As with most elements of Handmaids' lives in Margaret Atwood's dystopian novel, what happens after they give birth is grossly unfair. Soon after birth, the baby must be given over to the Handmaid's Commander and his wife. After this, the Handmaid will become the property of a new Commander. The Handmaid will then never see her child again. These forced "adoptions" are seen as part of the Handmaid's debt to society that must be repaid.

At the monthly Ceremony, the Commander seems to justify this way of doing things by recounting the biblical story of Rachel, Jacob and Bilhah, with Bilhah being likened to a Handmaid. Since Rachel was unable to conceive, she gave Bilhah to her husband to impregnate.

We learn more about the fate of biological mothers in chapter 21, when Ofwarren gives birth with the wife of her commander sitting symbolically above her. Immediately after the birth, the wife gets into the bed and the baby is given to her rather than to her biological mother.

The only "good" thing that comes out of giving birth from the Handmaid's perspective is that she will never suffer the fate of being declared infertile and will never be sent to work in the colonies.