Venturing Through the Surrogacy Pregnancy

The surrogacy pregnancy, believe it or not, is the easy part. Congratulations! You’re now entering the “I’m a pro at this” stage of your surrogacy journey! All the steps (and shots) you’ve been taking finally led you here: pregnancy. For many gestational carriers, the ~40 weeks of pregnancy itself feels like it just flies by.

And while pregnancy isn’t always comfortable (especially in those final weeks), or full of sunshine and rainbows every day, you know one thing for a fact: you are GREAT at being pregnant. Just imagine, hearing the baby’s heartbeat and getting to feel the flutter of those kicks for the first time. Watching your body change to support this new life. Knowing you have a team of people cheering for you—and the little one—for the next several months.

For the most part, surrogacy pregnancy will be very similar to when you carried your own children.

Let’s recap:

• Before the embryo transfer: begin daily progesterone shots to help your body sustain the pregnancy
• 10 days post embryo transfer: blood draw at fertility clinic to measure hCG blood levels.
• 12 and 14 days post embryo transfer: a second and third blood draw to be sure your hCG blood levels are increasing at the right rate.
• Weeks 1-9: Continue daily progesterone shots to sustain the pregnancy. Check in with your fertility specialist as needed. You may feel more tired than normal due to this spike in progesterone.
• Weeks 10-12: Expect to be released to your own OBGYN for typical prenatal appointments.
• Weeks 13-40: Typical prenatal appointments with your OBGYN, including the 20 week ultrasound.

By your tenth or twelfth week, you will likely be released to your own OBGYN and will no longer need to continue the progesterone shots. (Some women may need to stay on the progesterone a little while longer, up to 16 weeks.) You’ll resume your typical monthly prenatal appointments. It will feel very familiar to you with one exception: communication with the Intended Parents.

Communication and Relationship Building 

Every set of Intended Parents is different regarding the type and frequency of communication they want during the surrogacy pregnancy. Some want to be very involved in every part of the process. They may want a recording of their baby’s heartbeat and duplicates of any and all ultrasound photos. They may want to chat with you after every prenatal appointment, or even join you in-person or over Zoom at the clinic. Others may want to be more hands-off. Their level of involvement is something you should discuss and agree on even before signing the surrogacy contract.

Your surrogacy agency will help you navigate the level of communication between you and your Intended Parents. If at any point you are uncomfortable or have questions about what information to share, or how often, talk to your agency. They are there to mediate and make this process go as smoothly as possible for both parties.

Fun Ideas to Connect with the Intended Parents:

• Weekly belly pictures
• Record the sound of the heartbeat
• Send duplicates of ultrasound photos
• Set up a “rub the tummy” date during a time baby is usually active (they’ll love feeling the baby’s kicks)
• Monthly video chats
• Keep a journal you can share with them

The Big Reveal: 20 Week Ultrasound

Think back to your very first 20-week ultrasound. For may couples, this is the most exciting appointment, when the baby feels the most “real.” You got to see the outline of your little one’s profile. Count their fingers toes. And maybe even discover their sex.

Your Intended Parents will be feeling many emotions that day, too–excitement, anticipation, relief. Depending on what led them to choose surrogacy, their joy may also feel tinged by sadness or loss. They’ll probably want to be with you at that appointment, more than any other prenatal appointment. If the come for the ultrasound, they may also want the opportunity to tour the hospital and see where their baby will be born.

If they can’t make the trip, be sure to send them duplicates of the ultrasound photos. Some clinics even offer a video or 4D scan. You could also offer to make a video tour of the facility for them. Including them throughout the pregnancy can help alleviate worries about what the birth could be like and it helps them to pass the time a little more quickly. It can even help them bond emotionally with their baby. And it can make the experience feel more fulfilling and meaningful for you and your partner as you grow your friendship with them.

After this 20-week appointment, the attorneys step back in. They will be sure parentage is assigned to the Intended Parents at birth.

Writing the Birth Plan

Begin writing your birth plan at around 30-32 weeks. A birth plan helps set expectations for what you, your family, and the Intended Parents could experience when you go into labor.

Now, you may have written a birth plan for the births of your own children. It probably covered things like whether you wanted an epidural or any other pain relief medications, whether you wanted only your husband present or whether anyone else could be in the birthing room, whether you wanted the lights turned down, or if you wanted upbeat music playing the background.

And while this birth plan will have many similarities, it will have notable important differences related to the Intended Parents. Some surrogates want to labor quietly alone or with their spouse until it’s time to push. Others welcome the Intended Parents into the delivery room at any time. Some surrogates want their children to meet the baby after the birth and see the Intended Parents with the baby at the hospital.

Even though the baby belongs to the Intended Parents, you are the one giving birth. Think through what will make you comfortable during the delivery. Be open with your agency so they can advocate for you during the pregnancy and the birth.

Include in your birth plan:

• Who will be present in the delivery room
• When and where the Intended Parents can join you in the hospital
• Who will deliver the baby: your doctor only, or someone on call?
• Who will be with your children
• When your children will meet the baby
• What your pain management plan will be
• How many days you want to stay in the hospital after giving birth

Share your birth plan with your surrogacy agency, your partner, your OBYGN and/or midwife or doula. Communicate with everyone ahead of time to avoid misunderstanding and to set clear, manageable expectations. Don’t be afraid to ask your agency for help, either. They will know what typically works well and will be able to lean on their years of experience with other surrogates and Intended Parents.

And remember, you don’t have to be the strong, unwavering hero during the pregnancy or birth. Your feelings and opinions matter just as much as anyone else’s. Lean on your people when things get tough. Your support network of family, friends, medical staff, and agency is there to support you. They want to help—so let them!

Enjoy your months of the surrogacy pregnancy and the days leading up to the birth of the baby. This is the part of the journey that you are a pro at!

In our final blog of the series, we’ll talk about how to ease back into your life, taking time for self-care, and what to do about those post-delivery hormones.

What to Do If Something Goes Wrong in the Surrogacy Pregnancy

Even if all your previous pregnancies were uncomplicated, there is always the chance that complications could happen during a surrogacy pregnancy. Preeclampsia, high blood pressure, gestational diabetes–you will need to inform the Intended Parents of any of these diagnoses. If you need to deliver earlier than expected, they should be informed so they can make travel arrangements.

A good surrogacy agency will help you take care of any last minute details or changes due to your health. Trust them to communicate with your Intended Parents on your behalf.

While second and third trimester miscarriages or still births are not very common, they can still happen. Often, the reasons for them are not fully understood by the OBGYN or specialists. The loss of any pregnancy—no matter how far along you are—is heartbreaking for you, your family and the intended parents. Take the time you need to heal and grieve. Be kind to yourself and allow others to care for you, too. Even though the baby was not “yours,” you felt a connection to the life growing inside you.

Many gestational surrogates are highly empathetic, which means you may also feel the grief of the Intended Parents on top of your own grief. It’s important that you don’t internalize or bear the weight of their grief. Instead, communicate and grieve with your spouse. Speak with your agency. They may recommend a grief counselor for you. They can also help you know what to say to your children.

What about trying again?

If your agency and your OBGYN clear you physically and psychologically for another pregnancy, you may try again. Remember, your own physical and mental health and wellbeing are more important than the Intended Parents’ desire to have a baby. There will always be another set of Intended Parents you could match with, and another gestational carrier they could match with. If you do not carry their baby, that is ok. You need to do what is best for yourself and your family.