Private domestic infant adoption in the United States is an emotionally, psychologically, and financially fraught process. Since the economic downturn of 2008, “fall-throughs”—where a birth mother accepts money from a prospective adoptive family and then decides not to place the baby—have become more common. This ethnographic article examines the dynamics of these risky adoption exchanges as managed by the Chicago-area First Steps Adoption Center. Using the lens of clinical social work, the paper investigates the detective and protective strategies—indeed, the moral maintenance—adoption social workers employ to mitigate the effects of the “fall-through” for all parties to the adoption process.