Developing a Relationship with Intended Parents (That Really Works): A Guide for Surrogates

Becoming a surrogate mother, (also known as a gestational surrogate), can be an awesome, life changing experience. The relationship between a surrogate, and the intended parents (IPs) she works with, is a pivotal one. Like all good relationships, this very important connection requires effort, and the establishment of ground rules, boundaries, and expectations. Just like those of the IPs you choose, your needs, and hopes, are an important factor in this process.

Maintaining your relationship in a way that works for everyone is a shared responsibility, held by everyone involved, including the attorneys, counsellors, and physicians, you work with. You’re all in it together! Here are some suggestions for making sure your surrogacy experience is as beautiful as it can be.

It All Starts with You

Becoming a surrogate mother is a choice. If this is a path that feels meaningful for you, you may want to start by finding a surrogacy agency that feels like a fit. Working with an agency is one of the best ways to ensure that the relationship you have with your intended parents, starts on the right foot by having clear expectations and boundaries set for you and your IPs.

Women become surrogates for many reasons, but not every woman who wishes to be one, is qualified to do so. Working with an established, trusted agency is important, because the screening process they use to determine eligibility, helps to protect you, both medically and legally, as well as emotionally.

Just like everyone who wishes to be an IP, you will need to have several types of screenings, including a medical, and psychosocial one. These evaluations are used to determine your physical, and mental, ability to handle surrogacy.

The agency will need information about your personal, and sexual history, to determine your risk level for sexually transmitted infections, which might be transmitted to a fetus. You will also be asked questions about lifestyle choices, including history of drug or alcohol use, cigarette smoking, the foods you eat, your travel habits, and even your hobbies! Your educational background, and family’s medical history, will also be determined.

Other common requirements include:

  • Being of legal age – preferably, between 21 and 45
  • Many agencies require surrogates to have had at least one uncomplicated pregnancy which went successfully to term, but not more than five previous deliveries, or three previous deliveries via C-section (cesarean section).
  • Living in a stable family environment, or one with lots of established outside support

Your screening will typically take place over several sessions, both via telephone, and in person. The agency will absorb your travel and housing costs, if needed, during the process. It may all sound overwhelming, but is very important. This deep dive helps to safeguard all of you, and is in everyone’s best interest.

Legal Stuff and Why It Matters

If it’s been determined you’re a great fit for surrogacy, congratulations! You are awesome for wanting to go down this path, and for helping other people have the baby they so want.

You and your IPs will be picking each other. The creation of this partnership is largely determined by your mutual requirements, and expectations, during pregnancy, and beyond. This is where having an attorney to represent you comes in handy. The IPs will absorb the cost of your attorney, as well as for their own. You must have your own legal counsel, so that you never have to worry about not having someone in your corner with your best interests at heart.

Surrogacy is a complex legal process, governed by state laws. Your attorney should be completely knowledgeable about the laws in your state of residence. They will help create the agreement, establishing the relationship between you and your IPs. That agreement will cover many aspects of the relationship, including the frequency and type of communication you will have during pregnancy, and possibly, afterwards. There are no right or wrong expectations for this relationship, however, issues can arise if you and your IPs are expecting different things. Your attorneys will help everyone understand each other’s wants, and assumptions. This elimination of the question marks will help keep your relationship smooth, and stress free.

Additional issues included in your agreement are:

  • The financial arrangement, including fees, and payment schedule
  • Health care decisions about fetal reduction, and fetal anomalies
  • Prenatal diagnostic testing
  • Travel restrictions
  • Abstinence from alcohol, and other substances
  • Number of embryo transfers anticipated
  • Choice of doctor and hospital
  • Potential medical issues, such as preeclampsia, pregnancy loss, and premature birth

Your agreement will also include information about the parentage judgement process, which will take place during your pregnancy, usually after the first trimester. U.S. law has not completely caught up with the many ways people can become parents today, including surrogacy. Most states currently consider the woman who delivers a baby to be the legal parent. In a surrogacy arrangement, a judicial order, or judgement, naming the IPS as the sole legal parents is required. This judgement simultaneously determines that the surrogate is not the mother, and that her husband is not the father. This protects you from any type of responsibility for the baby at any point during their lifetime.

The number of embryos that are appropriate for you to have transferred, is not typically included in the contract. Often, this decision cannot be made until the embryos are ready for transfer, at which time, the right number is mutually agreed upon by the surrogate, IPs, and doctor. However, if not carrying multiples (twins or greater) is important to you, let your attorney and IPs know, so that you can discuss the option which best suits everyone, ahead of time.

Finding an attorney is not hard! Often, your IPs will have an attorney who is able to recommend a colleague to represent you. You may also go online yourself, and search through professional surrogacy websites, such as the American Academy of Assisted Reproductive Technology Attorneys. It is very important to choose someone who completely understands surrogacy law, and its complexity. Hiring an attorney who is already in the know, can help to safeguard, and maintain, the relationship between you and your IPs, freeing you from worry, and letting you concentrate on yourself during this special time.

Putting this agreement in place, prior to undergoing any medical treatments, is imperative. Your attorney may advise you all to wait to do anything further from a legal perspective, until after the first trimester, when the parentage judgement process will take place.

Understanding the Medical Process

As a gestational carrier, your eggs will not be used. Eggs from either the intended mother, or an egg donor, will be mixed with sperm from either an intended father, or sperm donor, to make embryos.

Your body will need to become ready to receive the embryos, when they are ready for transplantation. This delicate process requires timing, and the medical expertise of a reproductive endocrinologist, or embryologist.

Every situation is different, but some steps you can most likely expect include:

  • Early on in the process, you will begin to take prenatal vitamins daily
  • You will also be given medications, such as estrogen, or birth control pills. These are geared towards suppressing your menstrual cycle, and stimulating the development of a receptive uterine lining, ready for pregnancy.
  • The embryo or embryos, will be placed into your uterus, during a painless medical procedure, called an embryo transfer. This is done in a medical setting, such as a doctor’s office, and does not require anesthesia. It is a delicate procedure, but does not take much time to perform.
  • Once the embryos have been implanted in your uterus, you will be given other types of medication, including a hormone called progesterone, to help safeguard the pregnancy, over the course of several weeks.
  • After the procedure, you will be required to rest quietly, for about an hour. Normal activities may need to be curtailed for a day or two afterwards, including plane travel. These arrangements will be laid out clearly in your legal agreement.

Should pregnancy occur, you and your IPs will be ready to take an amazing adventure together!

Being Pregnant as a Surrogate

You still have a life to lead, even while a life growing inside you. Your IPs know that, but will need to be kept in the loop. You are carrying the most precious thing in the world for them, and it may feel scary for them, especially if they live far away.

This is a time when maintaining powerful, and effective communication, is super important. Your IPs may not realize how much your feet hurt, and you may not realize how nervous they are about the pregnancy. No, you don’t have to disclose every ache and pain you feel, but you do have to be sensitive to each other’s feelings about the situation. By maintaining an open, honest communication, you will be in the better position to be respectful of each other’s reality, during this time.

As a surrogate, you also should remember that your IPs have probably never experienced a pregnancy to term. Some things you say may be met with joy, but others may feel hurtful, or frightening. You know that your backaches are just part of the process, but they may become concerned that the pregnancy is in jeopardy. Even normal day-to-day issues might concern them, since they are not familiar with the biological process you are going through, in the same way you are.

Remember that your emotional state sets a lot of this stage. If you are nervous, stressed out, or anxious about anything in your life, your IPs may automatically go into worry mode. It may help to be mindful of the words you use when you speak to each other, and to allow the relationship to develop naturally, over time. If your communication styles don’t match, your agency can help all of you navigate this time more effectively, creating a win-win for everyone.

As grateful as they are for you, some IPs will require little to no contact. Others will want to see sonogram pictures, hear about that first baby kick, and schedule phone calls, or Skype visits regularly. There’s no right or wrong way to proceed with this relationship. As long as everyone is on the same page, things will go smoothly.

This pertains to post-pregnancy issues, too, including medical concerns you might face post-pregnancy. Things such as your willingness to express and donate breast milk, and further contact with each other, must also be firmly established ahead of time.

During your third trimester, a birth plan document will be established, which will include guidelines about the labor and delivery process. Things don’t always go according to plan, but having boundaries and expectations established ahead of time, will help keep everyone relaxed.

It’s Time!

Based upon the pregnancy, your labor and delivery may be timed, or it may be spontaneous. Letting the agency, attorney, and especially the IPs know you are in labor should be done as soon as you know it is happening. The IPs may have already travelled to your location, in anticipation of the birth.

It is up to you to decide if the IPs, as well as others, such as your partner or spouse, will join you in the labor room. The IPs are often an active part of the birthing team, but this is solely your choice to make.

Once the baby is born, their needs will be a priority. They may require a NICU stay, or may be able to go home with their parents shortly after birth. Typically, the baby will spend time immediately after delivery with their parents in the recovery room. This will allow you to rest in your own, private room, plus will give the new family time to bond, and enjoy this incredible experience. These arrangements may vary, based upon the type of delivery you had, the baby’s overall condition, and hospital guidelines. Discuss ahead of time how you will all say goodbye and what next steps, if any, will occur.

Remember, your partnership was created for a specific goal, and now that goal has been realized. Some IPs and surrogates maintain contact, and others don’t. Neither scenario is better than the other.

The post-delivery experience is unique to every woman who has ever given birth. What all surrogates deserve to feel during this time, is incredible pride. The gift you have given is unparalleled, and long lasting. Take a few moments to let it sink in. You are as incredible as everyone says you are.


This section of the Path2Parenthood website is made possible through a generous contribution from Growing Generations.