Selection of Surrogate Mothers
by Robert L. Meyer, Ph.D.
July 28, 1997
The critical elements which help to
determine the appropriateness of a woman to be a surrogate are of vital
importance in that they may, more than any other decision, determine the success
of the surrogacy. The obvious differences between this relationship and that of
an adoption is that the decision to give up the child is made well in advance.
It should be a well thought-out decision, one that has undergone scrutiny, and
one that in the end, as the adoption occurs, is a positive, loving experience
rather than a tormenting, difficult one. Although all individuals experiencing a
pregnancy worry or possible things going wrong which may interrupt the
pregnancy, for example spontaneous abortions or illness, within the surrogacy
relationship there are the additional factors of the psychological and emotional
health of the surrogate and her capacity at the end of the gestation period to
separate with the child and give it to the adopting family.
Many factors go into the selection of a surrogate, including a complete
background investigation which looks into the mother's health as well as her
psychological and emotional history. Women who have had past histories of severe
psychiatric disturbance, particularly involving personality characteristics, are
at higher risk of being unable to fulfill their commitment and contractual
relationship at the end of pregnancy.
Women who have had a history of alcohol or drug abuse may be at risk, not only
during the pregnancy, i.e. using substances and harming the fetus, but also as a
reflection of some other emotional disturbance in their background that may come
into play at the time of delivery. Beyond the physical and psychological
characteristics, the individual's social or immediate emotional environment is
Women who become surrogates are not alone in this world and are not living
isolated lives. All have families. Many are married. Many have previous
children. In fact, many of the best surrogates are those who have had children.
The decision to become a surrogate of course is personal, but it can be easily
influenced by those around. If a woman does not have the support of her family,
has not thought through how she may explain to her children how this "brother',
"sister" or "child" will be given away, or has not explained to friends or
others who have impact upon her life difficulty may arise. As the pregnancy
evolves and people begin asking questions, the woman must come up with answers.
In our society, a surrogate's role is not completely understood or accepted.
There will be eyebrows raised. There will be comments made. An individual needs
to be psychologically hearty enough to understand that what they are doing is
serving a worthwhile purpose and that they can raise up beyond these forms of
criticism. Further, one would expect that the best individual for this role will
also have family members who support her decision as well as tolerate any
criticism that may arise from others. As such, it is important to evaluate
others in the family to be assured they are comfortable and supportive of the
arrangement, that they understand what is occurring, and that they do not put
negative, undue influence on the surrogate.
The individual psychological make-up of the surrogate becomes a critical aspect
after the physical, social and environmental issues have been reviewed. There
are several aspects that need to be examined, such as the psychological
heartiness of the particular individual. This is defined as the individual's
ability to tolerate criticism, to go her own, to not be influenced by others,
and to make a decision and stand by it, regardless of what others may say or
think of her. Individuals who have good ego strength have been able to
demonstrate independence of thought and have strong personal identities of their
own, making the best candidates in this regard.
Moving beyond ego strength, an evaluator needs to look at the surrogate's
experiences at pregnancy. Many candidates talk about pregnancy as a wonderful
time in their life, a time when they feel best, that they enjoy being pregnant.
These women did not experience illness, but in fact felt more robust, healthier,
and had a positive self-image. They did not have undue problems with the changes
in their body, including the gaining of weight. There was not a history
following their pregnancy of post-partum depression. As stated, from their own
experience they enjoyed this time. Many women speak of how much they enjoyed
pregnancy and at the same time did not particularly enjoy child- rearing, that
they had their own children, had no need for more children, and were now
prepared to go through this pregnancy and separate.
Previous experiences with separation and loss also give good insight into a
candidate's ability to fulfill her role. Her past history must demonstrate that
she was capable to dealing with separation issues, for instance she did not
experience unusual abandonment fears or she was not looking for the child to
somehow make her complete. She must show that in the past she has dealt with
separations such as deaths, divorce, moving, loss of friends, even the loss of
animals or pets, in a psychologically healthy manner. Simply stated, she
tolerated separation without deepening into some form of depression. As one
surrogate described to me, her role was simply to "rent her womb". She
understood clearly that although she was going to do everything she could
protect this fetus, at the end of the pregnancy the child was to be given up.
She had thought out the separation from this child and had not allowed herself
to psychologically bond with the child as an expectant mother who intended on
keeping the child might. She viewed the child as a gift to others.
Another characteristic which is very important is the motivation or the
underlying reason for surrogacy. Obviously, what comes to mind immediately are
the financial benefits that may be reaped by the surrogate. However, financial
reasons alone are not a sufficient reason to recommend a woman for surrogacy. In
fact, financial reasons themselves, if that is the only motivation, may be a
risk indicator that this particular woman will not succeed as a surrogate. The
process of having a child within you and giving it up is difficult. However,
throughout history people have raised themselves above difficult situations and
done things for others out of altruistic concern; altruism being the highest
level of psychological defense that exits. Altruism is a fundamental
characteristic of a positive surrogate. The surrogate must feel that she is
giving a gift to others, that she is doing it to help someone else enjoy a
child, and that she is helping someone else fulfill her life. What stimulates
the altruistic quest may be varied. Some women, in the past, underwent abortion
and have carried a lingering sense of guilt because of this. They now feel they
can resolve this issue, to some extent, through the altruistic defense of
becoming a surrogate. This can be an appropriate resolution of this issue. Some
women have other altruistic motives for their giving. Truly, it is this
altruistic motivation that is protective and most indicative of a successful
surrogate candidate. The altruism itself helps the individual prepare for the
separation. They experience what they are doing in a very positive light and
this insulates them from the negative criticism in the community. They
understand that they are doing a wonderful thing. Those who simply are motivated
by financial means are at risk of experiencing what psychologists have long
referred to as cognitive dissonance. They create for themselves their own
psychological dilemma. In the end, they may begin to feel that they have simply
sold out. They may feel they can financially benefit more from holding onto the
child. They will not be able, beyond delivery, to think back at what they have
done as nothing more than, so to speak, selling out, which may potentially
create for them a great deal of emotional pain and difficulty. The best
candidates for surrogacy are those who say during interview "I would be doing
this for nothing because it's not really money motivating me to do this."
The evaluation of a surrogate is an in-depth process. It involves collecting
extensive social history, evaluating family members and other support groups,
and obtaining a clear medical as well as alcohol and drug related history. It
also involves the psychological exploration of the surrogate as to what her
motivating factors are and how she will manage both the separation and whatever
lingering memories she might have about the experience as future passes. The
evaluator who takes on the role of evaluating the possible surrogate is taking
on a very important position. The evaluator needs to recognize that by approving
the surrogate, he or she is participating in a legal arrangement that is subject
to legal complications and ramifications if surrogacy fails.
Dr. Meyer is the chief psychologist for Horizons Behavior Health, L.L.C. in
Woodstock, IL. He is also an Assistant Professor at Northern Illinois University
and active in a number of professional organizations. He has a sub-specialty and
five years experience screening surrogate mothers.