Author Archives: stopsurrogacynowuk

Commercial vs Altruistic, Old vs New, UK vs America – A comparison in research

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“The outcome of any serious research can only be to make two questions grow where only one grew before ” ~ Thorstein Veblen

As a new study on surrogate mothers was published last month we were inspired to look at various research that has been done over the years and was struck by one from 1994 that I read some time ago when I came to this topic. The 2022 study – with surrogate mothers in America, engaging with surrogacy under a commercial model – appeared to be both similar and different, to the women from a study nearly 30 years ago in the UK who were having a baby for someone else, for ‘altruistic reasons’.

Here we compare and contrast both studies and as these are just our observations we encourage readers to read the original studies and the other studies listed. 

Published in Dignity last month, findings from a survey and in-depth interviews of 96 surrogate mothers between 24-50yrs were analysed.

These are my top 3 key findings in this study:

  • The women were 3 times more likely to have a caesarean section
  • They were 5 times more likely to go into early labour
  • Surrogate mothers are “more likely to experience postpartum depression following the delivery of surrogate children than after delivering their non-surrogate children.”

With maternal mortality in the US remaining an issue for women, particularly for women of colour, it’s clear that surrogacy pregnancies are more likely to have both physical and mental health challenges, compared to pregnancies that are not for others.

“We found that surrogate pregnancies are more often labelled as high-risk pregnancies independent of maternal age or gravidity. This research supports the findings of Woo et al. (2017) in that surrogate pregnancies had a higher rate of delivery via Csection. Women were more likely to deliver at an earlier gestational age compared to their genetically related or spontaneous pregnancies.”

Of 141 pregnancies recorded in this survey, 157 babies were born, so ‘multiples’ of twins (or more) were present in this cohort and the highest number of complications, (such as pre-eclampsia, gestational diabetes, haemorrhage, infection related to pregnancy, pre-term labour, hyperemesis gravidarum, anaemia, placenta previa, placental abruption etc) in one pregnancy was 7.

To support their findings researchers reference existing studies:

“In their study, Duffy et al. (2005) documented significant obstetrical complications of ten gestational surrogate mothers. Almost a decade later, Merritt et al. (2014) sought to determine the impact of assisted reproductive technologies (ART) on pregnancy-related outcomes, including surrogate pregnancies. Their research found a fourfold increase in stillbirths, a fourfold increase in cesarean sections for mothers who used ART and a nearly fourfold increase in preterm birth (Merritt et al., 2014). Another study by Woo et al. (2017) looked at pregnancy outcomes of gestational surrogate pregnancies alone. It examined the records of 124 surrogates and found a significant difference in physical outcomes between their own spontaneous pregnancies and their gestational surrogate pregnancies.”

As well as pregnancy, birth and post-birth issues, such as post natal depression (which is 37.5% more likely in surrogacy pregnancies vs 4% in non-surrogacy pregnancies), I was interested in the educational background and financial circumstances of the surrogate mothers in the study. 

It showed that Surrogate Mothers by and large, educated but economically disadvantaged and therefore likely motivated by the payments they will receive for the baby they grow and give birth to. 

“Of the 96 women, 69 were employed at the time of the interview and the median annual family income reported was $85,000 (minimum income of $13,000 and maximum income $225,000—quite a large range). In addition, 74 of the 97 women had some post-secondary school education: 17 had an associate degree, 42 had a bachelor’s degree, 14 had a master’s degree, and 22 were high school graduates. Only one woman did not complete high school. No women had completed doctoral degrees. Of the 87 women who had a husband or a partner, 50% of the partners had a high school education or associate degree.”

The commercial aspect of surrogacy in the US results in obvious ethical concerns , but this otherwise apparent problem is often rejected as an issue for UK surrogacy due to the so-called ‘altruistic’ model we have in law. However, education, employment  and level of income are intrinsically linked. Additionally, as noted in our Egg Donor Blog, the payment for ‘expenses’ can be central to the decision making. This is the same with surrogacy ‘expenses’. Women who have contacted us tell us that the regular monthly payments for ‘expenses’ are key factor in their decision to have a surrogacy pregnancy. The US study remarks:

“Interestingly, women were less likely to admit that money was the motivating factor for entering into a surrogate arrangement, but held the belief that other women who enter into these arrangements are motivated by the money it offered. Regardless of perceived motivation, women in this study were more likely to use the payment they received to get out of debt or pay bills and none of the participants were in the upper tiers of taxable income.”

In the UK study from 1994, only 19 surrogate mothers were interview. Aged between 20-30 yrs the surrogate-born children they gave birth to made up roughly half the population of this cohort of babies at the time (all singleton births but for one set of twins and ongoing pregnancies). As the UK law had only been introduced less than a decade prior, and with the popularity of surrogacy at the time in no way reflecting the levels of surrogacy we have today in the UK, this can only serve as a snapshot in time. 

Titled “I wanted to be interesting. I wanted to be able to say I’ve done something interesting with my life“ the study aims to look at awareness of surrogacy as well as the reasons for engaging in surrogacy and the relationships that resulted for these women. There was some scepticism of IVF as  at the time wasn’t as widely used as it is today. Artificial Reproductive Therapy (or ART) was considered a new technology. Interestingly, one surrogate mother refused to transfer parental rights as she didn’t perceive the parents as suitable by the end of the pregnancy, another conceived through sexual intercourse (or what is now known in some donor conception circles as ‘natural insemination’, or unprotected full sex).

Whilst the majority of the women in the American study were educated and employed, in the UK study the vast majority of women had no higher education and in fact may have not completed school.

 “Fourteen of the women had left school at age 16 or earlier and only one had remained in full- time education to age 18, although nine had undertaken further vocational and educational studies, often on a part-time basis-combining study with employment and/or motherhood. Five women had left school with no format educational qualifications, the remainder gaining qualifications to GCE; and CSE level at least. For two women advancement through educational qualifications was an expressed priority and for whom the need to finance further education was a major motivating factor in becoming a surrogate mother.”

Despite the status of surrogacy allegedly being for ‘altruistic reasons’ two women sought it out for the purpose of investing in their education as to advance, or ‘escape,’ their current circumstances. 

“I needed some money and it seemed an easy way to gain a large sum. Secondly, I loved being pregnant but didn’t want to look after any more children … Once I am qualified and able to make money in a more acceptable way there is no possibility of me considering surrogacy again even though [it has] been most exciting and rewarding. I looked at it as a way of getting out of the poverty trap.”

Understandably, money, regardless of location, education or business model, remains a primary factor drawing women to surrogacy. This study noted that two women saw surrogacy as a “reasonably convenient” way of ‘earning’ money whilst being a stay-at-home mother and as recently as 2015, Kim Cotton from COTS was ‘recruiting’ women for surrogacy as a practical method to earn money as a stay at home mother. (For background, Kim Cotton is a UK resident who agreed to have a baby for an unknown couple from America before there was Uk law on surrogacy. She was paid £6,500 at the time.)

However over half of the UK women thought that money was not (and should not be) – the prime motivating factor. One commented that there were easier ways of making money, such as refusing to relinquish the child and selling their story! Laws regulating surrogacy were not a decade old when these women were interviewed but it mentions “ evidence of both sensitivity and ambiguity concerning payment.” This has been clarified by the 1998 Brazier report as “reasonable expenses”.

The study says:

“It is unrealistic to expect surrogate mothers to carry a pregnancy and hand over a baby (or babies) to the commissioning parents without reimbursement of expenses at least, in recognition of their time (e.g. loss of earnings), the inconvenience, discomfort and risks to which they were exposed, and additional costs incurred.”

So even under a ‘altruistic’ model, a ‘service’ payment was incorporated into the considerations of the sum. Expenses should ‘at least’ be paid, alongside a loss of earnings and exposure to risk. Now we see payments being referred to as ‘expenses’ but it’s unclear how an ‘expense of pregnancy’ is defined. From the Law Commission consultation it was noted that in 2015 only 4.4% of surrogate mothers were claiming in the £15,000 – £20,000 bracket, but by 2018 this increased nearly 10% to 14.6%. 

Have the lines become blurred to disguise a payment as an ‘expenses’ to to make surrogacy more socially acceptable under an altruistic model? 

(Regarding loss of earnings, it’s important to note that Maternity and Parental Leave didn’t come into effect until 1999 in the Employment Act so this study pre-dates this and in 2022, America’s maternity provision falls far short of the UK’s.)

The difference in the US study was that over half of the women had degrees but were stay at home mothers and it is unsurprising that military wives are a cohort of surrogacy candidates. A perfect example is La’Reina Hyanes, the surrogate mother for one of the Kardashian/West children. According to Heavy.com La’Reina has a degree in criminal justice but was a stay at home mother of two young sons at the time, her husband worked in the military and one of her sons has a medical condition. The US health system  would require money for her son’s treatment and would be a strong motivating factor for a surrogacy pregnancy. Her second surrogacy pregnancy was for the Kardashian/West couple who paid her $45,000 over 10 months. 

As was explored with our blog on BBC 3’s The Surrogates, we agree with the US study as…

“A great deal more could be done to study the financial incentive on the decision to become a surrogate mother”. The UK study highlights altruism as 11 women specifically identified the “pleasure and joy” given to the commissioning parents as the “best part” but there was an underlying sense of being kind or worth present.

“I wanted to do something that was out of the ordinary and that made me a little bit special. And I think, because I haven’t got a lot of confidence, I’m not a mathematician or anything like that, I’m not a world-class model, and just normal. And I didn’t want to be normal, I wanted to be interesting. I wanted to be able to say “I’ve done something interesting with my life.”

This sentiment is mirrored in some of the stories we hear from the women who have contacted us and for me it is worthy of exploring as in a wider context, I have a sense that there is possibly some form of ‘toxic femininity’ contributing to a women who see their value in their fertility and their ability to produce children.

Reproductive Gifts and Gift Giving: The Altruistic Woman – Raymond – 1990 – Hastings Center Report – Wiley Online Library

There appear to be some trends in both the situations and circumstance of the women who engage in surrogacy as well as the motivating factors involved in their choices. We aim to return to explore this further but no-one says it better than Janice Raymond. She argues that altruism, though mistaken for agency, “has been one of the most effective blocks to women’s self-awareness and demand for self-determination”. Altruism for women must be put into context to be fully understood. 

Another reason given was what we might recognise today as obstetric violence and a need to  rectify mistreatment from a previous pregnancy.

“It’s given me the chance to experience a pregnancy and a birth where I’m in control, not the doctors…. I know what I’m doing this time and I’m not going to allow things to be done to me that were done to me in my previous pregnancy.”

Both studies make reference to respect and relationships and the US study highlights some interesting statistics on respect in maternity care and extended family:

“Participants, on average, reported feeling respected 88.1% by intended parent(s), 85.5% by the agency, and 90.3% by healthcare staff.”

“My first two surrogacies, I felt very respected (100%) by the intended parents and the agency, but my last surrogacy I [felt] very disrespected (0%).”

“When you are pregnant with your own, everyone wants to help you, but, with my surrogacies, my in- laws didn’t want to help me at all—and my co-workers were annoyed because I got time off after my surrogate delivery because ‘It’s not your baby.’”

“My care team giving birth was amazing, but I was discharged less than 24 hours after birth. Nobody asked me if I was okay or how I was feeling.”

The UK study looked in detail at the relationship between parties and future contact.

“Whatever had been decided jointly at the outset with commissioning parents agreements concerning future contact, telling the child the truth about her or his conception and birth, and the payment of expenses, may not be kept. However, they recognized that they could do little about this other than trust the commissioning parents to keep their word.”

Referring to the children born of surrogacy and genealogical bewilderment, some of the women wanted to stay in the life of the child they gave birth to.

“I was adamant that I would never bring a child into the world and it was going to be lied to. I’ve had friends who were adopted and told at 16 and I’ve seen them crushed. It must be awful. And I said “I’m not prepared to be party to any of this. It’s to be told as soon as it starts asking questions at 2 and 3. It’s to be made as normal as possible, no big deal”. And we all agreed on that. And that was probably the first thing which caused the underlying problems … I discovered when I was pregnant that [the commissioning mother] was pretending to be pregnant to her family.”

In the conclusion it is stated that all the surrogate mothers felt some continuing responsibility for the future well-being of the children they had helped to bring into the world. Five surrogate mothers feared their involvement in the child’s life would only serve as a “constant reminder” and cause confusion or distress. There were two cases at the time of the interviews where contact was about to cease due to strain and the stress of the relationship. 

“It should not be assumed that parting with the child was unproblematic. Five mothers spoke about their sorrow and distress about parting with the child, and for two this was described as the worst part whilst one husband described his worst part as recurrent fears that his wife – having conceived – would change her mind about relinquishing the child.”

So where one woman may be occupied with thoughts of how to give the baby to the commissioning parents, her partner or husband is concerned that she may be unable to do so. Personally, I recognise the impact on other members of the family, including the surrogate mother’s other children. 

Two surrogate mothers experienced surrogacy regret.

“If somebody came up to me and said that they wanted to be a surrogate mother I would do my damnedest to talk them out of it. I don’t think I’d ever recommend it to anyone again.”

Similar sentiment was expressed in the US study.

“I suggest to every woman who thinks about becoming a surrogate: please consider another way, whether it’s for the money, or the delusional idea of self-fulfilment, or whatever. You’re not just hurting yourself, you’re hurting the baby you carry inside you as well.” 

To conclude (thank you for reading this far!), research is important. It informs policies and laws. 28 years apart, both studies explain their limitations and call for further research. We can obtain, statistics and facts, work out percentages and averages and at the same time recognise that each person has their own experience and this cannot be summed up as a number. But we also can recognise that each woman has their own individual experience  that cannot be summed up as a number or a percentage. Nor does quantitative data always give us the fullest picture in light of more women’s narratives. 

The women we hear from make up a miniscule percentage of the UK population but their experiences of surrogacy regret is of no lesser value than those who it works out for. For every happy ending there could be an equal number of stories of loss and regret, we simply don’t know. How do these numbers stack up, how many would you comfortable with, if laws are further relaxed…maybe 10 women with regret, maybe 100?

As the UK Law Commission prepares to deliver it’s report this Autumn we look forward to reading their recommendations that will draw from the public consultations and other research, as this will inform the reform of UK law that is likely to follow. We also eagerly await the outcomes of a study currently underway into the voices of the children born from surrogacy.

In both studies I reviewed there were women who did it for money, but not necessarily only for the money. A desire to help, to be useful, to give something to someone to realise their dreams  of parenthood – all can be true whilst also being paid for your ‘service’. The line of where that payment is for expenses compared to what earns you a different future can be thin. This must also be weighed against how much is too much for ‘reproductive service’ and does this mean that the final product, a newborn baby, equate to a trade in children and yet another method of exploitation in women?

Is surrogacy baby buying or a kindness only women can offer? What happens when the arrangements made isn’t what you thought it would be and you want to change your mind? What happens when the child isn’t ‘perfect’ and the commissioning parents change their minds? Is it reasonable for surrogacy to be funded on the NHS, similar to IVF treatment? Should parental rights be transferred at birth and how much control could then be exerted over the pregnant woman?

It is lawmakers who get to decide on the policymaking around surrogacy. These are men and women who have been elected and constituents are invited to write to their MPs to express their concerns around these practices. 

For more on these issues, please subscribe and follow us on Twitter.  @WombsNotForRent.

Surrogacy – In the Extreme

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UPDATE: This shocking story of child trafficking between the USA and UK has been shared by Centre of Bioethics. This complex case involved deception of the surrogate mother, employees of the genetic father and a nanny who brought the child to England.

The adoption was eventually agreed so we believe the child is with the genetic father, despite his reference to the child as the “project”.

Another shocking case in the USA involves siblings lying to fertility doctors about their relationship.

The UK’s First Surrogate Mother

In 1984, a woman called Kim Cotton sold a baby to a couple she had never met.  Often referred to in the national press at the time as exchanging a baby for ‘carpets and curtains’, Cotton was paid approx. £20,000 in today’s money. The following year a new law was put in place to prevent a baby from being sold again.

Kim Cotton went on to found COTS and has since spoken on many a TV and radio interview that surrogacy is based on friendship and trust, but she remains unaware of what happened to the little girl she gave away, she doesn’t even know her name.

The First Single Commissioning Father

The UK’s first single father might be considered to be David Watkins, but actually the first single father to obtain children through surrogacy was actually Ian Mucklejohn.

Mucklejohn was 54 when he had an agency in California arranged the surrogacy pregnancy with an egg donor (a 27 yr old civil engineering student) and surrogate mother (aged 30). Nannies were employed to care for the boys when they were young, they are now adults. Their mother suddenly died from a stroke aged 45. Her name was Tina Price.

The Youngest Surrogate Mother

The youngest surrogate mother was 17 at the time of giving birth. Abused and coerced into having a baby for her mother, who adopted her, her case was reported on back in 2013.

Another young surrogate mother is Shaniece Sturdy. As a single mother of one, she was 19 when she decided to participate in surrogacy. Aged 21 she gave birth to triplets (from one embryo) for a couple she met through an agency, via C section as the triplets were born prematurely. According to a recent TV appearance, Shaniece said she never held them and is no longer in touch with the family, she also spoke about post natal depression and how she should have not been on a post-natal ward after giving birth. 

The Oldest Surrogate Mother

Harriet Stole was 66 years old when she gave birth to her own grandson in April 1999.  Harriet was post menopause when had an embryo made from her daughter in law’s egg ad son’s sperm, implanted in her uterus.

And mothers having children for their children has become more common. A landmark case in the UK in 2015 led to the removal of the requirement for two people to apply for a parental order, as a mother had a baby for her son, a single applicant, making her the mother and grandmother and her son both the genetic father and brother of the baby boy.

The oldest surrogate mother in the world is believed to be a grandmother from Greece who gave birth to her grandaughter via C section, weighing 2.6lbs.

The First Same Sex Male Couple

Tony and Barrie Drewitt-Barlow were UK based when an American woman, Rosalind Bellamy gave birth to twins for them. They are now separated, having had more children born via a different surrogate mothers, but they live together with Barrie’s fiancé (his eldest daughter’s ex-boyfriend) with whom he has a second daughter and plans for more children via surrogacy.

Mother of the most Surrogate Babies

Carole Horlock is the most ‘prolific’ surrogate mother in the UK and has had to date, it is claimed, 13 children for others. It was reported in 2025 that she still hopes to have her more and before she turned 58 and despite the risks and her Doctors advice, she sought embryos implantation in Greece. With two daughters and a son (from a surrogate pregnancy, Carole and her partner decided to give him to the people she had the pregnancy for) Carole has had miscarriages at different stages of pregnancy, as well as multiple pregnancies (twins and triplets). Her youngest daughter has spoken about following in her footsteps and also being a surrogate mother but also calls her mother’s surrogate pregnancies as a “borderline addiction”.

Jill Hawkins is another example of ‘serial surrogacy’ having ten children for others, but no ‘keepers’ (not our term).

“And even though the legal secretary from Brighton, England, had complications with her last pregnancy and has been treated for depression and once threatened suicide, she wants to give birth twice more before she turns 50.”

There are not multiple examples of serial surrogacy in the UK, such as Ria Pawlow, Laura McCarthy and Tara Sawyer to name three. Some surrogate mothers speak on the addictive nature of surrogacy.

Surrogacy for a Gap Year

A young British surrogate mother called Kim had a son for a couple so to receive paid maternity leave and be able to take a year off to travel. She follows in the footsteps of her mother who had six surrogacy pregnancies when Kim was aged 5-11. Both women used their own eggs for their pregnancies. In 2024 Kim had a second child for others and in the announcement explained how she had lost touch with the first couple over difference of opinion on how public Kim is. (Kim also spoke about how the Getting To Know period wasn’t required for the second pregnancy as agency COTS failed to implement their own policy to meet Kim’s preferences).

Kim vlogs about her experiences here and has since lost touch with her first born son and last year had another child for a different couple.

Surrogacy and ‘expenses’

A 2019 study from the University of Kent revealed that of 177 sets of parents who took part in the survey, 30 % paid between £20,000 to £30,000 whilst 25 % paid between £10,000 and £15,000, and 21% paid £15,000 to £20,000.

Meanwhile 7% paid up to £40,000, and in five cases couples paid up to £60,000.

Oldest Commissioning Parents

A couple in their 60s had a one year old child removed from their care by social services. The couple used the services of an overseas fertility clinic, bypassing UK restrictions, to conceive the child. The Surrogate Mother and her husband signed a parental order and legal rights were granted to the couple.

In 2023 a 72 year old man in Edinburgh was granted a parental order for a 3 year old who was born to a surrogate mother in Oklahoma. By the time the application was made the man’s wife had already passed away in a nursing home. The boy appears to have been cared by nannies since birth and plans were being made for boarding school and for a legal guardianship.

_____

Aside from mainstream news, another example of extreme circumstances in surrogacy is shown here. The Commissioning father dies suddenly, prior to the birth of the surrogate-born child. As the father was the only genetic parent applying for legal parental rights the Commissioning Mother had to apply to the courts for a parental order to be granted, outside of the current laws.

Outside of the UK, there have been some recent extreme surrogacy stories in other parts of the world, such as this couple in Georgia who have 21 children born through surrogacy, and the Japanese Businessman who had 16 children via surrogate mothers, however we would like to end this by remembering the lives of the women who have died. I dedicate this blog to them, including the women we don’t hear about.

Jenny Craft – October 2021

Lydia Cox – July 2021

Surrogate mother – name unknown – died May 2021

Michelle Reeves – died January 2020

Crystal Wihite – died Feb 2017

Brooke Brown – died October 2015

and from the UK, Natasha Caltabiano who died on New Years Eve 2005.

2025 Update: In addition to a 22 year old surrogate mother who died in Ukraine we are also aware of another young surrogate mother who died after giving birth and that attempts have been made to cover up the circumstances of her death.

Perhaps, in time, the reporting of Maternal Death in the UK will record data on surrogacy so we can understand what links IVF drugs and surrogacy pregnancies have to the deaths of these women.

“Whole body gestational donation” for surrogacy: creating new life from death. What could possibly go wrong? – Guest Post from Paula Boddington

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There has been considerable attention to a paper by a Norwegian philosopher, Dr Anna Smajdor, in the journal Theoretical Medicine and Bioethics, outlining the case for what she calls “whole body gestational donation” (WBGD) as a form of surrogacy. This astounding paper was picked up first by Reddux, and since has received attention not just on social media but also in publications such as the Daily Mail and Cosmopolitan. The reaction is, in the main, mostly one of astonished revulsion, with a few voices as shown here (see the comments under the Daily Mail article).

The gist of Dr Smajdor’s argument is as follows: In 2000, Rosalie Ber suggested that women who have been diagnosed according to the brain death criteria, or who are in a persistent vegetative state (PVS) could be used as gestational surrogates. Yet, “surprisingly”, says Smajdor, this seems not to have been implemented anywhere in the world. Smajdor makes a few adjustments to Ber’s proposal, limiting it to women diagnosed as brain dead, and argues that with prior consent of the woman, it could provide a useful means to achieve pregnancy for those unable to carry a child to term, or, indeed, as an alternative to pregnancy for any woman, given that pregnancy is not entirely risk free. The existing system of organ donation is used to justify this, hence the description of “whole body gestational donation” which sees this as analogous to donating separate organs or body parts to save life or improve health in other individuals. Much could be said in comment on this paper but here we will simply make a few remarks…

Firstly, there are many reasons why this proposal does not seem to have been implemented, one of them being the high cost of sustaining a patient on life support, which would mean that to initiate and sustain a pregnancy until viability would be likely to involve costs in the hundreds of thousands of pounds if not more.

The high costs, plus other practical problems, does mean that this form of surrogacy may never be used in practice. But this does not imply that we should be complacent. One reason for concern is that such extreme proposals are often used rhetorically in debate. A troubling scenario is suggested. There is a general outcry. Then along comes the counter response: “We are not going to do anything so terrible! We agree this is going too far. We are proposing we do something far more reasonable!” Or perhaps, often later once the fuss has died down a bit, “We will do this, but don’t worry, we’ve listened to concerns, we’ll do it only with safeguards.”

But the proposed policy may be “far more reasonable”, may have “safeguards”, but is still nonetheless full of problems. “Not so bad”, may still be not good enough.

And a second reason for concern is that even if Smajdor’s proposal is never adopted, the ways in which she argues, including her view of childbirth, and of the human body in general and women’s bodies in particular, are firmly representative of much mainstream influential thinking in bioethics. There are many commonly used ways of arguing and of thinking about ethical problems which tend to skew towards certain “rational” sounding solutions, often favouring the use of new technologies, but which frequently present only a very limited and biased view of matters. Let’s look at just a few of the problems with Smajdor’s reasoning, problems which occur again and again in the field of bioethics.

We can start by looking at the analogy with organ donation, because it will alert us to some major problems. The argument goes by analogy:

X is really the same as Y. We accept Y. So we should accept X, in order to be consistent.

We accept organ donation. So we should accept donating the whole of one’s body, not just parts. Otherwise we are being irrational. “Those who accept brain stem death as an adequate basis for organ donation, should for consistency acknowledge its acceptability for WBGD as well”, opines Smajdor.

But Smajdor has actually shot herself in the foot by using organ donation as her model, because everything we know about organ donation confirms that human beings are not simply “rational” creatures, and the body is not merely a machine to be broken into spare parts.

Rates of organ donation are critically dependent upon sensitivity to the feelings not just of the donor but crucially of their families. Critical accounts in the media can greatly impact rates of donation, and sensitivity and empathy in explaining the situation and requesting consent of relatives is vital. Spain is often held up as having a particularly successful organ donation and transplantation system. This may be credited to its “soft opt out” system where the default position is that of consent, but critical to this is the extensive training in communication and sensitivity for those involved in requesting permission from families. Critical too, is widespread public understanding and acceptance, respect for those who opt out, and widespread agreement on the good that is being done by successful transplantation. (Remember the controversy that George Best had a liver transplant, only to continue drinking.)

How we treat the dead, including those who donate bodies, tissues or organs, is a deeply ingrained part of human culture. The very earliest signs of human civilisation show elaborate concern for proper burial. Disrespectful treatment of the dead has been used to mark disdain for enemies and criminals. But this, we now find abhorrent, showing how strong our respect for the dead is even in our “rational” and “scientific” age. We are moved to find that elephants also show respect for their dead. We cannot wave away these concerns with a few so-called “rational” arguments.

But this is precisely what Smajdor seems to do in her paper.

Smajdor acknowledges that in WBGD, the focus will move from caring for the patient, to using the patient’s body as a “repository of tissues that can be used to benefit others”. But, she says, this is just what happens anyway in organ donation.

Yes, it is. This is precisely why extreme sensitivity is needed. This is precisely why a different medical team deal with donation, not the team caring for the patient. This is precisely why, ideally, trained staff communicate with and care for the family. All this is overlooked in the name of “rational consistency”.

In the world of pure reason, truths are universal and eternal. Smajdor has no sense of time as for her it makes no difference. She recognises that in organ donation, we have to extend ventilation after brain death is diagnosed to keep the organs in a healthy state before they are removed for transplantation, and that in whole body gestational donation, this time would be extended. “But ventilating someone for two days, two weeks, or two years makes little difference except insofar as it forces us to acknowledge what we are doing before we hasten onto the next stage,” she writes.

But we are creatures who live in time, not in the abstract world of reason. Our experience of time is, well, an essential part of our lives, is woven into our entire embodied existence and development, our lives, our birth, our death.

Indeed, for families of those who donate organs, the time their relative spends on ventilation, and the harvesting of organs, does make a significant difference. The manner in which the family can say goodbye changes. This is not to be dismissed, and the generosity of families who willingly agree to this for the sake of others should be acknowledged. Smajdor seems to think that the issue can be resolved into overcoming our “distaste” for sustaining brain-dead patients for long periods. The “discomfort” here, she suggests, “relates to the liminal state between life and death that brain-dead patients occupy”, as if overcoming this discomfort is akin to, say, overcoming squeamishness at having to pull a splinter out of someone else’s fingernail.

For the rest of the human race, these “liminal states” are the stages of transition between life and death which form critical points of significance and meaning. The recognition of their significance is an integral part of our humanity. Neither at the start, nor at the end of life, does Smajdor understand the importance of how we respond to our embodied existence.

Furthermore, Smajdor has a pick and mix approach to evidence. She bends over backwards to examine the minutiae of the scarce empirical evidence regarding gestation in women who are diagnosed as brain dead while pregnant, speculating optimistically about what might be possible, and observing for example that “there is no known upper physiological limit to the prolongation of somatic function in the absence of brainstem function”. But this simply means we have virtually no evidence, because it’s never been done. Yet Smajdor uses it to imply we could carry on keeping the body going indefinitely. She seems to grasp at any shred of evidence that WBGD can be done. Yet at the same time, any arguments against it are dismissed as mere “distaste”.

The body is seen as a robotic resource, as a machine. The use of reason in this paper shows an instrumental rationality which understands the human body as simply part of the material universe, one more resource to be exploited and used, and as in need of improvement. The fact that even normal pregnancies are not risk free is used as an argument to justify using WBGD for any pregnancy, not simply in cases where an individual or couple cannot otherwise carry and birth a baby. But this is one place where Smajdor’s “rationality”, her mathematical calculation approach to ethics, comes apart – mysteriously, she never explains how eggs are extracted from a woman’s body, because that would remind us of the not inconsiderable risks of egg donation. Oddly as I have often noticed in much bioethics and discussions of technology ethics, it so often seems to be risks that occur in the natural course of life which are counted; risks caused by technology itself are either ignored, or it is assumed that improvements in technology can eliminate them.

Pregnancy, no; injecting a woman with massive amounts of hormones and other drugs to induce ovulation and egg extraction, yes.

The last comment for now concerns the child. Smajdor’s arguments address the physical health and safety of the foetus as it may develop within the womb of a woman who is brain-dead. Naturally physical health is extremely important. But again, she reduces the human being to nothing more than a biological, material creature. If a woman has become simply a “bio” version of a gestation machine, if she is brain dead, the baby born in such circumstances emerges from a static, unconscious and unfeeling mother. What emotional and psychological issues might this bring?

Children now often see their own ultrasounds from when they were in the womb. Recent celebrity same-sex male couples have shown off such ultrasounds, strangely isolated images, the mother entirely absent. The woman who bore a child in its first months from conception to birth is notable by her absence. What lack might such children grow to feel when they finally understand their origins? And what lack might a child feel who is born of a brain-dead donor, kept alive on ventilation for the entire period of gestation?

In surrogacy from WBGD, this is not parallel with those thankfully rare cases where a pregnant woman suffers some calamity and the pregnancy is sustained after a diagnosis of brain death to produce a child that she had wanted as her own. For in cases of WBGD surrogacy, under this scheme of technical rationality, a scheme which treats bodies as bits and pieces, and as machines to be exploited, the brain-dead woman is used as if she simply as an incubator or useful storage unit.

Of course she is never that. There are intimate biological links between a woman and the child she carries, even in the absence of any genetic relatedness. Fine-tuned adjustments to the mother’s physiology occur. Communication between mother and child takes place on many different levels. Free foetal DNA enters the maternal bloodstream. Stem cells from the foetus can help repair the mother. The growing child will recognise sounds, the mother’s voice, different tastes, the pace of the mother’s gait.

The consent of the woman to WBGD does nothing to remove these facts of human development or their significance. To focus on consent as a means of resolving ethical problems is again to see the question in terms of an abstract rationality, not in terms of the grounded biological reality and connectedness to each other which forms the underpinning of our mortal existence, which frames our moral compass.

In some jurisdictions, the families of those who donate organs may be sent anonymous “thank you” cards, or be updated anonymously about the welfare of those who received their relative’s organs. This is often a source of comfort, but must be handled with sympathy and sensitivity as families may feel their loved one “lives on” in others. With whole body gestational donation, these relatives will have waited months and months to bury their relative. What of their feelings about the child?

At birth, the child will be removed from the womb, and, presumably, the ventilation will be switched off. Will Smajdor and her bioethical colleagues tell us that concern for this is based on “irrational” feelings about the “liminal” states at the start of life, on “disgust” which we must overcome?

Arguments are sometimes presented as more rational, the more they abstract from reality they become; the more “emotional” the response the more it is dismissed or belittled. Good luck bringing up a baby on such a regime of pure reason.

Will it be left to the rest of us to explain that, no, human beings are not simply biological creatures to be manufactured to order; the dead are not simply vessels to be used to satisfy the desires of others for children. We need to explain to these “bioethicists” that, as significant as a child’s birth day is, so is their journey from inside the womb of great significance, and not just to the child but to the mother; just as the journey we all take out of this life is significant, and not just to the individual, but to all who love and care for us.

 ~ Paula Boddington is a moral philosopher. Paula has published on a wide variety of topics including the ethics of organ donation and transplantation, clinical genetics and genomics, and the ethics of new technologies.

Motherless doesn’t exist

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I was pleased to see coverage of a recent surrogacy dispute in the mainstream media last week. Pro-surrogacy lobbyists say these cases are rare but we cannot be sure of this. The family court is closed to the public and it is only with the judges’ permission that details of a case be released to the press. It was Julie Bindel who sought permission to write on the case of Z (the child) and her article was published in The Critic in June, with the mainstream press picking it up in The Times, The Telegraph and the Daily last week, so it it feels like a good time to revisit this particular case.

I am limited in what I can share for obvious reasons, but I can say that I am honoured to know and support the surrogate mother from when we met 3 years ago to today. She is the picture of dignity and strength in incredibly challenging circumstances.

When such disputes happen there are lifelong consequences for all involved. Perhaps what pro-surrogacy lobbyists mean is that it rare for judges in the family court to rule in favour of the surrogate mother. Such as this case where the commissioning parents were not entirely honest about a condition one of them suffered from and the surrogate mother wanted to withdraw her consent as she considered them to be unsuitable parents. The child was placed in foster care.

Or the case of a surrogate mother who, as she already had a large family and with no genetic connection to the child, the judge decided that the commissioning couple should retain custody. The surrogate mother is allowed to visit the child 6 times a year. (Significantly, in this case, the court notes state that a parental order “tells one nothing about what the best welfare arrangements for the child will be after birth.”)

We know of UK cases where there is significant pressure on a surrogate mother to agree to the parental order and situations when her consent is not forthcoming it can be ‘dispensed with’. Marie Anne wrote of her experience and told us that counsel for commissioning parents argued that because a UK surrogate mother had tragically died and was therefore unable to give her consent, so should she, a very much alive surrogate mother, have her consent dispensed with. (It’s likely that the wider public wouldn’t believe this unless they read about it in the papers or heard it on the news, but coverage of Marie Anne’s case was wholly positive at the time.)

These cases are complex and I am not a lawyer, but my reading of the case of Z it is that the commissioning parents had the early intention to remove the mother from their lives once they got what they wanted; the child. It was never their intention to have her as an extended family member, despite what they promised. The court proceedings made it clear that commissioning couple didn’t want a mother in Z’s life, there was “no vacancy to fill” and G, the surrogate mother was referred to as “just an egg donor”.

By applying this reductive, dehumanising language and failing to acknowledge reality and her role as mother, their aim to sever the connection with her child was made starkly clear.

Some say that G could have changed her mind and kept her son but once ‘signed up’ to surrogacy, it is very difficult to back out. It’s not a matter of simply changing your mind. You are pregnant with child you are told is not yours.

Whilst within the legal limits, a surrogate mother can access an abortion in the UK, but an article from New Zealand, where the laws are similar to ours, a woman terminated her surrogacy pregnancy and a politician (with now two surrogate born babies) put forward a private members Bill. The wording of which alludes to access for abortion in a surrogacy pregnancy possibly coming under threat.

“Labour MP Tāmati Coffey, who, with his partner Tim Smith, welcomed their son Tūtānekai by surrogate in 2019, currently has a members’ bill in ballot calling for modern laws for modern families. It includes reform of birth certificates, providing a way to enforce surrogacy arrangements and creating a register of potential surrogates.”

Outrageously, accusations of homophobia were made of G. In my view this (along with a legal argument of human rights) this was done to garner sympathy, claim victimhood and tarnish G as bigoted. If a woman was homophobic would she seek to engage in having a baby for a same-sex couple? No.

Whilst social services were in support of the two men the clinical psychologist in the case said “The fathers…claimed that they are a ‘motherless’ family” and it is from here we get the title of this blog: “Motherless’ doesn’t exist.”

Ultimately the judge ruled in the best interests of the child and that was for the child to know his mother and have an ongoing relationship. It is an unprecedented decision where “free and unconditional consent that is required by section 54(6) of the Human Fertilisation and Embryology Act 2008” was central to the ruling.

Had all parties stuck to the original agreement then the situation would undoubtedly be entirely different for the adults and more importantly, very different for the child. But the State cannot legislate to force a friendships in any form and this case demonstrates how the ‘friendship’ was temporary, one sided and transactional. It was not based on the natural-founded and enduring friendships we are led to believe is common in surrogacy.

Readers should be reminded that reform proposals seek to introduce a model of commercial surrogacy where a pre-birth order transfers the parental rights at birth. The mother gives her consent to transfer her parental rights before the birth but she is not required to confirm her consent afterwards. The Law Commissions of England and Wales and Scotland found this to ‘disrespect’ her autonomy:

“A requirement for further consent after birth also suggests that the surrogate’s consent before conception is not adequate, which does not respect her autonomy.” ~ Law Commission’s Core Report, Page 37.

But as we know from this case, a lot can change between conception and birth.

With the ‘cooling-off period‘ (which I use deliberately as a contractual term) much reduced from 6 months to just 6 weeks after the birth, a surrogate mother has much less time to raise the alarm, decide to try to reclaim her parental rights or instruct lawyers. Under the Law Commission’s preferred model her name has already been removed from the birth certificate. Her name, rights and role in the child’s identity documents, knowledge of their relatives and experience of their family has been erased from the outset.

Thankfully, this is not the case for Z who will know his mother but it would have been very different had reform been in place at the time.

We would like to thank the legal team who supported G and we invite anyone who is or knows a surrogate mother with regret to contact us. 

Open letter to the surrogate mothers – Guest Post from Anonymous

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Dear fellow surrogate mothers,

The baby you have in your womb is yours. Any woman that has a baby in her womb is a mother, she is the mother of her baby. It’s a law of nature and no one can change it.

Don’t give them this baby, don’t give them your baby.

This baby is yours, you feed it with your body. This baby feels what you feel, shares your food, calcium from your bones, your hormones. This baby is afraid when you are afraid, feels your laughter inside. They are happy when you are happy.

Don’t think this baby in your body is theirs because they have spent so much money. That you are just an ‘extreme babysitter’ and you are just ‘borrowing’ this baby and will be ‘giving the baby back’ at birth. No money can ever be a ‘compensation’ for the very existence of a human being. Money shouldn’t turn a pregnancy into a service, no amount of money can ‘reimburse’ you for what you are doing. 

Don’t think this baby is theirs because you are ‘gestational’ surrogate and not genetically related to him or her. Because this baby knows only you, needs you, wants you and loves only you. Because a fœtus knows nothing of genetics and does not care if they were conceived in a lab. He or she doesn’t care about IVF, clinics, money deals and all the discussions and paperwork between the adults and agencies that commissioned them. This baby is growing inside you and wants to continue growing with you, to be raised by you.

You are doing the most wonderful thing ever, you are creating a human being and you are going to give birth to a new life. They have no right to claim rights to your baby for the mere reason they have paid. Nobody can buy a human being, unless of course this human is a slave for trade and you are also a slave through surrogacy. This is the reality many do not want to face.

The fœtus inside you is your little precious life, and for the moment it is only you. The only person in the world that this baby will know is you; your odour, your diet, the sound of your voice, the movement of your body, your touch, your affection. You are the most important person, the only person this baby wants in their life, the only one able to fulfill their needs. 

When this little life comes into the world, it will know only you. It will look for your touch, your breast, your taste, your face, your protection. Skin-to-skin contact with you will bring him or her serenity, joy and tenderness. Don’t be cruel enough to refuse this.

Don’t think you’ll receive love, gratitude and respect for what you’re doing. You’ll just receive incomprehension and contempt from institutions: no one will understand that you could have abandoned your child – whether you were a traditional or a gestational surrogate mother – because abandoning your child at birth is not forgiven. Because getting pregnant, carrying and bringing a child into the world, only to abandon it at birth – voluntarily and on purpose – is unforgivable. 

Leaving your baby, giving it away is the worst trauma you can inflict on a fragile, new and precious life. The trauma of abandonment, being handed over to strangers will cause loss, confusion, feeling of emptiness and anxiety. The separation from you will create disruption, the deepest wound anyone can ever experience.

I wish I had never given my baby to them. I pray my son can ever forgive me for having abandoned him to his pretend (not ‘intended’) parents. It is a mistake I will forever regret. 

“I made the biggest mistake of my life, all to help someone”– Guest Post from Marie Anne Isabelle

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Ten years ago I was a gestational surrogate for a family member on the understanding that I would have ongoing contact with the child that I would give birth to. Naively, I did not realise that this would not be a guaranteed in our arrangement.  Had I known that it would not be guaranteed I would never have agreed to be a surrogate. I believe I was lied to, manipulated and exploited because somebody needed my uterus.

Surrogacy – being pregnant and having drugs injected into you daily for three months – is not an easy or pleasant experience at all. It inflicts enormous physical demands onto the body and the psychological damage is irreparable. My experience is testament to that. From the moment I was pregnant I was made to feel as though my body was no longer mine and I had no control over it. I was told what to eat and the freedoms around some of my daily routines were completely destroyed. But the worse was yet to come.

As soon as the child was born, I was abandoned by the very people I had helped and was made to feel utterly irrelevant to the child I had given birth to. This whole process had a devastating impact on my mental health to the point I was admitted into psychiatric care.

Anybody would have thought it would have been at this point that support and help would have been given to me, but no, instead the laws allowed for my mental health to be used against me, I was  silenced and my consent disregarded so that parental order could be granted.

Unfortunately for those that tried to undermine me, a psychiatrist was employed to ascertain as to whether I had the capability to consent. My ability to consent was established but by this time, after all the abuse I had sustained, it was now difficult for me to give my free and unconditional consent.   

I asked for a contact order but was told I would not be granted one as this would have deemed this as a condition. But the condition was central to the original understanding. It didn’t matter. I was then threatened with paying Child Maintenance by CAFCASS if I did not consent to the parental order. (I do not believe CAFCASS should ever be involved in surrogacy cases.) After being threatened, bullied and given endless false promises I relented, as my mental and physical health could take no more. I gave my consent and my parental rights were transferred to her and her husband. To this day I have never seen the child I gave birth to. 

This continues to have a devastating impact on my life, I am not sure how I can live without giving birth to a child I will never see. It is not a situation I had ever envisaged I would be in as I would never had agreed to be her surrogate if this was the arrangement. I do not agree with surrogacy, I believe it should be banned completely as there is no pathway for it to ever be safe.  It destroys lives and the cost not only to myself, but to many others, has been too great.

The amount of money spent on this by the tax payer should not be ignored either.  I have not been able to work, I have been under the care of the NHS for ten years. All of that expense has never been directed to the commissioning parents. It has come from you, the very people who are reading this.  That is completely unacceptable.

The Law Commission recent recommendations make no reassurances that what happened to me could not happen to someone else.  Instead, they make it more likely. Surrogacy needs to be banned around the world, before more people are exploited and it needs to happen now.

Surrogacy – a new job opportunity?

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Pro surrogacy lobbyists will say that surrogacy isn’t a job but when it is compared to forms of labour it is always to the riskier jobs. Comparisons are made to say, being a firefighter or police officer, but comparisons are never made to other service providers such as being a dentist or a cleaner. We know those roles are low-risk, so it’s subtle but we recognise there is an inherent risk in engaging in pregnancy for others.

With risky employment comes training, health and safety equipment and sometimes a significant risk allowance. If surrogacy was to be thought of as a job then there would be some health and safety guidelines, checks and an uptick in salary. And being pregnant is 24/7 with no breaks and jobs with long hours, like truck divers, rest breaks are scheduled for health and safety. Also, the riskiest jobs in the world have an element of knowingly putting yourself in harm’s way and this becomes part of the deal, and perhaps part of the draw.

With limited research in this area we rely mostly on anecdotal evidence and we have observed some common trends. Surrogate mothers will often have former careers in childcare, teaching, midwifery or nursing, and it seems to be fairly common for surrogate mothers to go on to become deeply involved in surrogacy ‘community’ and subsequently switch careers.

A small 2022 study * from a pro-surrogacy Academic, Dr Kirsty Horsey confirms that most surrogacy ‘teams’ meet through an agency as strangers and though only 47 surrogate mothers completed the survey their careers included midwifery, teaching and nursing:

“Regarding occupation, 12 surrogates identified as being in nursing, midwifery, or health care, seven were in teaching or childcare professions, and 11 in business administration, management, or accounts. Three were solicitors. Other roles included civil servant, police staff, a registrar, a hotelier, a retail role, two students, and two ‘stay-at-home moms’.”

The survey summarises that “Most responses (85%) indicated household incomes below £70,000. Four surrogates said their household incomes were above £80,000.” But it’s worth pointing out that 44 respondents answered that question and a quarter (25%) said they were on a joint income of less than £29k and another 30% said there were on a joint income of between £29k-40k. So that’s over half (55%) who are on significantly less than 70k. The footnotes for this suggests is was badly worded.

And there is a disclaimer: “Given the different professions identified, it is unclear if all respondents gave an answer reflecting personal or household incomes, suggesting that both should have been asked for in the survey. Because of this, it is unclear what weight can be given to these answers.” (Footnote 31.)

These trends bear out in real life further, these example shows that surrogate-mother-to-agency-employee pipeline is real. Take Gina Kinson for example. Having worked in nursing, Gina, a two-time surrogate mother, later became a Co-ordinator for My Surrogacy Journey. Or Sarah Jones, now CEO of Surrogacy UK, Sarah is an Early Years Educator and has had 5 babies for others. Another is Dawn Allen, a surrogate applications and agreement Co-ordinator for Surrogacy UK. Initially inspired to have babies for others after watching a documentary, Dawn came out of ‘retirement’ to have a baby for a couple at the age of 49 whilst working at Surrogacy UK.

So it appears common that a surrogate mother’s career will centre, at least for some, around care-giving and providing a service and having had a baby for others can result in becoming more deeply involved in the industry.

If surrogacy is a vocation where you provide a service in exchange for money, it’s a regular job like any other and one you can retire from. It’s not just ‘favour’ you do for a friend or family member, not least because women are having babies for strangers they are matched with. Surrogacy is no longer what we thought it was when it began back in the 80s. (You may have seen #changingthelandscape used on pro-surrogacy posts and they are not wrong, the landscape has indeed changed.)

In risky jobs we assess and name the risks using clear language in the job description so applicants know what the role entails. (Prostitution isn’t a job, but we have seen it be more commonly referred to as ‘sex work’, as a way to normalise and rationalise the act of using a woman’s body for paid rape as job she chooses to do or a ‘vocation’.) Now there are subtle shifts in language in surrogacy too. Agencies now refer to ‘compensation’ rather than the legal term of ‘reasonable expenses’.

Pregnancy and labour is unpredictable and carries risk. We don’t currently consider surrogacy as a form of employment in the UK, as ‘contracts’ are not enforceable (though that’s a whole different blog), but monetising women’s bodies is a slippery slope.

If you have concerns about surrogacy becoming more widespread, the impact on women and children and what proposed reform in the UK would lead us, please get in contact.

** With 47 respondents to this 2022 survey, this could be roughly just 10% of parental orders as 449 Parental Orders were granted in 2022.

Words from a Midwife: Part Three – The Unspoken

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There has been an interesting response to the Royal College of Midwives (RCM) webinar on Surrogacy. Perhaps it’s not surprising that those ‘with women’ wanted to offload their or share what they themselves have witnessed when supporting patients through pregnancy, birth ‘and beyond’.

Midwives got in touch with us to tell us of their shock at when they heard their union was considering hosting a webinar on surrogacy. We later heard from the women who attended that it was far from a the ‘neutral’ presentation they were promised.

Parts One and Two of this short blog series are direct accounts from RCM Members who attended and who remain anonymous and other midwives gave us permission to share their personal perceptions of surrogacy in their day-to-day jobs.

A Community Midwife noticed how the glossy images a surrogate mother posted online which promoted surrogacy as a wholly positive experience hid the very raw and real realities of her birth injuries.

Another midwife said something similar about a woman who had a baby for a family member. The commissioning mother was posting on social media about how amazing her ‘journey’ was, but this midwife knew the reality for the birth mother. It was filled with gestational diabetes (which can lead to higher risk of diabetes in future), obstetric cholestasis which is a liver condition (that can causes liver disease and other issues in the future) and high blood pressure. This risky pregnancy ended in a C section. The truth was this woman was devastated after the birth as she would never have another child of her own due to these complications. It put a strain on her own marriage as her husband, while initially supportive, didn’t realise the enormous negative affect this had on his wife’s health and the future of their own family. This desperately sad reality was not shared on social media.

Another midwife commented on the late maternal age of two surrogate mothers she cared for and she expressed concern that there are no upper age limits in proposed reform. Both of the surrogate mothers she supported were in their 50s. She felt that as the pool of women available for surrogacy was ‘slim pickings’, women with a complex obstetric histories may be considered by the commissioning parents as their options were limited. This was nothing to say of the risk to the baby.

And finally there was one patient that stayed in the mind of a midwife we spoke to by phone. She told us how she supported this woman through four surrogacy pregnancies. The midwife knew she had lost touch with all but one of the families she was pregnant and gave birth for. During these pregnancies the commissioning parents were her “best friends” but once the baby had been delivered, the surrogate mother was “ghosted” and she then grieved the loss of the lifelong friendship she was told she could rely on.

In sharing their experiences these midwives has a sense of release, as if they had to keep to the official line outwardly, but inwardly there was worry and anger building as they were unable to talk freely. In our conversations these women were able to air their concerns about the direction of travel of surrogacy in the UK. Several felt badly let down by their union as women and as midwives.

We were left with a distinct observation that midwives are on the ‘front line’ of surrogacy. Any legal disputes may end up in the court room but they begin on a maternity ward. It is the midwives and other healthcare professionals who will have to navigate the practicalities on the ground around consent, the removal of the newborn and ongoing mental and physical health problems as a result of surrogacy births.

Words from a Midwife: Part Two – Guest Post from Anonymous

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After we published Part One of this blog last week, a number of midwives got in touch with us to tell us more about Royal College of Midwives’ webinar on surrogacy. Part Two is a another written account from a Midwife who attended the webinar who also wishes to remain anonymous. If readers wish to get in touch with us, please use the contact form .

Prior to the webinar I sent the RCM a complaint regarding how inappropriate it is to platform an organisation that offers material incentives such as Ann Summers vouchers and apple watches to potential surrogates. Following my complaint and complaints from other midwives, the RCM sent out a standard response stating that the RCM is neither for or against surrogacy. They said they were neutral on the subject. The webinar panel was then amended to include other speakers such as Louisa Ghevaert, a family lawyer and Sarah Jones, surrogate mother and representative of Surrogacy UK, the largest surrogacy agency in the UK. 

The webinar started with the host informing everyone that it would not be a debate on the pros or cons of surrogacy and it would be an educational ‘safe space’. It soon became apparent with the lawyer’s presentation that the webinar was heavily pro surrogacy. Louisa spoke at length about the law reforms proposed which included removing surrogates’ rights to be the legal parent at birth. This element was glossed over so I asked a question about whether this included surrogates who were genetically related to the baby and whether that means it completely removes the surrogate’s ability to change her mind following the birth. I also commented in the chat that this scenario would mean midwives would have to remove babies from birth mothers and hand them over to commissioning parents and asked how we could be expected to do this? Both my question and comment went unanswered. Louisa continued to focus on how wonderful law reform will be as it provides criminal history and safeguarding checks for all involved. She insinuated that although the government had stated it will not be taking up this reform that this was just a formality and it will be back on the table in a month’s time. 

Sarah Jones was next to present and she spoke at length about her personal journey of being a surrogate and her motivations for surrogacy. Sarah did answer my question, she admitted that she had undertaken both types of surrogacy ‘host’ and ‘straight’, meaning she had given away her own genetic children. She stated that any commissioning parents involved with Surrogacy UK had to agree to having an on-going relationship with the surrogate after birth. Although, she failed to mention how this would be enforced. In my professional experience the surrogates I have cared for have both been ‘ghosted’ by the commissioning parents following the birth and have no on-going contact. (In those cases the surrogate born child was not genetically related to the surrogate mother.) 

Sarah spoke about how she is ‘bonded’ with the children she was a surrogate for but no mention of how the children feel being born by surrogacy or how her other children feel knowing they have siblings out there who do not live with them. 

Michael and Wes were next to speak. This was the most difficult part of the webinar for me as I find their whole organisation to be completely unethical. They offer membership ‘benefits’ which include Apple watches, Gousto vouchers, Merlin entertainment vouchers and Ann Summers gift cards. I asked them if they thought offering these benefits blurred the lines into commercial surrogacy. I was not expecting a reply to that particular question, however Michael did reply:

“All of the membership benefits were created from three years of research to the surrogacy community. Every membership benefit has a health, nutrition or support benefit to all our members.”

I struggle to understand what support benefit an Ann Summers or Lovehoney voucher brings to a pregnant woman. It highlights to me how loosely regulated the remuneration for surrogacy is. On the surface it may seem that the UK has an altruistic model of surrogacy but in reality we have a system of commercial surrogacy in disguise with unknown sums of ‘expenses’ being paid. I have also witnessed expensive gifts exchanging hands. I commented about how I felt it was unethical to set up a surrogacy agency in a developing country such as Mexico which has high levels of poverty. This comment went ignored. 

What stood out to me the most throughout the whole webinar was the complete lack of discussion regarding the children born through surrogacy. The focus was on how midwives should support both surrogates and commissioning parents. There was also a complete lack of understanding from all presenters about the role of the midwife and who the midwife owes a duty of care to. I asked Louisa about what should midwives do following the breakdown of a relationship between the commissioning parents and surrogate. Instead of getting the correct answer that midwives only have a legal duty of care to the surrogate I got a very long spiel about being compassionate and kind to the commissioning parents! 

It is difficult to understand how the RCM can claim to be neutral on surrogacy and then put on a webinar with only pro surrogacy speakers, there to give rose-tinted glasses spin on surrogacy and the law. It was biased and far from neutral. 

Disappointingly, most of the attendees seemed to be in favour and left gushing comments about how wonderful it all is and how fabulous they think Michael and Wes are. It goes against everything we are taught as midwives regarding the mother and baby dyad, during pregnancy and following the birth. It seems the rights of anyone wanting a child for themselves supersedes all ethical and biological considerations. 

We know the relationship between mother and child starts in the womb, we are monitored on our discussions with women by the ‘baby friendly initiative’. We must inform women that their babies can hear them in the womb, that they will recognise their voice and the bond starts before they are born. 

Is this all forgotten when someone is commissioning a woman to have a baby for them?

Words from a Midwife: Part One – Guest Post from Anonymous

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Following the Royal College of Midwives webinar on Surrogacy last week, a Midwife got in touch with us to share her experience and her concerns about what the promotion of surrogacy in midwifery means for her. To protect her identity we share the following without sharing her name.

As an RCM member for the past 28 years, I’ve always felt my union has had my best interests at heart. I’ve felt confident of their support and on the very few occasions I’ve needed their assistance, they haven’t let me down. But now I feel things may be starting to change, and I’m deeply concerned.

I attended their webinar last week which was advertised online as a discussion on surrogacy and how we, as midwives can support parents of babies born of surrogate mothers. The subject of surrogacy troubles me but the content shocked me.

Since I was a teenager at the start of my training, it is embedded into the heart of what it is to be a Midwife and that is to be ‘with mother’. Our role is to be her closest carer and her biggest advocate – yet here we were being told in this new way, she is not a mother, but a ‘carrier of a baby’. A baby who is to be given away at birth, and not only that, our care as midwives should be transferred over to these ‘intended parents’. 

It was very clear as soon as the webinar started that this was not a discussion or a debate on surrogacy, but well thought-out propaganda on the wonders of surrogacy, with stories from a surrogate mother and two parents of children born through surrogacy. 

There are no official stats on how many children are born through surrogacy in the UK. There is no disclosure on prospective parents and we know just by reading the news, that people from the UK are traveling abroad to buy babies. Although women in the UK are not paid for their ‘reproductive service’ there are incentives and ‘independant journeys’ (private arrangements) are being made online. If you’re lucky you get an Apple Watch and Ann Summers vouchers among other goodies from an agency. When someone in the chat questioned the ethics of this, they were told by the owners (two men) that it’s nice for the surrogate to have the Ann Summers vouchers to spice things up with her partner as she can’t have penetrative sex when pregnant. Oh how we laughed, does anyone want to tell them? Questions that criticised this controversial practice largely went unanswered.

The surrogate mother and CEO of another agency, Surrogacy UK, told her story of carrying 5 babies for other people, some her own eggs, some not and once during COVID. She was asked if she was concerned for her own health and well-being due to the risks of the amount of IVF pregnancies she’d put her body through. She said she made fully informed decisions by speaking to her obstetrician and was aware of the risks and happy to take them. It’s worth noting that the long term implications cannot be known but that multiple cycles of IVF have been shown to increase the risk of ovarian and uterine cancers. Not to mention the risk of vaginal/rectal/cervical prolapse in later years following so many pregnancies. Along with her other children this woman had a total of 8 pregnancies and births including 2 c sections.

The two men who were advocates for surrogacy having had two children by arranged births and egg donation and they have their own agency and have recently expanded into Mexico City. Promoting surrogacy and offering the incentives discussed, they talked about the horrendous experience they had of the surrogate being called the mother by a Midwife and that their name could not appear on the ID band of the baby in hospital. It’s worth noting that unless a couple have the same surname, the baby will always have the mother’s name on the ID band. This is not to offend or irritate but for the basic security and safeguarding of the baby in case of a mix up or kidnapping. They were quite proud to announce that the health board crumbled at their request and they got to put their names on the ID band. Who cares about safeguarding for babies anyway eh?

My biggest concern is the long term implications for the birth mother and the baby. A baby who has known nothing but their mother’s heartbeat, her voice, her body for 40 weeks, only to be taken away and placed with strangers. And for the mother, who needs her child close to her for both their wellbeing, to regulate temperature and heart rate, to stimulate feeding instincts, to contract the womb, minimise bleeding and to release oxytocin to reduce the risk of postnatal depression and complications. 

I know there are instances where this is unavoidable, but we shouldn’t as midwives, be promoting this as the norm. I don’t provide postnatal care to adoptive parents or to foster parents, so why am I being asked to treat these ‘intended parents’ as if they are the ones who have given birth? That is not my role as a midwife.These people are not my patients.

I am heartened by the fact that the student midwives I’ve spoken to feel that surrogacy is a problem in modern society. This seems to be due to the boom in celebrity surrogacy where it is clear the rich and famous are exploiting poor and vulnerable women, using them as a ‘vessel’ to carry a baby to avoid putting their own bodies through the trauma of childbirth. And the grotesque fad of lying on a hospital bed, as through they have just given birth themselves, is doing nothing to convince our new recruits that this transaction is anything other than a horrendous experience for the mother who has just given birth, and for the baby who has been removed from his or her mother literally seconds after being born. Sickeningly, there are numerous photos of babies still attached to the umbilical cord with the placenta still inside the womb, as the smiling commissioning parents hold this newly delivered baby that is crying out for their mother.

I have been taught a research-based approach throughout my career and to apply critical thinking whenever there is discussion or debate. Yet there was no other side to this webinar and the questions examining the other side were ignored. No known long term implications to the child born of surrogacy were discussed, no evidence of a long term follow up for women who have given their bodies and their babies to others. And no matter if surrogacy is commercial or altruistic, arranged on facebook or through an agency, if the mother uses her own egg or if the embryo has been conceived with a donor’s eggs, the social and moral outcome is the same. 

A baby has been taken from his or her mother at birth.