The coin was severed into two pieces, each with a puncture hole. The parents threaded string through one of the halves and pinned it to the infant’s clothes as they surrendered her to the foundling hospital. They kept the other half of the coin in the hopes they could use it one day as evidence to reclaim her.
This trinket – and others like it – is on display at the London Foundling Museum.
Since medieval times, parents unwilling or unable to raise their infants (most often due to financial strain or intolerable social conditions) surrendered them to churches or hospitals. Relinquishment was such a common practice that in Italy alone, hundreds of thousands were brought to foundling centers between the 15th and 20th centuries.
Gretchen Sisson, an adoption scholar, writes of the profound grief experienced by relinquishing parents. This is evidenced by other artifacts in foundling museums – from carefully embroidered textile hearts to engraved blessing cards – and counters the mistaken narrative that at-risk individuals lack the moral fortitude to raise their children.
Laws are Failing At-Risk Populations
In the US today, Safe Haven laws provide a location for parents to confidentially surrender an infant when they are unable to care for them. These laws claim to offer immunity from prosecution but parents must meet certain (sometimes stringent) criteria.
And while Safe Haven offers a location to surrender, such as a fire station, laws do not offer safe, confidential labor and delivery. This gap exists despite awareness of how this population consistently births alone – with no medical support – due to parents’ need for identity protection. These babies therefore present with attached placentas or hand-cut umbilical cords, and the parents are at-risk for hemorrhage, infection, and long-term trauma.
Who Needs Confidentiality?
Homicide is a leading cause of death for pregnant women, with stark racial disparities; Black pregnant women are three times as likely to be killed by their partner than white or Hispanic women. Some therefore require confidentiality during labor and delivery because they are at risk of violence if the pregnancy or birth is revealed.
Some need confidentiality because their pregnancy is a result of trafficking, sexual assault, or incest. Some minors hide their pregnancy, fearful of being shunned by their parents. Some are undocumented and fear deportation or judgment within the hospital. Some have other children and are already struggling to make ends meet.
Whatever the reason, their lives matter. As birth rates rise in Dobbs-impacted states, and some cities see 500% increases in infant abandonments, it’s well past time to provide necessary and compassionate care.
What is Confidential Birth?
Confidential birth means a pregnant person can have a safe place to give birth, at a hospital or birthing center, while under identity protection. While admitted, they can receive crisis support to help address their anxieties and challenges. They can also be apprised of all placement options for their child so they can choose the best option.
As evidenced by 100 co-signatories to last month’s open letter to US Department of Health and Human Services, confidential birth is urged by child welfare and maternal health scholars, clinicians, policymakers, indigenous leaders, and concerned citizens from across the US.
Confidential Birth is Logistically Viable
It may seem that confidential birth is too complicated within US medicine. However, confidential birth is quite similar to policies already in offered in most, if not all, hospitals.
The University of Texas Medical Branch, Hartford Hospital, Harbor-UCLA Medical Center, and others have patient confidentiality policies permitting a patient to protect their identity. The policies facilitate a temporary name change to a patient chart so that a patient can use a fictitious name during a hospital stay. These policies have been used for celebrities, gang members, and others needing privacy. Most hospitals and birthing centers have similar policies for survivors of intimate partner violence and sexual assault which also allow sensitive hospital records to be hidden, with commonsense exceptions for time-sensitive medical emergencies. Some states ensure patients can disallow Explanation of Benefit statements from being sent to the policyholder. This is essential when an adolescent or spouse needs medical care as an incest victim or after an assault but cannot disclose the hospital visit to their spouse or parent.
Confidential birth can piggyback off these policies to similarly ensure identity protection. At-risk people are often fearful of the medical system – and may also be exhausted and overwhelmed – and cannot be expected to research hospital confidentiality options and bring a proposal for confidential birth to a hospital. Therefore, confidential birth must be “packaged” and offered as a formal policy to ensure physicians and patients are aware of its existence and benefits.
What Might Surprise You: Confidential Birth Sometimes Promotes Family Preservation
Once they receive crisis counseling, some birthing people reconnect with their family to consider ways to keep the infant. Others struggle with substance abuse and may wish to temporarily place their child with a relative (through kinship care), or another family (through temporary placement) while they work to regain stability to reclaim their child.
Sisson’s research has revealed that many parents surrender due to financial pressure, and that even $1,000 – or enough for a car seat – could make the difference. These individuals benefit from learning about social services including family preservation funds. Others do not wish to parent and may elect adoption or Safe Haven surrender which offers identity protection.
State laws offer all these options, but they are rarely known to parents who may otherwise assume they have no choice but to relinquish through Safe Haven which rapidly terminates their parental rights. Confidential birth would address this knowledge gap.
We can Learn from Current Policies
Confidential birth has been available for over 200 years. Today, it is in France, Austria, Italy, Belgium, Germany, The Netherlands, the Czech Republic, Japan, and South Korea with varying benefits and drawbacks.
One Japanese hospital has offered confidential birth since 2021. In that time, they have had 38 cases, and of those, 37% kept their child, likely attributable to crisis counseling and informed consent.
France’s “anonymous birth” law received criticism from the UN and adoptee advocates since it did not counsel parents on the benefits to children to know their identity. France has changed its policy somewhat, including ways for the parent to optionally disclose health history and identity when the child reaches age 12.
A Call to Action
Will your US hospital be the first to offer a confidential birth policy? I challenge you to consider it. Even when hospitals don’t have a formal policy, you can utilize policies discussed earlier for identity protection. And with policymaker help, we can update crisis services (e.g., 211, EMS, and mobile crisis response services) to be aware of – and integrate – confidential birth. We should also press insurance companies to safeguard patient identities and consider legislation to ensure minimum standards and awareness.
Please join me – along with adoptee, family, and reproductive health advocates – to support confidential birth.
Lori Bruce, MA, D.Bioethics, HEC-C is the Associate Director at Yale Interdisciplinary Center for Bioethics. She can be reached on LinkedIn. Views expressed are her own.
