Episode 55 – Psychologist – Narelle Dickinson

Welcome to our podcast 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 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 episode, recorded in August 2021, features psychologist Narelle Dickinson. Narelle is a Brisbane-based and Zika accredited clinical and health psychologist specialising 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 in Queensland, 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. In this episode, we break counseling into four stages, pre-surrogacy, mandatory,

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ongoing while pregnant and ongoing after birth. The questions I posed to Narelle are, why would we need counseling before we find a surrogate? How do we prepare for the sessions? Will we pass the counseling? My surrogate is pregnant and is having some individual counseling sessions. Should I be worried? I thought we could talk about everything as a team. So why would she need to talk to a counselor? Why would IPs, intended parents, have sessions during pregnancy?

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Why would a surrogate or new parents need any counseling once surrogacy is over? And how many sessions should we budget for, for our surrogate? Although this webinar session was a couple of years ago now and the mention of COVID restrictions are not as relevant, most of Narelle’s advice is actually timeless. If you listen to this as part of a surrogacy team, I hope it can create conversations which might strengthen your team. I hope you enjoy the episode.

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Okay, so here we go. Here was my thought. So we’re brand new. We’re a gay couple and we need a surrogate or we’re a hetero couple and we’ve been told to have a family you need a surrogate. So yes, there’s mandatory counseling but why would we even need counseling before we found a surrogate? Yeah, I think there’s a growing tendency for people to take up the pre-surrogacy or pre-mandatory counseling, which I think it’s really good because if I take the two parts of that.

02:44
apart a little bit. If we’ve got a heterosexual couple that maybe has gone through a whole bunch of fertility treatment already and things haven’t gone well obviously and that because we’ve ended up at the point of needing surrogacy after trying a whole bunch of other different interventions and treatments often over quite a long time, they’re probably feeling pretty ragged from the whole experience and there’s often a bit of an opportunity there to…

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talk about how they’re feeling, you know, coming to terms with letting go of the idea of carrying the pregnancy themselves, sort of that grief that there is with that, exploring what the fertility diagnosis has ended up being, so whether it’s also a donor experience that they’re going to be looking at. But a lot of the time, people are also looking for a little bit of advice about how to find a surrogate or whether…

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the potential surrogate they’ve found is a good candidate for them, what that might mean for them. And I think I see this a little bit with the gay couples as well of, well, how do we go about this? What should we do? What sorts of characteristics should we be thinking about? So I think the difference with the mandatory counselling is you’re already into the process and it can feel a little bit like you’re already a train on some rails and it’s a little bit hard to get off. The pre-surrogacy counselling can be really useful because it gives you that

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opportunity to talk about what surrogacy might be like and the aspects of how it’s going to affect you without feeling like you’re already stuck on a path that you don’t know, you’re not 100% certain is really law I guess. So it doesn’t mean you’re broken if you have some counselling beforehand, is it sort of trying to set up for the journey and think about…

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journey you want. Firstly, I’ve been psyched for 25 years and I haven’t actually spoken to too many broken people. I’ve talked to a lot of people who feel very sad and some of them feel really scared and a lot of them are experiencing a lot of grief but broken isn’t something or mad is not something that comes up awfully often. This is about

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It’s not about clinical intervention. It’s not trying to fix people. It’s about having a place to talk and to explore and unpack things. Sometimes people…

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get some weird interaction or weird sort of comments made by family or friends of, you know, this is going to happen or that’s going to happen. You know, the classic one is, you know, your surrogate won’t be able to hand over the baby and it kind of strikes fear in the heart of a potential IP or surrogates are told some strange things sometimes that they want to just be able to explore. And that’s actually another thing. It’s not always the IPs that I see in these pre-surrogacy sessions. Sometimes I get contacted out of the blue by a woman.

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who’s considering being a surrogate, sometimes she knows that someone, one of her loved ones needs a surrogate and she’s thinking about offering, but she actually wants to go through what that might mean for her and what she needs to think about. Before she makes an offer, she doesn’t wanna have to pull that back. So there’s actually lots of reasons, but yeah, broken’s generally not one of them, I don’t think.

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No, and it would potentially be nice if there’s somebody in your state that they are establishing a relationship with you. So if their team does stay with you for the mandatory counselling, you’ve already got a lot of background work and getting to know each other. So lots of benefits there. Yeah, absolutely. And I have, I’ve been fortunate to see that where I might’ve met a surrogate or an IP at some point.

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in the past, sometimes quite a long time ago, and then they turn up and they’ve joined a team. And I think that’s awesome. You know, those conversations have driven this in a particular direction. And it actually does. I already know quite a lot about them. I tend to remember most things. So, you know, that comes forward. And that’s when we do the mandatory counselling, that really lets that session be quite focused on what are the issues that this team is dealing with or what are, you know, what are the characteristics of this team so we can really

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focusing in there and instead of just some general discussion of surrogacy, it lets it be quite direct. It’s another big advantage. That’s probably a nice segue to our next one. So then the team’s preparing for mandatory counselling. So then, so we have a surrogacy team and we’re getting ready to have that individual and group counselling sessions. How do we prepare for those sessions and will we pass the counselling? One of the questions I get asked from time to time is, do I ever not recommend a group? And the answer is yes.

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occasionally, there certainly are some red flags that pop up where either the IPs or the surrogate, there’s something going on where I think you’re not quite ready to go ahead. So it’s not necessarily a no, but it might be a not yet. But that is part of the role of the counsellor to provide a recommendation about whether or not.

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the surrogacy group is one that should be proceeding at this point. I mean, ultimately, fertility counselors are very eager to see families get created. So we like to see that we come at this from a really supportive perspective. And we’re much more interested in saying there might be some issues that we need to work on a little bit. Let’s have a look at what’s going on that lags up as something that’s probably going to turn up down the track and that might interrupt this surrogacy and make it not go so great. So let’s come back and address this now.

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An example might be something like instability in the relationship, in one of the relationships. If one half of a couple is really on board with the surrogacy, but the other one’s a little bit more ambivalent about it or really has some big reservations. If there’s been some other really massive stress or other events occurring recently, so maybe if an IP couple or a person has literally just finished their own fertility treatment, they haven’t had a chance to kind of process that properly yet.

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fling themselves into a surrogacy and they’re not quite done with unpacking what they’ve been through, that might come up as the pregnancy unfolds and that could become a little bit disruptive. So sometimes we just need to kind of say let’s just take a little bit of a pause and just make this right so by the time you know there’s a baby on board things are going to go really nice and smoothly and we don’t have anyone getting more distressed than we would you know no predictable distress is going to get

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unpacked there. Yeah, trying to anticipate things and sometimes it might be having a pause of a few weeks or a month in between an appointment and having time to simmer with ideas there. And so it’s not a roadblock or it’s not necessarily saying a no necessarily but maybe it’s a pause and sometimes the teams might themselves then decide we’re not ready by having those extra steps in place. But so the mandatory counselling I know in terms of what gets asked I know in some of the Facebook groups there’s some lists and I know for SASS teams we’ve got a list of discussion

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probably the time to ask other people and teams what have been asked. Have you got any quick overview of things to prepare as a team for that mandatory session? I mean on the website that you put up of mine before I actually have a whole list of the sorts of implications that we go through there. I don’t think it needs to be a secret. To be really blunt it’s pretty obvious when questions have been had really over prepared responses so if it sounds rehearsed you know we take a guess

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that it’s a job interview and we want you to have all the right answers and have the lines practiced. That’s not helpful. I don’t want the first time that you’re thinking about some of these really complex issues to be when you’re sitting in front of me. I’d like to be able to talk about it and say, okay, well, if this were to happen during your surrogacy journey, how do you think you might manage that? How are you going to solve that problem? How as a group are you going to work this out? Rather than me sitting down and saying, you know, so this might happen and this

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I think it’s much more useful when it’s a bit of a conversation rather than a test of some type. So yes, that they’ve already done some pre-work and reading and it’s a conversation. So that sounds good. And Morgan, I can see your question there. I’m going to tick that off that we’ve answered that. You asked where would we find a list of questions? So on Narelle’s website. Have a look through the tabs at the top and in some of the resources there, easy to find. Okay, so our next section, then I guess the IPs might say, so my surrogate is pregnant and she’s having some individual counselling session.

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Should I be worried about that? I thought we could talk about everything as a team. So why would she need to talk to a counselor and not us? And then that’s the surrogate having sessions, but then also why my IPs? So why might both parts of the team need some ongoing counseling during pregnancy at all? Yeah, they’re really good questions actually. I think I’m just going to go back really, really quickly to the slide. Actually, you don’t need to take it back, but nothing makes me happier when I know that people have actually gone through those questions. And I quite frequently have people

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wine and we went through them blow, blow, blow. And I think, gee, that probably would have taken more than one bottle of wine. So you might take a while. Yes. I love that because that means you’ve had the hard conversations and you’re already working out how to manage this and discuss things which are really sensitive and often quite delicate. And then the sorts of questions we don’t normally have even with quite close friends. So to have those conversations with people that

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before you get in the room with me, that makes me feel very optimistic about your ability to keep having those conversations as things go on. But I think those questions that you ask on the next slide about…

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why might the surrogate want an individual session? Why does she need to talk to the counsellor? Some of the reason for this is probably even responded to in why we do the individual sessions within the mandatory counselling, or certainly I do. I think we all have fairly similar processes. But there’s that opportunity to talk really freely and air things, to ask difficult questions, to say, you know, this is kind of my deep dark fear. And I don’t know if I word this, and I’m gonna, you know, if I don’t know if I say this to my IPs and I’m gonna upset them.

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Sometimes by sort of thrashing it out a little bit with the counsellor, it puts it in a different perspective, but sometimes it helps people to find a different way to approach the difficult conversation. In terms of during a pregnancy, sometimes people just want to talk things through. Sometimes surrogates start feeling responses to the pregnancy that they didn’t expect. I don’t know, adjusting to it. You know, sometimes they might have had a parent or a family member ask them some difficult

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second guess themselves. It’s an ability to talk about that without maybe upsetting or frightening the IPs. You know, if a surrogate says, I’m having some weird thoughts about this, IPs are probably gonna straight away think, oh, she wants to keep the baby. You know, she’s thinking this, she’s not gonna hand it over after all. Probably not. She’s probably just needing to have a bit of a talk about how she’s feeling. And sometimes people just get tired. If you’ve- They just need a vent sometimes and say, I know I signed up for this. Yeah, that’s hard. And sometimes,

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We’ve gone through a few rounds of fertility.

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treatment, it’s not working, maybe there’s been a miscarriage and she’s feeling upset, she’s feeling exhausted, maybe she’s feeling guilty. Again, she might not want to bring that to the IPs, but she needs to bring it somewhere and the counsellor is really useful for that. Yep, a safe place that understands it and sometimes I’ve probably almost forgotten a section, there’s the mandatory, but then there might be trying to get pregnant and there’s been a few miscarriages or embryo transfers that aren’t working or COVID restrictions and frustrated

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and not frustrated with the IPs just with how that all is. So just having a safe place to talk about that. Yeah I think the other thing I sometimes see as the process is unfolding, so there’s a pregnancy or maybe they’re still trying to get pregnant, sometimes it’s just that there has been a little bit of a miscommunication or communication’s gone a bit quiet. Things have been really tricky during COVID of course, we’re not able to have as much face-to-face contact as we’ve had and so some of those opportunities to

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and have a talk haven’t happened. And we’re relying on these kind of slightly artificial conversation experiences like online or texting or whatever, where things get a little bit lost in translations. And sometimes we just lose that empathy of what the other person’s experience is. So the counselor can be really useful because we kind of stand in the middle. We look in both directions. And so if I hear a surrogate say, you know, my IP did this, I am able to say, oh, okay, so, you know,

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was, I think they did this. Oh, okay, that’s really interesting. I wonder if there’s any other explanations for why they might have done that, vice versa. And so it kind of lets us just try on different explanations instead of making assumptions about why someone’s doing or behaving in a particular way. And that neutral party sort of thing. I’m just going to add one extra in. Is there a best case model then? For example, I’ll just give an example of what my team did. We sort of had an agreement that as much counselling as anybody needed, but Anna would have once

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So once every three months and as a team we had one in

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the third trimester at about 31 weeks, sort of preparing for birth and bringing it all back together. Do you have a bit of a model that you would recommend? Yeah, that’s probably not too far off what I’d say, actually. I tend to recommend that if, you know, if you have had three, four, five months of trying and it’s not working, you’re probably going to get tired. So that’s probably a good time to check in. You’re probably going to be, you know, having some conversations with your fertility specialist at that time. So maybe checking in with the counsellor then as well might be useful.

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Certainly if there’s a pregnancy loss, I think that ability to kind of take stock and you know, how am I feeling? Are we all ready to proceed at the same timing, at the same pace? Maybe the surrogate’s ready to jump back into another pregnancy attempt, but the IPs aren’t or vice versa. So talking about that. And then I think intermittently on an average of once a trimester is quite reasonable. Obviously the other time that you might need to talk is if there was something untoward, if there was an adverse finding on ultrasound,

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some really difficult decisions, if there’s just ambiguity in there about what’s happening, anything which is going to make you feel really unsettled and anxious about what’s happening in the pregnancy, that’s a good idea to sit back and have a chat. And again, the counsellor who’s done your pre-surrogacy counselling probably knows you pretty well, so they’ve got that background, and they’re going to understand the nuances of what surrogacy involves, which unfortunately, you know, the

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broad population of counsellors isn’t not necessarily going to get it. You might end up having to spend half your session actually explaining what surrogacy involved. The surrogacy counsellors are quite used to this because we understand how surrogacy works. Yes, and the complexities of having a baby with four adults. So you’ve pretty much answered one of those questions there. But I think that Klein has has asked that is it therefore usual for the IPs and the surrogate to have the same counsellor? What you’re saying is in the mandatory you all definitely do. There’s no rule that says you all have to then continue with the same. One of the parties might

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used to.

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the same counsellor and another one might use somebody else. But I suppose if you’re going to have a team session at any point, it would probably be good to have it with somebody who already knows a bit of your background that you’ve had a session with at some point, at least so that you don’t have to reestablish the groundwork. Would you agree with that? Yeah, absolutely. I think obviously if the wheels really fall off and things are getting really, really difficult, you might be needing to look at some separate people for some separate, you know, just some separation of conversation. But I guess we’re all… Never happens in a row, does it?

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got the gold. It’s all smooth for every team. Absolutely nothing ever goes wrong.

18:06
What could go wrong? I think that these little conversations often mean we kind of get it while it’s still small before it blows out of perspective. And you know, we don’t want things to go bad. We don’t want things, we definitely don’t want things to be dealt with by lawyers. We don’t want the lawyers to make any money. So we definitely want things to be held and managed at that early point. So it gets recognised as a misunderstanding or just a miscommunication rather than a major

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problem. And then setting some team norms or something moving forward, what are we going to do next time something happens? So catching things early. One of the things that is useful, again, I’m going to go back to the previous slide because you asked, you know, do we pass? You mentioned the fact that psychometric assessment or that assessment process is not mandatory in every state. Some of us do it anyway. I certainly do. I’m in Queensland where psychometric assessments not part of the legislation, but I follow the guidelines for counselling.

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guidelines that are set by some of the overseas agencies, including the ARM, which is the American Society for Reproductive Medicine, where psychometric assessment is pretty much a standard. And I often explain this to the groups that I do the assessments with. I think what that does is a few things. It tells me a little bit about each individual person. It certainly tells me about their interpersonal style and

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how good they are at managing conflict or difficult conversations. And then really importantly, it gives me a sense of how that group is going to work.

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So quite often what happens is someone in the group is going to come up really clearly as having a reasonably passive interpersonal style. They’re going to be really conflict avoidant. And maybe there’s somebody else in the same group who’s quite dominant, quite comfortable asserting themselves. That kind of just tells me, all right, that’s something to keep an eye out for because if they get tricky, someone’s going to feel really, really happy to speak their mind and somebody else is probably going to kind of acquiesce a little bit more than maybe is best.

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about if things are getting tricky, saying well do you just need to get better at asserting yourself and feeling you know does this person need to stop and just listen instead of speaking their mind and so we can kind of stage manage those interpersonal relationships a little bit. Yeah get to know the dynamic of the team and what to look out for long term. Yeah and so then I suppose then the last stage then is with that team has had a baby, wonderful, so some states have relinquishment counselling as sort of a debrief but then after that so why would a surrogate or the new parents

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any more counselling once the project’s over. And if you do have them for IPs to budget, how many should they budget for? Yep. I’m just going to quickly say, if you can hear a strange noise in the background, that’s my dog snoring just over there. So I apologise. I had a five-year-old wham for a second. So between us, we’ve got it all happening. I think with the post-surrogacy counselling, that’s really tricky. And you covered it really well before, because every state’s different. And it kind of even does my head in a little bit remembering what’s required in

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parentage order counselling, which is a second part of the process that has to happen. New South Wales has relinquishment counselling as well as the parentage order. So it’s really important to know that I think every state that requires mandatory counselling afterwards, that counsellor has to be a different person.

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to your pre-surrogacy counsellor. So that’s important. And if I can say just, I know that once a baby’s born, everyone gets distracted and busy and you kind of, but you also wanna get that parentage order done pretty fast. If you do need to have counselling done after, mandatory counselling done after bub’s born and before the parentage order can be made, please consider making contact with potential counsellors a couple of months before baby is due. Because if I, and I’ve had this this week,

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and say, baby’s due in a…

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Can we book the counselling? And I think, thank you. You have just taken so much stress off my life. Absolutely, it’s in the books. We’re good to go. And so, you know, that actually makes it easy for you because it’s just done. It’s just sitting there ready and that lets that process move nice and smoothly for you. But I know you’re actually asking me about the non-mandatory counselling. There’s lots of reasons for an IP. Becoming a parent is actually really hard work. If you haven’t done it before, you would already know. But it can be a little.

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bit of a head trip to suddenly be a parent after all of this if there’s been a long period of infertility or if you’ve been stuck in different states and your surrogate’s got her way through the pregnancy for you and then here you go, here’s a baby. In the trenches, in the trenches, broken sleeps. Yeah, that’s a big adjustment. So sometimes it’s an opportunity to just make sense of all of that, to come to terms with that. It’s to…

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renegotiate and by renegotiate, I mean, in your own mind, what is our ongoing relationship with wonderful person who did this for us? You know, how can we manage this? How do we include her in our life if that’s what we have decided to do, but also be parents? You know, so there’s a little bit of sort of redefining who I am now I’m suddenly a parent. And navigating out of the project of surrogacy and the intensity of it and navigating now

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or as friends. And I mean, I’m just going to add my little plug there. I think it’s very valuable for teams as individuals or a team to have it booked in just like the teams that are planning their counseling with you now, because you’re going to get busy and even finding the time to make a phone call in business hours is hard when you’ve got a newborn and visitors and you deprived of sleep. So I think it’s, they’re good check-ins to have to show that you’re valuing your own mental health and navigating out of this big project that you’ve done together and adjusting to life after.

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health of a surrogate too, but her mental health is part of it. How long are IPs obliged to care? Like when does their obligation stop? It’s such a tricky question because it comes, the legislation doesn’t define when these, you know, the reasonable expenses and the obligations for a surrogacy end. And I think it’s something, look to some degree it’s something you have to negotiate before you start. That idea of, you know, are we going to be thinking about our responsibility towards

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your care for three months after the baby’s born? Is it until the baby’s a year old? If there’s any physical or psychological injury, if I can use that phrase, that results as a result of the

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pregnancy, you know, does that mean we take care of that forever? I think, you know, that’s probably stretching a fairly long way, but discussion about, well, what is, what are our shared expectations of that is quite important. The tricky thing with counselling is before you start, you don’t actually know how you’re going to feel afterwards. But I think sometimes Sarah gets.

24:57
I mean, some surrogates don’t really feel like they need a lot of processing of what’s happened. They’ve gone into the surrogacy with absolute clarity over what this is going to be like for them. They’re very certain. They feel very comfortable when they hand the baby back to the parents. And that all feels really good for them. There doesn’t.

25:13
need to be a lot of unpacking about that. But for some surrogates, they do have some unexpected reactions. There sometimes is a kind of a lostness that they feel. They don’t want to necessarily talk about that with their IPs because their IPs are gonna think they wanna take the baby back. Yeah.

25:29
Well, they’re feeling sad because of the IPs that they’ve lost, but they don’t necessarily want to tell them. Absolutely. I think a lot of surrogates and myself talk about it, the project ends and we’ve just done this magical, intense thing together and it ends. I mean, yes, there’s life, which is wonderful, but for us, we miss being in their pockets quite often and having that much contact. And so that’s a very hard thing to tell your IPs that I miss you. Cause then it’s like, well, should they feel guilty about that? You know.

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life is just adjusting so it’s just talking to a counselor that understands that the project ends and it’s okay to have I guess it’s if you do a high school musical or if you’re part of a sporting team and the season comes to the end I’m sure AFL grand finalists probably feel a similar thing at the end of the season. Well I think we all know what that happens it kind of happens every year you know the lead up to

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Christmas maybe, you know, it’s that big build up at all, it’s got all this exciting stuff. We open our gifts on Christmas morning and then what is there, you know, what do we do now? We eat lots of leftovers. It is that kind of slightly anticlimactic.

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feeling afterwards. And the difference for the IPs is it’s not any climactic. They’re actually really, really busy. They’re taking care of their baby and they’re sleep deprived and there’s pressure coming on them from what everybody else around them about. Let me come and visit your baby and we tell you how to be a parent. The surrogate might be a little bit more in the whole, oh, it’s boxing day and I don’t quite know what to do with myself now. I feel a bit lost. Yeah. Yeah.

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her redefine what’s her next things in life that she’s going to focus on. Yeah, so I think they’re in that question then how many should we budget for you? As you say, sort of chatting as a team beforehand, talking about that three to six months. But then if she does have some physical issues that have cropped up because of the birth or the pregnancy, it’s hopefully an open dialogue about revisiting that. Oh, we’re at that point now, but I need a couple more sessions. And then I think that should probably do us. Hopefully that the friendship is still intact enough to be able to have those those conversations about that. So, well, that’s good.

27:27
done those stages. Troy’s question’s got six votes, so we should answer that one. So their team has had their couples counselling via Skype due to COVID has delayed face-to-face sessions and now they’re planning for their group session. Is it better to do that one everybody in the same room? But then they’re concerned about, I guess, waiting how long that might be, like, because we just don’t know with lockdowns or whatever, or is it better to push on? How much time?

27:52
Do you wait in surrogacy for things when everyone’s keen to get on with the project? But is there is it better to wait for some things? It’s actually a really tricky question. But we talk about it a lot as counsellors, because for a lot of us, we’ve only just gotten used to doing this whole telehealth online thing. And there is variation in how comfortable some of us are. So some counsellors certainly will be very encouraging of face to face sessions. Our guidelines for counselling certainly recommend that where possible.

28:21
we undertake at least one session in a face-to-face format. But I think particularly, goodness, particularly at the moment, where half the country is still locked down, it’s just not logistically possible. And it does really add to the stress and complications. So I had this the other day that a surrogate was literally about to come down to Brisbane for the session. And then we had a Northern Queensland lockdown. And so it was, what are we gonna do? And for me, I just thought, you know, I think we just should, rather than losing the momentum of the conversation,

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keep moving. This certainly is something much nicer about all of us being in the same room together but you may need to have the conversation with your counsellor to confirm that they’re comfortable to proceed. Ultimately it is up to your counsellor to determine what they think is the best way to proceed and whether they’re comfortable to do all of the sessions online. Yeah it is nice and it’s very very hard to assess a group dynamic of people on screens like this and that’s you know to get

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particularly if there’s as you say dominant personalities and if people are sort of backing up it’s it’s harder particularly if I guess the surrogate her partner and the IPs are in

29:29
different houses on this, you don’t get to bounce it off. So I guess definitely aiming for at least one in person, checking with your counselor, because they’re the ones that have to sign off on it. So they have to ultimately be comfortable and they might have a recommendation if they’ve already seen the team for individuals, they might get a feel for how you go. And I know Troy’s team there, that might depend if the team already has an existing relationship or not, or if they were strangers to start with. If you’ve got 10 years of history, that might be different. That’s exactly right. If you’re using your sister as your surrogate,

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feel pretty confident that there’s a you know there’s a rapport between the you know the group so I’m probably going to feel a bit more comfortable. If you’ve only met them through a forum a few months ago I might feel a little bit more anxious about that but I do think

30:13
You know, we are trying really hard to accommodate this. We’re not trying to add to the cost and the stress and the time of surrogacy by delaying just because it’s not what we’re out to do. Yeah. So Troy, I hope we’ve answered your question there. So an anonymous question here, is it beneficial for surrogates to consider pre-surrogacy counseling if they’ve had a difficult birth with their own child? Yeah, I actually think that would be really, really wise. You might have some anxiety, you might something about that birth that feels

30:43
finish. You know, you’ve had a caesarean that you didn’t want, you know, you really wanted a vaginal delivery and you’re fearful about what that might mean next time, you know, there might be some things to talk about there. Yeah, if you had

30:53
morning sickness and you’re thinking, oh man, I don’t know how this is going to be. We might be able to do some problem solving about what you would need to get through a surrogacy in decent shape, but before you meet your IP. So that might help to set your mind a little bit clearly about, you know, what do I need? What support looks like? What journey I want to have? Can they do that or not?

31:14
Yeah, I happen to know the person who I had this conversation with is online at the moment. So I hope she forgives me. But when I met her for the pre mandatory counselling, the first thing she said to me was, I don’t really know what I piece I’m looking for. You know, I said, well, let’s unpack that a little bit. And by the end of it, I said to her, you actually know exactly what your IPs look. You know, you know exactly who they are. She had a very clear sense in her mind. She just didn’t. She hadn’t been able to articulate it to herself. So we might have that about the IP.

31:44
but we might have that about the pregnancy or the birth that we want. And so it’s just that opportunity to talk all that stuff through from someone who’s seen, you know, I’ve seen over a hundred surrogacies now. So I’ve seen everything happen in all sorts of different ways. I’ve seen thousands of women go through pregnancy. So it’s that opportunity to talk about it without feeling rushed, without thinking you’re going to upset your partner or your mum or

32:08
whoever else. Yes. And I’ll add there, so if you are a team and the surrogate, or even if you’re considering being a team, the costs of that pre-surrogacy counselling would be covered for by the IPs. Even if the team doesn’t go ahead, it’s a surrogacy related expense. But if you’re a surrogate listening and you’re considering offering to IPs, but you wanna have a session beforehand, you might pay for that out of pocket. Or if you’re a part of SASS, we would pay for that pre-surrogacy counselling for you. And that’s the session that Narelle’s talking about. I think I know exactly who you’re talking about too.

32:38
cover that for surrogates too, one of those to talk through any of your thoughts, in particular sometimes partners too have concerns about surrogacy or the children of surrogates might have some questions there. So I’m going to jump to a different one, one that came in quite early. It’s about eligibility criteria, anonymous, I’ve got a feeling you were in one of our webinars the other weeks, this is probably a good person to ask. Usually eligibility for surrogacy in NARAL-4 women is a medical eligibility. Is there ever, I guess, a psychological…

33:05
but the word used is extreme, is it tocophobia, fear of childbirth? Fear of childbirth, yeah. Right, have you ever had a case of that happening or would it be a possible eligibility requirement with a few levels of psych and maybe psychiatrist assessment, do you think? Yeah, that’s a really good question. I have, I certainly have worked with women with fear of pregnancy and delivery. I’m happy to say I’ve actually helped them work their way through it. Right. So, you know, we haven’t needed to look at surrogacy as an option. Ultimately, the decision about eligibility

33:35
for surrogacy.

33:36
falls with a medical practitioner. So that would come back to convincing the medical practitioner that there was no basis under which you were able to manage that pregnancy. And if I think there are certain psychological or psychiatric conditions where we would definitely see that surrogacy was appropriate. If someone had such a significant psychiatric disorder that was managed by medication, for example, that coming off that medication,

34:06
or that the potential recurrence of that illness or exacerbation of that illness was going to occur as a result of…

34:14
pregnancy, we would see that in the same terms that we would someone who is healthy, but pregnancy is going to put such extraordinary strain on their cardiac condition or their kidney condition, they might not survive the pregnancy or it would cause permanent harm to them. So is there room in there to move? Yes. If you meet a diagnosis for a severe pregnancy and birth phobia, you’ve attempted treatment and it’s been determined that that is simply not a viable pathway for you.

34:44
that that might be a reason for therapy to be considered, but it wouldn’t probably be a quick process. I think you would require some psychiatric treatment and probably some attempted treatment. Yes, and to show some levels there. So I suppose if you’re anonymous that asked that, if you’re brand new to investigating that and you perhaps haven’t sought some psychological treatment up till now, please do that. And it could be one person if you’re in that state to contact or if you have, it would probably be in consultation with an IVF clinic doctor

35:14
person that would need to probably liaise with a psychologist to discuss any in-between steps first, but definitely working with a psychologist is a first step. Yeah, the analogy that’s coming to my mind, Anna, is that if someone has had unexplained volatility and they’ve had one or two miscarriages, that wouldn’t be viewed as sufficient grounds for a surrogacy eligibility.

35:35
But if you’ve got unexplained infertility and there’s been recurrent miscarriage and ongoing attempts, that probably would be considered as sufficient grounds for eligibility. So there’s a little bit of a nuance in that question. So it’s not a definite no. Oh no. So that’s good. So we’re providing hope. So that’s something today. So James is asking a question and saying, thank you very much, Narelle, for the detailed view of how surrogacy counselling works. Do you have any advice or tips

36:05
that we the IPs are entirely approachable and open to discussing any tough topics or questions that she may have. How do you reassure her? Oh…

36:14
I don’t know, I’m going to say, I reckon you just got to walk the walk. Yep. It’s by doing. We often speak louder than words. We often say under promise, over deliver. Yeah, have the conversation. It’s coming time and demonstrating the trust and that you do what you say you’re going to do. Yeah. And that could be in things like even being reliable in terms of we’re just planning a catch up or we’re going to come over and cook a barbie together and you do it. Yeah. And you just do what you say you’re going to do. But I mean, I’m not quite sure what’s driven that question. If you feel like you’re really you are walking the walk,

36:44
you’re doing everything, then I mean, maybe that’s, that’s actually a conversation to have with her about then where is this reservation coming from? What is the basis for you? Because maybe it’s a sign she’s actually not quite there yet. Yeah, she could be quite a high anxiety person and maybe that’s a personal thing in her life, regardless of surrogacy. And as we say, the mandatory counseling is not an opportunity for you to unpack all of your life challenges. So there’s some level of self responsibility that we need to have all parties entering into surrogacy

37:14
sure we’re okay. So that can be a tricky conversation James to then have if to gently suggest to your surrogate, how is she going with her own mental health traditionally? We’ve sort of answered that one James. I hope we’ve sort of pointed you in the right direction a little bit here. What are the costs involved for IPs for counselling around? I can tell you what I charge and I don’t know what other people charge. Yeah, I do.

37:36
Do you know the range, Anna? Is that a… Okay, I do. So for the counsellors at the moment, there’s one quite a cheapie. She’s down at 150 an hour, but it’s Katrina Hale. And she knows she’s down there, but she doesn’t mind.

37:48
She must have a buffer. But the range at the moment, I believe, is around 225 an hour to 250. That seems to be the standard rate. So then I suppose it’s traditionally our sessions for just sort of individual times. But then when you’re planning your team mandatory sessions, I’m guessing. Is there a report write up involved too, Narelle? So is it a package price you have or it depends on how many sessions? If I see a total of six hours of counselling, which is kind of my breakdown, I do two hours with the IPs, two hours with the surrogate couple.

38:18
two hours with the group and then the report, this is the pre-surrogacy counselling, my fee comes in at $2,500 as a total. And that for me, that means the assumption that everything will work and that

38:30
in about a year, I’m going to be writing an affidavit and running around and finding a JP to sign off paperwork and doing all that backward enforcing and communicating and setting up assessments and doing all that sort of stuff. And being there to just occasionally answer that quick question in between too. So yeah, so it’s a few thousand and that seems to be a standard sort of figure. I think that’s pretty reasonable from what I hear I’m going to say. So that would be you’d be in with a win if you went with Narelle.

38:56
What about traditional surrogacy? Are the counselling requirements any different for that? Yeah, I guess we need to make sure we’re covering off basically donor implications counselling as well as surrogacy counselling. So I try to write my reports up to be quite explicit in that form. So it’s quite clear. And it depends a little bit, I suppose, on whether I think people are planning to do Heim and Sam or whether they’re going through a clinic because some of the clinics, as you probably most of you probably know, are a little bit twitchy

39:26
So they need a little bit of extra reassurance that… They won’t be in two years once we’ve done our research project. Absolutely. So they need that little bit of reassurance that everything has been covered off and that kind of covers off on, you know, what their consenting is involved with, with the donor aspects as well. So it’s a similar process. So you have to do the mandatory counselling and the legal. There might be either a longer session or an extra session for the surrogate to also talk about the donor implications there.

39:56
So it’s more than being not just being a carrier, I’m always wary about using the word just, but the additional implications of also having that biological connection to the baby. Sure, excellent. What about the average time span for mandatory counselling for a surrogacy before pregnancy? So I guess if they contacted you and said, we’d like to book in that series of appointments, roughly what’s the timeline? I mean, you might obviously have a waiting list because you’ve already got some other people, how long could that all be done in?

40:26
me tomorrow, it’s going to be about five weeks before I could book anything in. Again, I have no idea where anybody else is at, you know, I can only speak to myself. What I tend to do is book the individual sessions, if I call that so, the couples sessions. They can be on the same day, they can be a couple of days apart, whatever, and I like to have the group session at least a week after the final of those individual sessions. You could theoretically get everything done within a week and then I can normally take a couple of weeks to get the

40:56
So it doesn’t have to take months to be a turnaround there, but probably being realistic that Katrina, I know is similar to myself, we’re little one man bands. So we do get very busy. We both only work part time. And so, you know, if you call and say, I need this done tomorrow, because we want to do a transfer in three weeks time, we’re not going to be able to do it for you. And nor should they. That’s too soon. You need to, my rough guide that I would like to, you know, predict my model is that I like six months of surrogacy dating,

41:26
if you previously knew each other, just time to talk about what that’s going to look like, and then allow six months to do that paperwork. So if you’re in your head, you don’t have the expectation it’s going to be done in one month, you go within six months, we’ll fit in the counseling, we’ll fit in the legals, and we’ll fit in the IVF clinic. That’s a good time span. That’s what I, I can preach what I like, right?

41:46
I’m not running this show. Whatever you want. I can say whatever I like. So we’ll just finish up with these last two. Do you have experience with the counseling requirements for overseas egg donor programs? So I’m guessing that’s IPs who are perhaps considering using an egg donor overseas. Does it change the counseling requirements in Australia at all? So sorry, so an IP who’s using an overseas egg donor, it depends on where you’re doing the treatment rather than where the donor comes from. So if you’re doing the treatment in Australia, if you’re doing the treatment in Australia

42:16
is coming here or your donor… Or you say don’t use the World Egg Bank. Yep and then the eggs are coming here. What applies is the Australian donor implications counselling. Yeah. Generally if you go through the egg bank they will have under… their donors will have undertaken counselling locally by NZECA accredited counsellors.

42:36
And for you as IPs coming into a clinic saying we’d like to use the bank, you will have to sit within the Australian counselling requirements, which are generally in excess of what an IP would have overseas, because it’s different about how we do different. We do donor treatment differently here. And is that guided by the IVF clinic of extras? Do they sort of set the lead there or is it something that yet or that you know as the counsellor? I suppose it doesn’t necessarily bother you. Or you would talk about where the embryo

43:06
are coming from. Yeah, absolutely. If you don’t, sir. Yeah, absolutely. Whether it’s a sperm egg or embryo donor, if I know they’re coming from overseas, we do talk about the implications of that because donor limits internationally might be different and the realistic opportunity for your child to have long-term contact with those donors might be different. So we definitely do talk about the additional implications of using an international donor, but it’s the guidelines applying to donor counselling here that would apply to you. Yes.

43:36
saying if it’s a US based donor program, not the World Egg Bank, they’ve indicated that we’d need to have a counseling session with the donor to qualify as a known donor.

43:44
the embryos would be created in the US and shipped and that’s just being explored as an option there. So it’s because we have a bit of a rule about knowing donors or yeah so that would um that might be New South Wales. I’m a little bit confused about the language that’s being used. I guess the difference with the egg bank uh if when the clinics use egg bank eggs here is the the donors have agreed to be

44:06
known by the time the child turns 18, if not four. Yes. Whereas it may be that in the United States, if their eggs were being used by a recipient there, they may remain anonymous. They don’t have to agree to have that ongoing contact. Though that said, that’s becoming much more common in the States as well. The well-being of the child and the rights of the child to know their biological identity is actually starting to become much more normative in the States too. Good. Well, that’s good to hear. I’m a supporter of that. So that’s lovely to hear. I’m looking for your question, Troy. I’m sorry. Yeah, I think we’ve approximately

44:36
I mean for a free webinar we’re doing pretty well I reckon. The last question I think they tie in together. I’m asking about a time limit in terms of the counselling and legals then to go with the pregnancy. Often the question is is there an order that it should happen? Yeah. Sometimes people wonder is it going to expire if… Oh right. ..the counselling and there’s a bit of a lag time so I wonder if that’s maybe what it’s about. I actually think they kind of they can happen concurrently to a point.

45:04
You can’t sign your surrogacy final agreement until you’ve completed your surrogacy counselling. It’s worth getting the legal information and starting the surrogacy process with a little bit of overlap because we do tend to talk about some similar things but you will not be able to finalise your legals and sign the agreement until the counselling’s been completed. Yeah? I was just thinking what if the team does the counselling and legals but the IPs are in Victoria which means the rules are the surrogate has to be in Victoria for the embryo transfer but we’re in

45:33
know when that’s going to happen. So we’ve done the counselling and legals, but now we’re just waiting for borders to open up. Will that counselling expire in six or 12 months? No, the end is no. I think the same sort of happens with donor counselling. There’s no hard and fast rule on this. I sort of think if it’s been 18 months, two years since you did the counselling, I’d probably be saying we might just have a bit of a refresher guys and make sure everyone’s sort of doing okay. There’s lots of things that might delay.

46:00
things kicking off. So if you finish the counselling today, but the plan is not to have an embryo transfer till after Christmas, or you don’t think the borders are going to open up and we won’t be able to do cross-border stuff till then, the counselling is not going to suddenly expire in that amount of time, it’s okay. Good. So maybe if you got to the 12 month mark, maybe consider a refresher, but if you’re going to transfer…

46:21
soon after that, but within 12 to 18 months, it might be worse. Yeah. And if I can put a qualifier on that, at the end of the day, the decision making about whether or not…

46:31
things can proceed. If you’re going through a clinic, it’s up to the clinics. So the clinics have what are called, they’re called all sorts of different things, but they’re usually called something like surrogacy committees. They’re effectively the directors of those clinics that have the final say, the final sign off on whether or not the clinic is comfortable to proceed with the surrogacy arrangement for you and facilitate that treatment. So the buck stops there kind of. Now, if, if you did the counselling a year ago, you did the legals a year ago,

47:01
and you ended up in front of the committee. I can’t say they wouldn’t tell you that you need a refresher. I just can’t say that they would. Because it varies from clinic to clinic. But yeah, I think six months, you’d be okay. Well, we’ve done well. We’ve answered all of our questions tonight. Any last minute parting words of wisdom or advice that you want to share with us? Surrogacy makes me so happy. I have to say it is my favorite work. Hands down, I just love it. Every time I’m contacted by a group, it makes my little heart sing.

47:31
This is a beautiful way forward for people that I know it’s hard work, but I love being in there and helping people solve whatever dilemmas there’s going to be. Just good luck. It might feel like a tricky, long process, but you know, you’ll get there and there’s lots of people to help you. Wonderful. Well, thank you. Thank you for joining us. Thank you for having me along. Lovely. Thank you all for your lovely comments. I was just reading them as they’re flashing up. That’s lovely. Thank you. It is.

47:55
Thank you for listening to this episode. 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.