The Organization of Parents Through Surrogacy
 




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CHOOSING SURROGACY AND GESTATIONAL CARRIER TO BUILD YOUR FAMILY
by: Andrea Mechanick Braverman, Ph. D.
Director of Psychological Services
Pennsylvania Reproductive Associates

 



It's a brand new world for each generation. What appears to be remarkable for one generation may be ordinary for the next. When I got into the infertility field, in vitro fertilization was a therapy for married couples only where the woman had blocked tubes. We've come a long way, baby. Test tube babies are no longer extraordinary. Infertility is no longer a big secret, and there are articles and resources available. This next generation will grow up in a world where IVF is standard operating procedure for infertility.

Are surrogacy or gestational carrier programs standard operating procedure for the next generation? Hardly. But will this next generation react to surrogacy and gestational carrier in the same way as current generations. I doubt it. Families have changed in the 1990's. Families are made up of kids with just moms, kids with just dads, kids that were adopted, kids that were adopted from another country, kids with grandparents, and kids with a mom and a dad. Watch Sesame Street and you will know that today's generation understands that a family is a group of people that live and love together. I am impressed with how generations see things differently.

Surrogacy and gestational carrier make up different kinds of families and I have had the opportunity to watch these families come to be over the last decade or so. The need for surrogacy and gestational carriers has also grown as men and women who wish to have a family are educated about the options of both surrogacy and gestational carrier.

It always strikes me that people are surprised by surrogacy and treat non-biological parenting as something brand new. Hardly. Since the beginning of time, we have had the capacity to care for children that are not ours genetically. And, since the beginning of time, we have had the capacity to give to others and care for each other as a community. It is pregnancy and genetics that we hold sacrosanct - a completely different entity from any other life experience.

I have come to observe that pregnancy and parenting is on a continuum not in discreet categories as most people observe. People feel very different about their gametes, their eggs and sperm, and people certainly feel very differently about parenting. In our program, we have both a gestational carrier and ovum donation program. Most of the women who volunteer to be gestational carriers have told me they would never consider and/or feel comfortable donating their eggs but have no problems carrying a pregnancy. Most of the women who volunteer to be ovum donors would never consider being a gestational carrier or a surrogate.

Indeed, research has shown that people feel very differently about what infertility treatments they would consider. Some of us would never consider fathers donating sperm to sons, yet others see this as the best option. Culture plays a huge role on what reproductive options we would consider. Research also shows us that it is not age, religion, or gender that plays the biggest role on how willing someone is to consider using third party reproduction such as a donor or surrogate or carrier -it is personal experience with infertility. A simple show of hands in any lecture room would most accurately predict whether you would be willing to consider using a surrogate. By the way, having experience with infertility through a friend or family member is not good enough. The impact is truly made when you have personal experience.

But surrogates and carriers don't have personal experience by definition. So the most commonly asked question of me as a psychologist is "Why on earth would a woman do this?" A fair question. In her 1994 book, anthropologist Helena Ragone summarizes the issue nicely "Until now the image of surrogate mothers has been principally shaped by media, legal, and scholarly portrayals of them either as motivated by monetary gain or as unwitting, naively altruistic victims of the patriarchy, mother who have been coerced into giving up their babies". (page 52)

Previous research has looked at the stated motivations of surrogates and carriers. Obviously, statements included a wish to help others, etc.... Overall, it is a strongly held belief that the surrogate or carrier can make a difference in the world. E.g. I may not find a cure for cancer.....

The media always likes to cite that surrogates and carriers are motivated by remuneration - though the women place this usually last on their lists of motivations. My experience is that compensation is part of the motive but not the main motive. Motivation is made up of many reasons. The desire to be a surrogate or carrier is not constructed from a single fabric, rather it is stitched together in a patchwork quilt. Compensation may be part of the pattern. Often the money is targeted to help the carrier's own family. Carriers feel that the compensation is earned for the discomforts and risks of pregnancy.

What has emerged is the concept that motivation for compensation constitutes a "bad" carrier while uncompensated carriers are "purer" or more altruistic. There is no research that has come to this conclusion. The carrier/surrogate does receive what she perceives as many rewards for her participation. Money may be a part. Another part may be the chance to be pregnant again. Another may be the chance to truly make a difference in another couple's life or to forge a unique friendship. Certainly, participation as a carrier or surrogate is exciting - different from the humdrum part of everyday workaday life as a homemaker or worker. These women see themselves as very capable, intelligent individuals who understand the risks and benefits to being a volunteer carrier or surrogate. The paternalistic viewpoint that they should be protected from themselves angers them.

Counseling is, therefore, an essential part of the surrogacy or gestational carrier process. For if women are truly considered capable of making their own informed choices, which I beleive they are, then they must be able to have the full information before getting into the surrogacy or gestational carrier situation.

Potential parents and carriers need to understand the emotional, legal, and medical demands of their programs. As best as possible, parents and carriers need to work out ahead of a pregnancy what type of relationship they would like to have together during pregnancy and after the child is born. Do the parents intend to tell the child about his or her origin - genetic or gestational? Most of our parents start a baby book with a picture of the embryo and a picture of themselves and their carrier in the recovery area after embryo transfer.

The carrier/surrogate needs to anticipate their feelings ahead of a pregnancy. I always tell these volunteers that it is easy to imagine the "good stuff", but it is our job to try to anticipate the less glamorous and "hard stuff" of going through this experience. We address how her children may be effected. To date, the children of the carriers we work with have had little difficulty with the issue of mom carrying a baby for someone else. But there is little empirical data to address this issue.


Among the issues that are raised and explored are:

-what will this pregnancy be like for the woman and her partner?
-how will her children react?
-how will the carrier or surrogate help her children deal with their feelings?
-how will her family react? her community react?
-is there anything in her psychosocial history that may effect/influence her experience?
-what feelings will arise during the pregnancy towards the baby?
-what are her expectations from the experience?
-what if she does not get what she wants emotionally out of the program?
-what if she does not get pregnant?
-what if there is a multiple pregnancy?
-what will it be like if she has medical complications with the pregnancy?

These are only some of the questions that need to be raised. In addition, in our gestational carrier program, the evaluation and counseling is an ongoing process. Indeed, feelings change over time and through experience, and carriers/surrogates need to have the opportunity to explore these new and different feelings as events unfold. We have had volunteer carriers who have elected to discontinue participation because events in their lives changed or because they tried multiple cycles unsuccessfully or other reasons.

There are emotional risks to everything we do in life. Certainly I would not suggest that choosing to be a carrier or surrogate is risk-free. I do believe that counseling can reduce the risks. The best analogy I have is dating and marriage. Every day, couples get married believing, hopefully, that this relationship has the ingredients necessary to make a life commitment. Every day, couples get divorced realizing that the relationship has failed. In a surrogacy or gestational carrier arrangement, it is critical that both carrier/surrogate and intended parents alike realize that the relationship may not meet their expectations and be willing to take that risk. Even when the relationship fails, both surrogate/carrier and intended parents need to be willing te work together to meet the basic needs of the child. If there is no pregnancy, then the group must have the courage to end the relationship and work with someone else who better meets their needs.

Ultimately, gestational carrier and surrogacy relationships are based on trust. Although we do ongoing psychological screening and counseling on both carrier/surrogates and on the parents, the process is dependent upon everyone doing what they say they will do. Carriers/surrogates trust that the parents will want, love and take care of this baby and take care of the carrier/surrogate emotionally, and the parents trust that the carrier/surrogate will take care of the baby by taking care of herself physically.

There is not enough time to go into the myriad of details of the psychological issues surrounding gestational carrier and surrogacy. Let me leave with you with some of the words from the women who applied to our program when asked what message they would write to the child(ren) born through their participation as a gestational carrier:



"Dear Child,

Several years ago I became close friends with a very special couple. Their love for one another was so strong that they decided to make a new life to share this live with. Their love for this life was indeed so strong that they decided to include me in their lives so that this life could be possible. This was a wonderful experience for me. It brought new friends into my life and helped fulfill a need of mine to contribute my time in helping other people to achieve their dreams. This experience happened over eighteen years ago and if I had to, I would do it all over again. God gave you parents' love a new life and at the same time touched mine.

Love Always,"



"Dear Child,

The day you were born - WOW! What a very special day. You see, a lot of great people had something to do with this day. The most important ones - being your parents. They wanted you for so long and tried so hard. But sometimes people can't do things alone and they need help. That's where I came along. By now I've already had my children and am very happy with the ones I've got. I couldn't imagine not having them in my life, just as I couldn't imagine not being able to have any children. Then I learned I could help another couple fulfill their dreams of having a family and that couple was your parents. And through the wonderful world of medical research and the doctors who specialize in making dreams come true - you were born.

And even though I have given birth to you, it is your parents who gave you life - which we all celebrate today!

Love, "

 

2007 OPTS - The Organization of Parents Through Surrogacy