When planning a surrogacy, the team should think of the birth and how they will navigate the hospital system to support their surrogacy birth. Surrogates will have their own experiences of birth and have ideas of how they envision the birth. Whilst it might seem a long way from planning the surrogacy to planning the birth, surrogates will have imagined the birth long before any pregnancy is achieved. It’s vital to have discussions about the birth before entering into a surrogacy arrangement, as the differences in value systems and understandings about birth can impact on the arrangement itself.
A fundamental tenet of surrogacy in Australia is that the surrogate maintains her bodily autonomy. This means that if she has strong views about her pregnancy care and birth options, the intended parents should be willing to accept her views or find a surrogate that better matches their own value systems. Whilst this isn’t a post about home birth versus hospital birth, most surrogates, regardless of their ‘ideal’ birth, will want to follow the advice of experienced medical professionals. We are not seeking to put ourselves or your baby at unnecessary risk. Home birth is considered a safe birth option for many women, whilst others will rely on the hospital system.
A surrogacy pregnancy should be treated just like any other pregnancy. Unless the surrogate’s health is a concern or the pregnancy is considered risky, the care she receives should be the same as that of every other pregnant person. The hospital and treating medical practitioners’ priority will be the health of the pregnant person and the baby. The surrogate will be offered all the usual diagnostic tests and treatments and birth options. She should be able to access Medicare rebates for pregnancy and birth care, just as if she were pregnant with her own child.
One thing to consider is whether the surrogate will receive treatment from a public hospital, or a private hospital. She might also have a private midwife. Some of these cost money, whilst others are covered by Medicare. If the surrogate requires private health insurance, the intended parents need to cover that expense for the period before and during the pregnancy. Most surrogates have birthed in the public health system for their own pregnancies and will not feel the need to go through the private system for the surrogacy birth.
You might like to make contact with the nominated hospital and ask them if they have a Surrogacy Policy, and if they have managed a surrogacy birth recently. Most hospitals will not appreciate the complexity of a surrogacy arrangement, unless they have managed a surrogacy pregnancy in recent years. You should make contact with the Social Worker or Patient Liaison Officer at the hospital and ask to meet with them, to discuss how the hospital will manage the surrogacy pregnancy.
Things to discuss with your team, health care providers and the hospital administration include:
- One-to-one care for the surrogate and team
Ideally, the surrogate should have one-to-one care during the pregnancy. This might not be possible, but it is an important consideration. Surrogates and intended parents don’t want to have to re-tell their story to a new midwife or doctor at every appointment. Ask if the hospital is able to provide the team with one primary point of contact at the hospital to assist in continuity of care and support. Continuity of care is proven to improve birth outcomes and experiences.
- Privacy and Information-Sharing
Most surrogates will be happy to give consent for their intended parents to receive information about the pregnancy and the baby, and for them to sit in on midwife and doctor’s appointments. But this should not be taken for granted, remembering that the surrogate’s bodily autonomy is important and she has a right to privacy. Be careful that the medical team is not given unlimited permission to discuss the surrogate’s pregnancy, health or body with the intended parents without the surrogate’s knowledge. Ideally, the surrogate should receive the information directly and share it with the intended parents herself. Most teams have agreements about the best way to share and receive information prior to entering the surrogacy arrangement.
- Birth Education and Parent Craft for the Intended Parents
Ask if the hospital will provide ‘parent craft’ and birth education for the intended parents. The birth and parent craft classes are usually offered to pregnant people and their partners, but your surrogate probably doesn’t need to attend. If you are not comfortable attending a hospital birth class as intended parents, you might like to have private birth classes with a midwife who is LGBTQI+ friendly and understands the complexity of surrogacy arrangements. My intended parents and I had our own birth education session with a private doula which was tailored for our needs and very helpful.
- Intended Parents in the birthing suite or theatre.
Will the intended parents will be welcomed into the birthing suite, or theatre, should there be a caesarean birth? Most hospitals will have policies that the birthing person can only have one support person with them in theatre. You should ask the hospital to reconsider this policy for your team, so that both intended parents can see the birth of their baby. Ideally, the surrogate’s partner would also be allowed in theatre. Some teams have been successful in having a birth photographer in theatre or recovery.
- A Room for the Intended Parents
Ideally after a surrogacy birth, the surrogate will recover and be attended in her own room, and the intended parents will get to know their new baby in a separate room nearby. However, public hospitals are often bursting at the seams and private hospitals may charge the intended parents to stay in a separate room. You need to address this with the hospital. Sometimes, the surrogate and one of the intended parents will share a room with the baby, if no separate room can be provided. The surrogate should not be made to care for the baby whilst the intended parents go home at the end of visiting hours – the hospital will need to be educated about the inappropriateness of such an arrangement and the potentially harmful impact on everyone involved.
- Birth Photography
The importance of birth photography for surrogacy teams cannot be underestimated. It provides a record of the labour and birth particularly for the surrogate. who has imagined this day for a long time and may not remember it in the detail she had hoped for. The team should discuss the option of having a professional photographer and make sure the hospital understands the importance of the team having a birth photographer present.
- Milk and Feeding
Some intended mothers will induce lactation, and you should mention this to the hospital prior to the birth. I’ve heard horror stories of hospitals refusing to allow the intended mother to breastfeed her own baby because ‘the surrogate is the legal mother.’ You should avoid the stress of it becoming a problem by speaking to the hospital well in advance and gaining their support. Further, the surrogate team needs to discuss milk and feeding arrangements. Some surrogates don’t want to breastfeed or provide milk for baby. Other surrogates will offer to express colostrum, or to express milk for a few weeks or months. Other surrogates, including myself have enjoyed breastfeeding the baby in the early days and then moving to expressed milk for baby. There is no wrong or right answer, as every team and every surrogate is different.
Rest assured, a surrogate who breastfeeds and has skin-to-skin contact with the baby will not become ‘too attached’ to baby, and this will not affect her ability to hand the baby over. On the contrary, in my experience the breastfeeding of surro-baby felt as natural as handing her over to her fathers, and felt like a lovely long goodbye between her and I. Breastfeeding in the early days is good for baby, and good for the birth mother – it helps her uterus contract and also allows her body to adjust to no longer being pregnant. My advice about breastmilk and feeding is to be flexible – we were still adjusting our plan in the days leading up to and after the birth, and I always knew I could change my mind if ever I felt it was too much.
- Leaving the hospital
The team should consider the logistics of the surrogate and baby leaving the hospital together or separately. If either needs to remain in hospital whilst the other is ready to leave, the hospital should accommodate that. However, this is often cause for problems as the hospital considers the surrogate is the legal mother at that time, and may not be willing to allow the baby to leave without her. The team should discuss with the hospital staff – management, or the social worker – what the hospital might need to allow the baby to leave without the surrogate. Some teams have provided the hospital with a Parenting Plan, which is a written document signed by the birth parents, relinquishing the baby to the intended parents. It is not binding, but can satisfy the hospital that the baby is in safe hands leaving with the intended parents.
Rest assured, hospital staff want the best for everyone, but surrogacy is not common and many hospitals will only see a surrogacy pregnancy every few years. You need to be prepared to advocate for yourselves and educate the staff about the complexity of surrogacy and the relationships. Be prepared to answer their questions and to be a bit of a novelty, but demand professionalism and discretion. Good luck! And be sure to get in touch if you need any assistance.
What’s next after the birth? Well, it’s the fourth surro-trimester.