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 significant.

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.