Being a Surrogate: Psychological Aspects, Risks and Benefits

By (embryologist), (gynecologist), (project manager) and (babygest staff).
Last Update: 08/29/2019

Surrogacy is a highly controversial issue, with a wide variety of arguments for and against it. The psychological and social aspects, as well as the possible risks and benefits that may derive, are some of the most studied topics. Therefore, we will review the main consequences of this process in this article.

Psychological aspects

In general, and especially in countries with adequate regulation such as the United States, Russia or Canada, women who choose to be pregnant, also known as surrogates, surrogate mothers or gestational carriers, show a common psychological profile. They are strong women, with great sensitivity, who do not usually experience psychological problems after the delivery of the baby.

Although the studies carried out are not too many and the sample size is low, there is generally no suffering or negative psychological effects in gestational carriers, nor has there been an increase in cases of postpartum depression compared with their own pregnancies.

To avoid possible repercussions, it is essential that the surrogate mother undergo a rigorous psychological study to determine her capacity for the process, as well as regular check-ups or sessions with specialist psychologists during pregnancy.

In these sessions it is important that the specialist confirms that the pregnant woman has a clear attitude towards the future pregnancy, that is to say, that she is fully aware that she will gestate a baby that is not hers. In this way, we will reduce affective attachment during pregnancy and facilitate the subsequent delivery of the newborn.

Importance of having own children

Most surrogacy programs around the world require surrogate candidates to have previously had children. This does not only answer a medical question, but also a psychological one.

A woman who has never gone through a pregnancy doesn't know how she's going to feel, her symptoms, the bond she's going to develop with the baby, etc. That's why it's hard to make an informed decision before she signs the contract if she doesn't know what's going to happen.

Since it is not possible to anticipate how the pregnancy will develop, it is important that this be a woman who has already gone through this experience. This will give her enough knowledge to know what she will be dealing with psychologically.

Benefits of being a gestational carrier

Contrary to what many people think, the main reason why many women decide to give birth to a baby that is not theirs is not economic, but to give the gift of life, to help other people achieve their dream.

This means that, although economic compensation exists and, of course, is one of the reasons why surrogate mothers intervene in the process, it is not the main or basic reason.

Below you’ll find three of the main psychological benefits for surrogate mothers:

  • Enjoying pregnancy: some women feel good about this state, feel more special, which also improves their sense of well-being and emotional health.
  • Personal fulfillment and self-confidence: altruistic and supportive motivation leads to a greater sense of well-being and happiness for doing something for the benefit of others.
  • Empathy and desire to help: is reinforced when there is a personal relationship with the intended parents. By understanding the suffering that future parents are going through, their ability to empathize is increased.

Many surrogate mothers claim to feel a mixture of emotions of happiness and sadness at the time of birth, when the process ends. Happiness because they have fulfilled their objective of helping a family and sadness because their help ends, their feeling of solidarity ends and, in short, the pregnancy, with which they normally feel at ease, is over.

Advantages of getting to know the parents

The relationship between the surrogate mother and the intended parents must be based on mutual respect and reciprocity, that is, the parties must collaborate for the welfare of both.

The main way to make the relationship between the parties as fluid and respectful as possible is through a high percentage of support and advice from the professionals involved. In this way, we will achieve two essential purposes:

  • Knowing what each one expects from the relationship and their expectations during the process
  • Knowing what the consequences would be if these expectations are not met

Intented parents and surrogate mothers who have established a close relationship confirm to have felt more secure during the process. In fact, if the surrogate mother knows that the baby she is pregnant with will grow up with a respectful family and that they are waiting to give the baby all their love, her confidence and well-being will increase.

According to a study carried out by Van der Akker in 2005, surrogate mothers who stay in contact with the families did not present any psychological dysfunctions during the last 6 months since delivery.

In this way, it is possible to make the appropriate assignment: the intended parents' vision will be congruent with that of the pregnant woman, and vice versa. Thus, the process of surrogacy does not lead to negative consequences not only emotionally, but also physically.

If the surrogate mother, for example, decides to abort in the course of pregnancy against the decision of the parents of intention, the consequences that this may entail should also be contemplated in the surrogacy contract in order to avoid the psychological impact that this could have on her.

Risks and social consequences

It is important that the environment of the surrogate mother knows the situation, understands the reason that leads to gestation in favor of others and that she receives ongoing support from family and friends.

Feeling supported by her relatives will make the surrogate mother feel better about herself, enjoy her life during pregnancy and feel happy to help other people, as well as reduce the possible fear or rejection at the time of delivering the baby.

If the surrogate hides the process, her true motivations or does not have the support of her loved ones, her feelings of frustration, denial and negative psychological effects may increase.

If the surrogate already has children of her own, it is also important that she take into account the possible consequences that a surrogate pregnancy can have on them.

The American Society for Reproductive Medicine (ASRM) advises you to think carefully about what data and how much information should be given to your own children about surrogacy.

To this day there are no studies or evidence showing that surrogacy can negatively impact the feelings of the surrogate mother's own children or that it leads to negative reactions on her part.

FAQs from users

Can the surrogate refuse to give up the baby at birth?

By Dr. Joel G. Brasch (gynecologist).

This is an excellent question because the answer really depends on the legal environment where the child is born. Fortunately, Illinois is a surrogacy friendly state which has a specific law in place to protect not only the interests of the surrogate, but the child and intended parents as well. This law allows for the courts to establish parentage between the IPs and newborn as soon as the baby is born.

Can staying in touch with the family and getting to know the child be beneficial for the surrogate mother?

By Natalia Álvarez (project manager).

The possibility of keeping in touch with the parents of intention after birth is a decision to be made exclusively by the parents and the surrogate mother. Some families prefer that their child do not know the woman who conceived it, while others agree that this would be beneficial for all parties.

This is usually more frequent when the parents of intention choose her or even if she is a woman of the family or a friend. At the same time, many surrogate mothers wish to continue having news of the evolution of the minor. Various studies have shown that this can even be very beneficial when it comes to informing the child, since it will be easier to understand.

What negative consequences can a surrogate mother experience if she carry a child to term for someone of her familiy?

By Natalia Álvarez (project manager).

It is true that although there are many families that prefer to resort to a woman of the family like a sister, aunt, sister-in-law, cousin, daughter, etc., not all are benefits in this type of agreements. The other side of the coin is that it can damage the long-term relationship.

If any complications arise during and/or after pregnancy, the stress generated can trigger feelings of resentment or even bring up past problems between family members.

This is why it is also recommended that both the pregnant woman and the intentional parents be evaluated psychologically and emotionally by a specialist in order to identify possible feelings or intentions that could damage the relationship or even have a negative impact on the welfare of the future baby.

What advice should surrogate mothers follow in order to avoid problems after birth?

By Natalia Álvarez (project manager).

As we said above, this is very relative and depends on the type of relationship you want to establish. However, it is important that a pregnant candidate be prepared to engage in this process and be aware of the benefits but also the risks and possible problems that may arise.

It is important to have professionals who help and guide all the parties involved from an individualised point of view. Having the support of lawyers, agencies, psychologists, etc., is fundamental in order to minimize short and long term problems as much as possible.

On the other hand, it is highly recommended that the surrogate pregnant woman and the future parents be in contact during the pregnancy and support each other. In short, attending to the needs of each one is fundamental for everything to go well.

¿What damages does a surrogacy process imply for the surrogate?

By Cristina Mestre (embryologist).

Surrogacy is an assisted reproduction technique that, as such, carries some risks.

If we are talking about medical risks, we must bear in mind that actually surrogate mothers are not the ones who provide their eggs, so the treatment for them begins at the moment when they must be medicated in order to prepare their endometrium for the transfer of the embryo.

The medication in these cases is not very strong, but it is still medication. Once the transfer has been carried out, 15 days will be waited to determine if pregnancy has been achieved or not. And, from that moment on, the risks are exactly the same as those of any pregnant woman.

As far as psychological damage is concerned, I believe that the good choice of the gestational carrier and the responsibility when doing so are what will really determine whether it is a natural process or whether it ends up being a painful process.

It is fundamental that the pregnant woman freely chooses to participate in this technique, that is, that no family member, friend, or her economic situation forces her to do so.

Evidently, there is an economic compensation, but this should not be what really drives a woman to gestate the child of another person: there must also be a reason for solidarity, the desire to help a family. This is what really makes the difference.

Women who have this clear live pregnancy as a precious process and at all times are very clear that the baby that grows in their womb is not their child.

Suggested for you

Do you want to know more about what makes a woman gestate another family's baby? then don't miss the article Motivations to be a Surrogate Mother in which we detail the solidarity reasons and other aspects to take into account.

As indicated, candidates for pregnancy must pass a psychological evaluation to determine their suitability to face this process. If you want to know all the tests prior to their acceptance, click here: Medical exams of surrogate mothers.

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Authors and contributors

 Cristina  Mestre
Cristina Mestre
Bachelor's Degree in Biological Sciences, Genetics & Human Reproduction from the University of Valencia (UV). Master's Degree in Biotechnology of Human Assisted Reproduction from the UV and the Valencian Infertility Institute (IVI). Embryologist at IVI Barcelona. More information about Cristina Mestre
Dr. Joel G. Brasch
Dr. Joel G. Brasch
Dr. Joel Brasch is the Medical Director of Chicago IVF, founded in 2005. He is board certified by the American Board of Obstetrics and Gynecology, and has over 25 years of direct experience in fertility treatment and reproductive care. He is also the Director of Mount Sinai Medical Center’s Division of Reproductive Endocrinology and Infertility. More information about Dr. Joel G. Brasch
 Natalia Álvarez
Natalia Álvarez
Project Manager
Graduated in Business Administration from the University of Alicante. She has more than 9 years of experience in the field of assisted reproduction and was the creator and director of the first assisted reproduction fair in Spain. She is the director of Wearesurrogacy and is an expert in the sector of surrogacy because during all these years has had the opportunity to know hundreds of real cases of couples who have carried out treatments for surrogacy and the best professionals, international clinics. More information about Natalia Álvarez
Adapted into english by:
 Romina Packan
Romina Packan
Babygest Staff
Editor and translator for the Babygest magazine in English and German. More information about Romina Packan

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