Overview. This study was designed with a view toward synthesizing quantitative and qualitative research approaches. Intent on harnessing the resources of the Internet and honoring the experiences and voices of birthmothers, I employed a multi-method research design: a closed-ended survey was complemented by a facilitated small group discussion. Members of birthmother online support groups and mailing lists were contacted via e-mail and invited to participate if they met the selection criteria. A web site (see Appendix A) was constructed for the purpose of processing survey requests. A cover letter, consent form and questionnaire were sent to qualified participants by postal mail (see Appendices B, C, and D). The small group discussion was intended to provide a qualitative framework within which to analyze the quantitative survey results. Birthmothers were invited to participate in the analysis of the survey results. Survey and group discussion participants were given the incentive of adding their voices to the growing numbers of birthmothers who have begun to share their stories and to enhance the body of knowledge available to the counseling profession.

Setting the Selection Criteria. Participation in the study was restricted to birthmothers who gave birth during the years 1965 through 1972 and who relinquished their infants at birth. I established this selection criteria cognizant of the social, political, and religious climate during this period. At the cusp of the "sexual revolution," young women during these years became sexually active without the benefit of easy access to birth control to prevent pregnancy or the option of legalized abortion to terminate pregnancy. Both the unwed mother and her "illegitimate" child were subjected to stigmatization by society. Closed adoption was often the only available course of action. The convergence of these factors supported the decision to study women relinquishing during this period as a cohort group.

Spreading the Word. Since birthmothers have historically been a clandestine group, the existence of online support groups provided a unique opportunity to solicit research participants. Utilizing various Internet search engines, I identified several online birthmother support groups. I was already a member of one large online group, The Sunflower Birthmom Support Group, whose membership exceeded 500, and two smaller online groups (Reconnected Bmoms and Bmom-Political-Social). Uncertain of how many birthmothers would qualify to participate, I decided upon a staged notification approach. I constructed a letter describing the study and requesting qualifying birthmothers to visit my web site if they were interested in participating. I first posted this letter to the three mailing lists I belonged to and monitored requests. Visitors to the web site were asked to provide an e-mail id and postal mailing address in order to receive the questionnaire. This information was automatically saved in a database and sent to my Internet mailbox. Thirty-six (36) requests were received within the first 24 hours. Seventy-seven (77) requests were received by the end of the first week. However, by the sixth day, requests had trickled down to one or two per day. I then sent electronic mail to owners of additional birthmother mailing lists asking them to post my request to their lists. I also joined an additional birthmother mail list and posted my request to that group. I attempted to add my site to an adoption web ring and to several search engines, but was unable to have my site added within the desired time frame. Several birthmothers notified me that they had forwarded my request to other birthmothers. Midway during data collection, a reminder notice was sent electronically to those birthmothers who had not yet returned completed surveys. By the end of the five-week data collection period, I had mailed out 109 questionnaires and received back 79 completed questionnaires, yielding a 72% return rate. During this time, the web site had been accessed over 200 times. All those requesting a survey were also asked whether they would be interested in participating in the analysis of the survey results by attending the small group discussion that would be held in New York City. Members of a local Manhattan Birthmother Support Group were also invited to participate in the small group discussion.

I encountered an unfortunate experience with one support group mailing list that I had joined. After several weeks of membership, I was summarily unsubscribed from the list. The list owner expressed concern that I intended to utilize the birthmother communications in my research without knowledge or permission. She pointed to my "lack of participation" in the group to support this belief. Since I was no longer on the distribution list, I was unable to respond to the group regarding her concerns.

The self-report closed-ended questionnaire was designed to collect data in the following areas: (1) demographic data, (2) assessment of traumatization, (3) physical and psychological health history, and (4) effectiveness of psychotherapeutic intervention. The Impact of Events Scale - Revised was included to identify the presence of PTSD symptoms; however, the time frame was modified from "the past seven days" to "since the relinquishment." The Impact of Events Scale - Revised measures intrusion, avoidance, and hyperarousal. The original Impact of Events Scale only measures intrusion and avoidance. I used the revised version of the scale to identify the existence or nonexistence of hyperarousal symptoms within the birthmother population.

The Survey Mailing. The questionnaire was accompanied by a cover letter, consent form, and self-addressed stamped return envelope. The cover letter included an introduction of myself, my association with Goddard, the purpose of the study, and an incentive to participate. The incentive was oriented toward the opportunity for birthmothers to collectively voice their experiences. A three-week return date was specified in each cover letter. The return of a signed consent form was a requirement for the inclusion of the questionnaire data in the data analysis. Participants interested in being notified of the availability of the survey results could indicate so on the consent form. Seventy-seven (77) consent forms were returned. The two missing consent forms were obtained electronically. A number of survey respondents wrote comments on the questionnaires or included letters with their questionnaires, portions of which are referenced in the discussion section.

Cross-Tabulation of the Data. All data was entered electronically and cross-tabulated by demographics. Means and standard deviations were calculated where applicable. Ranges were established where appropriate.

Post-Survey Small Group Discussion. In the spirit of experience research, the post-survey small group discussion was intended to engage birthmothers in the data analysis process and to provide a "birthmother context" within which to interpret the results. Four survey respondents and one member of the Manhattan Birthmother Support Group volunteered to participate in the small group discussion. The Manhattan Birthmother Support Group member was asked to complete the survey prior to attending the discussion in order to familiarize herself with the content; however, due to time constraints, her responses were not tallied in the results. Two of the survey respondents failed to attend the discussion. A consent form (see Appendix E) was electronically mailed to the participants prior to the discussion for their review. The consent form addressed the purpose of the discussion, issues of confidentiality, and consent to be audiotaped. After verbally stating the purpose of the discussion group, consent forms were signed and participants were asked to designate the name they wished to be known by in the thesis. Participants then completed a "participant profile" (see Appendix F). Cross-tabulations of the survey results were distributed to the participants, together with a list of 23 survey items (see Appendix G) where greater than 50% of the respondents selected a response at either end of the spectrum, such as "not at all," "often," "not at all true," "extremely true," or "severe." Also included in the list was one health item which had a considerably higher incidence than the others. This list served as a springboard from which to discuss the biopsychosocial factors relating to these responses drawn from their own experience. The objectives given to the small discussion group were: (1) to provide a real life context to the survey results (i.e., to add a perspective to the numbers), (2) to identify how the experiences of the discussion group participants related to the data, (3) to look at and uncover societal assumptions implicated in the survey statements and responses, (4) to consider how language and assumptions influenced the social construction of relevant concepts, and (5) to point out experiences that signify the marginalization of birthmothers. My role was to moderate and record the discussion. Occasionally, as facilitator, I posed questions to the group in order to stimulate conversation; e.g., "What does relinquishment trauma mean to you?" or "How does this relate to your experience?" The participants were co-researchers in the analysis and interpretation of the data. The group discussion, which took place in my home, was audiotaped and lasted approximately 3 hours. Summarizations of the discussion were agreed upon by the group and recorded on a flipchart.

Although the Internet provides access to a traditionally "difficult to access" population, the use of the Internet for sample selection introduces certain selection biases by excluding birthmothers without access to the Internet. One birthmother on the mailing list advised me that although she had e-mail, she did not have access to the Internet to access my web site. I circumvented the problem by requesting that she e-mail me her mailing address. At least one respondent accessed the site through Web TV. The demographics of computer users may differ from the general population for various characteristics, e.g., income and education.

Another limitation concerns the retrospective nature of the study and the extensive length of time since the relinquishment. Memory recall may be impacted by these factors. In addition, the experience of trauma may affect memory through activation of the defense mechanisms of denial, repression, suppression, and avoidance.

Nearly all of the participants were members of birthmother support groups, and many had undergone psychotherapy at some time. Since the writing and storying of traumatic events has been found to mitigate the effects of traumatization, the effects of trauma may be underreported. Also, since the sample was a convenience sample, self-selected from birthmother support groups and mailing lists, the results of the study may be biased toward birthmothers who have experienced trauma and may not be representative of those who do not seek support groups. Therefore, the results of the study are not generalizable to the overall population of birthmothers. The effects of relinquishment may also be confounded by the experience of multiple trauma or by psychological conditions that pre-existed the relinquishment.

Several birthmothers wrote separately that they experienced difficulty answering the questions as a result of shifts in feelings and emotions since the relinquishment. Denial and suppression of feelings during the years since the relinquishment were noted. It was suggested by one birthmother that "reunions are as traumatic as relinquishment." Several birthmothers noted that it was difficult to integrate the pre-reunion and post-reunion relinquishment experiences with regard to the survey. Another birthmother identified three distinct relinquishment periods: the early years immediately following relinquishment, the next 20+ years, and search/reunion. It was also suggested by a member of the discussion group that an analysis of factors differentiating birthmothers who were traumatized by relinquishment from birthmothers who were not would be useful.

At the onset of this study, I had hoped to draw upon the strengths of both quantitative and qualitative research approaches. The Internet provided access to hundreds of birthmothers who were otherwise inaccessible. I had hoped to obtain a larger sample of respondents using this approach. I believe that several factors may have negatively impacted the number of survey requests and the survey response rate: (1) The survey was conducted in December. Many individuals responded that they would have participated after the New Year. A number of potential participants were traveling during this period. (2) Due to the length of the questionnaire, I elected to conduct the survey by postal mail rather than electronically. Some birthmothers may have felt that their anonymity was compromised by providing their names and mailing addresses. (3) Linking my web site to popular search engines might have resulted in a significantly larger number of participants.

For the survey respondents solicited from support groups, the support group served as a safety net for emotional reactions to questions concerning trauma. URL addresses for obtaining birthmother support group information was included in the cover letter accompanying the survey. For group discussion participants, referrals for counseling were available if needed. Group interviewees were advised of their right to privacy and their right to decline or withdraw from participation at any time.

As a birthmother, I bring my own relinquishment experience into this endeavor. While I have attempted to design this study and present the data with professional objectivity, my voice as a birthmother remains ever present. Choices in the review of the literature, methodology, data analysis, etc. were informed by my experience as a birthmother. The focus of the study, the information gathered and the questions asked were informed by my experience as a birthmother. Throughout the research, I maintained a personal journal in which I recorded my reflections, biases, and assumptions. One such assumption is that knowledge held by the dominant culture about birthmothers is not reflective of the actual experiences of birthmothers. Hopefully, as a researcher and a birthmother, I have been able to align the research methodology with the lived experiences of the birthmothers who participated in this study.