I was sitting in a doctor’s waiting room the other day, waiting to get some immunizations for travel, when a book on the shelf caught my eye: Parental Loss of a Child by Therese A. Rando.

I had to take it down and look at it, and of course head straight to the index to see how much discussion there was of loss through adoption. I only had time to look briefly, but the content looked pretty accurate. One thing in particular stood out: the notion of adoption as an ambiguous loss, leading to unresolved grief.

What is an ambiguous loss? If your wife disappears and is never found, she’s obviously lost to you, but there is no closure, so your grieving is open-ended. Likewise, if you surrender your child in a closed adoption, and have no idea where your son is, or even if he is alive, that’s an ambiguous loss, too. How do you frame this loss? Did you cause it, or was it external factors that forced the decision? Will you see your child again? Does anyone acknowledge that you have a child who is now missing, or are you all alone in your grief?

Even in open adoption, where relationships are supposedly preserved, surrender can be a type of ambiguous loss. You might know where your child is, but have no actual contact. Or you had contact, and then the adoptive parents cut it off, meaning you’ve now got a double loss—the initial surrender, and the broken trust and pain that comes from losing your child a second time.

(To learn to manage the complexities and special circumstances of birthparent grief, my friend Brenda Romanchik often recommends this book: Ambiguous Loss: Learning to Live With Unresolved Grief by Pauline Boss. I haven’t read it yet, but if Brenda likes it, I know it’s got a lot to say to birthparents.)

Now back to the other book, Parental Loss of a Child. In my quick flip through its pages, I saw that it noted that another reason adoption grief is particularly painful because it is unsupported grief. In other words, birthparents are pretty much on their own in this case. There are no rituals for a woman who’s given her baby to others. No one holds a funeral-type ceremony, and no one gives you time off of work to mourn. There aren’t any greeting cards, and people flat-out do not know what to say.

You know your child is not dead, but it feels just as bad. How can you deal with this loss?

If you are considering surrender:

• Know that open adoption helps resolve adoption grief in a healthier way, but only if you can count on the adoptive parents to maintain contact. If they don’t, you’re in for a second helping of grief.

• Prepare for the initial loss to be more painful than you knew. Also prepare for subsequent losses, such as your future children’s pain at not getting to know their sibling.

• Steel yourself for people to say and do insensitive things. They will.

If you are a new birthparent:

• Try to find people who will acknowledge that you’ve just suffered a major loss, and surround yourself with their support.

• Hold your own ceremony with close friends or family to mark your loss.

• Take time off work if possible—don’t try to pretend that nothing is wrong.

• Know that grief is cyclical. The entire first year will probably be miserable, but grief will not be unrelenting for the rest of your life. It comes and goes in waves, often when you least expect it.