This is what a woman whom I'll call Laurel had to do to become a "gestational" surrogate: Take an injection of hormones to knock her fully functional cycle off its orbit and suppress ovulation. Take synthetic estrogen via pill and patch and inject progesterone suspended in oil through a twenty-two-gauge needle (it's big) into her bottom for six weeks. Along with her husband, abstain. Endure the hormones "wreaking havoc on my system," as she describes it. Shuttle back and forth to a lab two hours away for weekly blood tests to make sure said hormones had reached adequate levels, that her uterus had resumed an amplified, robotic version of its normal cycle.
Once the uterus is deemed hospitable for in-vitro fertilized embryos, fill bladder to bursting, lie back in stirrups, and be mildly sedated so that a catheter delivering the thawed zygotes could be threaded through her cervix and into her womb. Then return home and resume the hormone regimen for another six weeks, including the daily self-administered injections, even after the morning sickness kicks in.
And that was just to get pregnant. Of course, Laurel is healthy and fertile — that's why she offered her womb to a childless friend — but her friend wanted a child conceived of her own egg and her husband's sperm (hence the "gestational" surrogacy), so Laurel became a fertility clinic patient. She'd done some reading to prepare herself, but she wasn't expecting the volume of hormones or the invasiveness of their delivery. She wasn't expecting to feel "dehumanized" by the embryo transfer. Most of all, she wasn't expecting twins.
When the idea of being a surrogate occurred to her, Laurel envisioned a pregnancy like the ones she'd had with her own two children — generally charmed affairs with only minor discomforts that culminated in ecstatic births, her second in a birth tub with midwives. "The aftereffect was amazing — the feeling that I could do anything," she says. But a twin pregnancy is much more physically taxing, and this one has caused Laurel debilitating, unrelenting nausea — morning-noon-and-night-sickness — from the outset.
"I didn't really have a second trimester," she tells me. "Even before twenty-four weeks, I had all the third-trimester symptoms: low energy, shortness of breath, uncomfortable in pretty much any position." Many days she can barely get out of bed. I asked her if being so sick has affected how she relates to the babies growing inside her. "There have been some times that I wasn't feeling really good about the babies, especially when I was on my knees in the bathroom, and my children needed me, and I couldn't take care of them."
Laurel, a "compassionate" surrogate, isn't asking for any money for her labors, though she could. The going rate is $15,000 to $30,000 — for a job that is high-risk, 24/7, and lasts about a year, maybe more, depending on how many IVF cycles are required, how complicated the birth is, and how long it takes to get the feeling back in your butt. (No joke, another woman I talked to was numb down to the backs of her knees for seven months postpartum.) "I felt that money would somehow cheapen it," Laurel told me. "Now, I don't know . . ."
Gestational surrogacy, the new norm according to a recent New York Times magazine article by Alex Kuczynski, was supposed to make everything easier. "Traditional" surrogacy — when a woman uses her own egg and the technology involved in conception is usually no higher than a turkey baster — was laden with stigma. How could a mother hand over her own baby? How could you ask a woman to do such a thing? The surrogate-patron relationship had the taint of coercion. Moreover, it put the intended parents' hopes on very shaky ground: contract or no, they could never be certain that the biological mother wouldn't change her mind and want to keep the baby (like Mary Beth Whitehead did in 1985, known as the "Baby M" case). Psychological screening became more sophisticated following Baby M, but with assisted reproductive technology came the possibility of eliminating the mother-threat altogether: it stripped the surrogate of her parental rights. She would not be the biological mother; the baby would belong to the intended parents from its test-tube conception, and once it was born, the woman who had carried it would have no legal claim.
"The surrogates are happier," a surrogacy agency administrator told the Times, "because they don't want to have a genetic connection to the baby, and the legal issues are much clearer."
Women do seem to find it easier to compartmentalize when the fetus is unrelated. "I've had a couple of people say, 'Well how could you give up those babies after carrying them?'" says Laurel. "But I'm not giving them up, I'm giving them back." Another surrogate, let's call her Patricia, who carried IVF-conceived twins for a gay couple, described the disconnect similarly. "I always knew that I wasn't comfortable using my own eggs," she told me. "Saying goodbye to the babies was not hard. I really felt prepared mentally and emotionally: they weren't my babies; they never felt like my babies. I was going to be okay with it, and I really was."
Sarah Phillips Pellet offered to be surrogate for her sister-in-law and wrote a children's book to explain it to her boys, who were aged four and eight at the time. In the book, The Kangaroo Pouch: A Story About Gestational Surgery for Young Children, young roo Oliver tells the story of the Bouncing-Hopsalots, a couple who very much want a baby kangaroo but are unable, and his own mother, who offers up her pouch. "For several months, my mother kept their baby warm and cozy . . . My family and I still did all of our usual things together like playing soccer, going on picnics, and riding our scooters in the park . . ." Then, "My mother gave the Bouncing-Hopsalots back their baby to them. They were over the moon with happiness. Our happy family went back to the way it was before."
Pellet also wound up carrying twins. She has no regrets, but she wouldn't have done a traditional surrogacy. "I wasn't going to be able to do that, give away a baby that was half mine. And it would have been my brother-in-law's sperm, which is just weird." She says that knowing who the babies belonged to, relating to them as "the nephs," contained the experience within an intellectual realm. "Whenever we talked about it with the kids, it was, 'These are the cousins, these are not our babies. Mama's just babysitting them for nine months.' It was very matter-of-fact and very clinical. That definitely helped me in not forming a bond."
Instead of using the language of surrender or giving, the new surrogate has the lexicon of babysitting, foster parenting or nannying. Some have called it rent-a-womb. But is such dissociation healthy? And at what physiological cost? Multiple gestations are much higher-risk than "singleton" pregnancies; the long-term effects of IVF hormone exposure is unknown. And there's something else. This is in situ organ donation. What happens when the womb-renters have different ideas than the woman whose womb it is?
Laurel was sedated and in stirrups when she consented to the implantation of several embryos rather than the one she had expected (a stunning breach of medical ethics, but perhaps not so uncommon since Nadya Suleman revealed a fertility industry run amok). The doctor assured both couples that there was a 1% chance that more than one would "take." Defying those dubious odds, they all took. This created a huge, 100% avoidable moral quandary for Laurel, whose friend told her that any more than two babies was out of the question. The last thing Laurel expected was to go through the exhaustive process of adding only to have to subtract (though one can easily imagine the inverse scenario). Agreeing to a selective abortion is something she barely wanted to acknowledge. "She gets really emotional just talking about it," her husband told me.
Talking to Laurel, I did not get the sense that science has made this an easier or happier or less exploitative experience, as the Times piece implied. Some might even say that she would have been better off ovulating, basting, water-birthing, and handing over one infant to her friend (though she says she could never have done that). Nor are the legal issues exactly clearer in her case, because she lives in a state that doesn't recognize surrogate contracts, so a friendly judge will have to allow the intended parents to adopt their biological twins once they are born. And the judges thus far have not been friendly. Laurel jokes that they better find one soon: "I'm certainly not bringing them home!"
When I brought up the irony of biological parents having to adopt their own twins with medical sociologist Barbara Katz Rothman, she looked serious. "That's right. It is an adoption," she said. Rothman was the go-to thinker for socio-feminist analysis during the Baby M case because of her book The Tentative Pregnancy, which isn't actually about surrogacy at all. But when a reporter called her and said, "Hey, they don't know who the father is yet, but what do you think, who should keep the baby?" She said the answer came to her immediately: "Who cares who the father is, I know who the mother is."
Right, but we're talking about gestational surrogacy, I said. "That is so beside the point," she retorted. But the surrogate has no genetic connection; the surrogate is not the mother. Wrong, she said. "If you are pregnant with a baby, you are the mother of the baby that you're carrying. End of discussion. The nutrients, the blood supply, the sounds, the sweep of the body. That's not somebody standing in for somebody else to that baby. That's the only mother that baby has." My own grandmother seconded this with a stark visual. She carried my twin aunts and somehow only gained four pounds. "They were eating me, basically. You're going to tell a woman that her body is feeding these babies and they're not hers?"
Rothman puts "surrogate" in quotes whenever she writes about the issue. She refuses to elevate genetics above relationships, and argues that when we do, the pregnant woman loses too much. "Tell me what words you think of when I say here's a seed, you're going to dig a hole and plant it in the _____," she says. "Most people say 'dirt,' 'soil,' maybe 'earth.' But the energy and power is in the seed, and basically you just stick it wherever it will grow, often in a pile of manure."
For a long time it was believed that the sperm was the seed, and that women were just the place to plant it, and they thus had no rights during pregnancy. "Think of the homunculus, the nesting dolls, the idea that what makes a person a person is the seed from which it grows." When we focus on the seed — the genetics — argues Rothman, we slip into ancient patriarchal myths. In other words, we risk treating pregnant women like shit.
Certainly, being a surrogate does not have to mean subjugation. For Patricia, the motivation to carry for a gay couple was political — one might even say feminist — and she found the experience profoundly satisfying, even empowering, especially the moment at the hospital when she "gave back" the babies, when each dad was holding a twin. "It was indescribable, incredible," she told me, "Each had these looks of absolute joy. I just burst into tears. I was so overwhelmed, so full of joy, so proud . . . It was one of the best moments of my life."
But for feminists, it's threatening enough that notions of the fetus as separate often render pregnant women's rights secondary. A woman becomes pregnant and the state has an interest in her fetus; the father has an interest. What happens when she has no interest? Says Rothman: "I think the notion that a woman is pregnant and it's not really her baby is too dangerous an idea to let out of the box." If gestational surrogacy eliminates maternity rights, does it also erode the surrogate's reproductive rights — her bodily integrity? If the thinking is, "This is not my baby; this is not my seed; I am not the mother," can the thinking slip into "This is not my body"?
Visit the boards on Surromomsonline.com and you'll notice that the women often refer to the surrogacy as a "journey." It's natural language for an event with a beginning, middle and end, an event involving many unknowns. But a journey also implies a degree of surrender to the winds. And the women I talked to all related a loss of some control, a point of no return, especially during the embryo transfer. There they are in stirrups, literally open to the possibility (or probability) of a multiple gestation with fetuses that are inarguably part of their body yet are not "theirs."
And this journey is not without risks — serious ones. Five weeks after Sarah Phillips Pellet gave birth to the twins via cesarean she was in an emergency room hemorrhaging, bleeding out. Bizarrely, a routine pregnancy screen came back positive and ER physicians were convinced she was miscarrying, and in denial — genuinely hysterical. She lost five (of eight) units of blood. It took her months to fully recover. "They wouldn't tell me if I technically died, but I remember hearing, 'She's coding.'" The surgeon was flummoxed by what he eventually removed: a horribly infected placenta. "My theory is that the OBs who did the cesarean didn't quite get all the placenta, and the excess hormones caused it to re-grow, as if I were still pregnant."
Pellet almost lost her life; it's a miracle she kept her uterus. Is it reasonable to ask another human being to put so much on the line? To sacrifice her ability to mother her own children? How much is fair compensation for twelve weeks of intramuscular injections in the buttocks, for ten months of diminished quality of life, for undergoing major abdominal surgery? How much for assuming the unknown risks of high-dose hormone exposure?
Laurel spent hours on the phone with me while enormous and full of regret, a natural birth advocate now resigned to a traditional hospital birth with a heightened risk of surgery to appease her friends. Setting aside her own wishes is part of her gift of surrogacy, but the intended parents aren't reciprocating as much as she expected. They've even been traveling to tropical climes while Laurel is stuck in the wind chill. "So which island are they sending you to when all this is over?" I asked. She gave a hollow chuckle.
This article originally appeared in Babble, April 13, 2009