Whose Baby Is It? an International and Intrafamilial Surrogate Case Study

Background:

Although statistics are inconsistently reported, existing data reveal a dramatic increase in surrogate births.  Medical literature contains many articles about the ethical and legal issues associated with surrogacy.  The American College of Obstetricians and Gynecologists (ACOG) has guidelines on surrogate motherhood for physicians and the American Society of Reproductive Medicine has guidelines for patients. However, little information is available for nurses and other healthcare providers to guide care in the hospital setting.  Many hospital policies do not address surrogacy or are not flexible enough to apply to variations that likely exist in these complex cases.

Case:

A gestational carrier was identified prenatally when scheduling a maternity pre-admission appointment.  The intended mother was the surrogate’s aunt and the father of the baby was the aunt’s husband.  Department representatives from patient registration, accounting, pre-admission, legal, and care coordination met with the Director and Clinical Nurse Specialist of obstetrics.  We identified questions, concerns and resources, and developed an action plan to obtain solutions for the issues.   We contacted the Office of Vital Statistics and attorneys for the surrogate and intended parents.  Legal documents were shared prior to hospitalization to determine custody and decision-making authority. 

 We created a birth plan to direct staff in managing care for both families.  It specified individual roles in the case, identified who would be present for the delivery, separated the pre-registration and admitting process, payment accounts, and consent forms for surrogate care and infant care.  It outlined data for inclusion on the infant’s identification bands, crib card, and birth certificate and how to unlink the electronic medical records of surrogate and infant after copying delivery data.

The intended parents came to the United States specifically for the scheduled cesarean birth and returned to their home country one month later.  They stayed in a hospital room while the baby was hospitalized and fed expressed breastmilk from the surrogate. Nurses couldn’t match the milk to the baby per our usual procedure, so we allowed the two families to pass expressed milk directly between them. Post-discharge infant care was established while the family stayed with local relatives, pending completion of legal documents.

Conclusion:

Creating a plan prior to admission helps alleviate stress and questions regarding a complex case and keeps patient care the priority.  Familiarity with state laws and hospital policies regarding surrogacy and adoption is extremely helpful in being prepared.

Keywords:

Surrogacy, gestational carrier, surrogate birth, adoption, assisted reproduction