Their children thrive — just not with them. What happens to birth mothers after the adoption?

When someone asks Mary Kiker if she has children, there’s a fraught pause before she answers.

“I don’t want to say, ‘No, I don’t have kids.’ But I’m not completely ready to say, ‘I have a daughter. She lives in Virginia. I placed her with an adoptive family.’ ”

The question carries a sharper sting this time of year, when malls, movies, and television ads rollick with images of intact families. “I feel the loss a lot more during this time,” says Kiker. “When [the adoptive parents] send me pictures, and there’s all these people and a beautiful Christmas tree, I’m so glad my daughter has all that. But I want it, too.”

For birth mothers, often invisible members of the adoption triad that includes children and adoptive parents, the holiday season brings a wrenching mix of gratitude and sorrow, delight, guilt, and regret. Their children may be thriving. Just not with them.

Kiker, 39, was stunned to learn in the spring of 2017 that she was six months pregnant; She had no symptoms and had actually been losing weight. She lived with brutal pain after fracturing two vertebrae in a 2008 car accident. Her finances were sketchy, the baby’s father uninterested in parenting, and her family — “toxic, abusive, unstable,” Kiker says — was no haven.

“I knew that I wanted to place [the baby] for adoption. She deserved an opportunity at a beautiful, healthy life. I could not give that to her.”

Social workers at Adoptions from the Heart, based in Wynnewood, introduced her to the concept of open adoption: Kiker could choose the family that would raise her daughter and remain in contact, sharing photographs, emails, or even visits.

Now, Kiker and the adoptive parents swap near-daily texts. In July, she visited for the baby’s first birthday; the adoptive parents paid for Kiker’s hotel room and invited her to take part in their daughter’s bedtime ritual.

“For Christmas last year, [the adoptive parents] gave me a photo album. When I’m having a dark day, I’ll sit and read through the letters and look at the photos. … Being a birth mom is lonely, and not everyone understands the loss.”

For decades, adoption was smothered in secrecy: State officials sealed birth certificates, birth mothers knew nothing of their child’s placement, and adoptive parents often kept the fact of adoption hushed even from their children.

In the 1970s, that began to change. Adult adoptees argued that they had a right to know their genetic origins. Adoptive parents wanted more information about their children’s medical and social histories. And birth mothers?

“Having the chance to stay connected and watch her child thrive validates her choice,” says Meredith Rose, director of Open Arms Adoption Network. A trend that began with “just being honest with children about the reality of their births,” is now the norm, Rose says; A 2012 report from the Evan B. Donaldson Adoption Institute showed that 95 percent of infant adoptions in the U.S. were formed with some degree of openness.

Ongoing contact is healing for birth mothers, Rose says. Still, each turn of the calendar holds painful tugs: holidays, birthdays, the anniversary of the adoption. “These are times when a woman who made an adoption plan will be very tuned-in to the fact that her child is not with her.”

For SeAyra Greene, 26, this is one of those times. She gave birth to a son on Dec. 23, 2016, and placed him with a couple in New Jersey. She was raising a 2-year-old daughter, was about to be evicted, and knew she could not parent both kids alone.

Last December marked her son’s first birthday and a Christmas without him. “I was a full wreck.” But the journey has grown easier — in part, Greene says, because of post-placement counsel provided by Adoptions from the Heart.

Brittany Brooks, 29, runs the agency’s Facebook support group, launched in May and now numbering 19 members. She understands the struggles of new birth moms because six years ago, she was one of them.

Brooks was a 23-year-old college graduate, seeking antibiotics for a persistent cold, when a nurse tested her urine and said, “Congratulations!”

At the time, she was couch-surfing with friends; the baby’s father was exiting a bad marriage and already parenting four children.

“I’m a realist,” Brooks says. “I knew my situation was going to get better, but not in six months. Why should my child suffer with me?” Through a Google search, she found a Utah agency that provided an apartment for the last trimester and — most critical, Brooks says — a social worker who listened without judgment.

She wanted an open adoption. “I didn’t want my son to feel abandonment. I did want to know where he was going, how he was, if he was taken care of.” After viewing eight profiles of prospective parents, Brooks chose a couple in Kentucky; they flew to Utah and were with her for the birth.

Twenty-four hours later, Brooks cradled her infant son with her left arm and signed adoption papers with her right. “That’s probably the most profound moment I’ve ever really had. I thought: Once I sign that line, you’re not mine anymore.”

She left with a gift from hospital staff: a teddy bear in a T-shirt printed with her son’s birth date, weight, and length. Brooks clutched the bear every night as she curled into bed.

“When you lose a family member and bury them, it’s closing a door,” she says. “When you place a child [in an open adoption], you still hear about them, you see the pictures, you see them growing. You think: I wonder how much I’ve missed? You experience loss all the time.”

Her son’s adoptive parents call Brooks his “tummy mommy” and have offered to arrange a visit or plan a family vacation. Brooks isn’t quite ready for that. But she’s begun to make peace. She can enter the baby section at Walmart without sobbing. She can look at photos of her son and see “pure joy … it makes me really happy.”

And she can fall asleep without the stuffed bear in her arms. “When I could put it on my dresser, I knew I’d started healing,” she says. “But I’ll never put it away. Wherever I move, wherever I go, he comes with me.”

Some people tell birth mothers that placing their children was selfish. Others call them brave. Kiker, Greene, and Brooks insist that neither label fits. They bristle when strangers use the phrase “give up” to describe adoption. “I didn’t give up anything,” says Kiker. “I gave a gift to a family. I gave my daughter a life.”

At December’s support meeting in the Wilmington office of Adoptions from the Heart, participants made Christmas gifts for their children. They shook imitation snow into glass ornaments, then decorated them with patterned tape and stickers. Finally, each wrote a message to tuck inside.

“You are the best gift I ever received,” Kiker printed carefully on a piece of notepaper. “I love you to the moon and back, all the stars in the sky, all the sand on the beach. Merry Christmas, baby.” She rolled the note tightly, tied it with red ribbon, and slipped it into the fragile globe.