After a long wait for HCG beta results to confirm pregnancy and an eternal wait to hear that little heart beat, finally, the day has arrived! Your surrogate is pregnant and completed her medication protocol. She has now graduated from IVF and is moving on to OB care. What now?
Often times, this transition can be a scary one for parents because, up until this point, all the medical care personnel were doctors and clinics chosen by the IP. Parents have built relationships with their IVF doctor and staff. Parents are directly updated about next steps, outcomes, hiccups and successes. Once the surrogate is released from IVF, all of this changes. Depending on the insurance situation, often times the surrogate is returning to an OB she has seen for her regular gynecological care and natural pregnancies. She has built a relationship with this doctor and has a history with them. Parents can often feel displaced during this period.
Managing Expectations:
At this transitional point, if both the surrogate and the Intended Parents have a good understanding of the other parties expectations, this change can be one of new trusting relationships and exciting progress. Here are a couple key points to keep in mind.
- Prenatal Care: Talk with your surrogate openly about what you would like from the OB/GYN. What are your plans for attending appointments, scheduling with the surrogate, delivery etc.? This should be a fluid conversation where both Intended Parents and GC are open and honest about care moving forward. At a minimum, the OB/GYN should be Board Certified. As an agency, although this will vary from agency to agency and dependent upon geography, we require that the GC give birth in a hospital with a NICU. What are all parties' feelings about induction? Epidurals? Chiropractic care and prenatal massages? Be cautious in mandating what a GC can and can not do with her own body and make sure that everyone is comfortable with following the advice and care plan of the OB/GYN. If this conversation feels too overwhelming to have with your GC, ask your agency to step in and help facilitate the conversation.
- OB/GYN Communication: it is very uncommon for an OB/GYN to relay information to IPs directly if they are not physically present. In order to stay informed, work with your surrogate to keep track of when her OB appointments are so that you can check in on her and receive updates if she forgets.
- Testing: Throughout the pregnancy your surrogate will have regular check ups that measure growth, monitor blood pressure and screen urine samples. In addition, your surrogate will have several ultrasounds to check the baby's development, growth rate, and heart rate. All of this testing is routine and done at all providers. In addition, there are some other tests that you can discuss with your surrogate and let her know that you would like her to complete:
- Updating Insurance: Depending on a number of factors, it is likely that your GC has one of four policies that cover her OB care for a surrogate pregnancy: Policy bought specifically for this pregnancy through the open market, an employer based or privately purchased policy already in place for the GCs family, a lien policy (ie: Kaiser) or a private policy underwritten by Llyods of London. In all cases, the OB/GYN will need to be notified during the initial visit, that the GC is carrying a surrogate child. The provider will use different billing codes to inform the billing department of this detail. Once the pregnancy is farther along, the Pre-Birth Order (granting parentage to the IPs) will be supplied to the hospital's social worker or birth clerk.
- Updating Attorney: If not already completed, reach out to your attorney and let them know that you have confirmed pregnancy through fetal heartbeat (date needed) and estimated due date. This information will help your attorney schedule the pre-birth order in the appropriate time frame.
- Baby Growth Tracker: As a fun weekly update, you can sign up on apps or websites that track the average growth of a baby over time and usually compares the size of your baby to a fruit or veggie.
- Keep in Touch: During the next twenty weeks, there isn't much to do other than wait. Be sure to use this time to build a relationship with your surrogate. Check in, say hi. Communication doesn't have to be daily and doesn't always have to be pregnancy related. Organic friendships grow over time and frequent communication aids in this growth.
- Informing Your Employer: Usually people begin to start spreading the good news of baby on the way in the beginning of the second trimester. At some point, you will need to inform your employer and begin to think about maternity/paternity leave when your new bundle of joy arrives.
- Travel: If your do not live close, geographically to your GC, you can start to consider travel dates around the EDD (estimated due date). Keep in mind that this date is an estimation and babies are full term anywhere from 38-42 weeks. If you are an international parent, you will need to apply for a visa and plan to be here two weeks prior to the EDD and for 4-6 weeks after birth while you wait for a birth certificate and passport for your new baby.
When a GC graduates to her OB, there is a lot to celebrate; baby and GC are both healthy and a pregnancy is moving forward. With frequent communication and clear expectations, the next thirty weeks will fly by and baby will be here before you know it.