- Traditional Surrogacy uses a surrogate’s own eggs and intended father’s/donor’s sperm.
- Gestational Surrogacy uses a donated egg (NOT belonging to the surrogate) and sperm, which once fertilized is transferred/implanted to the surrogate to be brought to term.
It started with a Craigslist ad.
I was cruising the job section when the post caught my eye:
“Surrogate Mothers Needed Today! Earn up to $65,000!”
It’s true that a lot of my life-changing decisions have been born from Craigslist ads.
I’ve found jobs, I’ve found roommates, I’ve found vehicles, and I’ve found furniture I’ve fallen deeply in love with… but this decision would definitely take the cake!
The more I thought about it, the more it started to make sense.
As a struggling single mom, this was a way I could finally put some significant money aside to provide for my daughter’s future.
My pregnancy with her had been relatively easy and often times enjoyable, so I wasn’t turned off by the prospect of going through it again. And of course, I loved the idea of helping another family on such a huge and profound level.
It seemed to be a win-win scenario.
Before I knew it, I found myself filling out a ridiculously lengthy questionnaire on the surrogacy agency website.
The Two Different Types Of Surrogacy
Let’s first distinguish how surrogacy works by looking at the two different ways of being a surrogate:
Traditional Surrogacy uses a surrogate’s own eggs which are fertilized, through artificial insemination, with the intended father’s sperm.
For thousands of years (dating back to the story of Sarah and Abraham in The Book of Genesis!), traditional surrogacy was the only surrogacy process in existence.
Gestational surrogacy came about in 1975 and gained popularity in the mid-1980s. This type of surrogacy uses in vitro fertilization to create an embryo with the intended mother’s eggs and the intended father’s sperm, which is then transferred to the surrogate.
Now that the technology exists, gestational surrogacy is by far the norm. It is both emotionally and legally easier than traditional surrogacy, since the surrogate has no biological relationship to the child she’s carrying.
…It seems simple enough, but one surrogate told me that she’s had many innocently curious strangers ask her, “If it’s from you, it has to be your kid… right?!”
Why Do Intended Parents Turn To Surrogacy?
There are many different reasons why people end up using surrogates to grow their families. Here are a few:
- An option for couples who are unable to conceive, whether medically or for other reasons. This includes same-sex male couples, trans and other non-normative gender couples who wish to start a family
- Hysterectomy due to cancer or previous childbirth complications
- Uterine issues such as fibroids or scarring
- Health problems that would make pregnancy dangerous: heart defects, kidney disease, etc.
- Advanced maternal age
- A need to take medications that would harm a developing fetus
- Multiple rounds of IVF with no success (and leftover embryos that can be used in surrogacy)
Is Vanity Ever A Motivation For Using A Surrogate?
Does a woman ever opt for surrogacy because she wants to keep her figure, stay on track with her career, or simply doesn’t want to go through pregnancy (even though medically, she could?)
Termed “social surrogacy” in pop culture, I couldn’t find any reliable stats for how often this happens, although legally it could, in states where the intended parent isn’t required to prove medical necessity.
To note, the official stance of the American Society for Reproductive Medicine is that: “Gestational carriers may be used when a true medical condition precludes the intended parent from carrying a pregnancy or would pose a significant risk of death or harm to the woman or the fetus.”
Why Not Choose Adoption Over Surrogacy?
The main argument that I encountered when researching surrogacy was: Why not just adopt a child instead? Isn’t this an easier option?
I spoke with David B., a parent who chose fostering and adoption to start a family with his partner.
He told me the painful story of how the adoption of their twins almost fell through when the twins were 2 ½ years old, and the adoption was opened up to three other potential couples.
These were their daughters, whom they’d been fostering since birth, and they came extremely close to losing them.
David explained: “Can you imagine? Losing your child like this? Of course, I’m going to be an advocate for fostering and adoption, but at the same time, I understand why people choose the surrogacy route.”
Whether someone uses a surrogate, fosters or adopts to start their family, it’s never an easy path to walk. These options each present unique challenges.
Adoptions are reversible (and some folks don’t qualify), and when fostering, there’s always a chance that your child will reunite with their original family or be put in a different placement.
What Motivates Someone To Become A Surrogate?
In a study published in Human Reproduction, thirty-four surrogate women were surveyed regarding their motivations for becoming surrogates.
The primary motivations given were:
- 31 women (91%) “wanting to help a childless couple”
- 5 women (15%) “enjoyment of pregnancy”
- 2 women (6%) “self-fulfillment”
- 1 woman (3%) “payment”
Here are some of the motivations of the surrogate women I spoke to:
The Gift of Life
Each of the women I contacted told me that giving the gift of life was the primary motivation for becoming a surrogate.
Stephanie Allen, a Texan mother who was halfway through her second surrogate pregnancy when we spoke, stated:
“I took for granted how easy it was to get pregnant with my own three kids…I love being able to give women babies when they don’t have that option biologically.”
She (Believe it or Not!) Loves Being Pregnant
Another common motivating factor is the chance to experience the pregnancy journey again even if the surrogate is done growing her own family.
In fact, the advice that Stephanie gave was that “you have to enjoy being pregnant to do this.”
She added, “If I could keep being pregnant for the next fifteen years, I would, in order to do this for people…I’m one of those oddballs who love being pregnant!”
Money To Help Her Own Family
Most gestational surrogates receive compensation for their services.
The amount that a surrogate receives is determined by a number of factors, such as the intended parents’ budget, singles versus twins, previous surrogacy experience, and the success of the pregnancy.
Sarah Carlson, a 28-year-old surrogate who lives with her fiance and son in Chicago, told me “the money really did change our lives.”
She received $48,000 in total and was able to use this money to pay student loans, put a down payment on her sister’s surgery, cover medical bills for her epileptic niece, and support her fiance so he could become a carpenter.
She added that she would be a surrogate again “in a heartbeat,” except that she plans to grow her own family.
Surrogacy Is “Addictive!”
Many surrogates enjoy the experience and ultimately choose to repeat it multiple times.
One of the women I spoke with did it twice, one did it three times (two singletons and a set of twins), and one even did it six times (with three singletons and three sets of twins)!
Is Surrogacy Safe for your Health?
Surrogacy Requires An Extensive Health Evaluation
Several of the women with whom I spoke mentioned the very rigorous screening process that surrogates are put through by the agency to determine whether they make good candidates for surrogate pregnancies.
Dr. Jaime Seeman, an OB-GYN on our Medical Team shared with us:
“We use rigorous preclinical assessment for anyone wanting to attempt surrogacy. All modifiable risk factors should be addressed.”
This includes psychological and physical testing, blood work, medical history examination, ultrasounds, looking at the success of past pregnancies, accessing risk for illnesses and on and on!
Through screening, the agency is not only able to determine whether a candidate is physically well, but they can ensure that she understands the process, is emotionally fit and has the support system that she needs in place.
There is also a substantial list of medical disqualifiers that weed candidates out early in the process.
For example, a woman has to have at least one prior successful pregnancy, fall within a certain age range, have a healthy BMI, and no major complications from previous pregnancies.
Risks To Consider When Carrying Multiples
While the surrogacy process itself is relatively safe, it’s important to note that there are heightened risks when women carry multiples, which is extremely common with surrogate pregnancies since oftentimes multiple embryos are transferred to ensure success.
According to the CDC, between 1999 and 2013, (53.4%) of infants birthed from surrogacy were multiples.
Some of the risks associated with this include:
- Early labor
- Gestational hypertension
- Birth Defects
- Twin to twin transfusion syndrome
- C-Section delivery
- Amniotic fluid abnormalities
- Postpartum hemorrhage
As mentioned previously, some women are open to being surrogates because they’ve had easy and enjoyable pregnancies in the past.
It’s important to keep in mind though, that every pregnancy is different and every pregnancy comes with its own set of inherent risks.
Just ask Rayven Monique, a mother of three, six-time surrogate, author, and creator of a very informative blog where I first found her.
Rayven had five happy and successful surrogate journeys until the sixth one almost took her life!
After delivering twins early, she experienced several complications and ended up hemorrhaging to a point where she required eight blood transfusions.
Doctors determined that she had a condition called placenta accreta, in which her placenta failed to properly detach and as she put it, “Baby B [the second twin] literally went through it!”
Doctors eventually had to perform a hysterectomy and Rayven will have some long-term issues due to complications from a second surgery.
On top of this, she will have to deal with the bills since health coverage from the intended parents stopped six months post-delivery, as outlined in their contract.
Both babies from that surrogacy are now healthy and thriving, and incredibly Rayven told me:
“Even with what happened, I wouldn’t change anything. I can’t say that because a freak thing happened to me, that the whole thing wasn’t worth it.”
However, she does have some cautionary advice for women who are considering surrogacy:
Don’t assume that something can’t happen. Plan for it to happen. And know what you would do if A, B, or C occurs. As with any big decision, I like to think of the worst case scenario, and decide if I would still choose to go forward given that outcome. – Rayven Monique
She further adds that it’s best to start surrogacy after you’re done growing your own family and to really consider and involve your family when making the huge decision of whether to pursue being a surrogate..
The Issue Of Bonding As A Surrogate…It’s All About The Hormones!
One of the first questions I had about surrogacy was: What about bonding?
How can you give up a baby who has been growing inside of you for nine months?
Pregnancy and childbirth launch mechanisms that establish bonding with the baby. This isn’t based on a genetic connection to the child, but rather the hormones that are released during pregnancy.
However, some of the surrogates I spoke with said that it was an entirely different experience than when they conceived with their partners.
Stephanie Allen stated, “You go into it knowing it’s very clinical from the beginning. It takes so much to get there…All the shots, all the meds, all the screening…such a clinical process. It’s almost like watching somebody else go through it.”
She told me that she takes her job as a nurturer very seriously, but knows that the job comes to an end.
As she put it, “it’s giving the baby back, not giving him away.”
The Come Down
Still, it can be a difficult adjustment after the surrogacy is done.
Yessica Reedy, a three-time surrogate and author from Los Angeles, told me about how hormones and emotions come into play during the weeks following a surrogate birth.
Yessica pointed out the fact that after you give birth as a surrogate, you’re not only giving back the baby but you’re relinquishing your close relationship with the intended parents as communication with them often drops off.
It’s a lot to lose at a time when your body is all out of whack as well.
She told me that something surrogates don’t talk to each other about is the shame involved in feeling bad when they knew what they were getting into in the first place.
Said Yessica: “It’s easy to focus on what you’re doing wrong, versus realizing that this is a normal [hormonal] process, albeit in an abnormal circumstance.”
She advises that it’s important to keep this in mind and be very good to yourself in the weeks following the birth.
What Are The Legal Considerations In Becoming A Surrogate?
To get some insight on how surrogacy works from a legal standpoint, I reached out to Marla Neufeld, a lawyer with Greenspoon Marder LLP who specializes in Reproductive Technology law.
Marla had her own journey with surrogacy when she had her twins, and went on to write The ABA Guide to Assisted Reproduction.
There Are Different Surrogacy Laws In Every State
Marla pointed out that there are legal challenges since every state has different laws regarding surrogacy.
In some states, commercial surrogacy is legal while in others it’s not. In some states, there has to be a medical need established. In some states like Georgia, there aren’t any laws in place but it isn’t prohibited.
According to one of our medical experts, Dr. Jaime Seeman, OB-GYN:
“In Nebraska where I practice, even if I took someone else’s embryo and put it in a surrogate, the mom that actually births the baby is the legal mother. She then has to relinquish legal rights to the adoptive parents. She could change her mind at any time even though it’s not her biological child.
This trumps any surrogacy contract as well.”
In New York State, for example, it’s currently against the law to compensate a surrogate, but that law may soon change.
According to Marla, when a surrogate and the intended parents are in two separate states, the law of the state where the birth occurs is utilized since that’s where the birth certificate is issued.
She points out that the proper practice is to have separate attorneys review the contract and work together to protect the best interests of each person involved.
And the parties have to be on the same page with everything. This includes the assumption of risk, an end of life plan and insurance, conditions of the pregnancy…even a plan for pumping breast milk!
The list goes on and on.
Therefore, those thinking about becoming a surrogate, and those thinking about using one, should be VERY familiar with the laws where the birth will take place and the potential pitfalls and ramifications for any possible outcome.
Use An Agency
This is where the agency comes in.
Marla shared, “When there’s an agency involved, it takes out the need to negotiate money between parties… [Further] the agency knows what to look for and how to screen the parties for their fitness.”
To find a reputable agency, you can do a simple Google search as there are literally hundreds to choose from.
Be Prepared From The Start & Know When To “Put Your Foot Down”
Marla’s advice to both surrogates and intended parents is to speak to an attorney at the very beginning before diving in.
Rayven Monique touched on this as well as she pointed out:
“It took me six months to decide to do this and know what I was getting into…I’ve walked away from three contracts because [the other party] refused to budge on issues. You have to put your foot down when necessary – The contract is there to protect everybody.”
She further added, “This is not about feelings…This is about ‘I am a NO to this, and ‘I am a YES to this’ and sticking to your guns!”
A Question Of Ethics: What The Critics Of Surrogacy Have To Say
I have seen some interesting ethical situations (involving surrogacy) arise in my career. A surrogate became critically ill with severe preeclampsia at a pre-viable gestational age. The surrogate could have been in grave condition had the baby not been delivered. Ethically as a doctor, our obligation is to the patient (surrogate and baby) no matter how much financial or emotional investment has been given by others. – Dr. Jaime Seeman, MD, OB-GYN
Commercial surrogacy is illegal in many places because it has been an extremely contentious ethical debate, with headline cases like that of Baby M., Johnson v Calvert, and Baby Gammy stirring the controversy pot over the years.
It bears mentioning that none of the women I spoke with would agree with these statements, but here are some of the main arguments being made against surrogacy:
It Objectifies Women, Similar To Prostitution
The ethics of surrogacy: women’s reproductive labour quotes famous feminist Mary Warnock, who stated:
[m]otherhood is becoming a new branch of female prostitution with the help of scientists who want access to the womb for experimentation and power… Women can sell reproductive capacities the same way old-time prostitutes sold sexual ones but without the stigma of whoring…It is the womb, not the vagina, that is being bought.
…Of course, this then begs the question: does one consider prostitution itself immoral when it’s an arrangement made between consenting adults?
It Exploits A Power/Wealth Imbalance
One of the most vocal opponents of surrogacy is Jennifer Lahl, founding president of The Center for Bioethics and Culture Network. She states on her website:
“Even the promise of ‘just’ living expenses can be an enticement for a woman of low income with children in the home. Make no mistake: it will not be wealthy women who line up to make themselves available to gestate babies. It will, however, be wealthy individuals or couples who seek to buy such services.
Surrogacy takes something as natural as a pregnant woman nurturing her unborn child and turns it into a contractual, commercialized endeavor.”
It Denies The Pregnancy Bond
According to the official statement of the Stop Surrogacy Now Movement:
“A surrogate pregnancy intentionally severs the natural maternal bonding that takes place in pregnancy – a bond that medical professionals consistently encourage and promote. The biological link between mother and child is undeniably intimate, and when severed has lasting repercussions felt by both. In places where surrogacy is legalized, this potential harm is institutionalized.”
If you’re thinking of becoming a surrogate, it’s vital to learn everything you can about it.
Learn all the ins and outs of the process and consider the gravity of this decision for you, your family and your health.
That’s what I did and ultimately, I decided surrogacy is not the right fit for me.
During the course of my research however, I met some fascinating women with incredible stories to tell. I was struggling to summarize all my thoughts when my child’s father, a former first responder, leaned over to me and said:
“They risk their lives so that other people may have life.”
To put it simply, that’s just what surrogacy is – a transformative journey that requires a very special type of person.
A special thanks to Craigslist for throwing me down the research rabbit hole, and a VERY special thanks to the ladies and gentleman who contributed to this article.
What about you? Have you ever been a surrogate or wondered whether you could or should be? Perhaps you disagree with surrogacy and have a solid argument as to why?
Maybe you’ve used a surrogate and have a child now as a result?
We’d love to hear your thoughts and opinions! Tell us all about how you feel by clicking on the “Discuss” link/button that appears at the end of this article.