Jeremy | Exposure In Utero, a Medical Perspective

0:00Welcome to the Open Adoption Project. I'm Lynette Nelson and today on our podcast, my husband Sean will be talking with Jeremy Stone. As hopeful adoptive parents, we are asked to consider a lot of things in regards to health history when we're looking at adopting. And one aspect that hopeful adoptive parents might need to consider as they begin their adoption journey is whether or not they feel like they're equipped to adopt children who were exposed to different substances while in utero. Sean and Jeremy will be talking about exposure in utero, meaning drug or alcohol use during pregnancy, and the potential effects of that on children.

0:37This is a topic that we get lots of questions about, but it's also a really sensitive topic and it can be really hard to talk about. We need to be really careful not to villainize those who struggle with addiction. I think that a lot of us have experiences either ourselves or with people who we love regarding addiction. And parents who struggle with addiction can still be loving parents, and we know of many awesome open adoption relationships where there's a party who's recovering from addiction and their presence in their child's life is a huge blessing.

1:08So to be clear, this episode is not about judgment or talking about choices that lead to these situations. In this episode, we're talking with a medical professional who's also an adoptive dad. Jeremy Stone is a fourth year medical student, and he created a website that serves as a resource on this topic for hopeful adoptive parents who are looking for information. And the website is AdoptionMedEd.com. We hope that this is a helpful and informative episode. Thanks for listening.

1:55All right. Well, we are now on the podcast with Jeremy Stone. Jeremy, thanks so much for being with us. Yeah, no problem. It's a pleasure. Well, could you take a minute just to introduce yourself maybe a little bit and share with us your connection to the adoption community? Yeah, for sure. My name is Jeremy Stone. I am a fourth year medical student at Rocky Vista University and I have two adopted daughters. My wife, Brianna, and I adopted them at birth.

2:27They're both open adoptions done privately. Our oldest daughter is two and our youngest is one years old. They're 15 months apart. So it's very exciting right now in our household. Busy. Yeah. So throughout the process of adopting and looking at potential adoptive situations, of course, substance use and different medical issues came up, you know, as a question while we were looking through it, as well as just getting ourselves more educated about adoption.

2:57And I found that there wasn't a lot of really good resources to kind of guide us through those medical issues. And then I did have some other friends in the adoption world come across the same thing and have a lot of questions about it. And being a medical student, they came to me asking me questions about it. And so I helped kind of guide them through some of these things. And what I ended up finding was that, you know, there wasn't any good resources. So I felt like I was in a kind of a good spot as far as being part of the adoption community,

3:28as well as part of the medical community, that I could maybe bridge that gap and create something. So I created AdoptionMedEd.com. It's just a concise resource to help kind of navigate substance use and pregnancy specifically and help you to look at the different adoption adoption situations and help you navigate that, as well as possibly what you can do in the future, that type of thing. So, yeah. Perfect. So again, it's AdoptionMedEd.com. We'll put a link to that in the show notes so that the people that are listening can just go straight to it and check it out.

4:02It's a great resource. I have looked at it. I've looked through it a lot and I've actually recommended it to at least one person and shared it with another. So go and take a look at it. But while we're here with Jeremy, we're going to ask just kind of lots of questions medical related that might come up in. And the pursuit of adopting and hopefully this episode is just a great resource. So let's just jump in a little bit and talk about some of the like maybe most prevalent frequent questions that you hear about as far as like drug usage and pregnancy.

4:39Maybe maybe one of the first ones that I hear or kind of in the adoption community, like what amount of exposure is going to cause problems to a child if they're exposed during pregnancy? Yeah, that is usually one of the first questions that comes up. You know, how much exposure is actually going to be an issue or not be an issue? Unfortunately, the answer is it's really hard to know. And so there's no amount that is safe and there's no amount that will tell you, oh, for sure you will have problems with this baby or this pregnancy or anything like that.

5:20And so we don't know the exact amount of exposure, but a lot of the substances you can kind of link to the more exposure you do have, the more likelihood or percentage that you will have a specific outcome, you know, as far as maybe fetal alcohol spectrum disorder or, you know, any sequela of opioid use disorder, that kind of thing. So anyway. Yeah. And then I imagine you get lots of questions about specific substances and we'll talk through several of those during the episode.

5:58But any thoughts related to that kind of in general? Yeah, and I guess the first thing to say going forward and when you look at the website, it's really hard to separate a lot of these substances because a lot of times people will be using multiple substances at once. And so a lot of the data is conflicting and is not really straightforward just because of that fact that there's a lot of confounding variables that come with substance use.

6:31Not only, you know, are they using multiple different substances a lot of times, but also there's there's also, you know, socioeconomic status and a lot of different confounding variables that can maybe make the data hard to interpret. And so, you know, I do get a lot of questions about specific substances, but always keep in mind that you can't always know for sure the effects, so it's always a specific percentage or chance, you know, if something happened. What other questions would you say you get asked the most from from like hopeful adopted couples

7:06thinking about, you know, a situation where this might be the case? Yeah, so for hopeful adoptive couples, usually it's a question of, you know, how might this affect my baby and or my family? And a lot of that has to do with, you know, medical expenses, because sometimes what people are worried about is, you know, what can I afford as far as a baby is going to maybe stay in the hospital for a long extended period of time?

7:39Or, you know, what can I expect as far as long term outcome? And so we do we do get that question a lot as well. And as far as expenses involved, that also varies a lot. So unfortunately, I don't have a lot of really straightforward answers for you at this point, but we'll get more of those later on. But the. A lot of times, there's actually not a lot of expenses with just the substance uses.

8:09So we do have a lot of questions about what the substance use is, what the substance use is, what the substance use is, what the substance use is with the substance use at this stage. And it's mostly a matter of what the what the potential adoptive parents feel comfortable with as far as moving forward with an adoption. It really just comes to their their gut feeling about it. And so I think that's a really good question.

8:40And I think that's a really good question. So what is the goal of adoption med ed is? Yeah, for sure. Basically, our mission is to provide a basic and easily understood resource for any potential, you know, or current adoptive parents that they can easily go to to find questions about or to answer questions about substance use and pregnancy. And so we're not going to be able to do that.

9:10So we're going to be able to provide a basic and easy to understand resource for any potential adoptive parents that they can easily go to to find questions about substance use and pregnancy. And how to help you navigate those situations. Great. Well, we're grateful that you've created this resource and we're excited to see how it grows over time, too. We'll consider maybe long term effects, what your medical advice would be to someone considering

9:40adoption of an infant that's had this type of exposure. So let's start with just alcohol in general during pregnancy. OK, so alcohol, the the first thing that people think about with alcohol exposure and pregnancy would be fetal alcohol spectrum disorder or otherwise known as fetal alcohol syndrome. And that is composed of a bunch of different things as far as you can have fetal alcohol effects or alcohol related birth defects.

10:18There's a lot of things that go into it. The basis of it is there are certain facial features that children that are born with alcohol exposure may have, as well as usually their what we call neurobehavioral effects, which is the effects of the alcohol has on the brain. And then later in their adolescent or toddler life, they all have some behavioral symptoms. So that's usually what we see with alcohol exposure.

10:49But it's not like a guaranteed if you have any alcohol exposure, you'll have fetal alcohol syndrome. And that's why it's called fetal alcohol spectrum disorder as well, because there's a whole spectrum of the different types of syndromes and the outcomes you can have from alcohol exposure and pregnancy. And so that's the that's the first thing that people think of with any of these substances. You're going to have effects on the pregnancy itself.

11:20And so the outcome of the pregnancy, whether it will be viable, whether there's a risk for miscarriage or if there's a risk for different complications with the pregnancy itself and the birth, you know, and then there's also the question of long term effects on the brain and the growth of the baby. Right. So there are effects that can happen. And that can happen from alcohol on structural growth.

11:50So growth of the head, growth of the skeleton, vision, that type of thing, as well as brain development. And sometimes you'll find, you know, a smaller head, which is called microcephaly in some of these babies with exposure just due to the actual growth restriction that happens with any of these substances. So that's some of the main things that you are concerned about when you're looking at alcohol.

12:20So I think for most most of these, and you can correct me if I'm wrong, but with it being a really big spectrum, adoptive parents or hopeful adoptive parents should expect anything from, you know, no effects at all to some of the extremes that you talked about and somewhere in between. So I think that's a good point. And I think that's a good point, too. And I think that if there was exposure to alcohol, that that is a possibility. Is that right?

12:53That's right. Yeah. You you hit the nail on the head there. So it's you can have a lot of alcohol exposure and have anywhere from neuro noticeable effects to some pretty severe FAS and other abnormalities or birth problems. And you also have nothing to very severe effects. So it's you can't really predict what's going to happen, which is why the recommendation is always to not drink during pregnancy.

13:24Right. Unfortunately, a lot of times in any pregnancy, you know, moms may drink before they even know that they're pregnant and you never know what effect that may have later down the line. Yeah. OK, let's transition from alcohol to opioids. What are some of the long term effects and maybe, again, some of your advice to those considering adopting an infant with that type of exposure? All right. So the main thing that people think of when they think of opioid use in pregnancy is needle, needle abstinence syndrome.

13:58And this is what people typically say as withdrawal. And so a baby will have exposure to opiates during pregnancy. And then when those opiates are taken away at birth, they'll have withdrawal from those opiates. And usually these withdrawals happen within the first couple of days, almost always. It occurs within the first week. What will happen is if there's suspicion for it, the baby will be under pretty close surveillance for any symptoms of withdrawal.

14:32Sometimes can be difficulty sleeping, jitteriness or stiffness, sweating, sneezing, fever, irritability, those types of things. So they'll be looking for those and they can give medications to wean them off of the opioids. And typically there aren't very many known bad outcomes long term from that. It's mostly that withdrawal that occurs.

15:04And then after that, there shouldn't be any issues that occurs with the neonatal abstinence syndrome, if that makes sense. And so a lot of these substances will have some long term possibilities. But most of most of the effects that happen with these illicit drugs is going to be during pregnancy at birth and just after just after birth. So that's the main one with opioids is neonatal abstinence syndrome.

15:35But you can also have growth restriction, you know, some of the other things that happen with alcohol and that type of thing, too. So but for primarily, I guess you would say that baby in utero, the develops kind of this addictive behavior like body needs the opioids once they're born without, I guess, with the absence of those opioids begin to have withdrawal symptoms and they need to be treated in some way, being put on a medicine, a drug and then weaned off of it over time.

16:06Exactly. Yeah, I'm sorry. The body responds by increasing receptors, that kind of thing. And so the baby feels like it needs their brain needs those opioid receptors filled. And so that's what we do is we fill them a little bit at a time to wean them off of the drug. So. All right, well, let's switch then from opioids to marijuana. This is probably a pretty common question. Yeah. And this is also a very tough question to answer because there is growing evidence for some problems with marijuana exposure in pregnancy.

16:48But most of the data is pretty convoluted. It's kind of hard to parse out what is from the marijuana, because like I said earlier, marijuana or most of these drugs are used in conjunction with other drugs at the same time. Right. So there's that. And, you know, typically people think of marijuana as a pretty benign substance to use, you know, and they don't think that it has a lot of effects.

17:20But really, the THC and marijuana, the active component, does have quite a quite a few effects on the brain, which is why it causes the high that it does in people. But similar to some of these other drugs that can cause growth, some growth issues potentially as well as brain development. And in adults, actually, it's interesting. There's actually a high association with schizophrenia with marijuana use.

17:51There's some pretty good data suggesting that someone who uses marijuana for a while can develop schizophrenia. They haven't found that association with use during pregnancy. But there's things like that that they there's still not a whole lot of data yet to know whether or not it's going to have an effect. And so the recommendation is to still not use marijuana during pregnancy. Right. So there are some potential effects on the brain, you know, some of those behavioral effects, like maybe attention, hyperactivity.

18:25And the bottom line is to look for some of these signs in your baby. And if they do come up, you you don't know for sure whether they came from the marijuana or from the substance, but you treat them and try to treat their their symptoms as as they do come up in life. But really, there's not a whole lot of proof data suggesting that there are very serious long term or short term effects of marijuana use in pregnancy.

18:57And so we're still trying to figure that out in the data. So, yeah. Yeah. And maybe this is a good point to make this point. I think as an adoptive father, as an adaptive couple, we've looked at a lot of different data about adoption. You know, this being one aspect of that. And now I feel like there's starting to be more and more data about openness, about usage, about just tons of different things. And so I think we're hopeful for the future that we can gain data that will help adoptees.

19:31Right. At the end of the day, at the end of the day, that's really our mission to make sure that the adoptee is having the best experience possible. And so the more data we can collect over this huge spectrum of information for adoptees, I think the better we'll be able to provide for their needs. Yeah, exactly. The more data we can collect as well as the more that we can distribute that to adoptive parents, that they can then use that knowledge to help their children in the future.

20:02Which is the reason why I created a website. And the reason why you're doing this podcast is to distribute that and hopefully help some people down the line. And that's why I am doing research on my website. I have this survey before and after that you can fill out so that I can kind of prove that we need more resources like this and we need to keep going down this path of education. So, yeah. Yeah. So when you go to the website, there's going to be a prompt to take like a pre-visit survey.

20:35So take that and then visit the site, learn what you can and then take kind of this post-visit survey. Right. It helps you get more information and we'll be able to kind of form the way that you're going to add to your website, I assume. Yeah, exactly. And just show the scientific world that, hey, there's a need out here for more education in adoption, especially in medical education specifically that I'm looking at. Right. And so, yeah, it's hopefully we can just get better and better every day, every year and have better data out there. So.

21:10Awesome. Well, I created that segue. Let's go back. Let's talk about tobacco or nicotine in your usage in pregnancy. Perfect. So nicotine, the thing that most people think of or that in the scientific community, we think of with nicotine use is growth restriction in pregnancy. And so whether that's growth restriction during pregnancy or just a small for gestational age baby,

21:42basically the bottom line is it can cause slowed growth. And it's actually a pretty significant data showing that babies exposed to tobacco and nicotine have a much higher rate of being low birth weight. Right. There's also other risks of stillbirth and miscarriage, as well as a lot of people may have heard of the risk of SIDS with cigarette smoke.

22:17The data still says that even though even if your child is exposed during pregnancy and then doesn't have the exposure after pregnancy, there's still an increased risk of SIDS. And so that's a pretty significant data showing that. So, yeah, I say this because of the adoption world where you're going to be put in a different environment once you're born. Right. But it's significant from what I can tell, it's significantly decreased.

22:47Most of the risk has to do with cigarette smoke exposure in infancy rather than during pregnancy. Right. So, yeah, I think that's a pretty significant data showing that even though you're not exposed to tobacco and nicotine, there's still a risk of SIDS with cigarette smoke exposure in infancy rather than during pregnancy. So, yeah, I think that's a pretty significant data showing that even though you're not exposed to tobacco and nicotine,

23:22there's still a risk of SIDS with cigarette smoke exposure in infancy rather than during pregnancy. Okay. Yeah. So, stimulants, just kind of an overview. Maybe not everyone's familiar with what stimulants are. So, there are the main stimulus that we think of are methamphetamine and amphetamine. Amphetamine is Adderall is the common name for it. So, it's a very common name for the baby.

23:54And so, you can't really tell the difference between these two. So, I think that's a pretty good version of it. But with amphetamines and stimulants, you get a lot of growth restriction as well. The theory here is that these stimulants cause vasoconstriction, which means it narrows the blood vessels. So, you can have a lot of blood flow. And so, you can also have more long-term behavioral effects and cognitive effects down the road.

24:32And so, it's not as common to have a lot of blood flow. So, you can have a lot of blood flow, but it's not as common to have those behavioral effects. And so, it's not as common to have those behavioral effects, but it is a risk. And so, like I said before, most of the time, it's the growth problems that we're worried about.

25:04But it's not as common to have those behavioral effects. So, you can have a lot of blood flow. And so, it's not as common to have those behavioral effects. So, I think that's a pretty good way to kind of sort of sort of start to look at it. And then, I think, as a parent, I think that's a really good way to kind of start to look at it. I think that's a pretty good way to start to think about what parents might expect in those different situations.

25:39So, I know this is kind of a big generalized question. But what type of advice would you give adopted parents who are considering adopting an infant or child who has been exposed to different substances? right or wrong answer. As with any adoptive situation or potential situation, you kind of have to go with your gut, right? If you believe in God, you know, you pray, any other higher power,

26:11try to rely on something to kind of go with your gut because it's not all the time. It's very straightforward, whether you should pursue an adoptive situation or not. And so I guess that's kind of general, but every situation is going to be unique. You know, every, um, any expectant mom's situation is going to be unique. Your family situation is going to be unique. So there's no, there's no right or wrong answer. But the main thing from my standpoint is that you need to

26:44just educate yourself as, as much as you can, um, about specifically what we're talking about today, about, you know, the medical risks, the substance use risk, but as well as just any other, you know, issues that you might have or questions that you might have about the situation and just try to get as educated as you possibly can. Um, and, and then just go with your gut at that point. I think that's some great advice, hard to do in the moment. Um, but, uh, just relying on the,

27:17maybe the intuition or those feelings that you are being, you know, encouraged or discouraged to do something. Um, we talk a lot about open adoptions. Uh, we love open adoptions. We know that the data shows that open adoptions for the very most part, um, are really positive for everyone in the adoption triad. So thinking of that, um, what recommendations would you give

27:47to adoptive parents who might struggle then having a relationship with birth parents because they've struggled with addiction? Yeah, this is a, this was a really good question. Um, so I think that open adoption can be a scary thing for a lot of people, regardless of whether there's substance use involved or not. And I think the first step is to educate yourself and kind of familiarize yourself with open adoption, what it means, what it can look like

28:22for you and your family. There are a lot of good resources, including this podcast, um, other online resources, panels, that kind of thing that can help you understand what an open adoption is. My, the adoption, um, situations we have with my two daughters, they're both open and they're amazing. Um, we wouldn't ask for any other way, you know, and just having, it's just expanding our family. You know, we have all these extra people to love our kids.

28:52And I know you guys have talked about this on your podcast as well, as it's just more and more people to love your kids. Um, and we have just these, you know, it's, it's rocky, but we have these amazing relationships with these people, um, with these birth families. And, um, I, I think our kids growing up or they will know, and they do know that they're loved by their birth family and they're loved by us. And it's just, it's just an awesome situation. So, um, having that background

29:23of being, um, educated and, and being familiar with open adoption in the first place obviously is helps. But when it comes to specifically substance use, um, I know this is kind of tough because it's, it's kind of like any, any situation that you're in, where you're having to have a relationship with someone that doesn't come from the same background as you. And you know, it's very different from you. It's hard to have a really close relationship with that person. If

29:54they're very different from me, right. And so it comes down to finding empathy, understanding where they're coming from and compassion. And really the way to do that with substance use and addiction is to understand substance use and addiction on a deeper level. And, um, for example, when I was on, I did an addiction medicine rotation last year in medical school. And one of the things we learned was what addiction does to your brain, what some of these

30:26substances or any behavioral addictions do to your brain. And it was really interesting because what happens is that over time, um, the addiction takes over your fight or flight response in your brain. So your brainstem is kind of the control over your fight or flight response. It's the thing that we share with all other animals on earth is this brainstem, this kind of basic, um, you know, living, living being, uh, you know, response. And then our, the rest of our cortex

30:59is what, you know, helps us to think and navigate and all that. Um, and so what happens is that, for example, if someone was to take your head and push you underwater and hold your head underwater, you're going to do anything possible to try to breathe. You know, you're going to kick, you're going to do anything possible to try to, to get your head out of water and breathe. And that's your fight or flight response kicking in. You're not going to have reason at that point. Um, you're going to do anything to breathe. And so what happens is it's these substances and

31:29addiction hijacks that part of your brain. There's actual anatomic differences and physiologic differences in the brain that happen. And so that when someone is addicted, their brain tells them that they need this to survive. Right. And so, um, once I understood that I could help my patients a lot better during that rotation. And it helps me understand these adoptive situations a whole lot better, um, and have compassion for these people and have a better relationship with them

32:02because, um, because I understand what happens in the brain and that it's actual, it's actually a physiologic problem that happens. And, um, so just having some education and learning about how these things work, um, can help us to have compassion and, um, build a stronger relationship with these people, even despite the differences that we have. Does that make sense? Absolutely. So increased compassion, increased, um, understanding knowledge is going to be key,

32:33uh, and knowing that it's such a hard thing, right? Yeah. I think that that's just really, really good advice, uh, for anyone considering, uh, a potential adoption in this type of situation. If you can't see educating yourself or developing that type of compassion for someone in that type of situation, then maybe these type of situations, if, and when they present themselves, you need to be able to just say, you know, I don't think I can do this. Having that conversation with your

33:05spouse or with your partner, or if you're doing this alone, having really thought through what you, you think you can do or what you can't do, um, and making that decision kind of upfront so that when you're presented with a situation, then you feel a little bit more confident moving forward. Yeah, I completely agree with that because one thing that we learned early on is that it is okay to say no to an adoptive situation. Um, and this, in this situation specifically,

33:37um, you're not, it's not like you're a bad person for feeling like you can't handle it or that you're not going to be able to develop that compassion or anything like that. Um, it's just, it's just a matter of you feeling out, um, the situation, what you think's best for your family. And, um, there's nothing wrong with feeling like it's not going to work for your family, you know, just saying no. Yeah. And I think that, that opens up a lot broader conversation too, with other medical issues, um, having, having good discussions or decisions made. I remember

34:12some of the advice that I, that we received as a couple when we first started this process was if it could happen to you, like could Lynette and I have a child with Down syndrome? Yeah. Um, would we be okay saying yes to that situation? We'd probably have to talk about that and make sure that we're on the same page as a couple, right? And so there's lots of different medical situations or like what we're talking about now, I've exposed our situations where we can kind of pre make some decisions, but that way in the most, in the most, uh,

34:45that way in the moment we can rely on kind of that gut feeling that you were talking about earlier. Yeah, exactly. And, um, when you're just starting the process of doing your homestead and everything and filling out that paperwork saying, would I be okay with a baby having Down syndrome or maybe having heart defects or substance use or all these different things? Um, it's hard to kind of know at that point as well, you know, like, especially with all the education that would really be required

35:15to know what all those things are. But, you know, that's why it comes down. Like there's hardly anything that I would just outright say no to from the beginning without knowing anything. Yeah. And it really does come down to the individual situation, how you feel about it. I love that. Good, great, great advice. Well, if, is there anything else that you would share, um, to adoptive parents or potential adoptive parents struggling to decide whether an adoption situation might be right for them? What, what might you share with them?

35:47Um, yeah, just a little bit, kind of how I said before, but, um, getting all the education that you can, you know, websites like adoption, med ed, this podcast, talking to your doctor, finding other resources for you. And then a big thing is to take the fear out of it. You definitely don't want to make these types of decisions based on fear, right? Um, and so if you can do that, get yourself educated, take the fear out of it. And then, like I said before, just kind of go with your gut and pray about it or figure out how you're going to make that, um, final decision of how

36:22you feel about it. Then I think, um, as long as you going forward are emotionally, financially, physically prepared to take on whatever happens with this, um, you know, the out, whatever the outcome is, then, um, then I think you're okay just going with your gut on it. Right. And then, um, like I said before, it's, it's okay to say no, no, it's, it's okay to feel like it's, it's wrong for you. And that's really, that's really hard to do. I remember back when we were

36:56hopeful adoptive parents before either of our kids came along and you really are just, you know, hoping and praying that someone comes along with a baby and it's, it's really hard to think about it and say, well, actually this, this isn't right. It doesn't feel right for us. And, um, over the past couple of years, we've had to say no a couple of times, and it was only because it, it just didn't feel like the right thing for us. And we ended up having both of our daughters and everything worked out how it was supposed to. And so, um, I think just having the peace of mind that, you

37:30know, don't, don't make the decision out of fear, just kind of go forward and have faith that it will work out whether, whether it is the right situation or not, I guess. I love that. Love that a lot. Well, any, any other thoughts you have that you'd like to share or anything else on your mind, uh, as kind of some parting words on the podcast. I think open adoption is great. And I'm really grateful for this podcast and other resources, because I think going into it, as you're starting the process of adopting open adoption is, um,

38:06it was hard for me to kind of wrap my mind around a little bit. I, I wasn't against it, but at the beginning I was one of those that was on the fence about it. I was like, you know, maybe kind of partially open that type of thing. Um, but when it came down to it, when we met our daughters for a family for the first time, um, you know, we just had such a connection with them and we just wanted more of a relationship with them. And to be honest, my wife and I have, um, maybe wanted a little bit more from the relationship, maybe then, then they have so far,

38:37or maybe not necessarily wanted, but, um, we're just always hoping that we can, you know, meet with them more or that type of thing. And, um, I'm sure they're probably feeling the same way, but, um, it's just, it's just such a happy thing. And, uh, I'm just really grateful for our adopted, our adopted situations and our daughters. And, uh, I hope, you know, your listeners can, we'll agree and keep looking at open adoption as such a good thing. Awesome. Well, Jeremy, thanks so much for being on this episode. We really appreciate you and

39:09taking your time to share with us and for all the time you've put into creating your website. Again, we'll point our listeners there, but, uh, just thanks so much for all that you're doing. Yeah, no problem. It was nice meeting with you. Thanks. Thank you so much for joining us for this episode of the Open Adoption Project. Make sure to check

39:40out adoptionmeded.com for more information about exposure and utero and a big thank you for Jeremy for talking with us. We'll be back next Monday with a new episode. We'll be sharing an interview with a birth mom who has a very open adoption with her oldest child. And we are so excited to learn from her. Check out openadoptionproject.org for more information about our podcast. And we'll be back next week. Thank you so much for listening.

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