Surrogacy (1194)

• The surrogate mother may choose to include the intended parent/s in her appointments however, she should be encouraged to have at least one appointment on her own to discuss any confidential medical or personal history and any current concerns.
• The surrogate should be offered all routine screening tests during pregnancy and it is her decision whether to have them. Results should be directed to her and only shared with the intended parent/s with her consent.
• With self-insemination there is a risk of transmission of infection to the surrogate and the unborn baby. It is important that she is advised and offered testing. If a transmittable disease is identified, it cannot be shared with the intended parent/s without consent from the surrogate.
• Community/ named midwife should inform their Team Leader/ Manager of any known surrogacy arrangements. The unit lead midwife and Director of Midwifery should also be informed.
• Care should be offered to all involved in a non-judgmental and supportive manner.
• Midwives should ensure that they keep accurate and contemporaneous records of discussions and decisions reached.
• Confidentiality is vital and disclosure made on a need to know basis. Any reference to the surrogacy arrangement in the medical records should only be made after discussion with and permission from the surrogate mother.
• The needs of the surrogate mother are always given priority and all (final) decisions rest with her. We would encourage the surrogate mother to be accompanied by partner/ next of kin during delivery.
• Information to be given to the intended parent/s must be sanctioned verbally by the surrogate mother and documented in the records.
• The surrogate and intended parent/s should be encouraged to attend at least one appointment together antenatally to identify their plans / wishes with respect to:

• antenatal screening
• parenthood preparation
• birth plan
• birth partners
• infant feeding
• immediate care of baby
• postnatal visiting / accommodation for the commissioning parents. Intended parent/s will be supported to stay with the baby, ideally in a side room where possible. It should be discussed that limitations within the unit may exist if at capacity and this will be addressed at the time of admission. Consideration should also be given to outline appropriate release of information and intended cares of newborn in the event the surrogate mother is incapacitated immediately post birth. It is important to remember and communicate that legally, intended parents have no legal rights to make decisions for the baby in the immediate post birth period, regardless of biological relationship to child. These conversations should be clearly documented on Badgernet.
  
  
• Where a termination of pregnancy is being considered and the relevant legal conditions are met, the surrogate makes the final decision about a termination. The intended parent/s should be included in any counselling, information sharing and decision making only after the surrogate has given consent.

The surrogate can have up to two birth partners of their choice. This may include having the intended parent/s present for some or all of the labour and birth. Information about the birth should only be given to the intended parent/s with the surrogates consent.

Staff should consider that intended parent/s may feel vulnerable or anxious at this time as they have no legal standing.

During the intrapartum birth plan discussions it is important to consider:

• If the surrogate wishes to see or touch the baby at birth
• If the intended parent/s are not present at the birth, when will the baby meet them
• Who wishes to cut the cord and announce gender
• Who will give skin to skin contact

The immediate postnatal period is a time of great emotional upheaval, which may be compounded in a surrogacy arrangement and great sensitivity is required in handling both the surrogate and the intended parent/s. Where there is conflict the midwife must focus her care on the surrogate mother and the baby. Seek support from senior Midwifery team in this instance.

• Usually, the baby will be fully cared for by the intended parent/s from birth and so parenting support, advice and decision making should be directed to them until they and the baby are discharged. It is important that the postnatal ward staff are clear about the wishes of the surrogate and the involvement of the intended parent/s.
• Wherever possible, surrogates and intended parent/s should be accommodated on the postnatal ward, ideally in separate side rooms and away from other mothers on the ward to maintain privacy at a sensitive time. The need for the baby to be cared for by one or both intended parent/s, should not be limited by normal visiting hours or restrictions on overnight stays.
• A child born to a surrogate mother must be registered as her child.
• The surrogate may wish to be discharged independently from the baby. The surrogate mothers care should be transferred to her local community team and she should be cared for as per GGC postnatal care guidelines.
• Handing over the baby will take place following discussion and agreement with the surrogate mother. The outcome of this discussion and agreement must be documented in the maternal and neonatal Badgernet records.
• If the baby and surrogate are discharged at different times and the baby is not already being cared for by the intended parent/s, transfer of the baby to the intended parent/s should happen in an appropriate place on the hospital premises. They should not be forced to leave the premises to complete the transfer. Under no circumstances should the baby be discharged with the intended parent/s without the surrogate’s consent. There is no need to inform a social worker or lead for safeguarding unless there are safeguarding concerns.
• Once discharged, the intended parent/s and baby will require care from the community midwifery team. The ward midwife must ensure the local community team, including the intended parents registered GP, are informed of the birth prior to transfer home. This may be an out of area discharge, so it is vital that during the antenatal period the intended parent/s’ address, telephone number, local hospital and GP details are recorded in the surrogate’s antenatal records.
• The HFEA advises that, until the parental order comes into force, strictly speaking it is the legal mother who should give consent for any newborn testing. If the baby is discharged with the intended parent/s, there needs to be consent from the surrogate for a healthcare professional to perform screening tests such as the NIPE test, newborn blood spot, hearing test and vaccinations.
• Where the surrogate has given her consent for the intended parent/s to care for the baby, it is usual practice for the intended parent/s wishes to be considered by staff regarding the treatment of a sick baby. The intended parent/s should be included in any important decisions regarding the health of the baby, whilst recognising that the surrogate has the overall responsibility until a parental order has been issued (British Medical Association, 2008). 
• The intended parent/s, even if they have taken the child, have no legal relationship with it and no rights in law until a parental order has been made or until the intended father is jointly registered on the birth certificate. Until then, the surrogate mother has legal responsibility for the baby.
• Intended parent/s will apply for a parental order (if the genetic makeup of baby comes from either or both of them) or an adoption order where gametes from either of the intended parent/s have not been used. Until this time (6 weeks – 6 months) the legal mother is the surrogate mother. In Scotland, having the name of the father on the child’s birth certificate will ensure he has full and equal parental rights and responsibilities.
• If there are concerns about the welfare of the baby, they should be raised and actioned in accordance with the appropriate safeguarding policies. 

Birth certificate – is issued by the registrar of Births, Deaths and Marriages. Normally the birth of a surrogate baby will be registered by the surrogate herself and her name will be entered as the mother. The person named as father depends upon certain rules contained with the Human Fertilisation and Embryology Act 1990 and the Registration of Births, Deaths and Marriages Scotland Act 1965. Birth father – is the surrogate’s husband unless it can be shown that he did not consent to the surrogacy.

Birth mother – is the legal term for the woman who gives birth to a child as a result of a surrogacy arrangement regardless of whether the child resulted from her egg or not, in accordance with Section 30 of the Human Fertilisation and Embryology Act 1990.

Children (Scotland) Act 1995 – is the main legislation for matters to do with children and families. Its relevance for surrogacy lies mainly in the principle of parental responsibility and in the availability of parental responsibility arrangements.

Intended parent/s – the person/persons who have made an arrangement with a surrogate mother to carry a child for them.

Human Fertilisation and Embryology Act 1990 – for the most part effective from October 1994, this is the main piece of legislation relating to fertility treatment. A Parental Order can be made under S30 of the act effectively transferring rights over the child held by the surrogate (birth) mother at birth to the commissioning parents. The act also provides that the surrogate’s husband is the birth father of the baby unless it can be shown that he did not consent to the surrogacy which the act calls “treatment”.

Surrogacy organisations in the UK:

Brilliant Beginnings - Surrogacy in the UK and abroad

COTS Surrogacy UK | Home

SurrogacyUK

Cafcass

Further Education for staff can be found via the RCM online learning package below:

Surrogacy - Royal College of Midwives