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Words from a Midwife: Part Three – The Unspoken

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 (short read)

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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 (short read)

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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.