Your Surrogate Pregnancy

Once your surrogate’s pregnancy is confirmed, prenatal care takes center stage. Here’s what to expect from your surrogacy agency during the pregnancy. But the parents also have a role, and the long-term success of your journey may depend on your involvement in these pregnancy milestones.

After your pregnancy has been confirmed, the surrogate is placed under immediate prenatal care. Surrogates often receive more frequent checkups and appointments than they would with a personal pregnancy.

Prenatal Oversight in North America

In North America, the surrogate will live at home throughout the pregnancy. She will attend regular prenatal exams and ultrasounds by her personal obstetrician. The surrogate will manage her own pregnancy, and the agency (or journey coordinator) will help her keep track of all clinic appointments and share the results with the Intended Parents. The parents can also follow along with personal telephone calls or video chats. For some critical milestones, the parents may decide to be personally involved and (at the surrogate’s approval) physically present.

Prenatal Oversight in Eastern Europe

In other well-developed regions, like Eastern Europe, your surrogate will live at home, but the pregnancy is likely monitored by the agency’s IVF clinic (not her own OBGYN). The agency will work with the clinic, and they will send the Intended Parents all the results of prenatal exams directly.

The agency will provide a social worker to visit the surrogate on a weekly or semi-weekly basis. The social worker will send back reports to the parents on her mental and physical health, which may include photos and videos of the surrogate and her home to show that the environment is safe and secure. The coordinator will also ensure that the surrogate goes to all her prenatal office visits.

Prenatal Oversight in Developing Countries

In less-developed countries like Kenya or Mexico, the surrogate may be housed in a communal “surrogate house” and receive care from the agency’s assigned doctor. A surrogate house ensures the surrogate will have a reasonably healthy environment to complete the pregnancy, but many argue that it is a breach of personal freedoms and ethics.

Major Milestones During your Surrogate Pregnancy

Once the pregnancy has been established, there are a number of major milestones the Intend Parents should celebrate. Parents’ involvement can help form the important Attachment to the baby and make the transition to being parents more successful. You can celebrate these with the surrogate herself.

The First Ultrasound

A Transvaginal Ultrasound otherwise known, as a Transvaginal Sonogram (TVS) is performed anywhere from 6 to 8 weeks after the transfer. The first ultrasound will show the fetal yolk sac, gestational sac, and possibly the early detection of your baby’s heartbeat.

The first ultrasound is your first chance to actually see and hear your growing baby. It’s a momentous occasion for some parents. Some parents may ask to attend in person. But if not, there will be scheduled ultrasounds about every monthly (in most cases). Every ultrasound is a chance to hear the baby’s heartbeat, view photos of the developing fetus, and watch videos of the baby. Digital copies of all these results will be sent to parents that can’t attend.

The End of the First Trimester

The first trimester is the most fragile, when 80% of miscarriages happen. Many couples won’t announce the pregnancy until this fragile stage has passed. When the first trimester ends, the baby has made it through a major developmental milestone. Now is a time to take a deep breath, share the happy news with friends and family, and celebrate.

Learning the Gender

If you’re dying to know whether to paint the nursery pink or blue, you can usually learn the baby’s gender by week 18. Doctors can usually determine the baby’s sex during a routine ultrasound visit at this time, but not always. For obvious reasons it’s easier to demonstrate in an ultrasound image if the baby is a boy. Girls may need to wait a little longer before knowing with 100% certainty.

Gender reveal parties are a popular way to celebrate this milestone. But even a small celebration between the parents and the surrogate is warranted. And you can hone down your list of baby names by 50%!

NIPT Test and other 2nd Trimester Exams

The non-invasive prenatal test, or NIPT, is a highly sensitive test that screens for Down syndrome and certain other possible abnormalities. This test will be done around Week 14, at the start of the 2nd trimester. When the test comes back clean, parents can take a deep sigh of relief that the baby is healthy.

The NIPT will detect an increased of Down syndrome with 99% accuracy. But it is still a “screening” test rather than a diagnostic test. This means it can only tell you whether there is an increased risk of having a baby with an abnormality, rather than give you a definitive answer.

Other exams that may be used include Nuchal Translucency screening or the Quadruple Marker Screening also screen for chromosomal problems. If any of these tests show a increased risk, you will want to follow up with a diagnostic test such as chorionic villus sampling (CVS) or amniocentesis.

20 Week Ultrasound

Congratulations! You’ve reached the half-way point of the pregnancy!

It’s challenging for many parents to watch their pregnancy from the sidelines. The surrogate gets to feel the baby grow, kick, and become more “real”. This is a classic case of “no news is good news”, but parents still get anxious for news and milestones. So 20-week half-way milestone is a great reason to celebrate.

3D and 4D Ultrasounds

3D and 4D ultrasounds can create a 3-dimensitonal image of your baby. They’re not standard prenatal tests, but some clinics can perform them at the request of the parents. They let you see your baby’s face for the first time.

All ultrasounds use sound waves to create an image of your baby in your womb, but 3D ultrasounds create a three-dimensional image of your baby ( 4D ultrasounds create a moving video effect). Some doctors like 3D and 4D ultrasounds because they can show certain birth defects, such as cleft palate, that might not show up on a standard ultrasound.

Studies suggest that 3D and 4D ultrasounds are safe when done in a clinic environment. That said, experts caution against using external, commercial services that may not have the same level of training.

The Parents’ Role in Your Surrogate Pregnancy

In the U.S. it’s common for Intended Parents to be involved in the pregnancy. At a minimum, the Parents will want regular updates throughout the pregnancy. Anything beyond that should be discussed and agreed early in the relationship. If the parents expect to be heavily involved and the surrogate enjoys her privacy, they may not be a good match.

You should decide how much involvement is appropriate before signing the Surrogacy Contract. It’s important that the surrogate and the Parents mutually agree on how much contact the parents will have. Then it’s important for the Intended Parents to respect that agreement and give the surrogate her privacy.

Consider the following common requests from the Intended Parents. These should be discussed between the surrogate and the parents to set the level of their involvement early in the matching process:

  • Regular, scheduled video chats
  • Casual unscheduled phone calls
  • Attend the first ultrasound, or to hear the heartbeat
  • Attend regular prenatal exams
  • Personal visits to the surrogate’s home
  • Parents’ presence in the delivery room for the birth

Some surrogates and intended parents expect an ongoing relationship. If agreed, they may maintain contact long after the baby is born.

Remember that the surrogate is neither a servant nor an employee. She is a partner is the surrogacy journey, and so she is entitled to her privacy and autonomy. We advise all parents read about your surrogate and building a relationship with her.

Prenatal contact outside the U.S.

Overseas, contact with the surrogate is more complicated. Surrogates often don’t speak the same language as the parents, and a translator is needed for any conversation. The agency can arrange for a translator, but it requires every conversation to be scheduled well in advance.

Some international surrogacy agencies discourage any communication between the surrogate and the Intended Parents. This is usually to prevent the surrogate from directly asking the parents for additional payments or benefits. Surrogate requests made directly to parents can short-circuit the agency’s ability to manage the surrogate and her agreed responsibilities. Her requests may seem very reasonable, but they should be made through the agency to avoid any confusion or awkwardness.

Regardless of where the surrogacy takes place, Intended Parents should have regular opportunities to chat with the surrogate by telephone or video chat. Regular contact makes the surrogacy process more meaningful for the Intended Parents. It also reassures the surrogate that the parents are committed to the journey and to her.

Additional prenatal services for your surrogate

Pregnancy “concierge” services are often available to assist the surrogate during the pregnancy. These may include house cleaning and cooking, transportation, visiting nurses, and clothing allowances. In some overseas programs a coordinator will personally visit the surrogates. In the United States most surrogacy agencies leave the surrogate to manage her own pregnancy with support from the Intended Parents.

Most importantly, the Intend Parents’ agent should ensure the surrogate’s continued emotional and physical support. The agency should forward all clinic updates to the Future Parents. Ultrasound scans should be regularly sent to the Future Parents, along with the results of all tests and examinations.

HIPPA and Surrogate Pregnancy in the United States

In 2003, the U.S. government passed privacy regulations related to medical procedures and records, including pregnancy. These rules are collectively known as HIPPA. The rules restrict clinics and hospitals to sharing only the minimum amount of personal information about any patient’s medical situation.

For surrogacy, HIPPA often means that the surrogate’s OBGYN cannot share information about the pregnancy directly with the Intended Parents. It’s the responsibility of the surrogate to request paper copies of all her prenatal exam reports and forward them to the Intended Parents.

Even in cases where the surrogate has waived her HIPPA privacy, most hospitals and clinics have internal policies that allow only the patient (e.g., the surrogate) to receive the results of ultrasound exams, blood tests, and other prenatal checkups.

To help the Intended Parents stay informed, the Journey Coordinator should remind your surrogate to pass along this information. The Coordinator should also have a full calendar of the surrogate’s clinic appointments and can follow up afterward to get the results.

Paying for your Surrogate Pregnancy

The Intended Parents will pay for the prenatal care and selected concierge services. Payments are often made over the course of the pregnancy. Payments may be made monthly or during each trimester.

In the United States the full cost of the surrogate’s compensation must be paid into escrow at the beginning of her program – and her payments are disbursed from the escrow account each month throughout the pregnancy.

NOTE: If you are pursuing surrogacy overseas, the beginning of the third trimester is a good time for the Future Parents to contact their embassy or consulate overseas and begin arranging a passport and a VISA for the newborn. Consulate requirements often change, so it’s important for the parents to be in-touch with the local officials both early in the pregnancy and just before the anticipated birth.

Post-natal care for the Surrogate

Even after parents leave the hospital with their baby, their agent will continue to ensure the well-being of the surrogate. Some agents provide a range of options that allow parents to show their gratitude to the surrogate and her family.


About the authors

  • Bill-Houghton
  • Author: William Houghton

    Bill Houghton is the founder of Sensible Surrogacy, author of the Sensible Surrogacy Guide, 2x surrogacy dad, and a dedicated advocate for secure, legal and ethical Gestational Surrogacy. Read Bill's Biography

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