The practice of surrogacy is becoming increasingly prevalent in the United States. Data currently available from the Centers for Disease Control and Prevention and the Society for Assisted Reproductive Technology demonstrate the number of infants born to gestational surrogates has almost doubled from 2004 to 2008; from 738 infants to nearly 1,400. The growth of surrogacy will result in multiple implications for nursing practice. To effectively manage patients and those involved in the surrogacy situation, policy development and subsequent education is imperative. Furthermore, multidisciplinary collaboration is necessary to achieve optimal nursing practice.

Case:

 A 36 year old gravida 6 para 4 at 28 weeks gestation with twins, presented to Labor and Delivery. Previous history included a successful surrogate pregnancy and delivery. The patient reported this was also a surrogate pregnancy, and the biological fathers lived in France. The patient was supported by her husband and tocolytics were attempted without success. The patient delivered via cesarean section and the twins were admitted to the Level III NICU. The biological fathers were notified by telephone and began making calls to the NICU. The patient and her husband visited the twins in the NICU.

No documentation related to this surrogacy was available for two days. The nursing staff was confused and unsure of what was legally appropriate and at the same time tried desperately to figure out "the right thing to do?"

By day three, the "judgment" documents arrived via certified mail from the attorney representing the fathers who were named as the biological and legal parents. Subsequently, the judgment relinquished all rights of the patient regarding the twins. The fathers arrived late on day three. The patient was then denied visitation and later filed a complaint related to this decision. The two fathers stayed at a local hotel, eventually returning to France with their new son and daughter.

 Conclusion:

      As a result of changing family dynamics and the growing field of reproductive technology, surrogacy cases will continue to increase in the hospital setting. This case study illustrates the need for a hospital policy in order to effectively manage care, thus provide optimal care at the same time. It is vital to understand terminology as it relates to the parents involved. In addition, current state law as it pertains to surrogacy must be incorporated. Finally, true success resulting in positive outcomes for the surrogacy situation requires multidisciplinary support and education.

Keywords: Surrogate, intended parents, judgment of maternity and paternity