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How to Navigate the Intended Parent-Surrogate Relationship

The surrogacy process has a learning curve for all parties involved. Here’s how to establish a healthy partnership.
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Contributing Writer
Updated
October 6, 2022
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Image: David Prado

If you’ve embarked on a surrogacy journey, there’s a lot to think about—not least of which is navigating the relationship between you and your surrogate. It can be tricky terrain. Given that the surrogate had your fertilized embryo placed into their uterus, they’re essentially carrying and caring for your little one for months before you get the opportunity.

It may sound complicated, but it’s far from uncommon. The Society for Assisted Reproductive Technology reported an almost 40 percent increase in gestational carrier cycles between 2016 and 2018. Moreover, 2021 study by the American Journal of Obstetrics and Gynecology found higher rates of success in terms of clinical pregnancies and live births with surrogacy as compared to other Assisted Reproductive Technology (ART) methods. The research also shows that, overall, both surrogate moms and children born via surrogacy had positive outcomes. Even more encouraging? Families created through surrogacy showed fewer problems as a whole when compared with conception using sperm or egg donors.

Of course, there are quite a few hoops to jump through before a surrogate hands over your freshly delivered newborn to you. Even if you’ve done the research and all the prep work, there are quite a few moving parts and pieces to keep track of. Moreover, figuring out how to navigate 40 weeks (give or take) with a surrogate—who is more than likely a complete stranger—can feel fairly overwhelming. But mutual respect, boundaries and communication will guide the way. Below, experts offer tips on how to establish and maintain a healthy relationship with this very special part of your birth story.

1. Find the Right Fit for Your Family

If you’re at the very beginning of the surrogacy process, before you start meeting with potential surrogates, research the agencies, as they have considerably different approaches. “We met with two agencies and they were very different from one another,” says Erin K., mom to two children born from the same gestational surrogate. “The agency we selected advocated strongly for their surrogates… We submitted our ‘album,’ a very detailed presentation of who we are and our expectations and hopes of our family-to-be. This album is given to surrogate candidates, and if they are interested in working with parents, then and only then do the parents view their album.”

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The consensus among experts, intended parents and surrogates is that open and honest communication is imperative. “Make a list of all the things important to you and have them ready to discuss,” says Brittany L., a surrogate. “If, during the matching process, you can’t agree on something, catch a weird vibe and or don’t feel 100 percent comfortable, chances are it’s not a great fit.” And don’t get discouraged if you don’t match right away—it could take months. Think of it this way: If you were looking for a house, you probably wouldn’t jump on the very first one you spotted. Your surrogate is baby’s home for nine+ months, so you’ll want to choose wisely.

In addition to ensuring there’s a personality match, it’s also important to have similar lifestyle values. “Intended parents and surrogates need to have similar views on certain important subjects, such as whether they obtain the COVID-19 vaccine, the number of embryos to transfer, delivering in a hospital or birthing center and whether the surrogate delivers using a midwife or OB,” says Shiva Landry, founder of Shared Conception, a surrogacy agency with offices in Houston and Dallas.

2. Embrace the Emotions

Even when everything seems to align, know that there’s still an emotional learning curve. Pre-planning about expectations is extremely important, says Michelle Valiukenas, mom to a 3-year-old via surrogacy. While Michelle felt that she made a good match with her surrogate, she couldn’t help but question her decision. A couple days past finding out /[the surrogate] was pregnant, she found herself regretting the decision. “I felt like it meant I wasn’t really going to be a mom,” she adds. Fortunately, Michelle found support in other intended parents who had been there, done that. The built-in surrogacy community can certainly help—as can support groups, counselors and other professionals.

3. Get Your Legal Ducks in a Row

Once both parties agree to embark on the pregnancy, ART attorneys will facilitate the process by drawing up a contract. Typically, the intended parents’ attorney writes up the contract, and the surrogate’s attorney reviews it. All attorneys’ fees are typically paid for by the intended parents.

The contract can include—but is not limited to—the following:

  • Compensation and expenses
  • Number of embryos transferred
  • Health insurance and payment of medical expenses
  • Agreement to follow medical recommendations while under the care of a fertility clinic or ob-gyn
  • Specific hospital for delivery
  • Provisions on bed rest, childcare, lost wages, housekeeping and meal prep
  • Potential travel restrictions and expenses like airfare, mileage, meals and lost wages
  • Breast milk pumping compensation, supplies and shipping
  • Life insurance for surrogate
  • Escrow and balance requirements
  • COVID -19 vaccine preferences

“A surrogacy agreement also covers situations that hopefully never arise, such as death or divorce of the intended parents, life support and purchasing life insurance for the surrogate if she should die,” says Marla Neufeld, founder and partner in Greenspoon Marder Surrogacy and Assisted Reproductive Technology practice group, which represents parties using a surrogate, egg, sperm or embryo donor.

While surrogacy is not governed by federal law, the Uniform Parentage Act gives states a framework to establish a parent-child relationship. Each state has different laws regarding surrogacy. “Some states make it a crime to compensate a surrogate,” Neufeld says. “Others have surrogacy-friendly laws that provide clear guidelines on how the intended parent(s) are named as the legal parent(s) of the child.” To that end, it’s important that anyone considering third-party assisted reproduction consults with an experienced attorney beforehand.

A HIPPA medical release form is often part of the agreement as well. It helps ensure that the intended parents are comfortable with the health of the pregnancy. “Surrogates waive privacy rights as it relates to pregnancy-related medical records,” explains Neufeld. This allows you to speak to your surrogate’s doctors and care team, attend medical appointments and be in the delivery room at the time of birth. Some agreements even provide a mechanism for a second medical opinion, if needed.

Abortion is also often addressed in these agreements. “While a surrogate may agree within the surrogacy agreement to abort the pregnancy if requested by the [intended parents], ultimately, decisions relating to a surrogate’s body rest in the hands of the surrogate,” says Neufeld. While a court of law may not be able to force a surrogate to have or not have an abortion, you may have contractual arguments based on stipulations in the original agreement.

4. Show Empathy

Understand that your surrogate may be going through more than someone carrying out a pregnancy with their own embryo. Even if your surrogate had a complication-free pregnancy in the past, remember that every pregnancy is different. “Starting from the beginning, there are a lot of medications (shots, pills, patches) you take, making you sore, tired and extra hormonal,” says Brittany. “I was more cautious—any little symptom I had, what I ate, a contraction—in fear of something happening to the baby or not making it to delivery. There’s a lot of weight you carry when you’re taking care of someone else’s baby!”

Setting up counseling sessions can be helpful in understanding feelings and fears for both parties. Christy W. and her husband went to every appointment, but also got to know their surrogate, her partner and her kids, to build a more personal connection. Seeing the big picture can be imperative to a successful relationship in this process. The two families were able to find a balance that helped support each other. Christy would send cookies, meals and uplifting texts. Her surrogate kept the communication open by sharing when the baby was kicking, or even when she was having morning sickness. “We were ok with the good and the bad because we wanted to be part of it all,” adds Christy.

5. Establish Boundaries and Ground Rules

Each surrogate-intended parent relationship is unique, and you’ll want to maintain certain boundaries. For example, Landry recommends that intended parents and surrogates refrain from connecting on social media until their joint journey is complete. And while it may seem convenient to ask your surrogate to live in your home during the duration of their pregnancy, this is also generally a no-no in Landry’s book.

You’ll want to be cognizant of the frequency of communication too. It makes sense that you’d want to check in 24/7, but many surrogates have children, family obligations and jobs. Remain respectful of the agreed amount of communication early on in the process, Landry adds.

Of course, things like a birth plan should be communicated early in the process. This is usually based on a series of questions for both the intended parents and the surrogate. In challenging situations, reach out to your agency; they can act as a go-between to ensure everyone is on the same page without anyone’s feelings getting hurt.

6. Consider Maintaining Communication After Baby Is Born

Once baby is born, you may wonder how your relationship with your surrogate will change. Intended parents may feel awkward asking about attachment. “We encourage our clients to ask the surrogate how she feels about delivering a baby and not going home with the baby,” Landry says. “It usually puts the IPs at ease when they hear the answer.”

It’s common courtesy to allow the surrogate to see and hold the baby, if she desires it. “It’s important for the surrogate’s husband and kids to see the baby after delivery; it provides closure for the children, and helps them understand why Mommy was pregnant and how she has helped complete a family,” Landry adds.

Some surrogates will stay in contact after birth. They may even pump breast milk for a while, depending on the arrangement. (Again, this should be discussed in the planning stages and added to the contract.) Typically, you, as an intended parent, would pay extra for this bonus, or cover gas or shipping costs.

A business relationship works for some intended parents and their surrogates; others enjoy a friendship as time goes by. Of course, not everyone’s post-surrogacy relationship will continue. If the intended parents prefer to have more privacy, it’s encouraged that they at least send pictures and periodic updates for the first year, notes Landry. This allows the surrogate to see how baby is doing, while validating their decision to help another family grow.

Each family has their own transitional period. This is uncharted territory for many, and it’ll take some time to get used to the dynamic with your surrogate. Try to open yourself to the opportunity and experience—and keep your eye on the prize.

About the experts:

Shiva Landry is the founder of Shared Conception, a surrogacy agency with offices in Houston and Dallas. No stranger to infertility and pregnancy-related difficulties, Landry personally understands the rollercoaster journey of the surrogacy process.

Marla Neufeld is the founder and partner of Greenspoon Marder Surrogacy and Assisted Reproductive Technology practice group, which represents parties using a surrogate, egg, sperm or embryo donor. Neufeld experienced infertility and used a gestational surrogate to build her own family. She co-authored a book published by the American Bar Association titled The ABA Guide to Assisted Reproduction: Techniques, Legal Issues and Pathways to Success.

Michelle Valiukenas is mom to a son born through a gestational carrier in 2020. She had a long history of infertility and loss and was terrified to be pregnant again. Valiukenas was hospitalized at 21 weeks with severe preeclampsia. Her daughter, Colette, was born three weeks later, but spent her short life of nine days in the NICU. She felt like surrogacy was her only path forward. Valiukenas and her husband run the The Colette Louise Tisdahl Foundation in her daughter’s memory.

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