How Does a Gestational Carrier Choose her Obstetrician?

It’s common practice for a surrogacy agreement to include some language about where the gestational carrier receives her medical care once her pregnancy is confirmed by the fertility center.  In many cases the surrogate returns to the same medical practice that she used when she carried her own children because she already knows and trusts them. And again, in most cases, the intended parents want the surrogate mother to be comfortable and confident in her prenatal care, so this is a good arrangement for everyone.

But what if for some reason the surrogate mother isn’t able to use the practice she’s previously used? Perhaps she’s just moved to a new area, or maybe she wants to change to a new practice – what happens then? Who gets to decide which doctor she sees?

Generally speaking, it’s the gestational carrier’s right to choose the doctor she sees for her pregnancy and delivery.  But if she needs or wants to find a new doctor, what, if any, role should the intended parents play in the selection of the doctor? And what should she look for that’s unique to surrogacy?

At the start of my first surrogacy, I found myself in this position. I was 9 weeks pregnant with twins and I returned to the OB practice I’d used for my first two children (I’d had a midwife-assisted homebirth for my third child). While the practice was fine when I carried my own kids, I noticed a distinct difference in their approach toward my surrogate pregnancy.  This time around, the doctor was very conservative in how she managed the pregnancy – she wanted me to stop exercising, she said to expect an ultrasound at every visit, and she wanted me to refrain from having sex with my husband.

These precautions were all curious to me, mostly because I’d already had three successful pregnancies and deliveries and I didn’t have any complications with my current pregnancy. I got the feeling from the doctor that she viewed my surrogate pregnancy differently than she did a natural pregnancy – perhaps higher risk (needlessly in my case) and maybe more importantly, more high-stakes? I got the sense that she wanted to restrict my activities to cover her own legal bases and as you can imagine, that wasn’t an environment I, or my intended mother, was comfortable with.

So together we decided to pursue another practice. I talked to several friends and got suggestions and then based on geography, I narrowed it down to a few possibilities.  My intended mother and I both went to the interviews and got a feel for not only how they viewed a twin pregnancy, but even more importantly, how they viewed a pregnancy with two mothers – me and my intended mother.

Of the two practices we ultimately interviewed, one was similar to the doctor we’d started with – overly conservative in our eyes (e.g., the doctor didn’t want me using a recumbent stationary bicycle at the gym because he thought I’d fall off of it – clearly he’d never seen a recumbent stationary bike before because even the oldest of exercisers can manage that piece of equipment and I was a very healthy 32-year old and regular exerciser!). 

Luckily the second practice was a great fit for us – the doctor was an older man who had many, many years of practice behind him and looked at me as a low-risk patient, which was how I wanted to be treated (because I was, in fact, low-risk). And even better, he had worked with a few surrogate mothers in the past so he understood the dynamics of the process. Ultimately we were both happy with that office and had a good experience with them.

Some things that we took into account when we selected a practice were:

• Personality and experience of the doctor (obviously!)
• Experience working with gestational carriers (while it’s not essential, we wanted someone who wouldn’t be intimidated by the idea of surrogacy)
• Willingness to include the intended parents and their family in the prenatal visits
• How the doctor assessed my pregnancy and delivery history and my current pregnancy
• The doctor’s views on what constituted a low-risk pregnancy and a high-risk pregnancy, and how potential complications would be managed
• Location (the practice we chose was actually close to my IP’s house, but about 45 minutes away from mine – while I didn’t love having to travel that far, there were other advantages to the practice and hospital that I would deliver at that made the inconvenience worth it for us)
• Services offered (did the practice have ultrasounds and bloodwork on-site, or at least in the same building?)
• The hospital the doctor was affiliated with, which would be where we’d deliver

We were lucky that we found a great practice without too much trouble and we were all happy with the care we received there. Unfortunately though, the doctor retired after I completed my first surrogacy, so it was back to the drawing board the next time around.

When I was pregnant with my second surrogacy, I returned to that same practice and saw another doctor, one who unfortunately could not have been more opposite from the doctor I had loved there. Before my first appointment was up it was clear to me that I’d have to find yet another OB for this pregnancy and delivery.

My intended parents wanted me to choose the doctor myself – it’s not that they didn’t want to be involved, it’s just that they wanted me to be happy with my care and completely deferred to my judgment. So I interviewed a few doctors alone and selected a great one, one who I remained with for all of my future pregnancies and deliveries.

Hopefully your surrogate mother has a care provider that she likes and trusts and is one that helps make your surrogacy experience successful and memorable – that’s the ideal, of course. But if not, don’t fret, you have the chance to find someone who will be a great fit for all of you. Be sure that you talk about your expectations before lining up interviews so you’re all on the same page - that way you can make sure that everyone feels included as part of the interview and decision making process. 

When you go into the surrogacy with clear ideas and clear communication about what you need and what you hope for, you’re all much more likely to have a healthy and rewarding experience – which makes having a baby that much sweeter!