Chapter
III. METHODOLOGY
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.
PARTICIPANTS
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.
SURVEY
DESIGN
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.
PROCEDURE
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.
LIMITATIONS
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.
ETHICAL ISSUES
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.
