Counselling Before, During and After Pregnancy

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:

http://www.babycentre.co.uk/a536333/your-body-after-the-birth

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.”

Source:

http://www.babycentre.co.uk/a536333/your-body-after-the-birth#ixzz4BGStPRfY

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:

http://www.creatingfamilies.com/intended-parents/?counseling-issues-and-surrogate-parenting-132

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:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4126251/

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.

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.