The following comment from another agency was recently shared with us:

We have found that our chief competitors do extensive prescreening before a match.  This is a way for them to charge you more up front, give you a false sense of security and in the long run, end up having no extra added value.  The medical screening could be different when it comes time to match the Surrogate.    Also, the very involved psychological screening isn't necessary and drives up your costs; our screening process is so involved that we'll pick up psychological problems before matching.  Finally, they're very concerned with the Surrogate's needs and not so much with the Intended Parents' needs; we strike a healthy balance between the two.

This from an agency who claims to have been in the business in the field of surrogacy for 6 years and whose experience is based upon the fact that they became parents through surrogacy.  Their lack of experience and knowledge is rather startling. 

The following are our responses to each of those comments:

1.     Extensive prescreening is a way to charge you more up front:

All screening of a Surrogate Mother and her husband/partner, if any, is an expense the agency must incur.  If the Surrogate Mother does not pass psychological or medical screening, gets pregnant during the screening herself, changes her mind about participation in surrogacy, her financial circumstances change, she changes jobs and cannot take the necessary time off work needed, she needs to move to a different state, she divorces or there is illness in the family, etc., then the entire costs of all of her screening are borne by the agency.  It is unclear what they meant by “This as a way of charging more up front.”  Quite the contrary, does it make more sense for an agency to undertake minimal screening up front and pass the entire risk on to the Intended Parents? 

Secondly, all Intended Parents pay for the screening costs of the Surrogate Mother they work with.  Ultimately all Intended Parents will be billed for or have to pay directly for the costs of psychological screening, social disease testing, an appointment with a reproductive endocrinologist to evaluate her uterus and approve her to proceed with their program, and a background check. This is completely standard for EVERY surrogacy agency.

Therefore the only difference to be considered is WHO pays the costs of those candidates that do not pass the screening process.  In CSP’s program, a surrogate candidate that does not pass any stage of the screening  process is a cost incurred by CSP.  In other programs the cost is borne 100% by the Intended Parents.  Depending on what stage in the screening process the prospective Surrogate Mother reaches before she is deemed ineligible to participate, the prescreening costs can run anywhere from a few hundred dollars to approximately $4,000.00.  The upper figure is reached if the surrogate and her husband are completely psychologically screened, have undergone all social disease testing, background checks are completed and the surrogate was seen by an reproductive endocrinologist for her screening (including laparoscopy, etc) and she then decides not to continue as a surrogate  mother.

 

2.     Giving a false sense of security … end up having no extra added value

This statement is blatantly inaccurate.  What false sense of security can there possibly be in being matched with a Surrogate Mother and her husband/partner who is 100% psychologically screened, has undergone full social disease testing, completed her background check and been approved by a reproductive endocrinologist?  It is almost impossible to imagine that an agency is so lacking in knowledge and experience that they would ever utter such a shameful statement.  The value of a prescreened Surrogate Mother is immense, compared to that of a prospective Surrogate Mother who happened to complete an online questionnaire a week ago and was interviewed over the phone by an agency staff member whose only qualification, is that she was a Surrogate Mother once before.

 

3.      The medical screening could be different when it comes time to match the surrogate.

What CSP does is an initial screening with the Surrogate Mother and her partner to clear her for participation in our program. These tests are then transferred to the doctor’s office once the Surrogate Mother is matched and the doctor has the case. The IVF doctor will have additional testing for the Surrogate Mother, but that is in addition to what CSP has already done and the Intented Parents are not paying again for those same tests.

 

4.     The very involved psychological screening isn’t necessary

Of all the other statements this agency has made this is probably the one that causes us the most concern.  Are we to believe that they do not have their surrogate mothers undergo psychological screening by an independent licensed mental health provider?  This cannot be possible.  Do they claim that their apparent 6 years of experience equals that of a professionally trained psychologist or licensed psychotherapist with years of experience in the field of surrogacy?  Going back to the famous Mary-Beth Whitehead case out of NJ to the more recent tragic surrogacy case featured on the Dr. Phil show, it is painfully clear that surrogacy cases can go wrong, wreck lives and destroy a childhood when psychological screening is not performed and counseling is not available throughout the pregnancy.

 

5.     More concerned with the surrogate’s needs than the Intended Parents’ needs.

This is a statement that causes us to shudder.  Is it not in the interests of the Intended Parents that an agency take good care of their surrogate mother?  It is important that an agency deals with the needs of a Surrogate and her family so that these needs do not become overwhelming or become the burden of the Intended Parents.

Most agencies have a case manager – which is typically a prior Surrogate Mother – who is the contact person between the Intended Parents, the Surrogate and the agency.  CSP believes that each party needs a person whose sole responsibility is them. CSP has a case manager that works exclusively with Intended Parents.  The Surrogate Mother has a separate case manager who works with her.  The two case managers consult once a week with the counselor on the case. The counselor is a mental health professional – psychologist or psychotherapist – whose offers counseling, guidance and support to both the Surrogate Mother and the Intended Parent. 

Therefore the statement that CSP is more concerned with the needs of one party over the other is ridiculous. The Intended Parents have a representative, the Surrogate has a representative and both parties have a full time mental health professional working on their case. 

With other agencies if the Intended Parents do not get along with their case manager, they have no alternative.  That is the only staff member available to them. Their only choice is to retain an independent mental health professional at their expense to coordinate between them, their Surrogate and their case manager.  That cost would be an additional cost for the Intended Parents.

 

The danger lies in what an Intended Parent does not know about the surrogacy process.  CSP offers 30 years of experience.  In that time we have gained the experience from over 1,500 pregnancies, and we have dealt with couples from a variety of countries and cultures.  There is simply no substitute for experience.  CSP offers more experience than any other agency in the entire world. 

 

 

Part of the process of becoming a participant in CSP's program includes medical testing for the surrogate and their spouses/partners. Occasionally, we see an abnormal result that is surprising because of the generally healthy, young population we are testing. These abnormal results are sometimes the result of the person taking supplements. It's very important to note if you are taking supplements, and to discontinue use weeks prior to taking your lab tests.

 

Below are excerpts from a very informative article at www.clinlabnavigator.com that illustrates how OTC supplements can affect test results.

 

Recent surveys indicate that more than 50% of the population use some form of complementary and alternative medicine.   In the US, the sale of herbal medicines now exceeds $4 billion per year. Marketing campaigns imply that any natural product is safe. However, herbal medicines are classified as dietary supplements and do not have to be proven safe before being released into the marketplace.

 

Many herbs have been associated with adverse test results. Abnormal results may occur by any of the following mechanisms:  Assay interference (the way they actually analyze the test being affected by the supplements in the specimen); Herb-therapeutic drug interaction (the supplement may decrease the efficacy of your prescription meds, or increase their effect in an adverse way); Organ toxicity (the build up of the supplement in your system may become toxic as your body is unable to metabolize and expel it) 

 

For persons taking seizure meds such as phenobarbital or phenytoin, herbs like Evening Primrose, can decrease the drug's level in your system by 40%.  For persons taking warfarin, some herbal meds interfere with its anticoagulant properties and can increase the risk of bleeding by inhibiting clotting.

 

Some herbal medicines, like Kava, are hepatotoxic (toxic to the liver), and can cause an increase in ALT and AST (liver function tests).

 

Kelp is promoted as a thyroid tonic and anti-inflammatory medicine, but Kelp tablets contain substantial amounts of iodine, which can cause hyperthyroidism.  T4 and T3 are increased, and TSH is suppressed.

 

Chromium is a trace metal that helps to regulate glucose metabolism. Athletes and bodybuilders take chromium supplements to enhance performance, but large doses can induce hyperglycemia (increased glucose in the blood). In contrast, ginseng has been associated with hypoglycemic episodes (not enough glucose in the blood).

 

An additional risk of taking supplements is unexpected lead poisoning that may occur from herbal medicines contaminated with lead.  Some Chinese herbs have been found to have lead content as high as 20,000 ppm, which translates into approximately 200 micrograms per deciliter. The US accepted blood lead levels are less than 20 micrograms per deciliter for adults and less than 10 micrograms per deciliter for children.  Lead has no role in the body, and its harmful effects are myriad.

 

Generally, a balanced diet and a daily vitamin will provide your body with what it needs for optimum health, but if you do take any supplements, please be aware of the possible side effects and adverse reactions, not only the supposed benefits of it. And if you are doing any kind of lab work, or having any kind of surgery, let your health professional know and discontinue use a few weeks before your procedure.  

Nothing is certain but taxes and death. So the old adage goes, and it holds true even today. It begs the question, should surrogacy be taxed? A recent journal article written by Bridget J. Crawford, Professor of Law at Pace University in New York, argues that surrogacy falls within the realm of taxable services. She cites precedents that found selling bodily fluids to be taxable. The first one, Green v Commission (1980) determined that a taxpayer who regularly sold her plasma, was in the “business” of doing that, and while she was entitled to take deductions off her taxes for the costs associated with the plasma deposits, such as mileage and groceries, she was still required to pay taxes on the money she earned from the deposits. A second decision reached by the Department of the Treasury found that selling breast milk was also taxable, as the taxpayer selling her breast milk was selling “inventory” (Brown, 2010; Internal Revenue Service Gen. Couns. Mem., 1975).

There is the belief that surrogacy should not be taxed because the surrogate must endure pain and suffering in order to go through a pregnancy on someone else’s behalf. U.S. income tax law excludes from gross income any amounts received by a taxpayer on account of personal physical injury. This means that the surrogate would not pay taxes on her fee because the pregnancy would be considered personal physical injury. The argument against that, however, is that the surrogate pregnancy can not be considered personal physical injury when the surrogate mother contracted with the intended parents to undergo a pregnancy. But what if complications arise from the pregnancy? Complications such as the surrogate enduring a miscarriage, having to live through months on bed rest, or in the worst case, needing a hysterectomy and thus preventing her from carrying ever again, are all potential outcomes to a pregnancy. When the surrogate signed the contract, these possible eventualities were probably touched on, but likely dismissed as being improbable. It is therefore acceptable that the pregnancy be considered personal injury as the surrogate is accepting the fact that there could be extremely dire outcomes and is accepting of that possibility.

Ms. Crawford’s argument goes on to discuss her belief that taxing surrogacy would legitimize the practice. She asserts that the tax would enhance the well-being of women by making it part of the public dialogue. “Bringing surrogacy out of the shadows and into the sunshine of law is a step toward recognizing the value of reproductive work…Tax law and the enforcement of tax laws relating to surrogacy is a part of the progress towards justice for women…” (Crawford, 2010). In this statement it is apparent that Ms. Crawford believes her argument is helping surrogates, and women in general.

Enforcing a tax on surrogacy would ultimately hurt all parties involved. Surrogates may not want to undergo the process, for fear that they will not receive all the money they are paid because they will have to pay taxes on it. Additionally, they could have ethical opinions that cause them to not want to pay the government for something they did with their body with altruistic intentions. Intended Parents will have a hard time, too, because the surrogate’s fees will need to be increased to account for the amount she will need to spend on the tax. This in turn could make it cost prohibitive for the Intended Parents. Finally, it will hurt surrogacy agencies, because it could lead to fewer surrogates and fewer Intended Parents working with an agency, choosing instead to try to do everything “under the table” to avoid the tax. Taxing surrogacy is not socially sound and should not be enforced.

By Holly Langdon
Administrative Coordinator
Center for Surrogate Parenting, Inc.

References:
- Crawford, B. (2009). Taxing surrogacy.
- Comptroller General of United States, General Accounting Office Report (1975, 4 November).
- Green v Commissioner, 74 T.C. 1229, 1234 (1980).

More Surrogacy Articles >>

"The Little Couple" returns on TLC for season 2. The first episode premiers on Tuesday, June 1st at 10/9c. Bill & Jen will make an announcement about a big step in their lives. Tune in and share their news. Please check your local listings for "The Little Couple" on TLC.

At the end of last season, we left Bill and Jen after they moved into a rental house, started plans to custom build a new home and most importantly, they were considering their family building possibilities.

During last season, Bill and Jen were looking at their options for having a baby. Jen had some specialized medical testing to determine if she could safely carry a pregnancy. Unfortunately, this would not be an option for Jen since it was determined that a pregnancy would compromise not only Jen’s health but the baby’s as well. That is when Bill and Jen started to seriously consider surrogacy and adoption.

CSP's Joanne with Bill and Jen

A major step in their research was visiting the Center for Surrogate Parenting to be educated about the surrogacy process. This meeting helped Jen and Bill understand the complexities of surrogacy and the importance of working with the best professionals throughout their journey.

Now Jen and Bill will make an announcement about this big step in their lives.

Watch "The Little Couple" on TLC Tuesday, June 1st at 10/9c to share their news.

About "The Little Couple"

Jen is a neonatologist at Texas Children's Hospital in Houston and Bill owns his own sales, training and telecommunications business in New York.

Ever since their marriage Bill and Jen have been striving to reach their dream of having a baby. However, Jen is only 3 feet 2 inches tall and Bill is 4ft tall. Jen knows that a pregnancy could prove difficult and even life threatening because of her tiny stature but that has not stopped the little couple from dreaming of becoming parents one day. While many women with dwarfism are able to carry pregnancies to term, this is not the case for Jen. Her form of dwarfism (spondyloepiphyseal dysplasia, or SED), as well as the many surgeries she has had to endure since childhood could make it potentially life threatening for Jen to be pregnant and deliver a healthy baby.

For more on "The Little Couple" go to: http://www.creatingfamilies.com/home/content_detail.aspx?Id=209

More Surrogacy Articles >>

Surrogacy and India

 

International or cross-border surrogacy raises serious questions of law relating to citizenship, nationality, motherhood, parentage and the rights of a child to be raised by their parents.  It is for these reasons that is it important for intended parents to carefully assess the legal risks involved in surrogacy in the country the birth will occur and the country the child will be raised in.  (http://blog.indiansurrogacylaw.com)

   

Baby Manja's Japanese citizenship took over six months to resolve following his birth in India.  A German couple has been fighting their legal system for almost two years to get citizenship for their test-tube baby born through surrogacy in India and their case remains unresolved.    An Israeli homosexual couple has been denied the rights to obtain an Israeli passport for their two-month-old child born in India.  These are but a few of the problems caused by surrogacy in India.  (http://timesofindia.indiatimes.com/city/mumbai/5-yrs-in-making-holes-in-draft-law/articleshow/5915005.cms)

  

Is surrogacy in India safe?

 

This is a complicated question and the answer is yes and no.  The reality is that surrogacy in India is approximately 5 years old.  Reproductive tourism is a new field to India and the laws are immature and untested.  By contrast the laws of surrogacy are 30 years old in California.  The courts in California have dealt with thousands of surrogacy cases and the laws are known, tested and upheld by the Supreme Court of California.  India’s largest surrogacy clinic has participated in 167 surrogacy cases from 2003 to 2010 whereas just one of the largest surrogacy agencies in CA has participated in over 1500 births.

 
In 2002 India passes laws making surrogacy legal in that country.   In India the law states that a surrogate mother’s name is not to appear on the birth certificate and that she has no right to keep the child.  Rudy Rupak, co-founder and president of PlanetHospital, a medical tourism agency with headquarters in California, said he expected to send at least 100 couples to India this year for surrogacy, up from 25 in 2007, the first year he offered the service.  Lower prices in India make surrogacy affordable by middle class Americans.  Under guidelines issued by the Indian Council of Medical Research, surrogate mothers sign away their rights to any children. A surrogate’s name is not even on the birth certificate.  (http://www.futurepundit.com/archives/005073.html)

 

However in the Jan Balaz case the birth certificate carries the name of the Indian surrogate mother and Mr. Jan Balaz, the German National.  The Supreme Court of India will soon decide if Mr. Balaz must undergo an adoption of his child from the surrogate mother thereby confirming that the surrogate mother is the legal mother of the child she carries.  This is of course not in accordance with the agreement the couple entered into with their surrogate mother and the agency.  The decision of the Supreme Court of India shall have an impact on all the ongoing cases of surrogacy in the country.   It is highly recommended that intended parents wait for a decision from the Supreme Court of India before entering into any surrogacy arrangement.  There are strict rules governing international adoption and these rules will most likely be breached if a surrogate mother receives compensation for her services.  The laws in India are immature, untested and unpredictable.  Over the next decade, with more experience in this field, India may find a solution to how to regulate surrogacy.  There is no certainty regarding the laws of surrogacy in India.

 

 What are the pros and cons of surrogacy in India?

1.                “It’s not for nothing that countries like India are called the Third World. When you arrive there it’s like you’ve just stepped onto another planet.” (http://www.roadjunky.com/article/635/third-world-india).  The reality is that India is a country of sharp contrast between rich and poor.  For some India would be classed as a developing country.  The gap in India between rich and poor is far greater than in most Western nations, with little being done to try and close this gap. Indian society is extremely unequal, with little being done to ease the lot of the nation's poverty-stricken majority, and international relief agencies being required to operate in rural parts of the country. Standards of public health are low, and the human rights record is very poor, with much police brutality and abuse against low-caste Indians, and legal rights for them negligible.  Until these changes, India will be classed as a developing country. (http://wiki.answers.com/Q/India_is_a_third_world_country)

2.                SART figures for clinics in the U.S. show that fresh cycles in 2007 had the following results:

·        48% of cycles resulted in live births for women less than 35 years old

·        41% of cycles resulted in live births for women 35 to 37 years old

·        23% of cycles resulted in live births for women 38 to 40 years old

·        19%  of cycles resulted in live births for women greater than 40 years old

Of these cycles, 30% had twins, and almost 3% had triplets or more.  (https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0) 

Clinics in India have not published their success rates.  There are more than 1000 IVF clinics in India, but no laws govern assisted reproductive technology (ART), which includes surrogacy, and no watchdog has been authorized to police it.

"Most of the ART clinics in this country are not following these guidelines because they do not have any legal strength," said R. S. Sharma, the deputy director-general in the division of reproductive health and nutrition at the Indian Council of Medical Research.

A Canadian couple discovered their twins were not biologically related to them when DNA testing was done upon their birth in India and these twins may spend the rest of their lives in an orphanage because the clinic’s records are unable to identify their biological parents.

 

3.  At face value, surrogacy in India appears to be a win-win situation.  The intended parents receive a longed for child while the poverty stricken surrogate earns ten times an average person’s yearly salary.  However on reflection it can be argued that surrogacy in India is no more than the exploitation of the world’s poorest women and that intended parents pay a price that is a fraction of the price they would pay closer to home for surrogacy.  Surrogacy in America has had 30 years to develop and settle on the guidelines that govern the field.  Typical to most USA surrogacy programs and upheld by reputable IVF clinics is the following guidelines:

a.                          Surrogate must be between the ages of 21 and 42 years old.

b.                          Surrogate must have delivered at least one child herself (reputable agencies will also require that she has raised a child or is presently raising the child)

c.                          Surrogate cannot be receiving any welfare payments

d.                          Surrogate is entitled to independent legal counsel

e.                          Surrogate undergoes psychological screening (reputable agencies will screen the surrogate and her husband).

 

The 50 pregnant women at the clinic are mainly of lower caste and from impoverished nearby villages. The pay they can hope to receive following a birth is equivalent to over 10 years’ salary for rural Indians. (http://www.timesonline.co.uk/tol/news/world/asia/article7113463.ece) It appears that the majority of surrogates recruited in India would be ineligable to participate in surrogacy in the US.

 

 4.  In the USA it is unusual for a surrogate’s husband to approach a surrogacy agency and such solicitation would raise red flags for a counselor evaluating the case.  In India many husbands actively work to convince their wives to participate in surrogacy because of the financial benefits to the family.

They don’t want to appear ungrateful, but some surrogate mothers admit that they would not take the risk if they had a choice. “My husband took almost two months to convince me to do it,” says Anandi, a 39-year-old about to give birth for an American couple. “He said, ‘Do it for your children.’ But I have very young children and I was worried about leaving them.

“I will feel sad when I give away the child. I don’t know if I will be allowed to have contact with it. My children want me to give the baby away; they don’t want it at home. Nobody else knows about this. The village people would say bad things. I’ve just said that I’ve gone away for work, and I haven’t even told many of my relatives, only a few. They wouldn’t understand.”

Anandi had just moved from one of two “confinement” homes, where surrogate mothers live for the duration of their pregnancies. They may leave the gated premises only for hospital check-ups, and their husbands and children are allowed to visit on Sundays.  

If the first surrogacy is successful, Sumita would consider another. But 10 minutes later, it is time for Janisha to leave. In dread of another separation, she wails and grips Sumita’s bedcovers, before tearing away and running round in heartbreaking distress. Her anguish shatters any illusion that to be a surrogate mother is simply a way to make easy money.       

 ( http://www.timesonline.co.uk/tol/news/world/asia/article7113463.ece)

 

5.  It should always be remembered that surrogate mothers are first and foremost mothers to their own children.  Surrogate mothers in India must leave home for the duration of the pregnancy and live in a hostel run by the surrogacy agency.  The reasons given by Indian run surrogacy agencies are: 

a)      Poor obstetrician/pregnancy care in the village the surrogate lives in

b)      Poor living conditions

c)      Agency is unsure if the surrogate mother will have access to fresh fruit and vegetables during the pregnancy

d)      Agency not comfortable with the living conditions of the pregnant surrogate mother

e)      Problems with other village residents with regards to disapproving of a surrogacy pregnancy

f)       Inability to remain in contact with the surrogate during the pregnancy due to no or poor means of communication.

g)      Uncertainty of being notified when the birth occurs or if a birth is imminent.

h)      No place for the Intended Parents to stay for the birth and after the birth

i)       No neonatal intensive care facility close by for the baby after the birth

 

However, all these reasons concern the newborn baby and the Intended Parents. There is no good reason for the surrogate mother to have to abandon her family and move far away from her family for almost 9 months.  This relationship is clearly inequitable.  There appears to be no balance between a surrogate mother as a mother and a surrogate mother helping another couple.  Why not allow the surrogate mother to see her children every day or whenever they can make the journey to see her?  Why not allow the surrogate mother to have her children live with her?  Why does the agency simply advertise in neighborhoods that are safe and middle class so the surrogate can live at home?  The answer to the latter question may well be that to pursue surrogate mothers who from middle class families would result in surrogacy arrangements being of comparable costs as surrogacy costs in the United States. 

 This will often involve these women cutting themselves off from their families, including their own children, for the period they are gestating the child. They will take on the risks of childbirth for a child they will never know. If the pregnancy does not go to full term, or the child does not live, they are unlikely to be paid. Some will inevitably suffer psychologically from giving birth to a child from whom they will be immediately parted. The whole process is likely to be very alien to their culture.

It is arguable that their human dignity and right to bodily integrity is infringed, and the rights of their own children to the society of their mother may be compromised.  http://www.irishtimes.com/newspaper/ireland/2010/0419/1224268626911.html

 

 6.  The rapidly growing but unregulated field of surrogacy in India has led to calls for India to introduce tight laws on surrogacy to protect both the Intended parents and the surrogate mother.  New legislation has been drafted, detailing the obligations and rights of all parties, but it has yet to be enacted.  According to Priya Hingorani, a prominent Delhi lawyer and member of an expert panel drafting the bill, tight regulations must be enforced to offer the surrogate mother a comprehensive package of remuneration and medical and psychological care. “When I look at the poverty, and the genuine need of the couple who don’t have children, I think that surrogacy is all right,” she says. “But when I see the other side of things, when people are exploited, then there is the need for very strong regulation. Surrogacy has become more of a commercial racket as it becomes more prevalent. We are seeing a new trend of fertility and wombs on sale.”  The legal status of surrogacy is unsettled at this time in India.

A bill to govern assisted reproductive technology and surrogacy has been drafted that makes it much harder, and maybe impossible, for international couples to hire Indian surrogates.  Under the proposed law, a foreign couple wanting to enter an agreement with an Indian surrogate would need a written guarantee of citizenship for the child from their government.  There is also concern that the proposed Indian legislation would also prohibit gay couples from hiring surrogates.

 

7.   For prospective parent participating in surrogacy in India the entire process is also fraught with difficulties. Thousands of miles from home, the language barriers, culture shock and basic standards of a Third World clinic, where two women are often in the operating theatre at the same time, can make for a frightening experience.  Couples pursuing surrogacy in the USA are often concerned about the medical qualification of the obstetrician taking care of their pregnant surrogate mother and their unborn child.  They frequently ask questions about which perinatologist they should go to for the nuchal fold test, the cvs testing or the amniocentsis.  Couples request second opinions, want to know about the hospital their baby will be born at, what doctor will their baby see between birth and their return home.  What options are there in India? 

 

 8.  For some countries such as the USA, a couple can complete their paperwork within 10 days of birth and return home with their newborn baby.  However for other countries the stay is indeterminable.  Many British couple need to spend 2-3 months in India before returning home. 

 

 9.  Finalization of parental rights for most countries involves proving a genetic link between the baby and the parent.  For couples where only one parent is biologically related to the child there is an additional risk of doing surrogachy in India.  If a parent dies before the birth of their child, there will be no way of proving the child is genetically related to the parent and therefore impossible to obtain citizenship for that child.  These children must remain in India and potentially live their lives in an orphanage. 

 

 - Center for Surrogate Parenting, Inc.

 

 

More Surrogacy Articles >>

 

"I found a surrogate online.  We had a great experience with our first surrogate but for medical reasons she could not help us again.  We decided to do another surrogacy for our second child.  Then her attorney called me and said "It's a girl, you’re the father and she's keeping the baby." A statement by Tom Lamitina, a father of two, his son that he and his wife are raising and a daughter that their surrogate mother is raising.

Case # 1: The surrogate mother’s name is Stephanie Eckerd and she delivered a baby girl in May 2007.  Emma Grace was conceived with Stephanie Eckerd’s eggs and Tom Lamitina’s sperm.   This kind of surrogacy is termed Traditional Surrogacy or Artificial Insemination Surrogacy.   Florida law gives Eckard the absolute right to change her mind and keep the child for up to 48 hours after the birth.

According to the Lamitina’s attorney, Eckerd advertised herself as a surrogate mother online and stated she had been a surrogate mother before.

Case # 2: Shelly Baker advertised herself online as a two-time prior surrogate mother willing to help another couple. Ms. Baker stated that she wanted to help a Christian couple.  Amy Kehoe saw the message and was drawn to the fact that Shelly lived only 2 hours away.  They traded email messages and phone calls and met for dinner before agreeing to go forward with the surrogacy.

Shelly Baker case featured on Dr.Phil

In July 2008, Shelly gave birth to twins and the Intended Parents. Amy and Scott Kehoe took their twins home.  A week later all parties returned to court to transfer guardianship to the Kehoes.  During the hearing the judge asked several questions including psychiatric history and legal infractions. Amy stated she had a psychotic disorder not otherwise specified.  She had been under the care of her doctor for 8 years.  She sees her psychiatrist once very three months and takes medication every day.   Before her diagnosis, Amy self medicated and it was this self medication that was the reason for charges of cocaine use and driving under the influence.  However, Ms. Kehoe’s psychiatrist wrote a letter stating she would be a good mother because her disease had been fully controlled for eight years and she currently had no symptoms.

Ms. Baker said she was stunned at the disclosures of the mental illness.  Ms. Baker said she had no prior knowledge of this condition and it should have been revealed to her from the outset.  She became concerned that Ms Kehoe might relapse and be unable to take care of the twins.  One month after the birth of the twins, the Kehoes were forced to say goodbye to their babies and witness Ms. Baker drive off with them.

Two surrogate mothers, two different kinds of surrogacy, children not being raised in the homes they were intended to be raised in, a media circus, what went wrong?

The main thread connecting these two cases is the absence of professionals.

1. Both Stephanie and Shelly were repeat surrogate mothers and did not participate in psychological screening. There is no guarantee of performance just because she has done this before.  The first issue a counselor will address is why she wants to do this again?  What happened during the first surrogacy that she feels she never attained her goal and wants to try again?   What was the relationship like with the couple?  Interesting to note that Shelly Baker talked about calling her couple at 3 AM and asking them to bring her Tacos because she had a craving. Shelly said this was her way of allowing the couple to enjoy the pregnancy.  Perhaps Shelly craved attention and wanted to demonstrate her power instead of her craving for Tacos?  Most definitely behavior that would cause a counselor to carefully re-evaluate a candidate.
2. None of the parties completed an intake questionnaire. Remember those long forms you have to fill out for a new doctor?  That is similar to an intake application.  Most agencies have intake forms/questionnaires.  Included are questions about mental health, mental health treatments, prior psychological appointments, outstanding child support payments, etc.  The questionnaires are a tool used by mental health professionals to enable them to ask the right questions.  As an example: say a couple states they saw a therapist when they lost a pregnancy at 24 weeks.  Of course this is a very sad situation, but what it does is open the door to discuss the causes of the loss, was there testing done, did both parents or just one go to counseling, how long did they attend, was medication prescribed and is medication ongoing, etc.  Not only does the counselor gain valuable information, she now has a name of a counselor she can consult with if necessary and she can prepare the surrogate mother that perhaps this couple will be more cautious until the pregnancy passes the date of the last loss.
3. There was no psychological evaluation of the couple.  This is really an essential part of surrogacy.  We understand that every couple pursuing surrogacy desires to have a child.  However a skilled counselor can help a couple or an individual evaluate whether they can let go of so much control.  Think of it this way:  an infertile woman has gone through endless failed treatments and perhaps spent years trying to have a baby, a baby she wanted to carry herself.  Along comes a lovely surrogate and achieves a pregnancy on the first attempt. She makes it seem so easy.  The Intended Mother may feel resentment towards someone who was able to do what she could not. These feelings are not wrong and a person is not ungrateful in feeling these emotions.  They are normal, healthy emotions and a counselor can help process the couple so they understand and can cope with such feelings. A counselor will also ask questions about mental illnesses, treatments past and present, prescription medication past and present and she will discuss whether counseling was sought in the past and if any is ongoing.
4. There was no consultation with an attorney experienced in surrogacy prior to starting the medical procedures. This is a crucial aspect to pursing surrogacy.  It is really a simple notion – do not do surrogacy in a state where you will not be considered the parents.  In both of the cases highlighted above, the laws were not favorable towards the Intended Parents.  In Michigan commercial surrogacy is punishable by five years in prison and a $50,000 fine.  Shelly Baker was not compensated for the surrogacy, except for medical bills and expenses, and is therefore considered compassionate surrogate.  However, Michigan law states that surrogate contracts are void and unenforceable.  Neither of the Kehoes is genetically related to the children they created leaving them without a valid claim for the children. Ms. Baker gave birth to the children and therefore was the only person that had a claim to parent these children.    In the Florida case, Stephanie Eckerd was biologically related to the child she was carrying.   Traditional surrogacy laws are clear in Florida; the surrogate mother has 48 hours after birth to change her mind, even if there is a signed contract.   Neither one of these cases would have existed if the Intended Parents had sought legal counsel and followed their advice.  As lovely as both the surrogate mothers appeared to be and despite the fact that they had been surrogate mothers before, a qualified attorney would have counseled both couples to seek a different surrogate mother in different states.

Surrogacy is about creating layers of protection.  The state law is one layer, the legal contract is another layer, the psychological evaluation of the Intended Parents another, the evaluation of the surrogate mother and her husband another, ongoing counseling another, and so on. The above four points are all important and offer layers of protections.  Both these cases would not exist had each couple ensured they complied with this list and availed themselves of the layers of protection an agency offers.

People lie.  Some people do not mean harm to others, but they lie, small lies, but lies none the less.  Surrogate mothers lie about their medical history, that they had uneventful pregnancies, that they have never tried drugs, never had an affair.  Intended Parents lie about the true status of their marriage, that they will be respectful and appreciative to their surrogate mother, that they will always remember the gift she has given them, they lie about their drug history, about their finances, etc.  Not everyone lies of course, but even one little lie or deliberate avoidance of telling the truth can have such negative impact on a surrogacy pregnancy.  When two people are attracted to one another and one lies to the other, there is heartache, disappointment and lack of future trust.  The parties can simply walk away from their relationship,  However, when a surrogate mother is pregnant, no one gets to walk away.  A pregnant surrogate mother can either can come to terms with the lies a couple tells her, but still comply with the contract and simply wish she had made a better selection of couples to help.  Alternatively she may conclude that the lies are so material that she cannot comply with the terms of the contract.  Lives could be changed forever.

It is so very important that every surrogacy relationship is entered into cautiously.  Never, never enter a surrogacy relationship without all parties being evaluated by a licensed mental health professional with years of experience in surrogate parenting.  This is your insurance policy.  Be careful not to work with a mental health professional that claims he/she has years of experience.  Get it is writing that he/she has years of experience in the field of surrogate parenting.  Make sure you have a document that states he/she has acted as a counselor on over 100 cases or 500 cases.  Get it in writing.

The role of the counselor is to correct the misunderstandings, hurt feelings, and bad behavior and counsel everyone to understand, forgive, agree not to repeat and acknowledge that it is in everyone’s best interest to make this work.

Perhaps if Shelly Baker had access to a mental health professional she could have aired her concerns about mental illness.  Ms. Baker said she decided to keep the twins because of information that came to light about Amy’s mental health history that made her uncomfortable.  She said “I am not going to be one that’s going to feel guilty if something happens.”   It is perhaps reasonable to assume that if Shelly had the opportunity to discuss her fears and concerns with a counselor she was already familiar with and trusted, the case may have had a different outcome.  Perhaps Ms. Baker would understand mental illness, have allowed professionals to answer her questions and not judged an illness she did not even try to understand.

In the Florida case, there was a time when Stephanie Eckert did not know if the baby she carried was her boyfriend’s or the couple’s.  There was no counselor to help all the parties understand what happened and how the revelation destroyed the trust that had previously existed in their relationship.  Each party felt betrayed and there was no one to guide them in how to maintain a civil relationship.  Anger opened the door to poor communications, threats and statements that could be misunderstood and impossible to retract.  No one can guarantee that a different outcome would have occurred had a counselor been involved, but it is as certainty that a counselor would have prevented the writing of terrible emails and helped in calming everyone down, and focused attention on determining the genetics of the baby.

There are very few surrogacy agencies that have full-time mental health professionals working with them.  Do not be fooled by agencies that have a psychotherapist that screens the surrogate mother and is then available if ever needed.  A counselor who does not regularly meet with the parties will be ineffective in a crisis.  If a problem occurs, you need to be able to call a counselor immediately and get immediate action.  A counselor has not spoken to the parties for months it will take her several sessions to get acquainted with the case, the facts and the personalities involved before he/she can offer advice and guidance.  Valuable time will be lost and a possible solution may slip away.  One of the very few surrogacy agencies that has a full time staff of mental health professionals is the Center for Surrogate Parenting, Inc. (www.creatingfamilies.com)

Surrogacy done safely, surrogacy done right.

“We never even got a lawyer the first time,” Tom Lamitina, 45, said. “If you’re both on the same page, why bother getting an attorney?” Besides, he added, “If we did get an attorney, she could still change her mind at the end, so it wouldn’t matter if we had an attorney or not.”  No, Mr. Lamintina is wrong.  Had he worked with CSP he would have benefited from a private legal consultation and would only have been matched with a surrogate mother in a state that would recognize the Intended Parents as the parents.

“My husband and I would not do something like this unless we thought it was given to us to do, “Ms. Baker said.  “My belief is that God placed this on my heart for a reason.”  From the moment Ms. Baker decided to be a surrogate mother, she was determined to keep professionals out of the arrangement.  It was Ms. Baker who told the Kehoes she had been a surrogate mother twice before (in other words “you can trust me”), that there was no need for a psychological evaluation of any party or the need for an attorney.   It was Ms. Baker who decided Mrs. Kehoe was an unfit mother due to mental illness.  At no time did Ms. Baker consult with a professional to understand the disease. She could have called the Kehoe’s psychiatrist and, with permission from the Kehoes, had a consultation. She could have spoken to friends or neighbors of the Kehoes. She could have spoken to the people Ms. Kehoe worked with (Mrs. Kehoe worked at the same company for 21 years). She could have asked the courts to appoint an independent counselor to evaluate the case and make recommendations.  When Ms. Baker appeared on the Dr. Phil show, Dr. Phil offered to provide free evaluation of the couple by an independent psychologist, but Ms. Baker refused.  When Dr. Phil asked what she would do if the Kehoes went ahead with the evaluation and received a clearance from several independent counselors, Ms. Baker stated that it was too late, her family had bonded with the babies and it was not good for the children to bounce between homes.  Dr. Phil stated that the babies were now 6 months old and within the time period when they would have no long term consequences of changing homes. Ms. Baker declined to seek an independent opinion about the effects on returning the children to the Kehoes. At every turn from the moment she decided to become a surrogate mother, Ms. Baker refused to turn to professionals.  She is adamant in what she believes in and stands by the decisions she has made and cannot even contemplate that she may be making the wrong decision.  Finally when Ms. Baker feels she is losing an argument she turns to the safety of religion.  There was no winning for the Kehoes. They handed control to Ms. Baker from the outset and to this day Ms. Baker remains in control over the lives of these children.

Note from the author:  These cases are not over.  I understand that the parties involved believe that they are over because the law has decided that the surrogate mother in both cases gets to keep the child/children.  These cases are not over because these children will grow up and will have opinions of their own about who they call family and whether they want contact with the Intended Parents.  Tom and Gwyn Lamitina have a son who is biologically related to Emma Grace as they both have the same father.  Do these children have a right to know that they have biological siblings?  Amy and Scot Kehoe have remaining frozen embryos that they state they intend to use.  If a baby results from the frozen embryos then these children will all be 100% biologically related.   These cases are not over, they are just beginning for these children.  For the sake of these children it is so important that all these parents seek psychological counseling and guidance regarding future contact and conduct.

More Surrogacy Articles >>

Surrogacy can be a miraculous gift, a way for a childless or infertile couple to fulfill their desire to become parents. However, precautions should be taken to ensure that all parties have a positive and healthy experience. According to Bill Handel, an attorney and founder of the Center for Surrogate Parenting, Inc., there are 10 things you must consider before working with a surrogate.

1. You must have a medical necessity to participate in surrogacy.

Visit an IVF doctor and ask if he or she recommends that you do surrogacy. Keeping your good figure or a stressful high-powered job are not valid reasons to work with a surrogate mother. Most IVF doctors (and all good IVF doctors) will only work with couples that have a medical reason to do surrogacy. There are sometimes psychological issues that can be included, but we consider psychological to be a medical reason.

2. Psychological counseling for the couple.

See a counselor to discuss if surrogacy is right for you, and if you can actually do surrogacy. Can you allow someone to carry a child for you? There are women who need a surrogate mother, but will try to control every aspect of the surrogate’s life, and this will cause conflicts between them. Seriously consider child-free living, and discuss this option with your counselor.

3. Psychological counseling and evaluation for the surrogate and her husband or partner.

What is her motivation for becoming a surrogate mother? Has she done surrogacy before, and what went wrong or right that she feels the need to do it again? Does she understand that the couple will be involved in the pregnancy and may have different opinions regarding pregnancy care and treatment? How involved will she allow the couple to be? Get a written psychological clearance on your surrogate mother.

4. Understand the legal status of surrogacy law in the state where your surrogate mother lives.

It is crucial to get an independent legal consultation regarding the laws of the state she lives in. If there are any doubts about finalizing your parental rights, DO NOT proceed. If you plan on having her deliver in another state, DO NOT proceed, because she could have a premature delivery. All parties should have independent legal counsel represent them, and all parties must sign legal contracts before any medical procedure is undertaken.

5. All parties should complete a surrogacy questionnaire that is shared with each other.

These questionnaires include questions about mental illness, hospitalizations, genetic illnesses, prior marriages, prior children, health status, marital status, bankruptcies and legal judgments, prior pregnancy history, infertility history, etc.

6. Psychological counseling

There should be ongoing psychological counseling for all parties throughout the pregnancy and for at least two months after birth.

7. The cost of surrogacy

Do you have the financial ability to pay for the pregnancy? Can you cope with the costs of a high-risk pregnancy, premature birth and miscarriage?

8. At least one parent should be biologically connected to the child being conceived.

If both egg donor and sperm donor are needed with a surrogate mother, be prepared for a far more complicated relationship both legally and psychologically, and ONLY work with a surrogate mother who is a resident in the state of California. California is the only jurisdiction that recognizes such a relationship.

9. Openly discuss and document everyone’s expectation of the surrogacy relationship.

This is where each party learns what is expected of him or her by the other, and if they can do what is expected of them. They should also discuss the kind of relationship they believe they would want after birth. Many couples and surrogate mothers find they cannot answer this question, because they have never participated in surrogacy before. This is an answer in itself, as it indicates they are open to many possibilities. A counselor can guide the parties by giving them ‘what ifs." It is important to remember that the parties are coming together to help the infertile couple become a family and parents. No one is looking to become best friends. If everyone develops a friendship, that is wonderful, but everyone should remember the reason for finding each other. If a long-term relationship is expected by any party, that is OK, but the request needs to be evaluated in terms of what is in the best interest of the child. More specifically, the couple should not agree to continue a close relationship after birth and that the surrogate can attend all birthday parties. The child, at some time, should have the right to decide what relationship is comfortable for him and who attends his birthday paties.

10. Selecting the right agency.

Evaluate the advantages to working with a reputable surrogacy agency.

For more information, contact the Center for Surrogate Parenting, Inc.

From Dr.Phil Show

• Surrogate Mom Faces Her Critics

More Surrogacy Articles >>