This paper explores the impact of adoption on birth parents and grandparents. Six years post-adoption, interviews were carried out with 72 birth parents or grandparents of a child adopted under the age of four. The sample included child welfare and voluntary adoptions. Qualitative analysis of data focused on the different ways these birth relatives did or did not accept the child's placement for adoption, and three patterns emerged-positive acceptance; resignation; and anger and resistance. Positive acceptance was associated with being a grandparent (as opposed to a parent), and having face-to-face contact with the child after adoption (as opposed to mediated letter contact). Implications for practice are discussed.