Baby A judgment chillingly reminiscent of era of coerced, secretive adoptions

The Eastern Health Board is to be congratulated for its determined and persistent work in securing the return of Baby A to its natural mother from unlawful custody. Indeed, the judgment of Ms Justice Laffoy makes for chilling reading, being more reminiscent of the era of coerced and secretive adoption than of modern best practice and procedures.

It is ironic, at least, if suggestions of a link with the broad anti-abortion movement are correct, that the counselling agency involved in this case has, by its own ham-fisted and unethical actions, done significant damage to those wishing to protect the pre-born child. Suddenly, for many women with crisis pregnancies, on reading the judgment of Ms Justice Laffoy, the trip to the clinic in England will seem infinitely preferable to the alternative of continuing the pregnancy and considering adoption.

Other women will now opt for life as a single mother, with all the hardship that goes with that. For those who are striving to provide alternatives to abortion, of which adoption must surely be one, the actions of this agency are devastating.

Adoption has always been emotive and difficult for the birth mothers. It is also traumatic for would-be adoptive parents. Indeed, there has been significant debate in recent months about the assessment procedures and, in particular, the lack of trust between social workers and those wishing to adopt, an area which is now hopefully being addressed.

The primacy of trust in the adoption process is central - it permeates all the relationships that evolve before, during and after the adoption. In the case of Ms A, that trust has been breached and sullied.

The decision to place one's baby for adoption is one which can only be made by the woman giving birth. It is not sudden, forced or impulsive, and the task of a supportive counsellor/social worker is to ensure that this is so. The mother must realise the implications of her decision, both in the short and long term; she must acknowledge the totality of her feelings about the baby, about her partner and about the adoptive parents.

For her, these feelings will become more intense as adoption day draws near. Adoption is not about denying the pregnancy but about its total acknowledgement.

Similarly for adoptive parents, they must trust the competence of the social worker; they must feel that they are being prepared for a new relationship, not just with the baby but also with the birth mother.

The relationship will not be confined to the day when they meet the birth mother in advance of the adoption, but will continue over the subsequent years until the day when, hopefully, birth mother and child will meet again. It is complex and nascent, made all the more complex by its unseen nature. Proper preparation of all parties is mandatory if the invisible bond is not to fracture.

Adoptive parents fully acknowledge the need for thorough and appropriate assessment; they do not want to be perceived as baby-snatchers. Least of all do they want to hurt the birth mother who has taken the doubly courageous step of giving life and then placing the infant for adoption. Maverick counsellors have no role in such difficult areas and so, for very good reason, private adoption is illegal.

This case raises many issues, not least among them the fact that this girl felt unable to contact any of the many worthwhile organisations that advertise in the newspapers, in church porches or in doctor's surgeries.

Even more striking is the lack of knowledge of this girl and her family, whom she perceived as being supportive, about the adoption process. Such ignorance is very worrying in these days of mass communication. It highlights the need for a more proactive approach in relation to all aspects of adoption and of the requirement for much greater dissemination of information for these women.

It is also worrying that the judge alludes to the girl's perception of the cause of her distress as being the "intrusive attention" of the nursing staff and her perception that they were suggesting she was doing something wrong in contemplating adoption. If her perceptions are accurate, then much work is required to overcome these ingrained views, which stigmatise women who place their babies for adoption.

Of course, it is possible that these perceptions were driven by her distress or were an indication that the nursing staff were aware that correct procedures in relation to the proposed adoption may have being flouted.

THERE have inevitably been calls for the regulation of all agencies concerned with pregnancy counselling and this is most definitely required. However, such a move is not simple and begs the question of whether all counselling services should be regulated. At present a completely free market exists is relation to therapy - anybody can set up and call him self/herself a therapist.

Counselling is a very broad church and ranges from the mainstream, such as addiction and marriage counsellors, to the fringes where Reiki therapists, regression therapists and reflexologists operate. All have in common a clientele that is vulnerable, needy and fragile.

The resolution will require debate as to the extent of regulation, legislation to give effect to it, as well as disciplinary mechanisms for those not complying. Above all, political goodwill and motivation will be essential.

Meanwhile, as the discussion and debate about the "counselling agency" continues, women will continue to require help during the difficult time of an undesired pregnancy. If the respondents in this case genuinely care about women and about the future of adoption in Ireland, they would name their organisation and reassure the public that they have desisted from this area of work.

Until such time as they do so, rumour and innuendo will flourish and the damage will be unstoppable.

Prof Patricia Casey is professor of psychiatry at UCD and consultant psychiatrist at the Mater Hospital