Episode 121 – Surrogacy for Midwives

00:14
Welcome to Surrogacy Australia’s podcast series. I’m your host Anna McKay. Thank you for sharing your time to listen to this episode. These recordings are from the regular one-hour free webinars that I run, which I invite you to attend if you haven’t already. They take you through how surrogacy works in Australia, including how to find a surrogate or intended parents. There are opportunities to ask questions and you hear from a co-host each time about their own journey.

00:41
This episode recorded in September 2025 is slightly different to our standard webinar series as it involved three sets of co-hosts, Julie, Rachel and Ashley who are midwives who have supported surrogacy teams. One of the co-hosts, Julie, has also joined me on a webinar where she talked about her own two surrogacy journeys. You can find that on episode 92. This webinar recording can also be watched on our YouTube channel.

01:08
The questions we discuss you can find in the show notes for this episode. My secret dream when I coordinated these guests is so that this recording could be of use to future surrogacy teams and their midwives. If you are a midwife listening to this episode and it is of help to you, please send me a message and let me know. I hope you enjoy this episode.

01:28
So let me tell you a little bit about each of our co-hosts. What I’m going to do is we’re going to go to some photos that each of them have shared with me about their surrogacy journeys that they’ve either had as surrogates or been involved in. And I’ll tell you a little bit about each of them. We are going to start with Julie. Julie, who’s based in Sydney, has been a midwife for 23 years. She is a clinical midwifery specialist and is currently working in a midwifery group practice model of care at her local public hospital. She is a mother to one daughter and has birthed as a surrogate in 2019 and…

01:57
2024 for two different sets of IPs. Julie has also had the pleasure of being involved with three different surrogacy journeys and was 35 weeks pregnant herself when she delivered one of these surrogates. So welcome Julie, back as a co-host again on the webinar. Thank you for being here. Thanks for having me. Anything you’d like to tell us about each of these photos that I’ve had a little scan through there? Well, you summarized it well. I have had two journeys as a surrogate. So that first photo in the blue dress was when I birthed my first.

02:27
Sorrowbub back in 2019 and then the second photo is actually my second journey which was last year. Actually she’s, that baby turned one last week so just recently had a bit of a celebration for her birthday and that’s with.

02:42
the big sister and the IPs and my daughter. These are the photos from the most recent journey last year, back from August last year. Yeah, I’ve been a midwife for years, decided didn’t want to have a baby myself, but wanted to experience pregnancy and birth again. So thought best way to do that was to be a surrogate. Did it once when I was 44 and thought that was tick the box and told everyone I was way too old to do it again. And then five years or six years later, it again. Five years later, did it again. So yes. uh

03:12
It’s a crazy ladies. Everyone told me I was crazy and yes, I sit back and look at these photos and think yeah, I was a little bit crazy but. Beautiful and I’m sure we’ll come back and talk about it. But in these photos, we’re looking at some of the handover moments, which is a very important part of surrogacy. And then some photos that you did with the IPs post birth when there was a little newborn and they included you in those photos, which is part of the photo earlier was the professional photos from the photographer. So the IPs actually put a package that was pregnancy photos.

03:42
and then also some newborn photos. So I think she was about two weeks old then. yeah, they asked me to come, those photos were taken at their house. So they asked me to come over and it was lovely to be involved actually in those photos. Lovely. Well, thank you for being here tonight. No worries. Then we have Rachel. Rachel works in a hospital in South Brisbane.

04:02
as a private midwife and a diabetes educator. Rachel is married with three daughters of her own and has also carried five more children as a surrogate from 2010 to 2018 for three different sets of IPs and was Queensland’s first legal altruistic surrogate. She has also lived experience with IVF and she has been an egg donor multiple times. Welcome Rachel. Thank you.

04:26
But to briefly summarize, there’s many years of working with the infertility community. And here are my twins that I had through surrogacy for two dads in Brisbane. They’re also actually biologically my egg. Being two men, they obviously didn’t have the eggs to go with it. I have to say it’s been an incredible journey. The twins are turning 14 this year. When I went into surrogacy, I never really expected to be heavily involved with their lives. But having them live so close has been an extra blessing that I never even thought that I’d need.

04:56
um helping other families as well that are not so close. I’ve got a set of intended parents that are in South Australia that I carried. This is them here, two babies for one of them being Hugo, who sadly was only with us for four days of life. And this was his pregnancy that was incredibly complicated. m You know, he’s taught me a lot about life and honestly, being a surrogate has just given me so many blessings that I never imagined when I decided to do it for the first time.

05:25
Yes, some beautiful journeys and as you say, sort of the family in South Australia that you’re connected with too now and then carried again for them. So, yeah.

05:34
Some amazing things. So thank you for being here. Thank you. And then Ashley is a privately practicing midwife who offers home births, has admitting rights at Westmead Hospital and has a special interest in breach and VBAP births. Ashley and her husband live with their three young children in the Blue Mountains. She has supported a surrogacy team this year, 2025, so has recent experience understanding the dynamics that come with that. Ashley, we’ve got some lovely photos here, hands on during birth and labor.

05:59
Yeah, so I’ve had an experience of looking after surrogacies previously to this year just through segmented care sort of thing through the hospital system. I recently had my first experience of a surrogate through private practice, so continuity of care throughout the pregnancy, birth and postpartum journey. And some beautiful photos here, so the surrogate carried for two dads and so everybody’s in the room where it happened. Yeah, it was really cool.

06:21
And then, and yes, including you in the photos too. And then obviously then this last photo here of um some catch-ups, you say, that continuity. So that’s some of that post-birth care that happened. Lovely. Well, thank you for sharing those photos with us ladies. gives everybody a bit of a context as to. um

06:37
who you are and the work that you do and also your own private journey. that’s wonderful. Thank you for that. And for those that are listening to this as a podcast, I’ll just, that’s probably a good opportunity to do a plug that you can also find these episodes on our YouTube channel. And if you’re listening to this in another place, you can find this uh on Spotify and Apple and it’s called Surrogacy Australia Conversations. It’s over a hundred episodes now. So check that out and subscribe. Many other episodes, some of them themed like this and others where there’s been individual co-hosts. Okay, ladies, well, we’ll launch into the

07:07
I guess as we said to people, we put them in the chat. I guess in my mind when I was planning out this webinar, I sort of see parts of this journey segmented into some different stages of the pregnancy, birth and post-birth. So imagine there’d be this time where you either get allocated a surrogacy team or they come to you in private practice. And so then you initially have your first appointments with them and then you go from there. So Julie, do you wanna launch us off and tell us a little bit about, so like the first question for example.

07:34
could be when assigned a surrogacy team, what are your initial thoughts or concerns? So I was a surrogate first before I actually looked after a surrogate team, which probably drew that surrogate to ask for me to be her midwife. She had had six of her own babies and then was having a baby for her family member. And she knew that I worked at the hospital and had been a surrogate. So I think that really resonated with her. And that’s why she reached out and asked if I would be her midwife. Being a midwife.

08:03
I had the privilege of birthing where I work and also birthing in the modeler care that I work in, which is a midwifery group practice. in essence, I actually asked the midwife.

08:15
who was also a friend if she would look after me. she, her and I had a long established relationship prior to my own surrogacy pregnancy. I had that experience on board when I was then a midwife to a lady who was a surrogate. So I could, I guess, draw on some of my own experiences as a surrogate when I was looking after this lady as a surrogate. I mean, first and foremost, it was an absolute privilege to be involved in that pregnancy as Ashley.

08:45
said earlier, I think the important thing to realise is that the focus has to be on that birthing woman. So the woman that is pregnant, although not the parent of the baby, is the one that is carrying that baby and is the one that needs the nurturing and the love from the midwifery side of things whilst going through that pregnancy. with her pregnancy, she’s actually had two pregnancies, both where I’ve had the privilege of being her midwife. But one of those pregnancies was a local journey, the other one, her IPs were interesting.

09:15
So in the local journey, the IPs, the intended mother and a couple of times the intended dad came to the appointment. So they were there with her, which was really lovely. And then in the other…

09:27
journey being interstate, had, it was the surrogate on her own. So I guess it didn’t really change a lot because your focus is on that pregnant woman. That’s your focus because that’s who you’re providing care for, surrogacy complexities. Yes. So as you said, in that second time, it was an interstate or a long distance team. So the parents were not present at many or any of the appointments. A couple, yes. So there’s other ways of including them. Ashley, the team that you supported for the longer time, the two dad team, they were local to each other.

09:57
So did that mean that they were able to be present at more of the appointments? Yeah, I had everyone together for the vast majority of the appointments, but then also, you know, in pregnancy, the antenatal schedule of appointments is driven very much as well towards medically checking things that are all right. So obviously in that you’re checking a woman’s blood pressure and all of those sorts of things. So that’s very much the focus. And there was lots of sessions that were both together and then separately to kind of do all of the preparation and planning on who’s going to be involved in what part, like how

10:27
How are we going to do this handover process? How are we going to make decision making processes? Because it’s a different decision making process when you’re separating the birthing mother out from being the parent. then you have to get into decision, like not that you’re anticipating anything medically going that catastrophically wrong, but how do we make priorities? Who’s responsible for making decisions in these situations? yeah. Rachel can you…

10:52
you’re nodding along. Yes, I was just sort of thinking, you know, keeping in mind that every sort of surrogacy arrangement is going to be a little bit different. So it’s mostly just as Ashley was saying about having those conversations with people about what are you expecting from either party and how can we plan to make this sort of work for all of them that’s involved. Yeah, good point in terms of what their vision might be for BIRT. uh

11:18
Yeah, and the pregnancy and not everybody needs uh a huge level of education. Some intended parents are having second children, that’s not always their first child. So it’s mostly just about going into it and having open conversations and being open to what everyone’s needs are.

11:36
I’m probably aware that some people listening to this as a resource in the future may or may not be aware of how the surrogacy process works in Australia. What I might just briefly say is that the vast majority of teams engage with an IVF clinic and that’s usually how the surrogate gets pregnant through an embryo transfer. But prior to that, there’s counseling and legals that get done. So there’s two lawyers involved that draw up a legal agreement and then there’s counseling so that the surrogate and her partner, if she has one, have a session, the IPs have a session and then a long session as a team, sometimes extra sessions.

12:06
necessary. So as a midwife you’re probably aware that there’s been that counselling process involved to check if everybody’s ready for this journey. I suppose also that’s is that something to be aware of to to remind teams that there are those professional counsellors available should they hit road bumps at any point in their journey. I also imagine though that as midwives you often could be the first port of call for some of the little

12:29
bumps that might happen in a team and trying to help smooth them out. I can think back to my surrogacy team and particularly when we’re heading towards birth and my thoughts had changed on.

12:39
expressing and direct, expressing milk and direct feeding. my midwife helped to advocate for my thoughts on that. Can any of you think of an example where you almost became the counsellors? Rachel, can you think of one? I actually haven’t been involved with too many surrogacy teams. As someone who works particularly in just one area, I don’t tend to work in continuity of care models. I think as midwives in general, we are always the first one to call for counsellors because one, psychologists are not easily readily available. And two,

13:09
build such a trusting relationship with your women over time that they tend to rely on you heavenly. As a point of call, yes, sometimes we are there to be the advocate for the women. It can be tricky if sometimes intended parents decide that they need the advocating because really, ideally, as Ashley’s already said, you you’re going into it with caring for the woman. It’s being with the woman. That’s why we call midwifery is. So I guess it could get a little bit tricky and thankfully not a situation I’ve been involved with.

13:39
professionally. yeah. Ashley, did you want to add anything to that? Oh, think Rachel’s pretty much covered there. And I think sometimes it’s important to remember that as the midwife that is caring for a surrogate um who comes with intended parents that our role is their midwife. We’re not there as a counselor. We’re not there as the psychologist. So it’s important to make sure and we all know that they’ve had that counseling beforehand. So I think if we’re starting to see some issues

14:09
or some red flags, we certainly can help navigate some of those conversations in regards to facilitating discussions in regards to if I have to have a caesarian, who might be there at the birth. But if it’s proving that there is some, you know, perhaps some breakdowns in the communication with the team, it’s important that we remind ourselves that we’re not there as their counselor, we’re not there as their psychologist, and it might be timely to refer them back to those counselors that

14:39
are sort of experts in that field. Spot on, think that’s exactly what I was getting at, reminding them that there are the experts in that field. Sorry Rachel, did I cut you off for something there? I was just going to say I do work closely with a private obstetrician that’s dealt with the surrogacy arrangement that has fallen apart along the way and she has had to put firm boundaries into place to say she’s there for the woman and any conflict really needs to be escalated to you know the services that were pre-existing.

15:07
I think those conversations need to take place early in that so that as the caregiver, you don’t become the person that’s caught in the middle. 100%. Good point, because as much as possible, you want that to be a smooth journey for you and the team that you’re working with. You also don’t want to be seen to be taking sides. You don’t want to have…

15:26
the surrogate with one opinion and the intended parents with another opinion, they need to be able to mediate that together and work that out and perhaps they might need some professional help with a counselor to get through that rather than sort of expecting the obstetrician or the midwife to do that for them. Yes, that’s a good reminder there to remind them of that psychologist that they saw in those early stages or one of the others, that there are specialist psychologists who pretty much just…

15:51
just do surrogacy now and they are across Australia and they do Zoom sessions. So that’s a great resource to have. In some ways that some of the emotional challenges that teams can face during pregnancy or at any point in the journey, are there physical challenges that can be met as a team? For example, I’m thinking that I imagine navigating a journey with a surrogacy team could be much more time consuming in terms of either maybe some extra appointments or sometimes those appointments go for longer because you’re having to dish out the information in two ways. Is that any of the physical

16:21
or time sort of challenges that spring to mind. Ashley, did you have noticed that? look, uh as a private midwife, as a home birth midwife, my appointments naturally are far, far longer than what is allocated in the hospital system or anything like that, like 60 to 90 minutes per appointment. And in some ways that’s why it’s a good model of care in this sort of thing is because you actually have the time to allocate to people directly. You know, don’t have to go in and explain the surrogacy or anything like that, every single appointment, you’re not dealing with any of that stuff. But in terms

16:51
of physical things as well like

16:53
Quite frequently, obviously, Rachel said before, turn, parents aren’t always first time parents. In my recent case, though, that was, and my surrogate mum was carrying her fourth child, like her fourth pregnancy. And I mean, I see it all the time in all of my case, though, the difference between someone carrying, having their baby for the first time and someone who’s, you know, having their fourth birth is completely, completely different. So you can see that clash between perspectives in that as well. oh You know, first time parents, haven’t done

17:23
it before and you can’t expect them to have had the learnings and the experiences that come with that journey when they haven’t done it before. Most surrogates have had a baby before, not always, but as a general rule.

17:35
So the intended parents might be first time parents, but the surrogate tends to have, know, so pregnancy sort of, you know, is something that she’s experienced before, but you might have some intended parents that perhaps have had their own infertility, you know, concerns and, you know, spent many years trying to fall pregnant. They’ve turned to surrogacy. The surrogate’s pregnant with their first baby. So there’s a whole range of, you know, anxieties and complexities around that too. So, you know, you need to sort of take that into consideration too.

18:03
One of my colleagues also had a surrogate not that long ago and the surrogate mom was very much wanting to have a home birth. Obviously I’m a home birth midwife, fully on board with that. Sometimes those birthing preferences, it may not be something that the intended parents are necessarily familiar with in that environment, the birth location or even birth choices and how they might influence things.

18:26
And I think for some first time parents as well, they have put so much effort and time and mental load into actually just uh getting pregnant. They usually, when they finally do get pregnant, they come to those appointments with a whole list of questions. So uh absolutely being able to take time with them, which isn’t always available in potentially a private obstetric practice or even a hospital setting is always helpful just to set aside more time if you are planning on caring for a surrogacy arrangement.

18:55
Yeah, I was going to ask, is there any way to overcome that? Or is it you almost have to advocate at your own administration level? 100%. That would have to be the case. Working as a midwifery group practice midwife within the hospital setting, I organise my own appointments. So I would always allocate longer. As Ashley said, you know, it’s not unusual to do an appointment that takes 60 to 90 minutes. And that’s kind of what you need when you’re doing all the surrogate. So I’d be mindful of that and book that time out. But I also have

19:25
the flexibility of booking my own appointment schedule so you can do that. Whereas if the surrogate was coming through the normal midwives clinic that we have at the hospital, they’re half an hour appointments and you’re watching the clock and sort of trying to wrap things up very quickly within that half an hour because you’ve got a waiting room of people waiting for you. And you’ve still got to do a blood pressure and do an ablipalp and…

19:47
you know, do all that normal stuff as well that takes a lot of time. So yes, it can be tricky to manage time if you’re in a mainstream setting. Yes. I think this is really fascinating. So we’ve got Ashley, who’s, you know, private practice all the way and to home birthing. For the record, I home birthed my surrogate baby. Julia sort of midway in a hospital, but the midwifery uh group practice model. And then Rachel Moore in the hospital, sort of that clinical setting. So um yes, was there anything else to add then in terms of if we’ve got?

20:14
midwives or healthcare providers listening and they’re in that hospital setting, is there any flexibility within policies in terms of advocating for extra time or if it’s a case by the analysis? Oh, you know, it’s all that would all come down to collaboration with the team that you’re working with and just hoping that you are working with a good team that’s happy to pick up a little bit of load if your appointments do tend to go over, you know, it sort of depends on the setting that you work in.

20:38
I work in a tertiary center, so it’s very much a little hamster wheel that keeps turning, whether you’re running behind or not, whereas other hospital settings or maternity settings might not be quite as good at picking up the slack. yeah, it really sort of depends on something to consider potentially for intended parents and surrogates when they’re going in to choosing the type of maternity care that they want to use. That something like an MTP practice or a private midwife is an excellent option, essentially just so that you do have the time to spend

21:08
with your maternity care providers to go through not necessarily everything that the surrogate needs, but everything also that the intended parent needs from those. Rachel, in the most recent surrogacy that you carried yourself, were you part of one of those models? um I had a very complicated pregnancy with Hugo and ended up being case managed by the maternal fetal medicine unit.

21:32
more of a continuity model, but still in the hospital setting. My next pregnancy was also managed by them just because we did have extra invasive testing and they wanted to sort of see through the next pregnancy, which was thankfully a healthy, beautiful little girl. Not quite the same because I didn’t get much postnatal care and there was no labor support, but for the appointments I did have the same midwife and had very frequent ultrasounds and like that.

21:57
Well, I guess we progress through pregnancy and heading towards birth and often for surrogates, it’s sort of that handover moment can be that big payment moment for that altruistic surrogacy handing over the baby to see the family that you’ve created and the joy on the parents faces and that’s sort of what it’s about. So being aware of that moment, but obviously that’s one part of it. So as we start to plan for birth, logistically, a surrogacy team can take a lot of coordination at birth. Sometimes I often talk about if people are brand new and don’t

22:26
quite know how it might work. The surrogate might have one room in the hospital and the IPs might have a room in the hospital as well. So they’re a doorway apart. Yeah, what are some of the logistical things to plan for around birth in terms of the hospital? But I guess as we start to talk about birth, we could start talking about any aspect of birth that requires planning. So Julie, have you got something that springs to mind? I think to me, I entered surrogacy knowing what my non-negotiables were, which was…

22:52
where I birth and which model of care I birthed in. And I knew that if I had intended parents that perhaps weren’t comfortable with that, maybe they weren’t the intended parents for me. And so those discussions take place, you know, very early on. Once you sort of navigate that and we started the counselling with my first surrogacy journey, I completely underestimated the importance of that handover process. I think as a midwife, you know, the baby is birthed and you as the midwife, you hand that baby to its mother.

23:22
and that baby is on mom’s chest, simple. But in a surrogacy, how does that look? Who gets the baby? Who does the midwife hand the baby to? Who hands the baby to the parents? And I sort of hadn’t really given that much thought until I had counseling in our pre-pregnancy counseling. And it was sort of mentioned that that’s a really important part.

23:44
for the surrogate, you know? That’s the ultimate end of it, that handover, that real altruistic gift is that handing over. You’ve created those parents, you’ve created that mom, that dad, so that handover is really important. So I think for me, I guess I didn’t really appreciate that until I had.

24:03
you know, discussions with counselors myself. And so that became a real, a really big focus for me, particularly in my first surrogacy pregnancy. My first birth was a caesarian, so I was really keen for a VBAC. So, you know, all of a sudden I was thinking, well, what if I end up in theatre? What if I end up having a caesarian? What, who hands the baby over then? Who is in the caesarian? So all of these things had to take place during the pregnancy, just in case I ended up in theatre. And my intended parents were great. We’ve had lots of discussions.

24:33
and navigated all of that. So we had a plan in place. I didn’t end up in theatre. I did have a vaginal birth, which was great. That little girl’s just turned six and I can still remember the look on the parents’ faces as I handed that baby over to them because that was such an important part for me. And again, with my second surrogacy, right from the beginning, I said, you know, it’s really important to me. You what if this baby becomes unwell when it’s born and needs to go straight to the nursery and needs, you know, care and treatment in the nursery? What then? You know, like, you, do you intended parents just run off

25:03
to the baby and leave me in the birthing unit, then you know, do you see the baby? Do you get to cuddle the baby and do all of that without me? Don’t know if I’m happy with that. So those really difficult discussions had to take place because I made it very clear even before I was pregnant how important that handover part was for me. And I think I’ve shown you the photos, Anna, in the second surrogacy. There’s three photos in a row with the expressions on everyone’s faces and how lovely that was at that handover point.

25:31
Definitely. Those conversations were such an important part of the continuity of care, even to the point of going, my surrogate had had previous normal vaginal births. I wasn’t anticipating anything getting particularly medically complicated, but what if my surrogate mom was in ICU and was unconscious? What happens with the baby? How do we feed the baby? What are the plans? Like all of those sorts of things, because you’re still sort of between the two worlds there. really like coming back to that moment of actually the surrogate mom needs to hand the baby.

26:01
over to the parents and that needs to be at a really acknowledged point in this. It makes it a lot easier if you’ve had those discussions beforehand because you’re not anticipating that to be a problem but all of a sudden if it is and you haven’t had those discussions. That’s first planning isn’t it like that’s talking through and mapping out all of the different possibilities of things that can happen no matter how unlikely we think that they could happen like being sort of thing you know. I think I think that’s really important word that you use in terms of mapping things out you know it is really

26:31
important because birth like plans, yes, you have this beautiful moment as a surrogate. That’s the first thing I was thinking about when I became a surrogate was that moment that I handed the baby to its parent. So I think it’s really important definitely to map it out. If not, this is not the way it’s going to happen. Then what are your other options and how can we help to best facilitate that as your maternity care provider to make sure that everybody has that moment? Because I think that is pretty

27:01
much the number one thing a surrogate is looking forward to. And I’m not a surrogate at that point. know, if you, I mean, in my second surrogacy, I had a very unexpected and rather large postpartum hemorrhage. So what if I couldn’t advocate for myself at that point? So I’d had the conversation. So I was quite, you know, satisfied in the fact that my midwife would advocate for me if I got to a point where I couldn’t do that at that point.

27:28
though, because I knew she was on board. knew she knew what my thoughts were. Rachel, was there anything to add? Because I know quite a few, if not all of your surrogate births have been caesareans. um

27:38
Yeah, so unexpectedly I had all caesareans for my surrogate births and had all normal vaginal births for my own births. So it was a very big contrast to what I was expecting when I went into surrogacy. I always planned that VBAC, unfortunately never happened for various reasons. ah The twins, I had a placental abruption for at 27 weeks. So that was the proper emergency straight to hospital that were born at

28:03
You know, weighing less than a kilo each was definitely not the type of birth I was expecting. I don’t know who held them first, but I do remember.

28:12
their dad, pulling his eyes out as soon as they were born, finding out that they had two sons. So there’s still those amazing moments that I definitely had, but it certainly wasn’t what I was expecting. Luckily, the NICU nurses were incredible and you know, they definitely helped with some memory creation and that sort of stuff because I was recovering from a caesarean after a placental abruption, which is quite a significant event. So they were really helpful in helping me sort of recreate what those moments were like when they did meet the boys for the first time, which was

28:42
fantastic. And then when Hugo was born, I didn’t hold him until the day he passed away. So, you know, there’s so many variances, which is why I think it’s really important to map these potential heaven forbid they never happen. But there always needs to be contingencies in place. And if you can’t have this beautiful moment that you were planning from the get go of getting pregnant, then how can we make something just as

29:08
Definitely. Yes, mapping it out as a team there and all of those scenarios. As you said, Rachel, even the nurses there that haven’t perhaps been part of the whole journey can still play their role in building awareness and supporting teams there. Right. So I’m just looking at my questions there so that we’ve talked about some of the logistics to plan for that.

29:27
handover moment and then those emotional and physical challenges for the team around the time of birth. Is there anything else anybody would like to add in? Well, I suppose it sort of then leads into almost the first few days post-birth now, isn’t it? That is, there’s milk to consider for a surrogate coming in or not or stopping milk and feeding and then there’ll be hormone crashes potentially, you know, for a surrogate, baby blues that kick in. So yeah, anything to add there. Julie, did you want to kick us off again? To be mindful for the team in those first few

29:57
days post birth now. Yeah, I think the important thing to remember is that um the surrogate’s um heart knows that that baby is not theirs, um that they birthed that baby for its parents, but unfortunately her body doesn’t realize that and her brain and her hormones don’t realize that. And so her body goes through all of those normal postpartum changes in that first few hours versus weeks versus months really. They can sometimes be tough to navigate because you’re sitting there watching the joy

30:27
the parents faces and you know looking at what you’ve created and what you what you have helped to do but then all of a sudden you’re having these huge hormone surges your milk’s come in you’ve got sore breasts you’re you know engorged breasts you’re bleeding you’ve had stitches all those you know things and you also you’re you’re going home and you’re not walking in your front door with a baby I think

30:51
probably something that sort of, although my daughter was, what was she, 24 when I had my first surrogate baby, when I got home that afternoon, I sort of walked in and it was sort of 3.30 in the afternoon and I sat on the lounge and thought, well what now?

31:06
Do I unpack my hospital bag and then what do I do? You know, yeah, I’ve had a baby and I’ve done this amazing thing, but now I’m home alone and what now? You need that support. It’s really important to make sure you’ve got some people around you that can support you and support you for the fact that what you’ve done and help you ride those hormonal waves, get through the roller coaster of emotions, cry when you need to cry, cheer when you need to cheer. It’s important, I think, to have a plan in place of when your neck’s going to see that baby. I don’t think you should wave that

31:36
baby bye bye from the hospital door and say see you in a week. It’s to have a plan in place as to when you are gonna see that baby again. And these sorts of things are, know, dependent on how, what type of birth you’ve had, how long you’ve stayed in hospital, all those sorts of things. For me, I always thought it was good if I could say bye bye knowing that the catch up, there was another catch up planned, whether it was the next day, whether it was in two days, whether it was in a week. I knew that it was there and that helped me get through those emotions.

32:05
Definitely yes for me as a surrogate knowing when that catch-up was coming. I think sometimes in the community it’s sort of recommended you might see each other every day for the first week and then every second day and sort of

32:15
wean off and sometimes it’s having cuddles with the baby that helps or if the surrogate’s got young children herself sometimes she might need extra cuddles from her own keeper children at home there. Rachel did you want to add anything there about this? No I think that um the way Julie explained that the surrogate’s heart knows that the baby’s not her body but her body doesn’t is really important to remember. We go through all the same sorts of things and as midwives um it would be good to be there for the women, the surrogates that are going through that but you know there’s

32:45
also Sarah gets and are also helping the intern of parents with parent crafting and things like that. So I think it’s just important to keep focused on both parties um as a midwife potentially. Yeah, that’s pretty much I think Julie said it beautifully. I remember my midwife saying to me on my first journey, I actually when we left, had sort of three or four days in the hospital and when we left, I wasn’t seeing that seeing the baby for another week, we sort of hadn’t really planned it very well to have a catch up quite soon and my midwife

33:13
called me the next day and said, I’ll come and see you. You know, you’re obviously home. I’ll be there at two o’clock. I said, no, no, I’m fine. I don’t need you. Like, I don’t have the baby. I don’t need you to come and see me. And she just turned up, which of course led to lots of tears, lots of emotions, but it was because she was there to check up on me, check up on, you know, not just me physically, but me emotionally. And I thought that was really important.

33:36
And Ashley, the team that you helped there, guess, as they were saying, helping the parents understand parenting craft and checking in on the surrogate physically and emotionally, lots to still juggle. Yeah, I did postnatal visits, some together, and then when they separate as well. So I did two postnatal visits. So one for the intended parents and one for the surrogate. And I spent more time with the surrogate than what I did with the intended parents because that, like her recovery was very much my focus. In terms of logistics things, and this would vary hospital or hospital and state to state.

34:06
previous surrogates that I had experienced in Sydney had been infertility journey surrogates and so the parents were given room side by side but you cannot in New South Wales Health admit a male into a maternity bed so you cannot even border a dad into a bed and like in a New South Wales Health Hospital in a maternity unit and so we did some organization and in Adderley that thankfully worked because you know you just hope that you know the whole of Sydney hasn’t decided to try and birth on the same day and beds are actually available.

34:36
those sorts of things and we had a two bedded room.

34:39
that got closed off for the purpose. but that organization was all done anti-natally, mediation with the manager of the postnatal ward for that. because although the surrogate, you know, is friends or family with the intended parents and she has care for this child, she doesn’t want to be the one being the primary carer. We want the parents to learn their craft and enjoy that. I’m keeping my eye on the questions that we’ve posed, but also in the questions, some Mitchell has been typing in quite a few, which is fantastic. I may not be able to get to all of them, Mitchell,

35:09
but I also have a feeling some of them have possibly already been answered in what we’ve been saying. But one of them I will ask, Mitchell asks, can you speak to the benefits of colostrum and also to skin to skin contact with the surrogate immediately post-birth? Is that a conversation that you each had with your teams or were aware of in terms of, I guess the intended parents might not, being first time parents usually, um might not be aware of the benefits of colostrum and the skin to skin. Is that Rachel, something that you can remember for your team? Yeah, colostrum was very important.

35:39
for me as a surrogate to give to the babies. I luckily had one intended mother that induced lactation. So you just never know how well it’s going to work. So for myself, I expressed colostrum to the natally and I expressed them for three months postnatally just because I had it. So why waste it? And I just enjoyed the process of expressing. It’s not for everyone. I think it comes down to the individual. Some women don’t want that ongoing.

36:10
Yes, cholesterol is incredibly beneficial to babies. At the end of the day, are also babies born to mothers who have breast cancer and can’t feed or others who have had double mastectomies and can’t feed. There’s other options available. If you don’t want formula, are milk banks, incredibly expensive, but they’re still there. There’s also Human Milk for Human Babies where you can get it donated generously from the public. So if, you know, as an intended parent, you’re wanting that for your child, there’s lots of options. doesn’t happen.

36:39
come from the surrogate. Sorry. As for skin to skin, it wasn’t something that I felt like I needed as a surrogate, but skin to skin is incredibly beneficial. And there are so many studies about kangaroo care with preemie babies and newborns and it’s super important for parents, I think, to have in general. So immediate skin to skin, as much skin to skin as you can in those precious first few weeks is super important for bonding and for your baby to learn the scent of the parent and things like

37:07
I really like what Julie said before about like your brain, like your heart knows that you’re giving that baby to the intended parents, but your body doesn’t. Like we actually store.

37:16
the genetic makeup of every single baby that we carry inside our body for the rest of our lives. Babies are designed via skin to skin to regulate their own breathing, to regulate their own body temperature. And it’s one of the most effective ways of managing postpartum hemorrhage afterwards. And so having those conversations antenatally to actually realize to go there, there is actually a physiological purpose to that skin to skin and like how that can actually be quite beneficial. Yeah. I think I’d like to clarify there again for anybody new that’s listening.

37:44
between what Ashley and Rachel were just saying there, you’re talking about the importance of skin to skin, but I guess my question then is, is it okay who it is with? That Rachel, you mentioned about learning the parent’s scent, but I think what we’re also saying is that it is important for the surrogate’s body, for her to have skin to skin as well. Is that what we’re all saying?

38:01
It’s not something I ever felt like I needed as a surrogate. It’s not something that, um of course, I needed it with my own children. It was something, it was, guess, a boundary that I put in place. I never felt like I was going to get connected to that child, but it wasn’t something that I felt like I needed to do. Once that baby was out of my body, all the skin-to-skin that had been happening internally was done and I wanted my body back. uh

38:25
As Ashley said though, there’s lots of studies that point towards the importance of skin-to-skin for that immediate third stage, the separation of the placenta.

38:34
changing hormones, but I also think it’s very much the decision of the surrogate, very much their decision. So, and that needs to be respected. So if they don’t want skin to skin, then you know, it doesn’t happen. Some surrogates are very, very keen for that. And I think if they are, then, uh you know, it would be nice if the intended parents respected that. Particularly when the baby’s born, that cord’s not cut immediately. So in Rachel’s case, if you’re in theatre, skin to skin becomes

39:04
a little bit more complex. know, Rachel had twins at 27 weeks. Not a lot of time for skin-to-skin in that scenario. You know, in a term, birth, in a birthing unit, that’s quite different. So I think if the surrogate is keen for skin-to-skin, and as Ashley said, there’s lots of research to suggest the importance of that, it’s nice if the intended parents recognize that. then…

39:28
I think I just saw something flash up on the screen. Absolutely that skin to skin can happen with the intended parents. You know, after that placenta is separated, the cord’s been clamped and cut if the intended parents wanted to do skin to skin or for it.

39:42
I think the vast majority would, wouldn’t they? m And I think this probably highlights another question that’s been typed in this, do the IPs ever try to weigh in on a surrogate’s birthing preferences and these post-birth preferences despite the fact that it’s ultimately her birthing event? The one thing I would say to that is be prepared that she might change her mind as well. um That she might go into pregnancy saying, I don’t want skin to skin and then as it heads closer to birth, she might change her mind and you might need to have a conversation as a team with or without your midwife. Yes, did any…

40:10
body else. Ashley, did you want to add anything that we’ve said there? Yeah, I mean, it only happened briefly in my surrogate’s pregnancy. Her baby was Breach. Now I’m a vaginal Breach provider. I love attending Breach births. It’s not something though that is like 99 % of babies in Australia born Breach are born via cesarean and people’s preferences matter in that sort of thing as well on both sides of the equation. And it can be one of those situations where normally that decision around both maternal wellbeing and

40:40
neonatal wellbeing are sort of tied into the one person, but when they’re separated, it can actually make those conversations.

40:46
a little bit more complicated because from a vaginal breech birth, it is slightly more complicated for the baby, but in order to be less complicated for the mother. ah And normally you have the one person who’s weighing up those sorts of two things together, whereas when you separate them. ah I was really lucky that my intended parents were incredibly respectful um of the birthing preferences that I had. But again, as Julie said as well, like you’re going back to having these conversations, doing the birth mapping, you know.

41:13
Does your surrogate want to have that skin to skin? Do they not want to have that skin to skin? Are they okay with like, you know, if you’ve got a mother who has never had a caesarean section before and like hearing Rachel’s story, like going experiences as a caesarean, what does that mean for her? Obviously an abruption at 27 weeks is kind of like a don’t get much saying that sort of thing. But like, what does that mean for that birthing woman in her body? there’s so many dynamics to talk about. And another common thing might be how long do we let this pregnant

41:43
go. If it was the birthing woman raising her own child and she’s gone over the 40-week mark to 41 or 42 weeks in the past and for her own keeper children that’s one thing but I know that there’s often some anxiety that kicks in for the intended parents if they’re being told by certain care providers no we’re not going over 40 weeks that could be an example of

42:05
best interest for the child or fear factor just weighing up the risks there versus for the birthing woman. Is that something as well to consider? absolutely. I think a lot of intended parents do get to the point by the time they actually get pregnant with a surrogate is that they’ve had to release a lot of control. So um I think for most intended parents, by the time it gets to the birth chat, most intended parents will definitely go with what the surrogate says. You know, they don’t have much control over anything else.

42:35
So unless there’s obviously some major medical concerns for the life of the baby, I think it would be very rare that intended parents would speak up to interject on birthing preferences and birthing experiences. And you’ve often had a lot of those conversations prior to even more.

42:53
pregnant. So those discussions have all taken place, the care provider, home birth versus hospital birth, cesarean versus, you know, V bag versus normal birth, you know, all these sort of discussions have already taken place. Sure, there are challenges that are thrown in along the way that you may not have discussed. But if you’ve got those foundations down prior to even falling pregnant,

43:15
Good point. And that’s what we call sorrow dating, when you’re getting to know your team. And then when you do that official counseling, all of these conversations are happening and getting revisited many times, aren’t they? oh We’ve done so well to cover all of that. I feel that time has flown by. So we’ll just sort of start to wrap it up a little bit now. So ladies have a think if there’s anything pressing that any of you have wanted to mention that we haven’t got to. The last two questions I’ve got here are either what changes would you like to see for surrogacy in Australia, if any, that spring to mind? And also how has being a surrogate or

43:45
having worked with surrogacy teams influenced your work as a midwife? Rachel, I know you and I had chatted about that last question. is there something that you can say how has surrogacy influenced your work as a midwife? I think it’s changed everything about my midwifery practice being a surrogate. I think because I’ve had such big events occur during my surrogate pregnancy, think going into being a midwife, you you have an idea of what complex pregnancies are like, perinatal loss and that sort of stuff. But I think

44:13
Um, actually having lived through those experiences that changed everything about my practice. And it definitely made me, think I’m a well rounded midwife and a lot more open-minded to people’s experiences and life experiences. think just being involved in surrogacy in general, general will do that to any person. But then when you’re applying it to midwifery practice, it’s expanded my world greatly. Well said. Ashley, your recent experience.

44:41
One of the things I like about working as a private midwife is being able to give individualized care. I’ve looked after Indigenous women with half what feels like a huge family present. I’ve done births outside in hot tubs because that’s what people want to do. People ask me sometimes, oh is it okay if such and such is present at my birth? And I’m like, it’s your birth.

45:03
I get to have that nuance of actually just completely adapting my whole entire approach to someone’s individual journey. I do think it’s like, it’s complex, like all of the, there’s so many things to talk through. There’s so many feelings to talk through on so many different levels. I will always remember getting to witness that moment of seeing those dads handed their baby and like that is an incredibly special thing to do for someone. Yes. A beautiful thing to be a part of.

45:32
It’s almost a privilege, isn’t it? It’s a privilege to be involved in those births. We had a surrogate birth at the hospital a couple of years ago and a student midwife was present and witnessed that birth and I said to her, really don’t understand how lucky you are because these births are few and far between, especially at the hospital I work at. You know, we have sort of 1200 births a year and in the 20 years I’ve been there, I’ve only known of five surrogate births and two of them have been mine.

46:00
It’s a very rare and special event. take it, lavish it all up because it’s pretty special. yeah, I have been able to reflect back and realize with the working in a hospital system, birthing in a hospital system, political logistics that I was faced as a surrogate being able to achieve a VBAC just really made me realize how lucky I was, which was pretty special. yeah. Well done.

46:28
So I guess to wrap it up, imagining people that are listening to this, could be a midwife who has been allocated a surrogacy team or as a private midwife or in a hospital and they’re listening to this. What advice would you give them as they embark on this journey with their new surrogacy team? Rachel? I don’t know, just keep an open mind and enjoy the ride. Honestly, it’s a privilege as the ladies have already said to be part of it. Yeah, take it in and just be open to anything.

46:58
Ashley? Yeah, think to choose model of cares and

47:02
oh You know, you’re choosing your surrogates and your intended parents working really well together and respecting each other’s decisions and what everyone can bring to it. Yeah, being open. Thank you. And Julie? Just embrace it because they’re few and far between. So embrace it. If you can get into a continuity of care model, whether it be in a public hospital or with a private midwife, whether that be a home birth model or private midwife.

47:29
births in hospital, that’s think key to really having a hopeful, seamless journey with lots of open communication between you all. Thank you, well said. Yes, I think I’ve heard sort of anecdotally from the community of my many years around now that often Sarah gets advocating to go for that, you know, continuity of care or midwifery group practice model type of thing for those longer appointments and to have the time to talk to both parties for this journey there.

47:54
Okay, well, thank you everybody for joining us. I’ll wrap it all up there and say I hope you found it useful. I will mention that if anybody’s got further questions that they’d like to ask, you’re welcome to reach out to me at Surrogacy Australia and I can either try and answer them, point you in the direction of some ladies like…

48:09
these that have joined us tonight or other similar ones or other resources that might be of use to you. So if you still have lots of unanswered questions or would like them answered privately, consider joining SASS, which is Surrogacy Australia’s support service, and you can be connected with a mentor so you can have your questions answered in a one-on-one setting. Thank you for joining me. If you’d like to see other recordings with photos, head over to our YouTube channel to watch other webinars. You can head to surrogacyaustralia.org for more information about surrogacy.

48:37
Also check out our Zoom monthly catch-up sessions, which are a great way to connect with others in the surrogacy community. Attending a Zoom is scary the first time, but there’s only ever one first time. We have all been beginners at some stage. As we say, it takes a village to raise a child, and in the case of surrogacy, it takes a village to make a child. So welcome to the village. uh