When yet another celebrity obtains a baby via surrogacy in a blaze of publicity,
sparking debate across the internet, many people will say they disagree with
commercial surrogacy but altruistic surrogacy, such as between sisters or best
friends, is OK. Following an earlier blog post comparing commercial and ‘altruistic’ surrogacy, I wanted to take a deeper look at what that altruistic act really involves. I will
leave aside discussion of surrogacy that involves payment of “expenses” and may or
may not include a commercial element, and focus on what a more “pure” form of
altruistic surrogacy between family and friends involves by dissecting a couple of
podcasts I have recently listened to.

The Cambridge Dictionary definition of “Altruistic” is “Showing a wish to help or bring
advantages to others, even if it results in disadvantage for yourself”. Going through pregnancy and childbirth to give a baby away can certainly be said to bring “disadvantage to yourself”.

The first podcast I will look at was with a woman (Emma) who has three children through surrogacy thanks to her sisters and best friend.  A casual listener might think as the presenter did, that this is a lovely story and truly wonderful that she has been helped in this way. But let’s look at it more closely…

We hear that Emma was told, at age 17 by her gynaecologist, that she would
never be able to have children though she doesn’t explain clearly but presumably some sort of congenital problem caused her infertility.  The gynaecologist then asked her if she had sisters and explained that someone else could carry babies for her. I can’t think about this without feeling great anger, but more about this later. Going on to the story of her journey to motherhood: After returning from the gynaecologist her sisters crowded round and immediately assured her that they would have babies for her.

In due time, soon after marrying, her first sister had the first baby for her apparently without problems.  So far so good – although we know pregnancies with a donated egg (ie all gestational surrogacy as well as IVF when a woman uses donated eggs) – are at greater risk of a variety of complications, especially raised blood pressure, pre-eclampsia and premature birth. As Emma had always wanted a big family it wasn’t long before her second sister stepped up. Unfortunately this resulted in three miscarriages and no baby. We aren’t told the details of the miscarriages or how far into pregnancy they occurred, however it’s worth noting that this happened before abortion was legalised in the Republic of Ireland (2018) or Northern Ireland (2019).  Alongside the devastating experience of miscarriage if one had been complicated by infection whilst there was still a foetal heartbeat her life would have been at very real risk.  See the case of Savita Halappanavar who was denied appropriate treatment of her inevitable miscarriage due to the ongoing presence of a foetal heartbeat, and sadly died of sepsis at 17 weeks gestation. This is a risk for any pregnant woman, and any surrogate mother, in those countries and states in the USA where abortion is not allowed.

Next Emma’s best friend offered to carry a baby for her. She sadly had an intra-
uterine death (the baby dying for reasons not explained on the programme) and had
a still birth at 30/40 gestation.  This must have been very traumatic for the surrogate
mother/friend.  Often it is hard to get women into labour in these cases and the birth
process can be difficult and of course very upsetting – she will surely have had a
horrible experience. Was her grief at losing her baby acknowledged I wonder?
Perhaps it was only in the moment of that loss that this woman realised the depth of
her love for the baby she was carrying yet she had to prioritise the feelings of Emma
who was grieving the loss of “her” baby. I hazard a guess this woman has been
unable to acknowledge her own feelings and wonder if this is why she wasn’t
available to talk on the programme.

Finally a third sister gave birth to twins for her.  We do not hear whether the twins
were planned or how many embryos were implanted, but a twin birth is much harder
for a woman and significantly more hazardous than a singleton pregnancy and birth
for both the mother and the babies. So forgive me if I don’t hear a beautiful story of sisterly love.  I hear a story of four women being put at risk and suffering harm in the pursuit of providing Emma with the babies she wanted so much.

In the next podcast I have reflected on we hear the story of another woman
(also Irish but living New Zealand) who had a surrogate baby for her sister.  I accept
she wanted to do this, and she is glad she did it, and they are a loving family who chose to do it. However asked if she would do it again she says “I would never take back what
I’ve done but I don’t think I could do it again….the emotional, the mental strain, the
anxiety of the pregnancy was very, very challenging”… “Florence is always going to
be in our lives, she’s always going to be very special to our family, but it would be a
very difficult thing to do for a friend, or someone you didn’t know.”

As she discusses her surrogacy journey, she repeatedly mentions how difficult it
was, how challenging….”it was as if my body knew it wasn’t my genetics, from the
beginning”.  “I had been morning sick in my own pregnancies, but nothing as to how
sick I was with my niece.  I was vomiting every day, I had migraines, I was just so
sick”. ”It was much more challenging – in my own pregnancies I’ve never really
experienced prenatal anxiety.” “Anxiety in pregnancy floored me”. 
She had weekly counselling throughout the pregnancy.

As her due date approached there were concerns around the delivery – having
schooled herself to be detached from the baby she said “I was so detached, in my head… How was I going to deliver a baby I was so detached from?….It’s very hard
to deliver someone else’s baby”. Planning for the birth she was literally terrified of
having the baby put into her arms at birth as she knew she would bond with it in that
moment and never want to give her up.  As a woman who had given birth to her own
two children previously she knew how it is to give birth to your own longed for baby,
and how hard it is to go through that for a baby that she cannot keep. Women who
have been through pregnancy and childbirth, who have experienced the joy of a
newborn baby, need to school themselves not to attach to the baby they will give
away.  

After her waters broke at 36 weeks and although she had begged for an elective
caesarean the hospital would not allow this and she was induced. Despite two days of attempted induction her body wouldn’t co-operate, after the first day she told the team caring for her “You’ve actually broken me, how can you possibly expect me to get up and be induced again”. With her body shut down it’s not surprising she ended up having an emergency caesarean section.

Reflecting on the experience she explained she became pregnant again just three
months after the delivery, not something that is recommended so soon after the
previous birth, before the body has fully recovered.  She mused “When someone
asked me about my attachment to Florence I started to reflect that I was actually
attached to my third baby that I don’t have yet.  I think I was attaching to this baby in
my pregnancy with Florence and then, my body must have wanted this fourth
pregnancy so much, I think my body just wanted this so bad.” She needed to heal
her sense of loss and her empty arms with a baby of her own. As she said, “in terms of the physical side of it now my body has had four pregnancies which takes a toll on the body” and of course a second caesarean. So this surrogacy was not without harm. This woman may not previously have planned to have a third baby, and there are financial and career implications around that. She had two caesarean sections in a year, which as she said takes a great toll on a woman’s body and the second could have been very dangerous coming so soon after the previous one. There are risks of uterine rupture and morbidly adherent placenta (placenta accreta/increta/percreta) which is associated with uterine scars. There is also the toll it took on her mental health.  And we shouldn’t forget the wider family and her husband who had to support her in this and who will have had their lives and work disrupted as they took on additional childcare responsibilities, and caring for her after the caesarean.

So let’s return to that (female) gynaecologist who asked Emma if she had sisters,
before reassuring her that she would still be able to have babies. How dare that woman make the assumption that the sisters would want to do this? This sets in motion family expectation and low level coercion.  It assumes the sisters have nothing better going on in their lives that they can take time out of their careers to do this.  It’s not hard to think of all sorts of circumstances where it would be very detrimental for a woman to take time out in this way – they might be models, or travel a lot for work or be high level athletes.  Or maybe they just wouldn’t want to do it.  I think it is highly unlikely there is a female consultant obstetrician anywhere who would agree to be a surrogate mother, I doubt one exists, so they clearly value their own careers and bodies, yet think it’s OK to make that assumption for other women. I also doubt many heterosexual male obstetricians would be keen for their wives/partners to do this.  (For background I was an NHS midwife for 20 years. I can still picture one of our Consultants wandering around the labour ward in shock as his colleagues fought to save the life of his wife who had a catastrophic haemorrhage. Will they offer up their wives and partners to take these risks for another person? I think not.) 

It also makes assumptions of the partners and wider family of the sisters going through surrogacy and their contribution as they may need to help with childcare for hospital appointments or if the woman is admitted, more help around the house, nursing her when she comes home, perhaps recovering from a caesarean, very possibly feeling flat and depressed and needing general support. This makes me really furious.

Swedish journalist and author Kajsa Ekis Ekman discusses surrogacy in this podcast:
Regarding altruistic surrogacy she says:

“There are women who do it because they want to feel good about themselves, they
want to help someone, they really feel like it gives them value to help someone else
and this is painted as a great thing, like look how altruistic they are, how generous
they are, isn’t this a better alternative than some poor woman who is doing it for
money? I think this is the worst! I think encouraging women to be so selfless that
they go through pregnancy, which is so hard on a person, to go through all that for
nothing? You don’t even get a dime, and you don’t get a baby, you get nothing! … I
think that’s awful! I really think that if you view women like this, like our role is to be
altruistic and generous and just help others then this is so dangerous….. This is a big
trap for women in all walks in life. I just want to be nice. I don’t think this should be
encouraged.”

I have no doubt there are some women who will claim to have found the experience
of surrogacy very rewarding and joyful. The human experience is varied, there are always outliers, but I say it is not normal to want to carry a baby in order to give it away at birth. For most women this goes against all their instincts and is very painful. We should not be celebrating this.

We must not accept this as normal and must continue to challenge the popular
narrative. We need to talk more about infertility and how it is possible to live a
fulfilled life without children of one’s own. Especially for women – and men – who
have multiple nieces and nephews – there are lots of children in their lives! Be the
best Aunt, the best Uncle, the best support to your sibling as they juggle life, work
and children. But don’t put the health of your sibling at risk of harm. How is that a
loving thing do to your sisters?

To those that say altruistic surrogacy is a gift of love, I say it is a gift of pain, simply
transferring the pain of infertility to the woman who suffers the pain of loss, of empty
arms and full breasts and a longing for her baby. It is not harmless. This is not an
ethical alternative to commercial surrogacy. Women are not reproductive machines.