Episode 30 – Is Traditional surrogacy ‘riskier’ than Gestational surrogacy? – Narelle Dickinson, Psychologist

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Thanks for watching!

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series with Surrogacy Australia. Thank you so much for taking the time to listen and in turn for helping us spread awareness and appreciation for surrogacy. I’m your host Anna McKie and these recordings are from a regular webinar series that I run. You can find upcoming dates on our website at surrogacyaustralia.org. During the regular one hour webinars I will walk you through the surrogacy process in Australia and you can type in questions for us to answer. My co-hosts have all done surrogacy in Australia

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and they alternate between surrogates, gay dads, and straight mums. This webinar recording was different, as it was a discussion about a research project led by Narelle Dickinson to unpack the question, is traditional surrogacy riskier than gestational surrogacy? Narelle is a Brisbane-based and Zika accredited clinical and health psychologist specializing in the perinatal field with many years of experience of surrogacy cases.

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She has completed a Churchill Fellowship, which took her around the world to study surrogacy practice in the USA, Canada, Russia and Southeast Asia. At her practice, Lotus Health and Psychology, Narelle leads a team of expertly trained perinatal specialists to support people through preconception, pregnancy and into parenthood. If you’d like to arrange your own session with Narelle, you can find her at Lotus Health and Psychology. We hear from Narelle as she explores the findings of her research.

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Is traditional harder on the surrogacy relationship? Are traditional surrogates more or less supported by their IPs, intended parents? How do traditional and gestational surrogates perceive the surrogate pregnancy compared to their own? Do traditional surrogates have a harder time relinquishing the baby? Is there more conflict between the surrogate and IPs in traditional surrogacy? And are there greater mental health challenges in traditional surrogacy? The research findings were not a surprise to Narelle.

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to any professionals in the surrogacy industry, nor to surrogates themselves, that traditional surrogacy is not riskier than gestational. So if traditional surrogacy is not an issue, what are the issues? Narelle summarizes this beautifully when she says, “‘For potential and future surrogates, “‘you can stand on the shoulders “‘of all these wonderful surrogates “‘who came flooding in to say, “‘This is how to get it right. “‘It’s got nothing to do with traditional. “‘Focus on the relationships and communication,

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and it will save you a lot of time and pain. I hope you enjoy this episode. Great, thanks, Anna. I hope everyone’s okay. I might do a little bit more of a formal presentation of some of the findings that we had from our research study and then we can have a bit more of a relaxed chat at the end. If you have any questions, if anything pops into your mind as I’m going through, throw it in the chat. If there’s anything that pops up later on, please jump in, talk. I’d love to talk through any questions and I’d actually love to hear any responses and how it sounds to you, hearing what

03:02
what I’m talking about from the research as well, since the people who are listening are presumably the real experts here, the IPs and the surrogates. I’d love to hear what the perspective is on our findings. Thank you for the introduction, Anna. By way of a little bit more introduction of myself, I do a range of perinatal work, and I work with people with…

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a whole bunch of different fertility challenges, and a fair proportion of those end up undertaking donor-conceptional surrogacy. And for the 13 years that surrogacy has been legal in Queensland, I’ve provided implications counselling to hundreds of surrogacy arrangements now. Most of those have progressed quite brilliantly, but some of them, unfortunately, not so much. And really, as I’ve seen these different arrangements and how they’ve gone, it made me wonder what it is that makes some arrangements go wrong. And…

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whether there’s anything that we can be doing to better predict which groups should or shouldn’t proceed with a surrogacy and what might happen. So as a clinic here at Lotus, we decided to undertake a little research project to explore the question. First though, I’m gonna give a little bit more background about…

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traditional surrogacy, which was one of the core questions that we’re asking about. So to begin with, just some terminology. Gestational surrogacy, for those of you who don’t already have familiarity with the terms, it’s the phrase we use when a surrogate carries the pregnancy and births the baby, but she does not have a genetic relationship to the child. She will have undertaken IVF using an embryo.

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created either from the intending parents own gametes or they may have used donated eggs from a third person. It’s also possible to use a donor embryo or double donation where both donor eggs and sperm are used. And gestational surrogacy is different from traditional surrogacy, which is where the surrogate has also used her own eggs. And she might undertake an IVF cycle to create embryos, which will be later transferred back to her, or she might agree to home insemination from the intending father. Now, before I get into the research findings that we had,

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So just give a little bit of a history on some of the perspectives that have emerged about traditional surrogacy as opposed to gestational. So about 40 years ago, the case of Baby M made international headlines really for all the wrong reasons. William and Elizabeth Stern had entered into a surrogacy agreement with Marybeth Whitehead and Marybeth was inseminated with William’s sperm, making her also the biological mother.

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traditional surrogate. After the baby’s birth as arranged she relinquished the child but a few days later she came back to the Stearns and threatened to kill herself if she could not see the infant. The Stearns agreed to give her some time with the baby but Mary Beth then, to cut a long story short,

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she actually kidnapped baby M for about 87 days and threatened to kill the child rather than return her. This infamous case caused many to form a view that traditional surrogacy was more risky than gestational surrogacy. They really started to believe that it was the fact it was a traditional surrogacy that was the problem. And the view was that a surrogate would be less likely to relinquish the child if she’s the biological mother, in addition to being the gestational carrier. As a result,

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many governments here and overseas enacted legislation which expressly prohibited traditional surrogacy and in some places they prohibited surrogacy altogether. In some Australian fertility units still refuse to facilitate traditional arrangements even though the local laws might permit it and what we’ve really seen is that over time prejudices and fears about traditional surrogacy have

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kind of strengthened. The belief that it’s more dangerous and that the arrangements are more likely to fail or the traditional surrogates will refuse to relinquish the baby has settled as if it’s fact and yet there’s almost no research about the topic to empirically inform clinical practice or lawmaking. The impact for potential parents is pretty significant. For those who don’t have their own eggs, the restrictions on traditional surrogacy increase the complexity and the cost for IPs. IPs must locate an egg donor in addition to

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a surrogate or they might explore undertaking a traditional surrogacy using home insemination and in many cases that takes them away from the support and the guidance that they might have otherwise received from fertility professionals. In implications counselling, which is what I do in the lead-up to a surrogacy arrangement, both potential surrogates and IPs question the risks of surrogacy and without the guidance of sound empirical literature,

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It’s incredibly difficult to provide guidance to the key question that we were asking here. Is traditional surrogacy really more likely to cause problems in the arrangement? The legacy of Baby M’s case has lingered for a really long time. So our study aimed to provide some insight into the experience of gestational and traditional surrogates in Australia. And we had a core goal of identifying any measurable differences between gestational and traditional arrangements. And…

07:54
We were really hoping we’d be able to answer the question, is traditional surrogacy actually riskier than a gestational arrangement? Is traditional surrogacy a key factor in whether or not an arrangement will falter or fail? So I said at the start, we decided to undertake a little research project. The next thing we knew, we had managed to recruit 84 current and past surrogates through word of mouth, social media and direct invitation. We used a kind of snowball recruitment approach and we can thank SASS

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and Anna and a number of key surrogacy lawyers for helping us be utterly inundated with surrogates who from as far as I could tell were literally falling over themselves to participate in the study. So something that started as a quick little thing has turned into a…

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Fairly major project, which has been an extraordinary, although quite exhausting enterprise for us. Lots of work, but also lots of data. Lots of work and lots of data, yeah. It’s been amazing. So participants volunteered to complete either an antenatal or a post-surrogacy version of our survey. So there were some who were still undertaking their pregnancies and some who had finished. And after excluding some ineligible participant data, we retained 19 participants who were antenatal still and 54 in the post.

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surrogacy group. So it was a pretty hefty number of participants who completed our question. So we were asking participants about their experience of surrogacy and we were focusing on the perceived financial, emotional and physical support that they received from their intending parents or how much support they perceived they received and what the relationship with their IPs was like. We asked them if they had felt that their experience of

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pregnancy during the surrogacy was different from when they carried their own children for those who had children. We screened their current mental health using something called a DAS 21, which for those who aren’t familiar with it.

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is the depression, anxiety and stress scale with 21 items on it. And for those who had already completed the surrogacy, we asked about their experience of relinquishing the baby. Now, we were unable to locate any surrogacy specific assessment tools. I don’t know of anything which has been developed to particularly look at the experience of surrogacy. So we use some scales which are usually used to assess a mother’s feelings towards their pregnancy and baby. And I do understand that a surrogate is not a mother of the surrogate child.

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about their feelings of attachment towards the child during the pregnancy and for those who had completed the pregnancy we also were asking about how they felt afterwards. So the two scales that we used were the maternal fetal attachment scale which is something that assesses feelings of attachment during the pregnancy and also the mother-infant bonding scale which is a scale that looks at postpartum attachment. So I thought it was quite interesting to also let you know a little bit about who those participants were because it really talks a bit about

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So in our antenatal group, our surrogates were aged between 25 and 44, so there was a big range there. They were married or de facto, and some were single. My notes are muddled up there a little bit. All of them had children of their own. And one of the things I think was really, really interesting is that

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Over half of them worked in the healthcare industry. So many were nurses or midwives. So there’s something there about people who like babies and trying to help people have babies in all sorts of different ways. Quite a few others were also working within the childcare and education industry. So a real interest in children and family from our participants. Four of them had already completed a…

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previous surrogacy, so they were not new to surrogacy. And I’m not quite sure why we found this, but about 70% of them lived in either Queensland or Victoria, so it just seemed to be something to do with our recruitment. IPs were all either same-sex or other-sex couples. We had no single parents, no single IPs amongst the antenatal surrogates. And at the time of responding, about 80% were still in either the first or second trimester of.

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pregnancy. So they were a little bit earlier through. Of this group, two were traditional surrogates and both of them had undertaken home insemination. Of the 17 who had undertaken gestational arrangements or were undertaking gestational arrangements, seven were carrying a child that was genetically related to both of their IPs and 10 had used embryos where they’d also been egg donor. I’m just thinking that’s interesting, 10 from the egg donor. Oh, that doesn’t necessarily mean it was a hetero couple that needed an egg donor. No,

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How many of these arrangements were for whatever reason, it was not genetically both of the parents. So either IPs who also needed, sorry, other sex IPs who also needed an egg donor or it was same sex IPs and I haven’t got that breakdown in front of me. A real variety. Yeah, in the postnatal group.

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Almost 70% were either married or de facto, so about 30% were single women. Three of them had never birthed a child of their own, which I thought was really interesting. Same sorts of numbers in terms of other backgrounds, so 37% worked in healthcare. And in this group, respondents were from every state of Australia, except an NT.

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which makes sense because it wasn’t legal there at the time. Most of them had IPs who were either same sex or other sex, but I think we had one who had a single dad as an IP. 42 of these had undertaken and completed gestational arrangements. 18 of those.

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Both IPs were genetically related to the baby, but 23 there was an embryo created using an egg donor and one had used double donation. And seven were traditional arrangements, six of which had used home insemination. So of our nine traditional surrogates across the whole group, all but one had used home insemination. And I thought it was quite interesting with this group because three of them has actually started on this gestation or an influence that switched to traditional surrogacy along the way.

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A little bit more data, over 30% of our surrogates in the postnatal group had birthed in the previous 15 months, so it was fairly recent. 75% had been in the last five years, but one of them had occurred as long ago as pre-2010.

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and quite a significant number of our surrogates had commenced more than one arrangement, so this was not their first surrogacy. Five had previously birthed a baby through surrogacy. All the arrangements had resulted in a live birth of the individuals who participated and 83% had finalised the parentage order, so the surrogacy was completely completed. This is the post-natal…

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again. Okay, so the important bit perhaps, what did we all find? Well the summary is very very simple, gestational and traditional surrogacy, not a lot to distinguish in terms of…

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what might be happening. But if I pull it apart a little bit more, traditional surrogates did not report more adverse mental health impacts from their surrogacy. They did not perceive that the surrogacy pregnancy was more similar to their pregnancies with their own kids. 75% of our surrogates recalled that relinquishing the baby had been a positive experience, but there was no difference between traditional gestational about whether it was positive or otherwise. So 75% overall felt that it was a positive thing.

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but traditional did not distinguish. Traditional surrogates were not more likely to report negative relationships with their IPs than the gestational surrogates, and they did not feel less supported by their IPs. Within our antenatal group, more than 80% reported that there had been no conflict to that point with their intending parents, but unfortunately for those who had completed their surrogacy, about 27% reported some conflict, and about 14% reported.

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reported major conflict during the arrangement, but in terms of who was reporting conflict, the difference could not be distinguished between traditional and gestational surrogates. Scores on the mother-infant bonding scale, which is where we were measuring the surrogate’s attachment towards the baby following the birth, did not differ between the traditional and gestational arrangement.

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so being traditional did not mean that you felt more attached to the baby after the birth. There were some differences that we found amongst the postnatal group, so for those who had already completed the surrogacy, on their scores with the maternal fetal attachment scale, so this is where they’re back remembering what the pregnancy was like but they have actually already birthed, and so with this one we found that the traditional surrogates who had completed their pregnancy did report greater attachment to the baby while they were pregnant but it only showed up on one of the

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subscales of the MFAS and the overall scale. So to unpack that a little bit more, when we look at the two subscales of the MFAS, which is the maternal fetal attachment scale, the first scale is something called attunement. And psychologists see that as something being like prenatal parental reflective function is what we call it. So that’s that sort of feeling really interested in

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what the baby is feeling, what their experience is, and imagining the future interactions with the baby. And so if you think about what that does for somebody who’s becoming a parent, we’re getting to know the baby, we’re starting to imagine who they are and what it’s going to be like to get to know them.

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what our relationship with our child is going to be like. The second scale interaction is the one where I’ve put some examples up there on the screen. And it’s a little bit more about behavioral components of that attachment to the baby during the pregnancy. So it’s a little bit more functional. It seems that the baby kicks and moves to tell me it’s time to eat.

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I poked the baby to get him to move back. I wonder if he’s feeling a little bit cramped. So much less about what the baby is feeling and experiencing and much more about the physical stuff. So it’s this scale where we saw the difference that surrogates were describing higher scores on that subscale. They were not tuning in at that emotional level to a greater degree, but in terms of that physical connection and behavioral connection.

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they did seem to be feeling something a little bit different, although certainly remembering that they had felt something different. Because again, this is only reported amongst the postnatal group. Overall scales on the MFAS were also a little bit elevated, but we actually think that is just a feature of the fact that interaction scale was elevated and pushed the numbers up overall. Really importantly, the increased interaction scale that I was just describing did not impact postnatal attachment.

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as measured by the maternal infant bonding scale, nor did it impact the relinquishment experience that the surrogates were describing. So that’s a lot of numbers. So sorry, summary, I gave that in one sentence at the beginning. Our results give no indication that traditional surrogacy is riskier than gestational surrogacy. Now there are a few other studies around that have been undertaken overseas that have started to look at the same sorts of questions. Happily, our findings really reinforce

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what they’ve said. So in the research that exists, and I do think our numbers are more substantial than the numbers that have been done in places like the UK, but it’s consistent that this finding anything in research which suggests that traditional surrogacy is more of a problem, it’s just not coming through in the data. Now we do know, and I’m a psychologist so I have to do this, we talk about study limitations, so sorry. Anna, you’ll love this because you love statistics. Limitations to our study, even though we actually had

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pretty big numbers overall. Because the sample size and the groups are different, there is still fairly low power. So we understand that the statistics are complicated by that. That’s a hard thing to overcome when there’s small numbers of surrogates in real life. And considering the numbers that there are, actually I think our recruitment was pretty amazing. And in real life, I think the estimate is that traditional surrogates are about 10% of matters overall.

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I think we ended up with about 13% of our cohort were traditional. So we actually had a fairly, probably better than real life representation there. I think that was going to be one of my questions that, yes, although the number of surrogates overall was significant, the proportion of traditional was lower. Yeah. Is that a factor? But if you’re saying that the proportion matches or was a touch better than what we understand, is the ratio in Australia anyway, that probably helps bring some validity to it. When you were looking at participant numbers, do you ever look at…

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50-50 or is it just we take who we can get? We take what we can get, which is my next comment that it’s self-selection for recruitment. But the other thing we did do was use some clever pants statistical analysis to try to, that’s the official title, clever pants. I like that. Yeah. To try to work through the fact that the numbers were not equal between the groups. There was a lot more gestational than traditional. For those of you playing along at home, we use something called the Mann-Whitney U-test.

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Please don’t ask me what it means because I really haven’t got the foggiest except it helps to even up those unequal sample sets. So I actually think we did pretty well in terms of getting an in real life comparison and then our stats analysis kind of helped to manage that and make sure that we weren’t getting some inflated results.

21:05
deflated results with the traditional surrogates. I guess one of the things I was talking about when I went through the participant data was that there was a very high proportion amongst the antenatal surrogates who were still fairly early in their pregnancy. And that might’ve been affecting some of their responses in terms of sense of attachment to the baby. Remember I said that feeling of attaching to some of those biological outcomes, we only saw that in the postnatal group. It could be

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actually just simply because the antenatal group hadn’t started having a lot of fetal movement yet. So that you can’t say, yes, I’m connecting to the baby like that if you’re actually not feeling it particularly much. That makes sense. There is likely to be some recall bias amongst our postnatal group as well, of course. We were asking them to rely on retrospective recall of feelings, and some of those were recalling from years before. So.

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there’s obviously going to be some problems there. Although it’s interesting when we started doing the interviews with our surrogates, because this was actually just the first phase of our study, the clarity of memory of our surrogates for what their experience was like, it was really pretty striking when we asked them what.

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for those who completed the pregnancy, what it was like. There was a very high degree of clarity, so I think the recall was probably pretty strong. We have undertaken as a clinic a pretty major project without any funding, so that’s tricky to not have funding or to not have the support of a university, but I am incredibly proud of the student workforce that we’ve been able to engage to help us. And I particularly want to acknowledge my lovely admin, Alana, anyone who’s ever rung the practice

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met Alana on the phone. Alana has done an absolutely stellar job of coordinating our student workforce and I’m very cross that she’s about to leave me and go do her PhD so this has been a good practice run for research for her. Right. Probably this is the final thing I’d like to say here is that I just want to make the observation that this study did not attempt to explore the experience of intending parents nor did it look at the experience of the children born through surrogacy. That was not our goal. We only ever intended to look at the experience of

23:12
there are implications of traditional surrogacy for the children who are born and for their parents because we have to look through a lens of surrogacy and egg donation or in some cases double donation. So it’s, while it wasn’t what we were looking at here, I’m not dismissing the significance of those implications of a donor relationship as well. I talked about Baby M at the beginning.

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For those of you who are wondering what happened, it’s a pretty long and complicated story, but in 1987, ultimately custody of baby M was awarded back to the Sterns and the surrogate’s parental rights were terminated. The following year, New Jersey, which is the state where all of this happened, prohibited surrogacy entirely and that actually that prohibition remained in place until 2018. So it was a long time before we saw any changes there. The Sterns still shun media attention.

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raised little baby M. They really decided to keep well out of the limelight. But about six years ago, baby M, whose name is Melissa, she’s now an adult, said, I’m very happy I ended up with them. I love them. They’re my best friends in the whole world and that’s all I have to say about it. I do think the last word is best given to the person. Yeah, yeah, nice to hear from her. Amazing the impact that that had in the state of New Jersey. First…

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for so long there, there’s so much fear around that. So yes, just a little thank you for the surrogates who rushed to help.

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and the 26 who then went on to undertake the interviews with us for Alana who I was just talking about for our wonderful students and I mentioned before big thanks to all of the people who committed to helping us with subject recruitment and cheered us on from the sidelines which includes you Anna so thank you very much. You’re welcome it’s a pleasure to be part of something so significant that hopefully will make some positive changes for IVF clinics and and breaking down those barriers but those myths. So

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unpack that a little bit more for us. So in terms of what are some of the interesting things that you have found that you personally take away from that? Yeah look I mean I think the core thing is just the the basic idea that really it’s a myth of surrogacy that’s been sitting and getting stronger and stronger over the years that traditional surrogacy is the problem when things break down but really the evidence says pretty clearly that that is not where the problem lies. When we look at some of the cases where things have gone

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really, really badly, including the ones that have made it to the courts, they have not featured traditional arrangements. There have been gestational arrangements. When you look at what our surrogates were saying, both in the surveys as well as in their interviews later, there was not a higher proportion of problems that were occurring during the traditional arrangements. It was, we had more gestational surrogates and there was more problems amongst that group. Now that probably is just a numbers thing, but it was…

26:01
traditional was not the predictor of things going a bit pear-shaped. So then if it’s not traditional, that’s the problem. Are there other things that are the problem and the stress points in surrogacy teams? Yeah, this is going to surprise you not even a little bit, Anna. What it really all comes down to is relationships and communication. We saw that when we played with a whole bunch more statistical analysis and we’re still unpacking it a little bit, but it really is pretty clear.

26:28
that when a surrogate has felt less satisfied with the surrogacy, when something has happened during it, she ends up also describing that she’s got less good quality relationships with her IPs. And she also describes poorer relationships with the baby postpartum. So that’s pretty tough going. When surrogates do perceive that they’ve had their emotional and their physical and their financial needs met.

26:52
appropriately, they will talk about the feeling that the relationship is a more successful, more positive one for them. And that perceived support is really relevant in terms of sense of conflict as well. So if we’re in there, we’re taking care of each other and we’re communicating, well, things are going to go better. This is not rocket science stuff. I just saw someone say communication is key.

27:14
And when we say the word relationship, does that necessarily relate to teams who knew each other beforehand and had a family-friend relationship connection or is that just sort of that Surroship team? As I said, we’re still, I am knee deep in stats analysis, unfortunately, but we looked at that actually pretty carefully. We looked at every factor we could think of in terms of was there something about whether it was same sex IPs or other sex IPs? Was it something about people who knew each other or didn’t know each other?

27:44
it, you know, all of those sorts of things. And we’re just not seeing that there’s anything there which is predictive at all. We even looked at the age of the surrogate because in our interviews, quite a few of our surrogates who were a little bit older were saying they were a bit shocked by how much physically tougher.

28:00
surrogacy was for them. Not a big surprise if your older pregnancy tends to be a bit harder, but that was not a predictor of things becoming a problem either. They certainly did feel that if it was a tougher pregnancy they needed a lot more emotional support, not necessarily physical support, which is interesting, but they did need more emotional support. And again, not a surprise if you’re having a tough time with your pregnancy, you actually want someone to pat you on the back and say, oh man, this is hard, we’re here for you. It’s that sort of stuff that seems to really make

28:30
practice model then either from your own experience, there’s lots of experience with your surrogacy teams or from this in terms of how to help get make sure that that relationship is as positive as possible and that communication is there.

28:43
What advice to give teams? Yeah, I’m probably going to sound like one of your presentations, Anna, because it really is get to know each other, take the time. You know, quite a few surrogates in our interviews really reinforced that. I think one surrogate worded it as, if you take the time to build the relationship, everything else flows from that. And you’re motivated to protect the relationship as well as to have a successful pregnancy experience. So, you know, it really is that.

29:10
key of if you’re thinking about this is an important relationship for me, we’re in this project together to create this child. Let’s all take care of each other and be interested in what we need to be doing to make this work. One thing that did come through a little bit was that of people, I use the word naivety.

29:30
if I can describe it that way. And that’s sort of a few times people, and this is coming a lot from the interviews that our surrogates gave, was the idea that they had to expect the unexpected and that quite a few of them might have gone into it with a little bit of rose-coloured glasses and really know it’s okay, we’ll be fine, got good intentions. I think most of us do that, actually. I would hope so, I would hope so. It is a core kind of principle.

29:56
within anything we do altruistic, it’s well intentioned. But I think what’s pretty clear is that’s not enough. And that’s where the communication comes in and the relationship comes in. It’s taking the time to really dig down into the devil of the detail.

30:12
And if you haven’t done that, if you haven’t really explored, not just, oh, if something goes a bit wrong, we’ll talk about it. No, actually, what are you going to do about it? And let’s look at some of the things that really could go wrong. Then you’re probably not well prepared enough to get through those tricky times. I’m always curious as to, like, because some people might say, well, how long, how long should we take together? Which is tricky. As you’re saying, though, it’s a.

30:38
very intimate relationship that you’re doing together. And one of the other parallels I sometimes give is if you’re with your life partner and in a standard hetero couple there and you’re planning a child, it’s usually not something you rush into unless it was an accident. And so think about how soon would you want to get pregnant with your traditional partner? Therefore, surrogacy should be no different. You’re creating a life here and you should take the time to…

31:00
drill down. Yeah, I don’t know if there is a prescribed amount of time or if it’s more about when you’ve got to see each other without the rose-coloured glasses on and done something tough together in some ways. That’s exactly what I was going to say. I think it’s about getting through something tough together and I think that’s really important because sometimes groups feel a little bit discouraged, don’t they, when they’ve had a problem emerge or they’ve had a conflict emerge. Actually, I don’t think that’s a problem because…

31:25
If you’ve had a problem and then you’ve repaired and you’ve worked your way through it, you’ve actually proven that you can. Yes. And that’s the test of a relationship. It’s not that it’s all going well and everything’s fine. It’s that when it happens, how do we figure it out together? Yes.

31:42
And that’s probably the important bit. Yeah. It’s not that we’re going to go out of our way to set up difficulties or complexities, but it’s taking that time to coast some of the hard times and to maybe feel let down by each other and then say, I am not okay, how are we going to fix this and get okay? And that might take a little while.

32:02
Yeah. In my SASS portal of resources, there’s a list of team building exercises we came up with, things like building IKEA furniture together or moving house or going to the other person’s house and cooking dinner and cleaning up and seeing if they do it the way you like them to or not. And then how do you let them know if you want things done in a particular way or folding your washing? So there’s sort of some low level conflicts, but it’s about having that conversation when you didn’t do it the way I liked. Can we talk about this?

32:30
Yeah, it’s a hard thing to manifest and pretend to do. It’s until you’ve actually had a bump in some ways. But yeah, as you say, though, then that shows that you’ve gotten through that. And what is your team dynamic then for how you’re going to handle future conflicts?

32:45
Absolutely. In your findings then of the people that did have significant struggles, did anybody regret having done surrogacy? Actually it was really interesting that at least within the interviews there was just nobody described a regret for the surrogacy. There was no one who said they wished they hadn’t done it because even for the surrogates where the relationship had completely disintegrated there was no longer a relationship, there was no longer contact between themselves and their IPs or themselves and the baby and there were a few.

33:13
that we interviewed who it was catastrophic relationship breakdown. Their view was, I still did this, I still helped these people become parents. If I hadn’t done it, this little baby wouldn’t exist and that would be a terrible sadness. So it’s worth it because the child exists and I know that they love. So no matter what had happened between the group within the surrogacy, it’s still, and there may have been a great deal of grief about what had happened, there was still not grief for the surrogacy per se.

33:42
The baby’s the reward, I suppose. Preferably to be in their life, but what a point to get to as a surrogate to go, I still did a good thing. Yeah, I was really struck. I mean, I’ve talked to a lot of surrogates over the years, but I was really struck by this incredible generosity of nature of the women that were being interviewed. And some of them had had a really tough time. As I just said, there was some really, really sad relationship breakdowns, but that…

34:10
Capacity to step back from that and say, deserving people became parents, a baby exists because of what I did, and that makes it worthwhile. I’m gonna let that make it worthwhile. I think that that is an incredibly generous stance. Yeah, powerful stuff. With your findings then, my initial thought of the positive impact this might have is influencing IVF clinics. Those that have been reluctant to say, we don’t do traditional surrogacy, it’s against the law. Okay, no, it’s not against the law. We just, our clinic doesn’t want to do it.

34:40
because it’s riskier. I would like to think that now we can wave your research in front of them, so to speak, and go, boo, it’s not, I would like to do that too.

34:50
I feel very frustrated when I hear people being told that traditional surrogacy is prohibited or dangerous or whatever, because it’s the evidence just isn’t there. Actually it’s not that I have particularly an issue with home insemination. I know there’s lots of reasons people do that, but if they’re only doing it because a clinic will not support them and that’s pushing them away from potential support systems or making them feel like they’re doing something which is a bit wrong, that is a real problem. And what we saw actually with

35:18
when we asked people why they undertook a traditional surrogacy, and this is from the interviews that we did, it was really convenient. All of our IPs of our traditional surrogates that we interviewed were all same-sex dads, and I do know that traditional surrogacy isn’t only the case with same-sex dads, but that was certainly the case with who we talked to. A number of them switched.

35:42
from gestational to traditional. I loved the quote by one of my beautiful surrogates that we interviewed. And she said her justification for traditional surrogacy was if I get her words right, I don’t have them right in front of me, but they’re burned in my brain because they’re funny. She said, it felt more efficient and I’m all about efficiency. That’s surrogates for you. They’re busy women, busy lives. And I just thought, yeah, okay, fair point. Don’t have to manage a clinic then. That’s right, yeah.

36:11
Ah, good on him. Yes, so that would be one of the changes that we’d like to see. Any other progress that you’d like to see your research move forward? Yeah, I think it probably it’s battling some of the other myths as well. I think I’m often struck by media responses to surrogacy in a sense that surrogates are being taken advantage of or they don’t have agency. That did not come through at all in our interviews, just as an aside. These surrogates…

36:37
were very much meeting and eating themselves, to be helpers, to take care of people. Quite a number of them had a real pay it forward mentality. There had been a significant number of the surrogates that we interviewed had actually had some help to have their own kids, either a donor or…

36:54
whatever else, or they knew people. It was very much someone took care of me and I want to take care of somebody else. So very much a pay it forward, very, very clear in their purpose, which was to help people become parents. Some of them specifically wanted to be pregnant again. They just didn’t want another baby. It came through that there wasn’t any regret. They were very much comfortable in their decision. And this was something which they had chosen to do and they felt very powerful with it. A lot of them were describing a sense of

37:22
extraordinary pride for what they’d managed to do, which was really beautiful to hear that, including for some where there had not been such positive experiences. So I’d really like to get rid of that myth that Sarah gets a poor, helpless, meek little creatures being taken care of, because I haven’t seen a lot of evidence of that. Yeah, powerful women who set a goal and achieve it.

37:44
And probably the other big thing that, you know, it came through quite a lot within the interviews that it was really interesting. We saw a bit of a split between some surrogates felt really kind of annoyed by the process. They felt that it was expensive to their IPs. It was slowing things down, a bit of an irritation more than anything else. And then a whole bunch of our surrogates said, we should have had more counselling. We didn’t get into the detail. We didn’t, you know, we weren’t prepared enough. And they were certainly the ones who said we probably went a bit.

38:13
bit naively. I guess I’d love to see that we can influence that and shift that a little bit, not because I’m particularly trying to make more work for myself, because the counselling room is a place where we can have the uncomfortable conversations because you’ve got someone like me taking you there and…

38:31
making you get down into the devil of the detail. And that third party to hear it from both sides and help the other side see it from the other person’s side without it looking like an attack. Yeah. So is that, we obviously have to do the mandatory counselling before getting pregnant. I’m assuming you, it’d be nice to see teams have ongoing counselling during pregnancy and post-birth. Yeah, absolutely. I’m always a bit confused by the states. I mean, when I’m queen of the world, I’m going to change the legislation to make it all make sense. So, you know, we’ll get that done first.

38:59
But I’m confused by the legislation or the states where there is no post-birth surrogacy because that opportunity to kind of have a bit of a debrief and unpack it and look at what happened, it’s really sad if that’s not there. I think anytime we have a really mandatory process…

39:15
people feel like they’ve just, you know, got to sit up nicely for the headmistress so they don’t get into trouble. And hopefully by now you figured out that I’m anything but a grumpy headmistress. So- The naughty girl in the back corner yourself. I am, I’m the kid in the back row of the bus actually. That’s not the agenda. My agenda is to help you ask hard questions and talk about difficult things. I think the problem is that we can do that to a point before we start the surrogacy. But-

39:43
When we think about the fact that surrogacy is probably a two-year-long project for a lot of people and we’re so busy just trying to get a pregnancy on board at that point, to try to honestly think about what that’s going to be like in a year and a half and 35 weeks gestation and now what are we going to do in terms of postpartum care. Most of these surrogacies happened during COVID and that was something that came up over and over again of expect the unexpected and hopefully we don’t have any more pandemics to deal with but

40:12
Not knowing what’s around the corner means we can’t fully complete that process before we’ve gotten started. So to engage with a counselling process which is going to be supported in that way along the way and particularly if you don’t do it at any other point think about it.

40:29
before the birth so you can write, this is, we’re now here, the baby is coming, how are we gonna get through this in good shape? How are we gonna support each other after the baby’s been born? And the IPs are suddenly busy and we don’t want the surrogate to feel like she’s been dropped like a hot potato because they also, the surrogates also told us that relinquishment’s not the problem, that’s actually the reward. Handing the baby over that moment, yes, that’s the bit we’re all waiting for. And then it’s a bit of a, now what? And me, it was almost the relinquishment of my friends.

40:58
and losing the friendship, the intensity that we had. I missed them, I didn’t miss the baby. And it was adjusting to what life looks like as a team now.

41:07
that we’re getting back on with our lives and they’re being parents and adjusting to the new normal. Absolutely. And that’s, I would suggest that’s almost impossible to imagine before you’ve even had an embryo transfer. So to give permission for that, to not see it as an inquisition or an intrusion, but to see counselling as a supportive process that keeps you safe along the way. Yeah, I’d love to see us get to that point.

41:30
Hmm, I think that’s nearly a perfect way to sum it up in some ways. Is there anything else that you’d like to add then, Narelle, about your findings or just surrogacy in general? I know that for anyone who works in this industry, there is nothing that I just said which is surprising to you.

41:43
Like I know that there is not a single finding that is a shock to you or to the other counsellors who work here. And it’s not even going to be a shock to the experienced surrogates. If for anyone coming through, you can be thinking about this and using it and you can stand on the shoulders of all these wonderful women who came flooding in to say, this is how to get it right. And it’s got nothing to do with traditional. It’s all about relationships. It’s all about communications. Then it’s going to save you a lot of time and a lot of pain.

42:11
I like that. This is how to get it right. These women batting down your door to say relationships and communication is the underlying thing. Doesn’t matter if we’re traditional or gestational. These are the key elements to a successful team. Yeah. It was as though I suppose in some ways you had to do this research to have credence for some of the other people to say, we’ve got the evidence now. We’ve done it. Yeah. Prove what we already know. Prove what we already know. Yes. It’s the next research project in plan now.

42:36
when you’ve had a break after this one? I might have a bex and a lie down first. A bex and a lie down, yes. Yeah, I’m sure there’s ideas simmering away for the next things to unfold. Longitudinal I reckon, that’s what we need to do. Oh yeah, track throughout. Thank you for listening to this episode. To see the slideshow mentioned, head to our YouTube channel to watch the webinar recording there.

43:00
If you’re looking for more support and potentially connecting with a surrogate or intended parents, head to our website, surrogacyaustralia.org, to check out the resources and to learn more about SASS. Please subscribe to this podcast if you found it valuable and share it with someone so they too can benefit from this conversation. Until next time, welcome to the village.