There is no general state or national policy on how a hospital should manage a surrogate birth. It is up to each individual hospital, and the management and staff within that hospital, as to how they accommodate a surrogate birth. Basically, surrogacy requires that the existing maternity policies, that are set up to facilitate parenting and bonding between the birth mother and baby, be adapted to facilitate parenting and bonding between the Intended Parents and the baby. A hospital may or may not have had experience with a surrogate birth previously, and even if they have, your birth scenario may be different, so it is important to have discussions with your hospital and your obstetrician or midwife (if applicable), well before the birth, to educate them about surrogacy and to mutually come up with a plan that best meets the needs of your surrogacy. Remember, surrogacy is legal, even if the hospital policies have not yet caught up, so should be accommodated and respected by the hospital.

• Talk to each other first about your ideas about your birth plan, then talk to the hospital about what their policies are and how they can be flexible, and then work together with your doctors and hospital to make a plan.
• If possible, speak with multiple hospitals about how they might accommodate a surrogate birth so you can choose the one that suits you best
• Speak to the most senior people you can eg the Head of Maternity, and/or Hospital Director, and get any agreements in writing and signed off by them. Bring the signed plan in with you when you come to hospital, so that staff on duty can refer to this when drawing up your birth / admissions plan
• The surrogate is in charge of all decision making in regards to her body and the birth. She has the right to change her mind at any time about any aspect, regardless of the birth plan you may have agreed upon and put in place.

Roles and Terms

• How would you like to be referred to by hospital staff eg Surrogate or Birth Mother / Father, Intended Mother / Father or Mum and Dad?

Antenatal Classes

• What is available and who can and will attend?

Birth

• Ideal Birth Scenario – what type of birth, what type of room, pain relief, who will attend?
• Support person for Surrogate ( in addition to Intended Parents)
• How will the Surrogate separate from and the Intended Parents receive the child post birth?

Alternate Birth Scenarios

• Induction
• C-Section – planned / emergency
• Complications for Surrogate
• Complications for Baby
• Complications for Both

What might happen? Who can attend? How will the Surrogate separate from and the Intended Parents receive the child post birth? Will there potentially be a loss of the Surrogate witnessing the Intended Parents seeing their child for the first time? Can this be videoed?

NICU

• How will the Intended Parents be able to visit their baby?

Hospital Accommodation

• How will the Intended Parent/s be accommodated to care for their baby?
• Would the surrogate prefer her own room or to room share? What is available?

Feeding Baby and Lactation

• Expressed Colostrum /Breastmilk
• Formula Feeding or mixed feeding
• Medication to shut Birth Mother’s milk supply down post birth
• Induced Lactation by Intended Mother
• Donor Breast Milk

What is your choice? Speak with hospital lactation consultant or private lactation consultant to plan and prepare

Newborn Care Support

• How will the hospital support the provision of newborn care support by maternity nurses to the new parents

Consent and Forms

• How would you like to make big and small medical decisions, as Surrogate (and partner) will be legally responsible for providing consent: eg who should the medical staff approach first to talk about any medical issues or decisions?
• Medicare – get separate card for baby
• Birth registration – surrogate (and partner) must be registered as birth parents

Vaccinations, Testing, Circumcision etc

• Does the Surrogate support the Intended Parents’ wishes?

Discharge

• Can baby and Surrogate be discharged separately if one needs to stay in hospital longer?

Mothers Groups / New Parent Support

• What is available? Ensure information and referrals are provided to Intended Parents

Post Birth Care

• What follow up care will there be for Surrogate and Intended Parents and Baby post discharge?
• Dealing with grief, loss, trauma, or post birth debriefing – counselling support available for Surrogate and family and Intended Parents

Other Birth Planning Considerations

• Support Person for Surrogate during and post birth – Intended Parents will be newborn support
• Care arrangements for Surrogate’s children during and post birth – ability to extend care if birth is complicated
• Restful environment for surrogate to return home to post birth so she can physically and emotionally recover from birth
• Additional childcare and home support on standby if there are birth complications and Surrogate’s partner needs to focus on Surrogate.
• Expected visitors for Surrogate – own family and friends, Intended Parents family and friends, so she is not left alone in hospital, especially if birthing away from home
• “Push Present” for Surrogate and Partner (and children) to recognise their efforts and sacrifice
• Arrangements for contact between surrogate, surrogate’s partner and their children with baby in early days post birth
• Post birth counselling support or support networks – Intended Parents are newborn support, so their capacity to emotionally support the Surrogate may be decreased post birth
• Photographer or videographer for birth or post birth