Although practices vary state by state, most adoptions start with the birth mother reviewing dozens of adoption profile books [11] or online profiles of prospective adoptive parents. Usually, these are adoptive families who have retained that agency or attorney to assist them in the adoption process. Most US states permit full openness not just regarding identities, but also personal information about each other. Just as the adoptive parents want to learn about the birth mother's life and health history, so does the birth mother want the same information about the people she is considering as the parents for her child.[12]

Closed adoption, also called a confidential or traditional adoption, refers to an adoption in which there is no relationship between the adoptive family and birth parents. In a closed adoption, the birth parents and adoptive family arrange the adoption via a facilitator, attorney or a case worker at an agency. Neither member of the adoption triad knows identifying information about the other. By opting for a closed adoption, a future birth mother is trying to have as little involvement as possible with the placement process. For some women, this is a way to distance themselves from the emotional decisions associated with placement. However, the distance is something many adopters fear will make it easier for a birth mother to change her mind about placement.
Many in the adoption community first learned of search and support resources through newspaper articles,[8] the Dear Abby column[9] and various TV shows and movies. Starting in the mid-1980s, many adoptees and their parents first learned about the possibility of reunion on the NBC (later CBS) television program Unsolved Mysteries hosted by Robert Stack. This was under their "Lost Loves" category, the vast majority of which involved closed adoption. More than 100 reunions have occurred as a result of the program, many of those being the adoption-related cases. Reruns of the program (with a few new segments and updates) were also aired on the Lifetime Television cable network until mid-2006, and very briefly on Spike TV in late 2008. In September 2010, the program returned to Lifetime from 4 to 7 pm ET/PT.

Choosing between an open and closed adoption depends entirely on the adoptive family's preferences. It's strongly advised that couples that do not entirely support an open adoption should not engage in one. However, it's more rare to find an agency or attorney that is completely comfortable with a closed adoption and will not suggest a semi-open adoption to a birth mother.
Most open adoptions lie somewhere in the middle, according to Grotevant and McRoy, exchanging letters, pictures, and phone calls, and having face-to-face meetings once or twice a year. Whatever their situation, many families report that relatives and friends condemn openness, and voice fears that the arrangement will make the birth parent want the child back.
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