissa Goldstein:
Thanks for having me, Nicole. Good intro.

Well, to let our listeners know what to expect. Today, we're going to focus on issues relating to some of the medical risks prospective parents may encounter when matching with an expectant mother, including drug exposure, chronic medical conditions, social characteristics, etc.. And I'm sure you could spend hours talking about each of these things. So, unfortunately, we're going to scratch the surface a bit.

But why don't we start with, I think, what the most top-of-mind topic often is for pre adoptive parents, which is substance use. In medical terms, I believe that is teratogenic. Correct?

Dr. Goldstein:
Correct. Correct.

Okay. So, these are the agents or factors which cause or can cause malformation of an embryo. So, I am just going to turn it over to you if you want to walk us through some of the more common ones or the more impactful ones, and let us know sort of what you tend to see in those areas.

Dr. Goldstein:
Sure. Sure. So, so thank you for having me. I think, before we get started, I do want to just tell you what my role is. If you're starting the adoption process and you're working either with an attorney or an agency, they often will ask you to get information that you receive on the birth mother evaluated with a physician. That's what I do. And there are a bunch of physicians that do it. They call it adoption medicine.

And so, what we do is we help you analyze birth mother records. Or sometimes, if a woman presents to the ER and doesn't have any prenatal care and she didn't make an adoption plan, then we may be evaluating actual baby records. So, if we didn't have a pregnant woman to analyze or analyze her medical information, then we're talking about analyzing a live baby or a baby, postnatally, so to speak. So, that's when I come into play.

And when I'm working with a family to try – I think the goal is what you just stated is to try to get as healthy as possible. That seems to be what everyone's goal is, understandably. And I think there are ways to do that and there are processes. We certainly have very – I'm sure everybody listening and you, Nicole yourself, knows great stories of wonderful, successful adoptions.

And I think there are ways to increase the chances of having a healthy baby or what other people say a non-special-needs baby. Of course, that's a bit of a subjective term, so I think we should all be on the same page when we're working together.

So, I will just tell you what I am thinking about when I think about a special need or a non-special needs child and then usually I'll adapt a little bit to the family's needs and desires.

So, to me, a special needs child is a child who needs a specialized school. And I don't mean they need speech therapy and tutors, because that happens all the time and I think everybody should expect that when you're raising a child, either adopted or biological. But I'm talking about a specialized school where they can't be mainstreamed and might need to actually not go to your, let's say, local public school. And then possibly not be able to live independently post-high school into their twenties and thirties, that they just don't have the capacity, cognitively, to live on their own. To me, those would qualify as special needs cases.

And I think we can, by utilizing and evaluating risk, I think we can really decrease the chances of having, again, what I consider a special needs child. And each family's definition of special needs may be different. But for purposes of the discussion, that's sort of what I'm thinking of, of a special needs child.

So, when I'm looking at either prenatal records of a birth mom or I'm looking at the records of a baby, I'm going to focus in right away on three major characteristics. And the first one is going to be the size of the baby.

Now, it might be that the size I'm talking about is something that's been evaluated on an ultrasound. So, for example, if she's 20 weeks pregnant or 25 weeks pregnant and she goes to her obstetrician, they sent her for an ultrasound. And certainly, there are different kinds of ultrasound, but the anatomy scan is the most valuable and detailed ultrasound. And they provide measurements of the baby's length, femur length, abdominal circumference, head circumference and estimated fetal weight.

Those parameters, really, we like to see them in the normal range. The normal range is quite large. We're not talking about, oh, a little bit on the small side. When someone's not growing or when a fetus is not growing appropriately and they're not fitting in the normal range, it's called small for gestational age.

Or if a child is born and they're estimated to be a full-term baby and their birth weight is not in the normal range that's considered small for gestational age. You really need to compare the gestational age because obviously like a 26-week gestational age is going to be smaller than a 36-week gestational age.

So, when we look at the size, I always tell families, “We need an ultrasound. We need an ultrasound,” if it's a prenatal case. And that's why, because I really need to see that the fetus is growing well in utero.

And the reason being is that a lot of the teratogens that we're going to talk about are a lot of the things that a baby can be exposed to in utero that have a negative impact on growth, causing a small for gestational age baby, also have a negative impact on cognition and may be leading us towards what we just described as a special needs situation.

So, I'm always going to hone in, and any family that I've worked with will note that I'm sort of a little bit obsessive about growth. And that's why.

And the second feature that I hone in on is the head circumference. So, which I guess is sort of like size, but it's specific to the head. Microcephaly, you might recall, Nicole, during the time of Zika when we had those mosquitoes that were carrying the Zika virus. And the reason they were so concerning is because they created microcephaly to a fetus when a woman was infected with the Zika virus. And microcephaly means small head.

And so, you can have a normal weight in a normal size baby, but if the head circumference is not in the normal range for that gestational age, that's a big red flag. Because again, so many of the traditions that we're going to talk about can lead to microcephaly and also cognitive impairments. So, you'll hear me, if we're working together, say, “We need the head circumference.” And again, we can be talking about prenatal records or we can be talking about a baby that was born without any prenatal care and just presented as an emergency placement.

And then the other big feature that I focus in on, which is we might not know if we're dealing with a pregnant woman, is prematurity. Prematurity comes with its own risks. Google prematurity and you'll see this whole long list of problems that come with prematurity. And of course, the more premature, the more problems.

So, for example, a 27-week gestational age baby is much riskier situation. And when I say riskier, I mean in terms of having a special needs child compared with, say, a 34-week, which are both premature, but obviously to different degrees.

Term of pregnancy should be somewhere between 37 and 41 weeks. So, anything earlier than 37 weeks is considered preterm, but obviously with varying degrees.

So, prematurity by itself carries risk. But there's also something about prematurity that says to physicians that something was not right in utero that made this baby come early. Something was inhospitable or less than ideal, that somehow it was better for this baby to be on the outside than the inside.

So, that means that we're thinking about prematurity as a risk, but also thinking about what caused the prematurity. So, for example, cocaine, if you go on a cocaine binge, we know that cocaine can induce labor in large amounts. So, now we've got to worry about the prematurity, but we've also got to worry about what does cocaine mean during pregnancy. So, that's why we get a little bit more concerned with more premature cases.

Of course, we might not know if you're matched with a birth mother and she's pregnant, you might not know that she's going to go into preterm labor. But this is something that we evaluate as we go along.

Okay, yeah. And I think that's a great context in terms of looking at all of these products and items that the expectant mom might be using in terms of how do they impact ultimately the baby's health. Because I think a lot of people get caught up in, “Oh, did she do this one time or did she do that” as opposed to really thinking about the big picture, “Am I going to have a healthy baby?”

Dr. Goldstein:
That's so true, because a lot of these things as we go through, you'll see like, “Okay, if she did it a little bit, maybe it's okay. If she did it a lot and it had this impact, then maybe it's not okay.”

If it's okay, I'd love to just start talking about some of the individual risks that we come across when we're evaluating a birth mother's medical history.

Yeah, absolutely. Please do.

Dr. Goldstein:
So, I think the one that people are most – It's actually – I think it's if you've done any reading at all, and your listeners probably have done some, then you know that the worst thing that a woman can do during her pregnancy by far is be an alcoholic. In fact, we know this so much that they actually name something after it. They have something called fetal alcohol syndrome, which means that you drank your face off. You were drinking so much during pregnancy that it led to a child who is what we call fetal alcohol syndrome, FAS, which has the following features; small for gestational age, microcephalic, dysmorphic facial features, which you might not see on an anatomy ultrasound and you might not even notice actually when the baby's out. So, that's why those other features are so important and cognitive impairment.

So, you've got these four main features. There are also some other features that are a little bit more minor characteristics. But this is why we get so nervous about a baby that's not growing well in utero, because maybe it was alcohol and we won't see the cognitive impairment, we might not see the dysmorphic facial features, but we will see the microcephaly and we will see the size. And that's why we get very nervous about when a baby's got a small head and growing poorly in utero.

I've almost never seen a microcephalic child have normal cognition because small head means small brain. So, that's why alcohol is alarming. And we've studied this well, we know this so well that we've named something after it.

The problem is that some people drink a little bit, but they're not alcoholics. Maybe they have a couple of glasses of wine during their pregnancy. Maybe they have a glass of wine a week during their pregnancy. I was born in the seventies and alcohol wasn't known, not thought of as being as taboo. And my mom enjoys her wine.


Dr. Goldstein:
She's not an alcoholic but she enjoys her wine. So, maybe she had a glass of wine a week and I'm doing okay so far. So, you have to take these things into – know that this is a spectrum. So, if somebody is a mild drinker and the baby's head circumference and their growth and everything else about the pregnancy looks okay and she's had a couple of glasses of wine maybe before she knew she was pregnant or she's had like five beers during the pregnancy; real mild drinking. It's probably okay as long as these parameters that we just talked about are okay.

If she's an alcoholic, it's probably not okay. It's those moderate drinkers that are a little bit tricky. And then we have to look to what your risk tolerance is, because you may have something called fetal alcohol spectrum disorder, which means you didn't fit the criteria for fetal alcohol syndrome, so you don't have maybe the small for gestational age and maybe you don't have the microcephaly, but you've got the cognitive impairment. Maybe you don't have the dysmorphic facial features. But that moderate drinker is hard to pick up. So, you really have to kind of think within yourself what your risk tolerance is when you're talking about a moderate drinker.

It's everyone's personal decision, but I do find that many people who are striving for the as-healthy-as-possible, non-special-needs cases are usually turning down the moderate and severe drinkers, but considering the mild drinkers.

Yeah, absolutely. That's what I see as well.

Dr. Goldstein:
So, that's alcohol. Cigarettes are also very well studied. We know what they do very well. It's probably, in absolute terms, the second worst thing you can do during your pregnancy because there's such a cause and effect and we know so much about it. So, we know that if you're a heavy smoker, I don't know what even a heavy smoker is anymore, but let's say you're three packs a day; you always have a cigarette in your mouth, you will have a small baby because the carcinogenic effect of the smoke inhalation and the nicotine in the tobacco, these things are vasoconstrictors and they make the blood supply to the fetus narrower and smaller so that that baby is going to get less nutrients, less oxygen, and be smaller. So, we know that large amounts of cigarette smoke does this.

It also can cause preterm labor and it has been known in really excess to cause miscarriages. There is no good studies out there that will tell you that if you're a heavy smoker, you will have a cognitively impaired baby. If that's the only thing you did. There's nothing that that will say that. But we do tend to see a relationship between small for gestational age, microcephaly and cognitive impairment.

So, what I say to people is, “If you have a birth mother who's smoking and the estimated fetal weight, everything on the growth parameters is normal, including the head circumference and it's a full term baby, I say I don't really care.” Because obviously, it wasn't enough to have the things that we know happen. And there is again, nothing out there – You can always find a study, but there's no real replicated good studies that say cigarette smoke leads to cognitive impairment.

Okay, yeah. And I'm sure that's great peace of mind for a lot of people because this one comes up so often, because so many potential birth moms do smoke. Although these days, I find that we see much lighter smokers than we did in the past. Is that what you see as well?

Dr. Goldstein:
I do, but I still am surprised by the amount of people who are smoking, because most of the others that I see are living below the poverty line, so that they're really concerned with where they're going to pay for their next meal and their electricity. But yet they're paying for these, like I don't even know what it is, 8, $12 packs of cigarettes. So, I still find it really interesting that there's as much smoking as there is. But I agree that it's gone down.

We do see an increase in e-cigarettes, which arguably might be a little bit better, because it has a little less of the smoke inhalation than the carcinogenic effect, which is displacing the oxygen. So, maybe that's better. Of all the nicotine's that you can do, certainly the patch or gum is better than the smoking. And sometimes an OB will try to encourage a birth mother to start a nicotine patch, usually not so successfully, but I have seen them try to do that because the nicotine patch is better for the fetus than the inhaled nicotine. \

Marijuana, I do see a lot of. Marijuana is not as well studied and characterized in terms of what it does for the fetus. The smoke component of inhaled marijuana certainly is not good in terms of growth because of what we talked about with how the inhalation and the carcinogenic effect of sort of displacing the oxygen as you're inhaling smoke is not good for the fetus.

But the THC component is a little bit more unclear. There are some countries that use THC or cannabis in the early stages of pregnancy when women are nauseated and vomiting. So, obviously, those countries don't think it's too deleterious. But I think what I say to people with marijuana is similar to what I do with the cigarettes is if the parameters are okay and she reports some marijuana use, even if it's daily, we usually will not put up a massive red flag for that.

Okay, good. Yeah, I think those are the ones that I hear come up the most. Of course, there are other ones which I'm sure you're going to get to that which fortunately seem to come up a little bit less often. But do you want to delve into some of those for us?

Dr. Goldstein:
Sure, if you'd like to. I think of them in three separate categories. So, I'll just breeze over the depressants which are like anxiety medication. So, Xanax, Valium, even like Benadryl or the over-the-counter Unisom that you can buy if you're having trouble sleeping. These medications don't seem to be as much medications of use in the population as they are. I'm sorry. They're more medications of use rather than abuse.

So, if a pregnant woman goes to her obstetrician and she's just overly anxious, which understandably, a lot of these women are anxious and depressed. I mean, they're usually, like I said, living below the poverty line, living in dire straits, victims of abuse, sometimes physical, domestic violence, whatever. They're depressed and they're anxious and they're giving up their baby for adoption. I mean, it's kind of understandable that they're feeling some anxiety and maybe having some trouble sleeping. And the mental wellbeing of a birth mother, we've learned, is really important; how she just feels and her general sense of wellbeing.

So, the obstetricians will prescribe a sleep aid to pregnant women who are really having trouble with anxiety and insomnia and they will be okay with it. It's not like we encourage people to take it, but we do want birth mothers to have a good night's sleep and to not be tortured by their anxiety.

If they overdose on these medications, then they're not going to wake up. And that's obviously not good for the fetus. But using them in a controlled, prescribed manner is thought to be okay.

On the tail end, when the baby comes out, if the woman was using regular sleep aids, you might have a sleepier baby. But once that medication is metabolized, the baby should fare just fine. And we don't have any evidence that there will be long term consequences of these kind of uses of the depressants, anxiety attacks, that {indistinct 20:47}.

Okay, good. Good.

Dr. Goldstein:
And the other big category is the stimulants. This comes up a lot. This is like things that make you want to party, things that make you very focused and hyper alert and stimulate. So, we're talking about in terms of illegal drugs; cocaine and crystal meth, Molly, MDMA, Ecstasy, Kellogg or Special K; there's other stimulants that are illegal and then there's the ones that are legal that people are using for ADHD, like Ritalin, Concerta, Focal and Vyvanse. As a pediatrician, we see these all the time.

And if anyone's ever taken these medications, they're big appetite suppressants. You see this a lot in the world of pediatrics, that you have a skinny kid who's got ADHD and he's just not eating any lunch because the medication is in him and he has no appetite suppressant.

So, if a woman is an addict; a coke addict or a crystal meth addict, usually she's not going to provide or she's not going to nurture a healthy, good-sized baby because her appetite will be down.

In addition, these medications have a similar effect, kind of like epinephrine. They're vasoconstrictor. So, they actually decrease the blood supply to the baby. So, if you're a crystal meth addict or you are abusing Ritalin or any of these stimulants, you're probably going to not make a normal size for gestational age baby.

In addition, these medications are known to induce labor; pre-term labor. So, if you're presenting a full-term good sized baby and the woman dabbled with some cocaine during her pregnancy, I would probably say it wasn't that much, because if you're a coke addict, the baby's not going to make it. They're probably not going to make it and they're certainly not going to be full term and 8 pounds.


Dr. Goldstein:
You know, I think when cocaine was really big, like in the eighties, the concern was what kind of just drain this was going to put on our resources in society when all these coke addicts went on and had babies. But in reality, it didn't do it. And I think it didn't do it because if you did a ton of cocaine, I think you miscarry. I don't see a lot of coke addicts or crystal meth addicts as birth mothers present it to me. Usually, it's a dabbler or occasional usage. And the reason being is I think those babies will die in utero; the pregnancy will be terminated; spontaneously aborted.

So, I think if you like I said, if you have a birth mother who does a little bit of – I'm not saying this is okay or encourage it, but does some cocaine and everything looks great on the growth parameters and the pregnancy seems to be going well, I think we can do it.

Yeah. I also think with, with the women who are addicts and who have a major problem with that, I think they just don't sort of have what it takes to, you know, going through an adoption plan takes commitment and they need to be showing up at the agency and filling out their paperwork and that sort of thing. And I think that early on, they kind of get almost weeded out of the process because they just don't have the wherewithal to make those commitments and stick by them.

Dr. Goldstein:
Yeah. Certainly, for somebody to present in the second or early third trimester, we probably wouldn't see an addict do that. The addict might present more like walks into the ER without any plan and gives birth in the ER. And now you've got a baby who surprisingly made it but probably is not going to be, in terms of the graphs and the gestational age, not going to be a good size.

But no, I totally agree with you; we don't see the addicts present during their second or early third trimester, as we do for much of the birth mothers.

And I think your next category, well, subcategory here is the one that gets a lot of press lately, correct?

Dr. Goldstein:
Yeah. Yeah. And this is an interesting one because opiates or opium has been around forever and it's actually, when it's used appropriately, it can be quite a good analgesic and quite a good painkiller. And if a pregnant woman has a, let's say, tooth abscess or something and she's just miserable and the dentist has to pull her teeth and she's just so tortured by this pain, they may give her like a day or two of Vicodin. Maybe they'll give her two Percocets or something, and that will be fine. In fact, if a newborn baby needs surgery, for some reason, part of the anesthesia is going to probably be something in this family of opiates; maybe some morphine.

So, we know, structurally, these things are okay. The problem is when people use them as an abuse them. And that's because I think we have such an addictive quality that that comes up a lot.

So, let's say there was a birth mother who was somehow got her hands on some Percocet and that's pretty expensive. And then she really liked it and she couldn't get it anymore, so she went to the street and she got heroin and now she's getting high on heroin and she's an addict. Well, what happens in these situations that's the most dangerous part is the withdrawal.

So, if you're a heroin addict, you get high and then you come down and until you can get the heroin again, you go through some degree of withdrawal. Withdrawal is where your body is kind of craving the opiate. And it's really dangerous; all your hormones are out of whack. And so, while this birth mother is going through withdrawal, so is the fetus, because the fetus has the same exposure. It does pass through the placenta.

So, this withdrawal is actually, I mean, it's horrible to watch. I've only seen it in the movies, but it's horrible to watch and then to think of this fetus going through it also. It's really hard.

So, what happens is when you have a woman who is a heroin addict or a prior heroin addict, we don't want that withdrawal to go on during a pregnancy. We don't really want that withdrawal to go on any time. But it's quite dangerous for the fetus. So, what obstetricians will sometimes do, if a woman is not already doing it, is put them on one of these rehabilitating medications like Methadone or Subutex. And what these do is they sort of cover the receptor, so you lose that craving, but you don't get high. So, you don't have the lows, but you don't really have the high. So, it's a much more steady state of the opiate. And so, that's what the fetus is exposed to; this sort of steady state of opiate.

And that's actually a lot safer than the heroin user who uses it; stops, uses it; stops, uses it; stops because this fetus is exposed to a steady state and you have to probably prove that you're not using heroin and you have to go and check in and get your prescriptions for your methadone. And so, someone's kind of having eyes on these people. So, I think, from an attention with doctor standpoint, I think they tend to be getting some degree of care.

The problem is that when the baby's born and the methadone is metabolized, say, on day two, day three of life, the baby then will go through withdrawal. Birth mother won't; she's still getting her methadone, but now the baby is not. So, now it's day two of life, baby's already matched with the adopting parent or parents, and now the baby is going through withdrawal.

We were looking out for it because we probably knew that this was a drug addict. Maybe she didn't have any prenatal care. We may be tested her or we put a urine toxicology bag on the baby and we knew that there were opiates in the baby system. So, we're prepared for it. And so, the baby is probably maybe in an observation unit like the neonatal intensive care unit, and the baby starts to go through withdrawal. And it's really sad that they don't get any sleep. They're hard to feed. They're jittery. They just can't settle down. They're so uncomfortable.

So, the physicians in the observation unit, wherever this baby is, will evaluate the situation and most likely stop it. And the way to stop it is to give back some opiates, just a little small amount, hopefully as small as possible, maybe in the form of morphine, maybe in the form of methadone. But they'll stop the withdrawal so that the baby isn't going through that, because, like I said, the withdrawal is actually more dangerous than the opiate itself.

And then they slowly wean it, as opposed to that quick cutting like we did with the umbilical cord. Now it's going to be a slow wean. And most of the time, this is always taking care – I shouldn't say always, but I would say for the large majority of cases, this is taking place in the hospital until the baby is off everything.

And when they're off everything, they do really well. I have a ton of these kids in my practice who, if they've stayed with me as their pediatrician or if they haven't, I follow them and like to see how they're doing and they're really faring quite well. A lot of them would love to brag about how their kids are at the front of the kindergarten class. And number one, in their first grade class. You know, I've only been doing this about 15, 20 years. I don't have like whether these people necessarily went on to become rocket scientist, but they do very, very well.

So, I think opiates are doable for the right family, for the right people. But that situation in the nick where you're watching your child withdrawal and giving them back, it's this hard; it's really hard. But I do think the people that have gone through it are quite glad they did. And the babies, like I said, are doing really well.

And I appreciate your explanation of trying to have more of the steady state versus the highs and lows, because I find one thing that tends to really surprise the pre-adoptive parents, if they're matched with an expectant mom who is on, say, methadone or Subutex program, their initial expectation is, “Well, shouldn't the doctor be trying to wean her off of that?” And then sometimes, during the course of the pregnancy, they'll actually increase her dosage, as she gains weight and as her blood volume goes up.

Dr. Goldstein:

And that tends to be a big surprise and it’s counterintuitive to them. So, I definitely appreciate that explanation of that.

Dr. Goldstein:
Totally. I think you can find some institutions or some obstetricians in the country that don't handle heroin addicts in this manner or former heroin addicts, but I think that the large majority are in favor of keeping pregnant women on their rehab medication and trying to get them on methadone if they're on heroin. Because, like you said, the steady state is better than the highs and lows, because the lows are so bad. Obviously, the highs can be quite bad. If you take too much heroin, you won't wake up. You know, somebody who ODs on heroin, they didn't OD from the withdrawal. They OD'd because the heroin amount was so high that it halted their respiratory center, so they stopped breathing.

So, the highs aren't great. But in terms of the fetus and if somebody survives the highs, the lows are really bad.

Well, so talking in this category, you did refer to depression and anxiety and some of the medications associated with those. Could you comment briefly about bipolar, since that's something that does come up fairly often as well?

Dr. Goldstein:
Sure. Sure, it does. It does. I see it. Most of the time, I see it on the social history and the medical history that the birth mother filled out herself. So, they fill out something in most cases that then we get to evaluate. And it might say that they suffer from depression and anxiety. And as I mentioned, those, I would be surprised if they didn't because I imagine giving up a baby for adoption is one of the hardest things anyone has to do. So, I would think that there's depression and anxiety there. Plus, as I said, a lot of them are living in dire straits in terms of resources and I see a lot of cases where people admit that they suffered from physical or sexual abuse in their homes.

Bipolar, I find that it's often written on their history, but often not backed up by a clinician. So, sometimes, I think that that's a self-diagnosed disorder. So, I would need to follow that up with questions about who called that diagnosis and how is it being managed. So, for example, if a woman writes that she's bipolar but it's nowhere on the medical and she's going to work every day and she's not on any medication, maybe it's a mild case or it's not really been called that. Maybe she's mistaking that word for moody.

And I think bipolar, I think it's become a much more popular term that psychiatrists and psychologists are using, and I think it can be quite manageable. But if you have a birth mother who is bipolar on her social history that she's writing bipolar on the medical report from the obstetrician and she's on medication for her bipolar and she's debilitated by her bipolar, that's a little bit more of a red flag to me, because I think the more severe it is, I think you're increasing your chances of the inheritance of it.

But the bipolar is, I always think of it like the moderate drinker. It's a gray area, but I think it deserves more digging. But if somebody is debilitated by their bipolar disorder and seems like they've been on multiple medications for it, it probably would give me more cause for concern than somebody who just writes it on their history and it's not backed up by any medical provider.

Okay, excellent. Well, this has been just a ton of super valuable information. Before we wrap up, is there any other category or anything else that you see sort of frequently that you think would be important to cover?

Dr. Goldstein:
You know, occasionally we see that birth mothers are called cognitively impaired or autistic or they might say that the birth mother was mentally or intellectually disabled. That's a hard case, because there are so many reasons why somebody could be intellectually or mentally disabled, but some of them are hereditary. So, we do, you know, we have to – Of course, we don't know exactly what causes autism, but we do think there is some genetic component. So, it is something that myself and the family have to think about, whether they can handle that and that fits into what would fit into their family.

Because I do think that if somebody is intellectually disabled, they do have a higher chance of having an intellectually disabled child, from a genetic standpoint.

Well, Dr. Goldstein, I can't thank you enough for being so generous with your time and knowledge. And I know I speak for everyone listening when I say how much we appreciate you.

Dr. Goldstein:
My pleasure. I love to. I mean, we're forming families here. It's a great thing. And I appreciate you having me.

Oh, sure. Sure. So, listeners, again, this is Dr. Melissa Goldstein of Carnegie Hill Pediatrics in New York City. And she can be reached at

And listeners, most of all, I'd like to thank you for tuning in. I hope you've learned something today that will help you make informed decisions as you progress through your adoption journey. Please be good to yourselves. Take care and I'll catch you next time.