The
“Families through Surrogacy” Surrogacy conference in Brisbane in June 2016,
raised a number of interesting topics.
One
very interesting perspective raised by a number of psychologist guest speakers,
is the importance of counseling before, during and after the pregnancy.
Michael
Condon - Clinical Psychologist (contact: michael.condon@qfg.com.au) spoke at
the conference about “Avoiding and Responding to Disputes”, of which counseling
is an important tool.
Condon
identified that pre-counseling is required, and often a requirement of approval
for a surrogacy arrangement. The Western
Australian approach is to have a counselor available at the clinic and also a
psychology assessment during the application process. There is no requirement within the Surrogacy
Act 2008 of post birth counseling.
Condon
indicated that during pregnancy three monthly catch ups were preferred. If this
was not possible then he recommends that at least the surrogate, her partner
and the intending parents to catch up every two months.
A
number of the counselors at the conference also recommended counseling post
birth.
The
Queensland Surrogacy Act 2010, requires post birth counseling.
“After
the birth of the child the birth parents and intended parents must get a
surrogacy guidance report from an appropriately qualified and independent
counselor after your baby is born. This cannot be the same counselor you spoke
with before entering into the surrogacy arrangement.”
Source:
This
largely addresses legal requirements that relates to ensuring an appropriate
parenting order is prepared.
Surrogates
talk of the importance of understanding the post birth emotions. The Intending
Parents can be distracted with a beautiful new demanding baby and anecdotally
the surrogate can feel isolated. In
addition, the surrogates talk of some very powerful physical reactions to
giving birth that can be difficult to rationalize and can impact on their
mental wellbeing.
There
are many physical impacts of pregnancy, the contracting of the uterus occurs
after birth is one.
“Your
uterus (womb) is shrinking back to its normal size and position, and you may
have afterpains as it contracts down. Afterpains feel like mild labour
contractions, and often happen while you are breastfeeding.
This is because the hormone oxytocin, which encourages your uterus to contract,
is released while you're feeding. It also can cause redder or heavier blood
loss.”
Anecdotally, the contraction of the uterus can occur when the
surrogate is cuddling the baby after birth and the baby is nuzzling for food. Obviously,
this physical reaction can lead to a more intense emotional response.
A number of surrogacy web sites identify the importance of closure
post the birth of the child. Birth and post birth, is physically demanding and potentially
a mentally difficult time for surrogates.
The following is an extract from the Creating Families website
that identifies trends counselors are noticing in the surrogacy sector.
“As professionals, we can often help individuals understand the
importance of obtaining some sense of closure. Perhaps, one of the clearest and
most important examples of this issue is the birth plan and good-byes at that
time. Given the awkwardness, the exhaustion, the anxieties, and the newness of
it all, it is all too common for the long awaited "ending" not to be
as well planned as other stages. My partners and I find ourselves giving more
and more attention to birth plans, simple rituals, symbolic and tangible
acknowledgments. Surrogates need to feel validated and trusted, not rushed.
Couples need to be present with her and create a feeling of safety and comfort
for themselves. A respectful, warm, and moving birth/hospital stay helps the
surrogate to minimize feelings of exploitation or emptiness. Attention to
closure helps the prospective parents reduce anxieties about the unknown, helps
them feel secure in the relinquishment, and provides a positive story to tell
their child. Additionally, having some clear understanding about the post-birth
contact frees both parties from misinterpreting behavior.”
Source:
The Australian and New Zealand Infertility Counsellors Association, have
developed “ANZICA Surrogacy Guidelines - Post Delivery Counseling” to assist
with this difficult time.
“Follow up counselling after treatment, whether successful or not, is
highly recommended and should be available to all participants. In some
jurisdictions, there is a formal requirement for counselling throughout the
pregnancy and post delivery which may be provided by the external assessment
counsellor. This necessitates a review of the counselling ‘contract’ to move
from an assessment role to a supportive counselling role. In other
jurisdictions a post treatment surrogacy guidance report, for use in an
application for a parentage order, must be prepared by an independent and
appropriately qualified counsellor.”
Source:
http://www.fertilitysociety.com.au/wp-content/uploads/110829-ANZICA-SURROGACY-GUIDELINES-FINAL.pdf
Post birth counseling seems like a reasonable approach to this
phase of the surrogacy process. There are some interesting statistics about the emotional
responses of surrogates in other countries. In Iran, research has been in the
emotional effect on the surrogate when she gives the child to the intended
parents.
“Important
biological bonds are established between mother and her fetus during pregnancy.
One of the most concrete examples of the importance of this bond comes from
knowledge of fetal-maternal physiology. Oxytocin hormone plays a crucial role
in priming the pregnant mother to respond in accordance with her natural
maternal instincts. Therefore, there is a concern that the rented mother
establishes such a firm emotional bonding to the fetus that separation of the
newborn after giving to commissioning couple may be very difficult because she
believes that the baby belongs to her and not to the commissioning couple.
There is a risk of postpartum depression and psychologically harmful feeling of
guilt or anger in these women.”
Source:
This
paper refers to statistics from England. Jadva’s research in “Surrogacy: the
experiences of surrogate mother” showed that “all of the surrogate mothers in
postpartum period, with no doubt, delivered the babies according to previous
agreement. The follow up of those women showed that 32% of women had emotional
and psychological problems for several weeks after losing the babies. After a
few months, this rate decreased to 15% and continued until 1 year only in 6% of
cases.
Source:
Jadva
V, Murray C, Lycett E, MacCallum F, Golombok S. Surrogacy: the experiences of
surrogate mother. Human Reproduction. 2003;18:2196.
The
Iranian study, “Emotional experiences in surrogate mothers”, identifies that
surrogates have a positive experience however counseling is required.
“Our
study showed mainly the positive experience of surrogate mothers however,
surrogacy needs special care in various aspects that its management is very
important and requires deep consultation to select suitable host. Meanwhile,
counseling should be continued for surrogate mothers during and after
pregnancy.”
Source:
Iranian
Journal of Reproductive Medicine. 2014 Jul; 12(7): 471–480. Emotional
experiences in surrogate mothers: A qualitative study. Hoda Ahmari Tehran,
Shohreh Tashi, Nahid Mehran, Narges Eskandari, and Tahmineh Dadkhah Tehrani,
Anything
that clinics, intending parents and medical practitioners can do to support surrogates
post birth and therefore reduce the potential for post birth mental health
complications should be undertaken.
