Now that we are well into the 21^st century, women in their 40’s are no longer an exception but rather a common recipient of prenatal care.  With the advances in technology, as well as a better understanding of the reproductive system, including how to manipulate physiology to achieve a pregnancy, we are seeing men and women becoming parents in a variety of ways.  Through artificial insemination, IVF and GIFT, it is not uncommon for a birth mother to hand over the newborn to the intended (often biological) couple.  However, as the concept of a surrogacy pregnancy has become more recognized in the state of California, so has the volume of local, national and international issues.  We have noticed the number of surrogacy pregnancies increasing over the last 5 years in our facility.  Moral, ethical and financial problems came to our attention so a multidisciplinary team, including nurses, physicians, administrators, social workers and risk managers, convened. The Problem Statement issues such as timely notification for successful financial screening, atypical involvement of a third party in medical care, international composition of patients with diverse expectations, minimal legal regulations, patients touching a wide range of services within the Medical Group and the Medical Center, were acknowledged.

The proposed Solution Summary included defining portals of entry into care, sharing databases, admissions/financial screening, hospital policies and procedures, understanding our risk and potential exposure.  The task delegated to the clinical care providers was to develop the policy and procedure to support our care.  Content included definitions, judgment papers, banding, and release of information, visitation, human milk feeding, birth certificate, guest policy overnight stays, transport/transfer, discharge and fetal death/demise.  As the team accomplished each of the directed goals, we saw the importance of each element in an effort to truly provide quality cost effective care to this high risk perinatal patient population.