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"Medical Care in Surrogacy - Consideration of the Surrogate's Rights"
By: Gretchen Wetzel, a surrogate mother
When a woman decides to become a surrogate mother, she almost always has experienced pregnancy and birth at least once. Usually she has an established relationship with an obstetrical team who has cared for her during her previous pregnancies. What happens when she becomes a surrogate? Who will provide her healthcare, and who will make decisions about the specific care provided during pregnancy and birth?The prospective parents (commissioning couple) are also likely to have a well-established relationship with an infertility practice. In gestational surrogacy, the biological parents' infertility specialists usually handle the IVF procedure. The same infertility practice may be involved in traditional surrogacy requiring artificial insemination, or this procedure might be done by the surrogate's physician. Once the pregnancy is confirmed, however, it is not likely that the surrogate will be cared for by the infertility specialists. Her care is transferred to another obstetric practice.
The American College of Obstetricians and Gynecologists has published a Committee Opinion on Ethical Issues in Surrogate Motherhood. (No. 80, 1990, Washington, DC). Two of the eight policies proposed in the opinion are:
1. The surrogate mother and the commissioning couple should be regarded as distinct parties agreeing to cooperate for a defined purpose. Each party should be separately represented, both medically and legally.
2. The surrogate mother, in consultation with her physician, should be the sole source of consent for medical decisions regarding pregnancy and delivery.
These policies are proposed in order to ensure that a surrogate does not sign away her rights to direct her medical and legal care. One of the "danger signs" that was present in the infamous Baby M case was that the adoptive couple sought to direct the surrogate's medical care, questioning the advice of the surrogate's physician and even prescribing medications.
A surrogate should choose her own medical caregivers. Surrogacy contracts are unethical and illegal if they ask a surrogate to waive her medical rights. She may not be coerced by the commissioning couple or their physician(s) to undergo any medical procedures or tests during pregnancy, labor, and delivery that are against her wishes. These procedures include, but are not limited to, ultrasound, chorionic villi sampling, amniocentesis, or termination of pregnancy.
The surrogate and commissioning couple should consider their plans for medical care and testing in advance of deciding to work together. Each party should understand the risks and benefits of any procedure. The commissioning couple should make the surrogate aware of their feelings regarding prenatal care and testing at the start of the relationship. In any case, the final decisions as to appropriate care and testing must be made by the surrogate and her chosen medical team.
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