DOI: 10.1111/tog.

12010 2013;15:113–9
The Obstetrician & Gynaecologist
Clinical governance
http://onlinetog.org

Surrogate pregnancy: ethical and medico-legal issues in

modern obstetrics
a, b
Celia Burrell MPhil, MRCOG, MRCP, Post Grad Diploma in Medical Law, * Hannah O’Connor MBBS, MA,
a
Consultant Obstetrician and Obstetric Lead for Risk Management, Barking, Havering and Redbridge University Hospital NHS Trust, Queen’s
Hospital, Department of Obstetrics & Gynaecology, Rom Valley Way, Romford, Essex, RM7 0AG, UK
b
Foundation Year 1 Doctor, The Shrewsbury and Telford Hospital NHS Trust, Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury,
SY3 8XQ, UK
*Correspondence: Celia Burrell. Email: burrellcelia@yahoo.co.uk

Accepted on 9 October 2012

Key content Learning objectives

 This comprehensive literature review of the medico-legal  To explain current legislation surrounding surrogacy in the UK.
challenges of surrogacy in modern obstetrics, highlights recent  To discuss ethical and moral concerns regarding the practice of
changes in UK law, the limited guidelines and legislation available, surrogacy.
and the legal requirements for parenthood and parental rights.  To apply medico-legal principles in the management of surrogate
 UK legislation involving surrogacy and the medico-legal definition pregnancy.
of parenthood is reviewed.
Ethical issues
 There is new UK surrogacy legislation affecting the parental order
 The exploitation versus empowerment and autonomy of women
qualification, indicating that obstetricians will see more surrogate
participating in surrogacy.
cases in the immediate future.  The commodification of reproduction through surrogacy.
 Conflicts can arise when surrogacy agreements are broken, since
 The validity of consent with the possible presence of emotional or
they are lawful but legally unenforceable in the UK.
 There are ethical and legal dilemmas for healthcare professionals in
financial coercion, and the unpredictability of outcomes in
surrogacy arrangements.
managing surrogate pregnancies in the absence of professional
guidance, and as a result the authors of this review introduced a Keywords: child protection / parental order / risk-management /
practical guide and pro forma. surrogacy agreement / surrogacy legislation

Please cite this paper as: Burrell C, O’Connor H. Surrogate pregnancy: ethical and medico-legal issues in modern obstetrics. The Obstetrician & Gynaecologist.
2013;15:113–9.

Introduction ethically unacceptable’. The first UK case, in 1985, involved a

British surrogate and an American commissioning parent,
Surrogacy involves an agreement between a third party
and caused media sensation.2 By 1990, the British Medical
(commissioning couple) and a woman, that she will become
Association (BMA) had changed its stance from condemning
pregnant with the intention of handing the child over to the
surrogacy to accepting professional involvement in surrogacy
commissioning couple after delivery. This can take two
in some circumstances,3 and later, in 1998, The Brazier Report
forms:
reviewed financial arrangements, regulation and legal
 Host surrogacy (gestational or full surrogacy) involves in
governance.4 It recommended the development of national
vitro fertilisation (IVF) using gametes from the intended
comprehensive regulation incorporating legislation and a
parents and/or donors, and embryo transfer into the
code of practice. It emphasised prohibition of
surrogate. The surrogate has no genetic link to the child.
commercialisation except allowance for reasonable
 Straight or partial surrogacy entails artificial insemination
expenses. In 1996, the BMA branded surrogacy as ‘a
using either the intended father’s or donor sperm. The
reproductive option of last resort’.5
surrogate mother’s egg is used and she therefore has a
The number of surrogate pregnancies in the UK is
genetic link to the child.
unknown, since some arrangements proceed without any
Since the 1980s, surrogacy has gradually gained more legal or medical input (especially those between friends and
acceptance from medical governing bodies and the public. In family members), and the baby is handed over without any
1984, The Warnock Report1 branded surrogacy as ‘totally legal formalities. About 50% of surrogates are known to the

ª 2013 Royal College of Obstetricians and Gynaecologists 113

 Surrogate pregnancy

commissioning parents. The Brazier Report estimated that synonymous, while others may argue the woman who
annually in the UK, there are around 100–800 surrogate raised the child is the mother. Children born by intercourse
pregnancies, resulting in about 50–80 births, and 1–2 between two consenting adults (i.e. between the surrogate
disputes.4 Currently there are no UK guidelines to provide and the husband/partner of the commissioning couple) falls
advice for surrogates, commissioning parents or healthcare outside of this law. HFE legislation determines the definition
professionals. There is no guidance about eligibility for of fatherhood under the Adoption and Children Act 200211
treatment, no formal data collection about the incidence and section 111, stating that the man whose name is on the child’s
outcomes of surrogate pregnancies, no standard screening, birth certificate acquires parental responsibility. However in
and no formal requirement for counselling, unlike IVF surrogacy, common law paternity rights are trumped by the
pregnancies. There is no follow-up on the children, who on HFE Act 20086 section 38, which treats the surrogate’s
reaching adulthood after counselling have legal access to their husband as the father unless he objected to the treatment.
original birth certificates. Some IVF units have local
guidelines that offer fertility services to potential surrogate
Parenthood: gaining custody of the child
mothers <40 years old, with a completed family of at least
one child, and counselling is offered. The commissioning parents gain custody of the baby by
applying for an adoption or parental order. Of course, there
are some cases whereby the parties involved do not seek legal
Medico-legal background
input, and a parental order is not sought. The criterion for
In April 2010, the Human Fertilisation and Embryology granting the order is explained below. Prior to the HFE Act
(HFE) Act 20086 part 3 came into effect, giving same sex and 2008,6 the commissioning couple could only acquire parental
unmarried couples the same legal rights as married responsibility through adoption. The Adoption and Children
heterosexual couples to apply for parental orders. The Act 200211 bans payment for adoption. Legally, surrogates are
Surrogacy Arrangements Act 1985,7 bans the commer- only paid for reasonable expenses of about £10 000–15 000.
cialisation of surrogacy, but the HFE Act 20086 permits In the case of Re S (Parental Order),12 reasonable expenses
non-profit organisations, for example Childlessness did not include costs to the surrogate that she would
Overcome Through Surrogacy (COTS), to charge a fee to normally incur, for example rent. It may include medical and
advertise and match surrogates with commissioning parents.8 legal expenses, travel costs to medical appointments and
Both parties sign a surrogacy agreement, which is lawful but maternity clothes. The UK courts must ensure that the
legally unenforceable, of which its challenges are discussed in surrogate agreements do not equate to payment for a child or
the cases below. circumvent childcare laws, but must act to prevent parental
The Surrogacy Arrangements Act 19857 section 1A, orders being awarded to unfit parents.13 It is normally in the
(amended by the HFE Act 19909) states that: best interests of the child for a parental order to be granted.
However, the court can grant alternative orders, for example,
“…no surrogacy arrangement is enforceable by or against any
residence orders, adoption, or additional orders for the child
of the persons making it …”
to have contact with the surrogate.
In the UK, the surrogate has a prima facie legal Under the HFE Act 20086 section 54, parental orders are
responsibility for a child that she never wanted and leaves granted if:
the commissioning couple with no legal responsibility for this  The commissioning couple are married, in a civil
child whose creation they actively seek.10 partnership or cohabitees, and both are >18 years old.
 The conception must be from placing the embryo, sperm
The legal definitions of motherhood and fatherhood or egg into the surrogate mother or by donor
in surrogacy insemination. The egg or sperm must be from one
Under UK laws, the legal mother is unambiguous in both member of the commissioning couple, thus providing a
partial and full surrogacy. The HFE Act 20086 section 33, genetic link.
confirms that the surrogate is the legal mother. It states:  The application must be made within 6 months after
delivery.
“ ..the woman who is carrying or has carried a child as a
 The child must be living with the commissioning couple,
result of the placing in her of an embryo or of sperm and egg,
one or both of whom must be domiciled in the UK.
and no other woman, is to be treated as the mother of the
 The surrogate (and the legal father if not the
child…”
commissioning father) must give consent for the
The HFE Act 20086 section 47 further states that a woman parental order transfer within 6 weeks after delivery.
cannot be treated as the mother as a result of egg donation. In  No payment should be made to the surrogate (other than
some countries, legal and genetic motherhood is reasonable expenses). Expenses are decided by the court.14

114 ª 2013 Royal College of Obstetricians and Gynaecologists

 Burrell and O’Connor

Ethical and moral debate A 2005 American study demonstrated the real possibility
of maternal and fetal morbidity and mortality. In 10 cases of
The right of autonomy is fundamental in a democratic host surrogacy, an intrapartum hysterectomy and a late
society. The risk of exploitation of women remains a crucial puerperal hysterectomy were required in 2 cases. In the first
concern. A UK study of 34 women who had surrogate case, the infant also had cerebral palsy, and in the second case
pregnancies showed that 1 in 34 women sought financial one of the subsequent triplets died due to a hypoplastic left
gain, but most were altruistic in helping childless couples.15 ventricle, and the surrogate mother sustained multiple
However, whether or not the morally pleasing concept of cerebral infarcts and blindness.19
surrogacy for altruistic purposes is used as an ethical and Only an overview of some moral and ethical conflicts in
legal veil, disguising desires for financial gain is debatable. If surrogacy can be addressed here, but additional challenges
this is the case then the courts allowing for ‘reasonable and learning points are seen in the case law discussed below.
expenses’ may be a legal fiction. Furthermore, if surrogacy is The focus of this review is to offer a practical and clinical pro
exploitative (which requires us to accept that the practice is forma as a much needed guide to help healthcare staff.
unfair, whether or not it is harmful or advantageous to
all parties), why does legislation only make agreements that
Perils of surrogacy: case law
are legally unenforceable rather than making the practice
legal altogether? A successful surrogate agreement relies on the cooperation
Surrogacy could be argued as a treatment for some forms of of all parties. The critical distinction lies in balancing
childlessness; for example, post-hysterectomy or malignancy. between reasonable compensation for services rendered, but
Legal restriction to ban surrogacy agreements could be argued short of inducement to gestate. Financial payment surrounding
as being paternalistic, and could force surrogacy surrogacy remains a contentious problem, especially when
underground.14 Lack of clarity in legislation in Canada this involves foreign surrogates as the legislation may differ
regarding what counts as reasonable expenses has raised from that in the UK. Currently, only the birth mother
concerns over covert surrogacy arrangements,16 which could (surrogate) is entitled to maternity pay and leave, and the
drive vulnerable women and childless couples further away intended father is entitled to paternity pay and leave if he is
from potential protection. This could be avoided by respecting the legal father.
a woman’s right to participate in surrogacy, with adequate The postnatal period remains the most cautious and
accompanying regulations. In spite of the Human Rights Act anxious period for both the surrogate and intended parents.
(HRA) 199817 article 8 (right to a private life), HRA 199817 There is no case law to provide guidance regarding the period
article 12 (right to marry and found a family), and HRA 199817 of time from delivery to when the baby is handed over to the
article 14 (prohibiting unjust discrimination), society may be intended parents if the Parental Order has not yet been
harmed by the perception that reproduction is trivialised and granted, making the surrogate the legal mother with parental
commercialised by transactions that translate a woman’s responsibility. The hospital’s risk management and legal team
reproductive capacity and infants into commodities that can should be informed regarding whether they are prepared to
be bought and sold.18 The concept of depersonalisation of discharge the surrogate mother and baby separately. This is a
pregnant women as vehicles for genetic perpetuation (and the contentious issue with no legislation or official stance. If they
providing of an heir), must be balanced against benevolence to are not, the baby and surrogate should be discharged
help childless couples. together, and this should be clearly documented. In the
Surrogates are asked to sign a detailed agreement or event of a surrogacy arrangement (suspected or confirmed)
contract which attempts to cover many eventualities. These emerging in the postnatal period, the community midwife
might include fetal abnormality, a handicapped child, or death should escalate to the supervisor of midwifery, the child
of the surrogate or commissioning parents during pregnancy protection safeguarding midwife, the clinical risk
before the parental order is granted (life insurance is management team, and the hospital legal department for
sometimes provided to the surrogate by the commissioning further advice. The postnatal care should be maintained in
parents). Funeral arrangements are usually discussed, keeping with the Trust’s guidelines. See the learning points
including who would pay the costs if the baby dies. Payment in Box 1.
would be discussed in detail involving full payment for a The first US surrogacy case, Doe v Kelley,20 scrutinised the
healthy baby, but reduced payment in case of a miscarriage legality of payment. If any party is domiciled in the UK, then
(whereby proof is usually needed, and the reduction in UK laws apply regardless of where conception occurred;
payment depends on the gestation), stillbirth or intrauterine otherwise the child could be born stateless and not eligible for
death. Additional payment is usually offered in the case of a passport, as it may be that neither the surrogate nor
unplanned surgery, for example, hysterectomy. It is ethically commissioning couple are legal parents under their own
debatable how to quantify compensation for hysterectomy. country’s legal system. Re K (Minors)21 involved a UK

ª 2013 Royal College of Obstetricians and Gynaecologists 115

 Surrogate pregnancy

commissioning couple and a surrogate from India. The twins the surrogate handed over the child, who then settled into
were delivered in India, and remained there from birth until their new family, then changed her mind and wanted the
18 months old. Although in India the commissioning couple child back, the court would usually act in the best interests of
were the registered legal parents at birth, they were denied the child to prevent undue disruption. This was seen in the
UK parental rights as the babies had permanently domiciled cases of Re MW (Adoption: Surrogacy),28 and C v S.29
outside the UK. In the case of Re G (Surrogacy: Foreign However, there have been cases when the surrogate proved to
Domicile),22 this involved a Turkish commissioning couple be unfit due to repeated deception and the court acted in the
and a British surrogate. The child was born in the UK and best interests of the child to retain parental right to the
handed to the Turkish couple, but they were not domiciled in commissioning parents. This was seen in Re N (A Child)30
the UK and so were ineligible for a parental order. The UK and Re P (Surrogacy: Residence).31
In the US case of Johnson v Calvert,32 the surrogate
Box 1. Learning points changed her mind while still pregnant. The US judge
awarded parental rights to the commissioning couple,
Best interests stating that the surrogate by voluntarily contracting away
Healthcare professionals should always act in the best interests of the
her rights to the child, conceded its best interests were not
surrogate, to whom a duty of care is owed.
Consent with her. The perils of surrogacy can be far reaching. Even
The surrogate mother is entitled to make all decisions, even if they are after a successful parental order transfer, the surrogate
not in the best interests of the child. mother can return to seek custody of the child years later.
Management plan
A consultant-led multidisciplinary management plan should include:
In the US case of Re Marriage of Moschetta,33 the surrogate
• a risk assessment who was the genetic and gestational mother sought custody
• clear documentation and communication. of the child 1 year later when the commissioning parents
Protection of the child’s welfare divorced, but this was rejected as not being in the best
Until the Parental Order is granted, the surrogate mother’s consent is
needed for all treatment.
interests of the child.
Postnatal care Conversely, there have been more uncommon instances
The community health visitor should visit both the surrogate mother where both the surrogate and intended parents reject the
and the baby wherever they reside to provide continued support. subsequent child. In 2001, a British surrogate took the
Risk management and legal support
As a result of the absence of UK guidance, the risk management team, American intended parents to court in the USA after she was
hospital legal team and/or a medical defense union should be discovered to be carrying twins. In the USA (unlike the UK)
consulted if advice is needed. surrogacy contracts are legally enforceable, so the intended
parents had rights over the twins. The intended parents
attempted to back out of the contract upon discovering it was
judge decided that it was in the best interests of the child to a twin pregnancy. The surrogate succeeded in quashing the
allow the couple to take the baby to Turkey for adoption. Re legal rights of the intended parents, and proceeded to have
X and Y (Foreign Surrogacy)23 involved a UK commissioning the twins adopted.18 This case highlights the potential for all
couple and a married woman from Ukraine. The twins were parties to reject subsequent children, particularly in cases of
delivered in Ukraine, after implantation with a donor egg multiple pregnancy, disability or birth trauma.
fertilised by the commissioning father’s sperm. Under Though some surrogacy arrangements do face problems
Ukrainian laws, the surrogate and her husband had no like those discussed, the many cases that proceed without
parental rights, but under UK law they were the legal parents. problems should also be remembered, though not
The UK judge granted the parental order as this was in the best represented numerically.
interest of the children. Two US cases; Re S (Parental Order)24
involving a UK commissioning couple and a Californian
surrogate; and Re L (A Minor)25 involving a UK commissioning Surrogacy in practice
couple and an Illinois surrogate, demonstrated the judge Before the changes in the law in April 2010, The Brazier
granting parental orders in the best interests of the children Report,4 showed that there were less than 1000 surrogate
despite there being payment in excess of reasonable expenses, pregnancies in the UK, resulting in under 100 deliveries. It is
since all parties had acted in good faith. estimated that annually there are about 1–2 surrogate
Individuals enter a surrogacy agreement at their peril. If pregnancy disputes that are publicised, compared with
the surrogate changes her mind, she is usually allowed to about 723 913 annual live births in England and Wales in
keep her baby, as seen in the cases of Re P (Minors) 2011.34 There are no official data from the Office of National
(Wardship: Surrogacy)26 and Re T (A Child) (Surrogacy: Statistics, the Human Fertilisation and Embryology
Residence Order).27 A surrogate would be deprived of her Authority or the Department of Health. COTS, who were
baby if she was an unfit mother however it was conceived. If involved in their 600th surrogate pregnancy in 2007, quote

116 ª 2013 Royal College of Obstetricians and Gynaecologists

 Burrell and O’Connor

98% of pregnancies organised through their organisation healthcare staff. The pro forma incorporates the NICE
reaching a successful conclusion.35 clinical guideline on antenatal care, which recommends
Healthcare professionals may have limited legal or that 10 antenatal visits is adequate for nulliparous women,
professional guidance; however, it is expected that they will and 7 is adequate for multiparous women.37 Since there are
encounter more surrogate pregnancies due to changes in the no guidelines to determine the suitability of a woman for
law. Pregnancies can take place with no medical input, so surrogacy, healthcare professionals can be faced with women
high-risk patients may present to obstetricians already who are high risk, so performing a risk assessment is
pregnant and with a signed contract, or the agreement may essential. Care should be tailored to individual needs.
only come to light in the postnatal period. Healthcare With the increase in high risk pregnancies, when managing
professionals should avoid conflicts of interest by ensuring a patient with a surrogate pregnancy, consultants are advised
they do not manage both the intended parents and the to ensure that the next of kin is documented correctly (and
surrogate. The American College of Obstetricians and not presumed to be the intended parents). Therefore, in the
Gynecologists (ACOG) Surrogate Motherhood Guidelines36 case of fetal or maternal morbidity (for example, special care
advised doctors to avoid cases of exploitation, where there is admission or maternal HDU/ITU admission), the
possible coercion by emotional or financial means from appropriate people will be informed.
the intended parents to continue the pregnancy against
medical advice.
A duty of care is owed to the surrogate mother. The Conclusion
unborn fetus has no legal rights, so the surrogate must make The law surrounding surrogacy is precarious and indirect,
all decisions, even if it is not in the best interests of the fetus as it was developed in a piecemeal fashion under the
(including lawful termination). In the event of conflict, the umbrella of IVF legislation. While IVF-assisted surrogacy
surrogate should be supported to make the final decision lies within the legal framework of the HFE Act 1990,9 other
without coercion. Clear documentation is key, and it is forms of surrogacy fall outside. This has resulted in a
recommended that an additional copy of the antenatal notes profound dichotomy. With the changes in the law allowing
should be kept by the hospital. This enables the trust to have same sex and unmarried couples to apply for parental
an additional copy of the notes, separate from the orders, the demand for surrogacy is unlikely to abate.
antenatal notes that are carried by all pregnant women in Healthcare professionals may have limited legal knowledge,
the UK. The medical staff should be neutral, non- and with the absence of national guidance, the practical
judgemental, respectful and supportive. Confidentiality guide and pro forma discussed in this review will provide
remains paramount when formulating a multidisciplinary help in managing these cases. Current parliamentary debates
management plan. In addition to the obstetric team, other are addressing the legal rights of civil partnerships.
key personnel may be included on a need to know basis for Problems that can sometimes occur in surrogacy are
high-risk cases, so the care will be tailored based on highlighted in case law, discussed above. The Brazier
individual needs. The antenatal, intrapartum and Report recommended a code of practice and a
postpartum care plan should be consistent with the trust’s consolidated Surrogacy Act, but these are outstanding.
guidelines. Additional antenatal investigations (e.g. growth With the anticipation of an increase in surrogacy assisted
scans, glucose tolerance testing) should be done based on pregnancies, national audits (though still not entirely
clinical indications. The mode and timing of delivery (i.e. accurate) would help us to understand these pregnancies
early induction of labour and the option of vaginal birth after better, and guide healthcare professionals in the future.
caesarean) should be done in keeping with the Trust’s Additional legislation and guidelines are needed to prevent
guidelines. Labour can be anxious for both parties, so the exploitation, support altruistic surrogates, help childless
management should be consistent with the trust’s policy, and couples, provide safeguards for children, guide healthcare
healthcare staff should be informed if the intended parents staff, provide support in case of unpredictable adversities
are expected to attend the delivery, and should be aware of and thus prevent covert surrogacy arrangements.
the immediate postpartum plans.
In the absence of national guidance, the authors have Disclosure of interests
formulated a pro forma (Box 2), which is a guide to help None disclosed.

ª 2013 Royal College of Obstetricians and Gynaecologists 117

 Surrogate pregnancy

Box 2. Pro forma for the management of surrogate pregnancies

Patient name: Consultant:

Date of birth: Person completing the form:
Hospital number: Date:

Prepregnancy counselling
h Offer counselling to the surrogate and intended parents both h Discuss the birth plan and plans for feeding the baby.
separately and together. h Discuss with the hospitals legal and risk management team
h Refer to a consultant early if it is a high risk case. whether the baby can be discharged with the intended parents.
h All medical staff must maintain accurate and contemporaneous h The surrogate should be seen alone for at least part of the
record of all discussions and decisions. consultation. The intended parents may be present for part of the
consultation, with the surrogate’s consent.
Antenatal care h Escalate to the consultant if any concerns/conflict.
8–12 weeks
h Midwife booking visit, alone with the surrogate initially, to discuss: 36 weeks
 Risk assessment; including medical and pregnancy issues, lifestyle h Consultant review to discuss timing and mode of delivery.
and health issues. h Check maternal and fetal wellbeing.
 Consultant referral in the first trimester if high risk
(i.e. prepregnancy medical problem). 38 weeks
 First and second trimester screening and investigations, and any h Midwifery review, to check maternal and fetal wellbeing. Escalate
other health concerns. to the consultant if any concerns or conflict.
 Clear documentation of information to be disclosed to the h Consultant review if high risk.
intended parents.
40 weeks
12–14 weeks h Midwifery review, to check maternal and fetal wellbeing. Escalate
to the consultant if any concerns.
h Clinic review for:
h Consultant review if high risk.
 Antenatal screening blood tests to be taken.
h Discuss membrane sweep and induction of labour if indicated.
 Dating scan.
Intrapartum care – labour and delivery
15–16 weeks
h After delivery, the surrogate should be given the option to spend
h Discuss booking blood results.
some time alone with the baby. She should be given opportunity
h At least one early antenatal appointment between the consultant
for private discussion with medical staff if she changes her mind
obstetrician and surrogate mother alone.
and decides to keep her baby while still on hospital premises, so
h Risk assessment by consultant obstetrician and midwifery staff.
that this can be escalated to the risk management and legal team
h Multidisciplinary management plan involving the general
for additional support.
practitioner, safeguarding children midwife, risk management team,
h Healthcare staff should be informed if the intended parents will be
supervisor of midwifery, and the community midwife.
present at the birth.
h Surrogacy agreement to be discussed, copied and included in
h Review the plan for intrapartum care. Clear documentation and
the medical records; but only with the surrogate mother’s consent.
communication both verbally and written is crucial. In the case of
20–21 weeks maternal or fetal complications or conflict, escalate to the
h Ultrasound anomaly scan and review. consultant on call and/or the patient’s consultant and the risk
management team if needed.
25 weeks
h Midwifery review; escalate to the consultant if any concerns Postnatal care
or conflict. h Plans must be in place for the surrogate to consent to screening
h Discuss antenatal classes and care of the baby. and treatment of the baby, since she is still the legal mother until
the parental order is granted.
28 weeks h If the hospital does not agree to the baby being discharged with
h Midwifery/consultant review, routine blood tests and anti D the intended parents, the baby and surrogate mother must be
if required. discharged together. Document this clearly in the medical records.
h Check maternal and fetal wellbeing. h Notify the general practitioner and community health visitor on
h Surrogate to be seen alone to discuss any concerns in private. discharge, document the surrogate’s address/contact details, and
follow normal guidelines for postnatal care.
31 weeks h Document the intended parents address/contact details and follow
h Midwifery review; escalate to the consultant if any concerns normal guidelines for postnatal care.
or conflict. h Document the address of where the baby will be residing.
h Support should be offered to the intended parents regarding
34 weeks feeding the baby.
h Midwifery review; to check maternal and fetal wellbeing. h Community healthcare staff should maintain a good relationship with
h Discuss the surrogacy agreement, including if the intended the surrogate, so that she can communicate freely and be given
parents will be present at delivery. support if she changes her mind before the parental order is granted.

118 ª 2013 Royal College of Obstetricians and Gynaecologists

 Burrell and O’Connor

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