Surrogacy is becoming increasingly common, with both couples and single men and women turning to a surrogate as a way of starting their family. Midwives need to be able to give excellent and individualised care for the surrogate (this is the preferred term) as well as the intended parents or parent.
Our new clinical briefing on surrogacy is aimed at midwives and maternity services. We want to ensure that midwives and maternity support workers know the legal situation of surrogacy as well as giving some practical tools to help them in the care of these families. Our i-learn module complements our briefing with additional information and learning points.
In the UK, surrogacy is undertaken on an altruistic (expenses only) basis. UK-based couples and individuals can also choose to use commercial surrogacy organisations which are based abroad. However, as the pregnancy and birth are in the home country, midwives do not get involved in these cases.
The surrogate should be the focus of maternity care from their midwife and others in the maternity team. We know that the actions and attitudes of healthcare staff can have a significant impact on the experiences of surrogates and intended parents so compassionate care and understanding should be given to all.
A birth plan is normally part of the surrogacy agreement prepared by the surrogate and intended parents or parent, ideally before conception. This sets out the many issues commonly found in birth plans, such as place of birth and who would be present at the birth. A care planning meeting should be held from 32 weeks gestation between the midwife, surrogate and intended parents or parents to discuss the birth plan and early postnatal care.
It is helpful to consider:
- whether the surrogate wishes to see or touch the baby at birth;
- if the intended parents are not present at the birth, when the baby will meet them;
- who wishes to cut the cord and announce the baby’s gender;
- who will give skin to skin contact to the baby?
Legal parenthood lies with the surrogate and her partner (if she has one) until it is transferred to the intended parents through legal process. This currently can only be applied from six weeks after the birth, although the law is due to change in 2022. Staff should recognise that intended parents or parent can feel vulnerable and anxious as the time of birth approaches. They have no legal standing and their relationship with the surrogate can vary. The birth may also be a time of psychological distress to some intended parents due to personal history of fertility or loss.
The RCM recommends:
- Hospital Trusts and Boards should publish local guidelines for surrogate pregnancies, based on the Department of Health and Social Care 2021 guidelines.
- Hospital trusts and Boards should have an identifiable lead for surrogacy who can provide expertise, advice and support to health care professionals.
- Electronic records should be able to record surrogate pregnancies for better data collection.
- There should be more research into how surrogates and intended parent/s should be best cared for and supported by midwives and other maternity staff.
- Midwives, MSWs and others in the maternity team should receive education and training on surrogacy.
Surrogacy organisations in the UK: