By Tracy Morris
The Facebook photo portrays a rare scene: a black woman with upswept braids tearfully wraps her arms around a white woman lying in a hospital bed with a blissful smile. Alisha Jackson had just given birth to the other woman’s child.
“This is it — why we do it. I cry every time I look at this photo,” Alisha’s caption reads. Last August, she delivered the much-longed-for first child of the other woman, who is in her early 50’s. Maternal age is one of several reasons that some people turn to surrogacy to grow their families.
The image is an emotionally moving illustration of one of life’s deepest connections of gratitude. But unlike typical social media photos proudly announcing a baby’s birth, this one remains posted only on a private support group page, out of public view. That level of respectful confidentiality is part of the bigger picture of the world of surrogate pregnancy.
Of the more than 1% of all infants born in the United States every year conceived using ART [assisted reproductive technology], several hundred are born through gestational carriers, also known as surrogate mothers. Beyond the tabloid stories and traumatic tales about celebrities and the very wealthy reportedly using surrogates (who are often depicted as witless or conniving) merely for convenience, the more ordinary reality is that thousands of children have been born to people who desperately wanted to be parents, an accomplishment they could only achieve with the compassionately collaborative agreement of appropriately compensated women who love being pregnant.
The 50-something, brand new mom in the photo hails from Africa. She and her husband now make their home in Houston, and they came to Prime Genetics, a surrogate-matching agency, after years of failed attempts to conceive and have a child. The agency’s director, Stacie Getgood, understood their infertility: she underwent an anxiety-filled pregnancy, being diagnosed with cervical cancer and refraining from fertility-impacting chemotherapy until after her son was born. But she also knew the couple’s special need for utmost discretion about their use of a surrogate to build a family.
“We have a lot of intended parents, or IPs, from other countries,” Stacie explains, “and some are from places where infertility treatment of any kind is not socially acceptable. And surrogacy, in general, has a particular type of stigma associated with it, even when it’s perfectly legal.”
Kristen Chambliss’ job as a psychologist specializing in reproductive issues requires she bring a deep understanding of surrogacy’s interwoven circles of concern. She helps both hopeful intended parents and generous surrogate candidates tease out and clarify dreams and expectations in a way that most people who have children never have to do.
And while some personality and mental health testing is involved, Kristen clarifies, “Our goal is to help people build their families, not be a gatekeeper. For the few of us who specialize in this field, we’re already clear that most of the IPs have been experiencing ongoing emotional trauma. There’s a lot for everyone to navigate.” She sees the psychology professional’s role as helping all the individuals deal with related internal conflicts, whether about surrogacy or family or personal issues, and those discussions cover territory from first establishing a surrogacy relationship all the way to thoughts about the resulting child’s future. Seeing a psychologist is certainly not in the normal list of pre-pregnancy events for most people. Kristen adds, “My work is as a team member, not as a judge.”
Nancy and her husband are embarking on a third “journey” with a gestational carrier in hopes of finally having a child — after more than 20 years of trying to build a family. Their experience has run the gamut from her own recurrent miscarriages to trying to quench her parenting desires through fostering special needs children and teaching Sunday school to using one of the country’s largest surrogate agencies. After their initial surrogate was unable to conceive within two IVF cycles, Nancy says she felt a little forgotten by the large agency.
“We’re already in our forties. We worry about how old we’ll be when our child finally comes along. So we decided to go independent and find our own carrier.” Not long after they’d established a relationship via Skype and signed contractual agreements with a surrogate in another state, they were more than disappointed on meeting the woman in person. “She misrepresented herself,” Nancy recalls, “and once we were face-to-face, she could no longer hide her true character.” One specific example: the couple is very religious and had been led to believe that the surrogate was, too. But that turned out not to be the case. Trust is paramount in successful surrogacy arrangements.
Vigilant about such “red flags” from her experiences within the foster care system, Nancy and her husband quickly ended the arrangement, with the help of her reproductive physician’s staff who then referred her to Prime Genetics. In hindsight, Nancy cautions couples who are considering surrogacy to let an agency do much of the work.
“[An agency] can screen surrogate applicants to hopefully avoid misrepresentation or even worse, scammers,” she says. “They can ask the interview questions that are uncomfortable to discuss, and if any problem does arise, there’s someone in between so you feel protected.”
Similar concerns are expressed by surrogate applicants who often describe their ideal IP as someone who will provide any resulting children with the utmost in love and life’s opportunities.
Another layer of security for everyone involved comes from the use of professionally managed escrow accounts and highly specialized attorneys. Simi Denson sees the surrogacy story from all sides — besides being an assisted reproductive technology (ART) attorney, she has twice given birth to other couples’ children. Her attorney role is to represent any party in the journey, and she strongly advises that separate representation (for the intended parents and the surrogate) be a part of the process long before any medical procedures begin.
“Even in the most congenial relationships, every person has interests at stake in a surrogacy journey,” Simi explains. She assists in creating contracts that first must meet certain state requirements and spell out “any expectations the IPs have for the surrogate’s conduct all the way from screening, to cycling [a term referring to the IVF process], pregnancy, labor and delivery, any subsequent financials, and specifics for the relationships after the child is born.” Her personal experience lends a special sensitivity to the rights of women who carry a pregnancy for another woman.
“Part of my job is to make sure the surrogate fully understands both her obligations and rights in each unique match,” Simi says. She adds a surrogacy agency can be beneficial, and that independent matches can work well, too — especially if the individuals are “very detail-oriented and don’t need to be walked through the process closely” — but she says that in no case should anyone enter into legally binding agreements without qualified legal counsel.
The complexities of surrogacy — variances in social acceptance and family laws, the crucial need for empathic interpersonal skills, and nothing less than people’s grandest hopes and dreams — can easily overshadow its pure and basic purpose: To help women and men have a baby. In virtually all cases, the choice by intended parents to use a surrogate’s services has come only after much deliberation. For many people, surrogacy is literally the only way to have a child with a genetic connection. This sobering fact is the most-cited reason by women who choose to be surrogates.
The real women who choose to be gestational carriers are a far stretch from the rare horror stories, but occasional exploitative news items or reality TV shows often provide the biggest chunk of data most people have about surrogacy.
Dominique Side is an organization consultant and realtor who has four children with her EMS RN husband.
“I didn’t know what to expect the first time, so I was probably a little guarded,” she recalls. “I let [the intended mother] guide the growth of our relationship, which turned out to be like a sisterhood.”
Now on her second surrogacy journey, Dominique feels more prepared with what to expect. And in this case, that will include six weeks of “pelvic rest” following embryo transfer, a highly cautious choice by the fertility specialist and a commitment that impacts her husband as well.
“But he’s amazingly supportive,” she says. That’s crucial in the selection of surrogates.
Stacie Getgood explains, “The partners of surrogates have to be fully on board, and for carriers who are single, we need to know who their support system will be during pregnancy, whether that’s other family members or close friends.” In any case, Stacie can often be found wearing medical scrubs so she can be available to drive from embryo transfers to deliveries all over the Houston area. “Holding hands is by far one of the best parts of my job.”
During Dominique’s first surrogate pregnancy, which was happily uneventful and resulted in a baby boy for a couple experiencing secondary infertility (they had already given birth to a prior child and could not conceive again), her husband was in full agreement and picked up household slack like a champ. But it was only after her delivery that she learned just how agreeable he was with the whole idea.
Dominique started out a few years earlier as an egg donor, after hearing and being moved by a woman’s infertility story. But the total anonymity and lack of contact left the young mother feeling like her own journey to give was incomplete. After she’d completed her own family, she learned about surrogacy. She now says that aside from birthing her own children, having a baby for another woman was her “proudest moment and a feeling that just cannot be duplicated.”
“My husband said that moment changed his thinking about surrogacy forever. He was always supportive, even in light of related sacrifices we all had to make. But not long after I delivered, even in the midst of me recuperating and pumping and still not being 100 percent yet, he asked, “Do you want to do it again?” It was so reaffirming.”
Alisha, whose new blended family includes six school-aged children, had a similar experience.
“At first, he thought that this surrogacy idea was just ‘neat’,” she recalls. But after her delivery, her husband’s proud Facebook posts — including one to a “Submit Your Hero” page of Alisha in her hospital nightgown — ranked him high by friends as the kind of supportive partner every woman wants.
Like most moms, Alisha’s time is spent juggling schedules and trying to balance the needs of her children, her husband, and herself. Whether because of her natural open-mindedness or her prior years in the Coast Guard, the Texas native was comfortable interacting respectfully with her Nigerian IPs, even around topics that might be a little challenging to discuss frankly, like religion or nutrition during pregnancy.
“I learned a lot about their culture and ways, and we shared a mutual respect about everything,” she says. “Even if we differed about things, our same goal was always what’s best for the baby.”
If there are any outstanding characteristics about the women who become gestational carriers, it may be the ability to not just feel great compassion for others, but to express it, too.
Dominique describes how being a surrogate has impacted her life. “I never truly understood all of the ways that a woman can have fertility problems, and how much the experience consumes their lives. When I encounter something of that magnitude, it makes me feel smaller. I appreciate my own children even more now than ever before — what a miracle they are… As much as I wanted to help someone else, being a surrogate has changed me way more than I could have imagined. Sometimes I think maybe I was drawn to surrogacy so I could realize this part of me.”
The surrogacy journey to build a family might be likened to a village of ordinary women striving for the same simple, beautiful goal, even if it requires extraordinary means.