Celebrities like Sally Obermeder, Kim Kardashian, Tyra Banks, Nicole Kidman and Sarah Jessica Parker have all been open about their use of a surrogate to carry their unborn babies.
How do you become a surrogate and what leads you to make the decision to carry another mother's child?
We asked Jess*, a surrogate who lives in the United States and is about to carry another couple's baby for the third time. She carried twins in a previous surrogate pregnancy.
Jess has described being a surrogate as "the most rewarding experience".
"I had pretty low self confidence and was basically always a quitter growing up. I got the idea in my head that I wanted to help a set of parents become a family, and it completely changed me. It was incredibly hard work, but I persevered and was able to carry twins for a very deserving couple, then a little boy the following year to help complete another family."
Jess has just been matched with a family for her third surrogacy journey.
Here, Jess shares what it's really like to be a surrogate.
Is it difficult to let the babies go to their intended parents after birth?
Not at all. I knew what I had signed up for when I applied to be a surrogate.
I had no genetic link to the babies, and I adored the families I was carrying for. I was so happy for them to finally be parents. The best way I can describe it is as if the babies were nieces or nephews. I cared for them and loved them while I had them, but I still got to sleep through the night once they were born!
What's involved in getting pregnant with a couple's baby?
As a gestational surrogate, I have no genetic link to the baby I am carrying. Therefore, I go through IVF in order to become pregnant. It involves hormone injections and many monitoring doctors appointments so it's very time consuming.
When I carried the twins, I had terrible morning sickness that didn't go away until I delivered. But the good definitely outweighs the bad. I've stayed in touch with both couples and watched the babies grow, and that part has been very fun!
Do you believe in pre-birth imprinting and do you think surrogacy affects the parents' bond with their baby?
I have read things which lead me to believe that babies do pick up on some things, like stress levels, while in utero.
I don't think that the baby is any less compatible to its biological parents, though. I spent a week with the nearly two-year old twins recently, and those kids adore their mother.
They were so wanted, and you would never know that she didn't carry them herself. The babies don't know anything different, and I don't believe they're any worse off because of it.
Can you make money from being a surrogate?
(Note: Jess is from the US. It is illegal for a surrogate from New Zealand or Australia to accept any form of compensation).
The compensation varies
If you go through an agency, you agree to their standard package. If you match independently, you can ask for whatever you want, you just have to find a couple willing to pay it.
The standard for a first time surrogate is usually $20-25k, plus all the medical expenses covered.
I received $25k base my first journey, paid in monthly increments starting when the pregnancy was confirmed, and I received the last payment after delivery. For twins, you get a bit extra. In my case, it was another $4k after delivery. And there's other payments listed in the contract, depending on circumstances. A cesarean, for example, would've paid an additional $1500.
Subsequent surrogacies get paid more, as you're now "experienced." So I earned off the second singleton pregnancy what I earned off the first one, which was twins.
It's certainly not enough money to live off of, if you look at the journey as a whole. Both times for me, it was about 18 months from matching to delivery, and I was lucky enough that both IVF cycles took on the first try. Some people invest a lot longer into it.
What if you have a miscarriage or still birth?
It's not morbid, it's stuff that has to be discussed during the contract phase of surrogacy.
The payments are in installments throughout the pregnancy. And while different lawyers might do it differently, in my case I received a small fee when I started IVF meds, and a small fee after the embryo transfer, and the first actual payment once a heartbeat was confirmed.
If you miscarry, or lose the pregnancy at any point, you keep whatever payments you've received up until then, but you don't get paid the full amount until you're full term, or close to it. It would be the same if the parents opted for an abortion, for whatever reason. Miscarriage was a fear for me, probably more so than my own pregnancies. In part, because I've been fortunate never to have had one.
I didn't want to disappoint the parents, because I knew how much they had invested in their baby, even if rationally I knew it wouldn't have been my fault.
We know of a situation where a surrogate ended up pregnant with triplets, a single baby and a set of identical twins.
Those intended parents opted for an elective reduction - as the twins were showing signs of health problems - and she ended up carrying the healthy singleton to term. You can't really "not believe" in abortion to be a surrogate. It's part of the contract that you would agree to it, if the parents made that decision. Legally, if you were pregnant you could still make the decision to not go through with it.
There have been cases of this happening (which do give surrogacy a bad rep), and there have been surrogates who have ended up keeping the child they carried. Personally, I would've had an abortion it if that was what was asked of me. I felt like it was not my baby, not my decision.
But, I was very fortunate that it didn't come up.
Do you do anything differently for your surrogate babies than you did for your own pregnancies?
I did, actually. For both IVF cycles I gave up caffeine through the first trimester, which I did not do for my own pregnancies.
It felt, somewhat, like there was pressure on me for the cycles to be successful, even though in reality my decisions had little to do with if the embryo(s) implanted or not. I felt that, if giving up caffeine lowered my chances of miscarriage, I could give it up for a few months. I had no contractual obligations to eat or not eat anything specific, though.
I mostly followed standard practices when it came to pregnancy. I also did a lot of research during the twin pregnancy and ultimately decided on a natural birth, after having epidurals with both of my own children.
I opted for a natural delivery with the second surrogacy, also, and likely wouldn't choose pain medication in any pregnancy moving forward- whether it was my own or another surrogacy.
Emotionally, how different were your pregnancies and your surrogate pregnancies? Do you keep in touch with the families ?
It's hard to compare them, because there was about a five year break in between my youngest daughter and my first surrogacy.
I was 20 and 21 when my daughters were born, so the emotions for that were mostly a mix of excitement and fear.
For the first surrogacy, it was all excitement. I was on such a high after the first natural birth, and the thrill of completing something that I had dreamed about doing for a very long time. There was some sadness saying goodbye to both sets of Intended Parents when it was time for them to go home, but not in a devastating "I'm giving away my baby" kind of way.
Very similar to if a sibling who you care about is moving away, but you know that you'll see them again. I cared about the parents, and I was sad to see them go. And again, it marked the ending of an amazing journey that I had invested a lot of myself into.
I do keep in touch with both sets of Intended Parents. The nearly 2-year-old twins actually came and visited us about a month ago. Between the two families - one in Europe and one in South America - we keep in touch via text messages, email, Facebook, and Skype.
*Jess is not her real name.