Adoption systems in many countries have been hit hard as social distancing restrictions meant the closure of courtrooms and clinics, while travel bans have made connecting with a surrogate or transferring a child between households far more difficult.
Most international adoptions have been put on hold after countries closed their borders and canceled visa applications, according to agencies who spoke to CNN.
Dwight Burton and Monik Kadarmanto, who live near Portland, in the US state of Oregon, began the adoption process in September 2018, and were matched with a three-year-old boy living at an orphanage in China just before Christmas.
The couple applied to US immigration in early January for final approval to fly to Changchun, in Jilin province, northeast China. Several weeks later, just as they were expecting it to come through, their adoption agency canceled travel to China, and the US State Department issued advice against travel there.
The Chinese government has now closed its borders to prevent further waves of coronavirus and the couple is in limbo, waiting for news on when they may be able to bring their adopted son home. They say it has been hard to get updates on him, with the orphanage in lockdown without administrative staff.
"There's so much uncertainty and I think that's the toughest part about all of this," said Kadarmanto, 40. "There's nothing easy about adoption, there's a lot of just every step, you know, kind of not getting our hopes up too much."
She said the couple was "doing fine" but some days brought "a lot of heavy emotions. We just really want to be with him."
The couple are staying isolated as their community reopens to ensure they are healthy for travel. They don't know whether they will need to quarantine in China, or whether only one of them will be able to go.
"As first-time parents, of course, we feel a nervousness about, 'Are we going to be good enough? Have we done enough?'" said Burton, 41.
"And yet at this point, we also are like, none of that matters anymore. What matters is for us to be united as a family and to be able to start that process of becoming a family."
Holt International, the inter-country adoption agency working with Burton and Kadarmanto, has 250 adoptions on hold, according to Susan Cox, vice president of policy and external affairs. Fifteen families already had plane tickets, and another 25 were almost ready to travel. Those adopting from South Korea have to go through the country's family court, and hearings that have been scheduled for months have been canceled.
Satwinder Sandhu, chief executive at IAC inter-country adoption agency in the UK, told CNN he knew of families stuck in Morocco and India after traveling there to adopt.
He said that developing countries often rely on children's homes and orphanages rather than foster care, and resources are stretched. "For children waiting in these institutions, every month that goes by is another month lost, really, where they could be accessing and making attachments with a new family.
"We're very conscious that in some countries, if parents become ill, they might not have the resources for other people to care for their children."
He said there were "large numbers of families who are ready" to adopt and "thousands of children waiting."
In India, for example, there is already a two-and-a-half year wait after adoption papers are lodged with the authorities, Sandhu said.
Catherine Doolan, from Leicestershire in England, decided to adopt as a single parent in April last year, was approved by a panel in February and found a match in the UK, but that adoption fell through.
Doolan, 34, was preparing to start again when the coronavirus hit Europe, and the matching process stopped. "It definitely feels like life's on hold," she told CNN. "I suppose it does for a lot of people. It hit me a lot harder than I thought."
The fashion designer said it had been a "strange" experience going from seeing a social worker every week since last summer to not really knowing what was happening.
"I've cried quite a bit about it. Because I was really gearing up toward something and then it's almost like the rug has been pulled out from underneath you."
Some families have found creative ways to complete adoptions during the pandemic.
Brian and Mary-Jo Sullivan, from New Jersey, told CNN they were waiting for visas to travel to Haiti in March when the country closed its borders.
The couple, who had met four-year-old Gracie a year earlier through Holt, were concerned it could be many months before the borders reopened. Mary-Jo, who had previously worked in Haiti as a pediatric nurse, said she knew Gracie had an underlying medical condition and was worried about what could happen if she was infected with coronavirus.
Their contacts in Haiti worked frantically to get the child's passport, visa and other paperwork approved, and to get her on a repatriation flight to the US with a missionary couple. They managed to get the documents approved hours before the flight, and Gracie made it to the US in early April.
"We were just racing against time," said Mary-Jo. "It was nothing short of a miracle."
Several families in the US have turned to technology. In Fort Smith, Arkansas, Kimberly Wieneke and her husband adopted two-year-old Jaden via a Zoom hearing after the court was closed. In Columbus, Ohio, Laura and Casey Wieck also said they adopted their son via a virtual hearing, in a post on Instagram.
Moving a child between households is also a practical challenge. Most children are transferred from foster care to new families through a gradual handover and a series of meetings. Regional UK agency One Adoption West Yorkshire said it had been working to find emergency accommodation for adoptive families to enable this to happen, and some foster carers had even let adoptive parents temporarily move in with them.
Giving birth under lockdown
The pandemic has affected all kinds of adoptions. Parents with pregnant surrogates also have to plan around the birth of their child. Some of the parents who have opted for this route within the US have driven long distances between states, and rented accommodation early on in the outbreak to ensure they would be nearby for the delivery, said Kim Bergman, senior partner at Growing Generations, which assists with surrogacy in the US and internationally.
Many hospitals were only allowing one person to be present at the birth, which often meant a difficult decision between the surrogate's partner or the adopting parents, she said.
"And of course, there are people who couldn't come for the delivery at all because they were impacted by travel issues or travel bans or quarantines," Bergman added.
Growing Generations has helped such families make interim arrangements for the care of their baby, which have included former surrogates who live locally helping out, friends of the parents who live nearby becoming temporary guardians, and hiring baby nurses.
Bergman said some people were "devastated and really sad" at the prospect of missing a birth, but most were just grateful that their babies were safe.
"Trust is a really, really important part of this process," she said. "You're already trusting strangers to take care of your baby and take care of your family building. And this is just another level."
Bergman told CNN that clinics stopped doing all in-person medical procedures and screenings from around mid-March, affecting everyone who had a surrogate ready to be screened or to start a cycle, and anyone planning to fly to the US or interstate for their own egg retrieval.
"So that had a really big impact, it essentially put a pause button on the entire process industry-wide," she said.
Most IVF clinics in the US have now reopened and are operating with careful safety procedures in place, said Bergman.
Delays were particularly hard for people who had already spent years going through fertility struggles, she added. "Of course, there's a lot of hopes and dreams put on this process and any delays are really felt very, very, very strongly."
Some had decided to postpone for six months or a year because it was "too unknown and too stressful" but others remained determined, she added.
“Some intended parents have said, you know, this just has made me more resolute that having a family and loved ones is the most important thing.”