Texts dealing with surrogate motherhood—mine included—usually start with the explanation of the difference between traditional and gestational surrogacy, and they also stop there. The adjective is explained, while the noun is taken for granted. But what is motherhood? What is conception, what is pregnancy, what is delivery?
In order to comprehend the process of surrogacy, and in order to sweep away any doubt that still might be hovering about who the mother is, I find it important to describe the biological developments and processes in becoming a mother in the flesh. Not because it should be substantively different in surrogate agreements from all the other kinds of pregnancies, but because—before proceeding to analyze both the law on surrogacy and the cultural consideration of it by its participants—we must be sure to know what we are talking about. Absurd definitions abound in literature and conversation. One example is the expression of sympathy for the insurmountable pain and sorrow that the intended parents would suffer if the birth mother decides to break the agreement and keep her baby: "They have been waiting for the child, they have been expecting it for nine months!" The pregnant woman did not, of course. Not much value is given to the experience of the biological mother, while the intended parents are pitied, as for nine months they should live in uncertainty—which is by the way intrinsic to the process of pregnancy in many other ways. But intended parents have a typical White, middle-class vision of the procreative process: voluntaristic, manageable, supported by technology and an essential vehicle of happiness, as Zsuzsa Berend concluded in her 2010 analysis of the forum www.surromomonline.com.
Coitus or artificial insemination at the proper time, determined by the woman with self-observation of her menstrual cycle, start the process of surrogacy. Artificial insemination can be performed without the manipulation of the seminal fluid and gametes, in a sort of natural way. But generally this is not how it is done: insemination takes place under the control of doctors in a clinic, where sperm is manipulated and the woman who tries to become pregnant must first assume hormones to regulate her cycle and enhance her chances.
The principle followed is that "Doctor knows best," while Nature can always be improved upon. This is called "the technological ideology" by Katz Rothman. Acceleration is another principle ruling innumerable aspects of contemporary society, geared to reach an "economic optimum" of (apparent) efficiency. And once unpleasant procedures are in place, nobody wants to submit to them multiple times. Money is a factor, too. The more efficient the pregnancy rate per cycle of insemination, the better for its consumers, as each attempt is pricey and only few countries include ART in the common health care of their citizens.
So, hormones are used en masse. This is an example of a protocol in a clinic:
Start BCP's 3–4 days after the start of your cycle
Start Lapron 14 days after the start of your next cycle
Start Estrace 7 days after your cycle
Lining [of the uterus] check between 6–7 days after start of estrace
Transfer up to 14 days later
A breakdown of the meds for that cycle (before transfer)
33 BCP's
28 Lupron Shots
20 Doxycycline Pills AM &PM
8 days of Vivelle patches (ranging from 1 @a time to 2 @a time)
16 asprin pills
6 Medrol Pills
21 estrace pills
1 Valium
5 PIO IM Shots
2 Progesterone Suppositories
Prenatal vitamins for the entire cycle (Alexander 2006, 51)
The protocol of the clinic is undisputable:
One of the questions you should ask the R.E. [reproductive endocrinologist] during the initial visit is—how long does your clinic require me to continue meds once the pregnancy is established? Not all clinics will give you a straight answer about their protocol,[51] but as with any other question you've asked thus far—you never know until you ask. According to the online surrogacy message boards, there have been reports of some surrogates who were required to continue meds until 8 weeks of pregnancy and others who continued until 14 weeks of pregnancy or longer.
Asking these questions earlier on will help prepare you not only physically but mentally.[52] (Alexander 2006, 64)
But, preparation aside, problems can always arise:
any procedures might create future problems with conception: "fertility" treatments could render a fertile woman subfertile […] If a woman knew the certain psychological stress and likely physical harm in IVF, could she ask any other woman to help produce her baby? How could physicians carry out such schemes—even if their priority was to alleviate suffering of the childless? Is this "healing"? Or is it a spell cast by technology and by pleas of potential patients? (Bequaert Holmes 1986, 49)
Current procedures in a clinic involve concentration of the sperm by elimination of most of its seminal fluid, in order to place it directly in the uterus, which would otherwise reject it. The sperm is put into a culture, and will be centrifugated to obtain gametes in a concentrated form. Sperm are then put with a little pipe into the vagina or the tubes (if the clinic believes a little more than usual in natural processes), or into the uterus, or also used for in vitro fecundation with ripe eggs that must be harvested, after the now familiar "controlled ovarian hyperstimulation." In vitro fertilization of eggs and sperm can occur simply by putting them in contact, or by the more interventionist injection of chromosomes directly into the egg nucleus. This ICSI (intracytoplasmic sperm injection) is done in case of "weak" sperm. Many steps in the natural fusion of the gametes (still unknown to scientists) are skipped by using this injection. The current image of the egg patiently and passively waiting for the winner of the sperm race to penetrate it, is completely wrong. The egg captures a sperm, interacts biochemically with its particles, and actively modifies its covering and its structure before the fusion of the two DNA chains.
The obtained morula is then put in a Petri dish, waiting for it to multiply its cells, until they become eight in few days. Two of these cells are often removed for a genetic analysis. As for all other kinds of genetic and gamete manipulation, the long-term consequences of this practice are unknown and unresearched, though it seems that everything is fine, as a new and complete human life does grow out of the six cells left. The embryos are observed, eliminating the abnormal ones. The embryo transfer to the womb is made 2–4 days after the fecundation, by means of a catheter, and anesthesia is not required. As seen, the woman has usually been given hormones, starting weeks before the transfer. She must keep on self-injecting them daily, up to a couple of months, as they enhance the possibility for the zygote to nest, avoiding miscarriages. They harmonize the menstrual cycle of surrogate and intended mother, whose eggs are extracted and fecundated in vitro. The surrogate's own maturation of eggs must be stopped in order to be able to receive a zygote derived from another woman's egg.
And this is what happens "Before and after the transfer," related by Latashia Alexander:
Before the transfer commences, you may or may not be given a Valium pill to relax during the procedure. Usually performed 3 to 5 days following the egg retrieval, during this procedure you may be required to have a mildly full bladder so that your uterus can be seen by abdominal sonogram during the procedure. Usually the attire will be a hospital gown and no clothes from waist down. Next, you will be instructed to lie on the table with your legs in stirrups. The RE [reproductive endocrinologist] will then insert a speculum into the vagina and clean the cervix. As with a pap smear, you may feel cramping as an outer catheter is placed through the cervix into the lower segment of the uterus. A small catheter is then placed though an outer transfer catheter and advanced near the top of the uterus. Once the placement is correct, the embryos will be expelled from the catheter and inserted into the uterus.
After the transfer is complete, you will go into the recovery room where you will be instructed to rest on your back for at least two hours. (Alexander 2006, 53)
In order to guarantee nesting in the uterus, multiple embryos are used at one time. The flip side is that all of them might nest, starting a multiple pregnancy which is much more dangerous than carrying and birthing a singleton, both for the mother and for the developing children: preeclampsia and gestational diabetes for the pregnant woman, preterm and/or operative delivery are the risks enhanced by multiple gestations.
Nevertheless, following the principles delineated before, it seems reasonable to try to implant more embryos to improve the success rate, reducing the time, money and stress involved on all parts—especially on the woman who tries to become pregnant. But who takes these decisions? This is peculiar to the different clinics, only a few national laws deal with this matter.[53] It is also a matter of where the power lies: surrogates in India do not have any other say after volunteering to become pregnant, as Sama (Resource Group for Women and Health), the Centre for Social Research, Amrita Pande, Kalindi Vora, Usha Rengachary Smerdon and other researchers have shown. The doctors take all the decisions, and even volunteering is often a family resolution to which women obediently submit—as we will see in chapter 4.
When multiple embryos nest in the uterus, to avoid the perils for the health of mother and children, and to avoid having to care for more babies than wanted, another technique is deployed, called "embryo reduction." It consists of aborting one (or more) embryo(s) that appear less healthy, while sex selection should be forbidden. This can only happen in countries where abortion is legal:[54]
SD2, who had yet to deliver the child in her second surrogacy, had already been approached by the agent for entering into a third arrangement in which the commissioning parents' demand for a male child would be accommodated by sending SD2 to Thailand, where the surrogate would undergo a sex-detection test and consequently a sex-selective abortion, towards bypassing the impediments of the legal framework in India. (Sama 2012, 67)
The decision about this procedure is not a technical one, but it is in fact one of the greatest conflict points of surrogacy, as we will see.
Using a sexual relationship for achieving fecundation is not a very widespread method, as the intended parents are usually a monogamous couple, and the "surrogate" usually has a monogamic partner, too. Artificial insemination, in vivo or in vitro, is nearly always used. How successful these techniques are, depends on a variety of factors. One of them is the fitness of the gamete providers and of the birth mother herself. Ova coming from an aging woman have less possibility to become viable embryos. The International Committee Monitoring Assisted Reproductive Technologies, a board of specialists, found that IVF and ICSI (inserting the DNA from the sperm directly into the egg) were both successful in one case in five, while the subsequent Frozen Embryo Transfer (FET)[55] is successful only in one case out of six: "The overall delivery rate per fresh aspiration for IVF and ICSI was 20.2% compared with 16.6% per FET" (Sullivan et al 2013, 1375). Embryo transfer resulting in pregnancy and delivery ranges from a success rate of 31% in some clinics, down to 9% in others, according to the report summarizing the most wide-ranged and recent collection of data on all forms of ART in 2,184 clinics from 52 reporting countries and regions (but still related related to the year 2004). Hope and faith in assisted reproduction techniques are constantly spreading, no matter how disappointing the success rate is—though this should also be considered in the light of the low success rate of intercourse in human reproduction: our species is not a very fertile one.
Multiple pregnancies and deliveries, albeit reduced, are still a big proportion of ART pregnancies: "The overall proportion of deliveries with twins and triplets from IVF and ICSI was 25.1 and 1.8%, respectively, but varied widely by country and region." Premature delivery is high, too: "The proportion of premature deliveries per fresh aspiration for IVF and ICSI was 33.7% compared with 26.3% per FET." The following datum is difficult to compare with the absolute perinatal death rate, as it is a synthesis comprising different regions of the world with very different health conditions to start with: "The perinatal death rate was 25.8 per 1000 births for fresh aspiration for IVF and ICSI compared with 14.2 per 1000 births per FET" (in Italy it is 7–9 per 1,000).
Longitudinal observations (the monitoring started in 2004) show that the procedures for ICSI and embryo transfer are growing in proportion: they are mainly used to bypass problems of sperm "weakness." It has also become more common to transfer fewer embryos, also because of authorities' interventions:
Notably, the increasing proportion of cycles that are FET, the change in practice to single embryo transfer and the cessation of the transfer of three or more embryos in some countries has resulted in improved perinatal outcomes with minimal impact on pregnancy rates. (Sullivan et al 2013, 1375)
The disadvantages in the health of the babies born with the help of ART are well known and also documented in the report: "Higher incidences of congenital anomalies and of both autosomal and sex chromosome abnormalities specifically have been reported in both IVF and ICSI compared with spontaneously conceived infants" (Sullivan et al 2013, 1388). That ART babies are somehow disadvantaged in terms of health, is to be expected because of the very nature of ART, which make the infertile fertile, often using their own chromosomes and bodies: "It is difficult to determine the degree to which these associations are specifically related to the ART procedures versus any underlying factors within the couple, such as coexisting maternal disease, the cause of infertility, or differences in behavioral risk (eg, smoking)." (ACOG 2005). Some research[56] did not find any difference in the health of ART babies:
Most retrospective and prospective follow-up studies of children born as a result of ART have provided evidence for congenital malformation rates similar to those reported in the general population. In contrast, an Australian study of 4,916 women found that the risk of one or more major birth defects in infants conceived with ART was twice the expected rate (8.6% for ICSI and 9.0% for IVF, compared with 4.2% in the general population). As with other studies, the control group was not ideal because it did not include couples with infertility who conceived without ART. (ACOG 2005)
This is possible, as the medical definition of infertility is that procreation has not been achieved by the couple after a certain period of attempts, that experts have diminished over time from two to one year. The conclusion of the report is that more studies are needed to further define the risk of ART to offspring, which does exist.
From the implanted embryo, the future baby develops. The embryonal phase ends at the eighth week, then the fetal phase starts. This stage is the one in which the growing organism gets its arms and feet, and the facial feature characteristics of our species appear, differentiating the human fetus from the other mammals. Senses develop. Tact becomes functional already towards three and a half months; the sense of hearing after the sixth month; smell develops at six or seven months; taste at around seven-eight months; and finally the sight, which takes more time: the infant won't be able to see at its maximum potential before the age of three.
As its senses develop, the fetus' cognition of the pregnant woman's body and of her activities and relations develop as well. The future mother's body is the most immediate environment that surrounds the fetus before the birth, and information is absorbed from it as well as from the larger environment in which she lives, and from the people she interacts with. If its genetic parent(s) are not in the presence of the future birth mother, the developing child does not possess even a vague cognition of them.
And the pregnant woman's body is not a passive environment at all! Aristoteles was wrong—even apart from genetics—because the mothers' body influences the embryo and then the fetus through material exchanges. This is called epigenetics, that is "what happens around the genes," especially in terms of the hormonal makeup. Hormonal messages modify the structure of the embryo, contributing to its unique mental capacities, illness-resistance, neurological structure, and other physical features (remember the controversy about hormones making male fetuses gay). In comparison with genetics, epigenetics is the Cinderella of contemporary thought: in vulgarized science all is attributed to DNA, giving people a sense of ineluctability, as if everything in social life had been anticipated by our genes. Epigenetics, on the contrary, speaks about the influences of the environment on the developing child—primarily the maternal body but also the whole of the environmental stimuli and substances absorbed or perceived through her belly: sounds, temperature, presence of particular elements in the air, the water and the food that the future mother takes in.[57]
A difference is there between surrogacy and other pregnancies: surrogates report to distance themselves mentally from the developing child. They do not talk to it, nor touch it very often, leaving these activities to the intended parents. The developing child is imagined as a very unwelcome guest, and five months of its fetal movements are ignored (Teman 2010, 75 ff.).
Between the 37th and the 42nd week pregnancy comes to term, and birth approaches. Does the "industrial delivery," as many call the normal birthing process in developed countries, have something to do with how we have ended up even considering the possibility of having a baby, and then taking or leaving it by contract? Indeed, the impersonal way in which births occur in our society does not seem at all unconnected to the idea of women being used—and volunteering their bodies—as machines to obtain babies. This social attitude trivializing procreation does not start of course at delivery: the whole antenatal care by its specialists has been developed in order to control women's bodies during pregnancy, while the efficacy of its philosophy of treating all pregnancies as potentially abnormal is questionable. Ann Oakely wrote:
When antenatal care began, a few per cent of pregnant women were regarded as "at risk" of their own or their fetuses' mortality and morbidity. The task of antenatal care was to screen a population of basically normal pregnant women in order to pick up the few who were at risk of disease or death. Today the situation is reversed, and the object of antenatal care is to screen a population suffering from the pathology of pregnancy for the few women who are normal enough to give birth with the minimum of midwifery attention (Oakley 19862, 213)
The woman in labor who enters a hospital's or a clinic's birth department, will most likely be admitted to a Goffman-style total institution that uses rituals such as the relinquishment of personal clothes, a tricotomy, an enema, to mark her body as property of doctors. After these questionable procedures, the lower half of her body will be considered "sterilized," that is, out of reach for anybody who is not a health professional working there.[58] She is in a strange environment, under surveillance, more in the company of machines than of people. In the labor room her waters get routinely broken. As the woman in labor reaches the second stage of delivery, she will be put in the recumbent position and at this point she will have to submit to another painful ritual: an episiotomy. She will be attached to a fetal monitoring machine and a drip-feed apparatus, her veins perfused with synthetic oxytocin to accelerate the dilatation. At this point, to shoulder the increased pain from the oxytocin (contractions become instantly stronger) she will for sure ask for an epidural anesthesia that lessens her ability to feel her body and push the child out. The fact that women ask for epidurals is fully understandable in this context. The tolerance of pain, that gives the possibility of pushing more effectively by feeling the contractions, and eventually of experimenting the descent of the baby through the birth channel as pleasurable, can only happen in a supportive environment, that women certainly cannot obtain in the hospitalized birth, with intimidating, downright frightening conditions.
Though there have been attempts to invert the course,[59] the fear about something that should be a natural process is pervasive, as the institutions where births take place do not reassure women. On the contrary: they organize the work of the medical personnel as if they were on an assembly line, with babies obtained as "products" at its end. Personnel chat during the woman's labor, infantilize her, operate on her body as if she were an object without explaining the procedures, without asking for her consent, disrespecting to the highest degree this unique moment in a woman's life.
An excellent study on how the "assembly-line delivery" is conducted took place in the '80s in Milan, Italy (Regalia, Colombo, Pizzini 1984). Participant observation of 106 deliveries took place in five different hospitals and clinics, each with its particular birthing style—one was offering a "humanized delivery," that was little different from the others. All verbal and physical interaction of all people entering and exiting the waiting and the delivery rooms were recorded, and their spatial positioning as well. Impersonal and depersonalizing practices, barely masked as "scientific procedures," were thereby unveiled: they were in fact aimed at expropriating women from their centrality in labor, turning them into passive objects of medical manoeuvres and chemical inducement:[60]
Sometimes, and this happens everywhere, the visit [in the labor room] is also associated with a manual operation to enlarge the edges of the cervix in order to accelerate the dilation. This happens more if the woman is considered "troublesome." It is to this kind of woman that the procedures for acceleration are often addressed.
[From the field notes] The doctor examines the woman and says to the midwife: "Yes, she is giving birth, there is still a bit of rim but you can almost take her in" (into the delivery room)—the examination continues. Woman. "Ouch" (screaming).
Doctor. "You mustn't say ouch. If you want to be helped, push towards my fingers and please keep your mouth shut."
This maneuver seems to be performed off the record, because the staff makes no confirmation, even to colleagues, of having done it, nor it is recorded on the woman's clinical chart.
A doctor is examining the woman who suddenly shouts: "That hurts!" - The nearby midwife casts a look of reproach at the doctor and says, "Hey, what are you doing?"
Doctor. "Nothing."
Later, the midwife declares "that guy has a heavy hand, and who knows what he's capable of doing to get it over fast."
The personnel present there realizes that manual dilation is being performed by the evident reaction of pain by the woman in labor, not warned at all about what they are about to do. (Colombo and Regalia 1985, 73)
Sheer brutality was exposed in the practice of the obligatory cutting to enlarge the vaginal opening. The consequent stitching up was also performed without anesthesia (apart from the worst cases), scolding the women who expressed their pain. The same brutality plus scolding happened during the routine, again mostly unnecessary, of carving up of the uterus in search for the remains of the placenta, without even checking first whether it already came out intact.
I cannot help but compare these offences to the awe that people are encouraged to feel during the rituals of all religions. The men's words get worshipped in churches, mosques, temples, but the women's unique deeds (or words, for that matter) are trivialized and trampled upon.[61]
Unsurprisingly, satisfaction is low:
In Cartwright's study, 81 per cent of the 2,378 surveyed mothers wanted to be able to exercise choice about the medical management of their pregnancies and labours. Seventy-eight per cent of women who had their labours induced, did not wish to repeat the experience, but 93 per cent who had their babies spontaneously would choose to do so again. (Oakley 1986, 208)[62]
This hasn't changed, nor stopped (McIntosh 2012, Spandrio, Regalia and Bestetti 2014). "I will not have a second child," tells me a friend, the mother of a one year old girl, who gave birth to her in an Italian hospital.
Dehumanization has already occurred. Women in the birthing process have been deprived of their own timing, strength, capacity, to be put on an industrial assembly line. Franca Pizzini comments: "The generating power of women has been harnessed by technology; it is no longer able to scare men, who have the science, and the knowledge to apply it" (Pizzini 1985, 136). Then she quotes Chadeyron:
The woman is depersonalized, she must be silent and stay still. She is an embarrassing container through which one comes into contact with the fetus. Obstetricians monitor the baby inside the woman, who is considered inconvenient [...] The pregnant woman is far less than a sick individual: she is nothing more than the container of the fetal object explored by technology. (Pizzini 1985, 136)[63]
This "development," that has rendered the woman in labor a simple passive object on which doctors act to extract a baby, is akin to thinking that making a baby and delivering it to somebody else should be an easy act, feasible even on behalf of total strangers, or even a job.[64] What is most astounding is that these very strange conceptions are typically shared both by intended parents and by surrogate mothers, as we will see.
But let us now assume that the mother has had the best physiological delivery, in the positions that she has chosen, that her words and wishes have been carefully listened to, her requests fulfilled by the "birth team" of her choice. Let us also assume that the newborn is not narcotized as result of the anesthetics given or requested by the woman during labor.[65] What happens then?
The newborn is able to recognize its mother (her voice, her smell), and finds comfort in her physical proximity. It is reciprocal: the mother is pleased by the presence of her newborn, her level of oxytocin peaks in the meeting of the two protagonists of the birth. This meeting is nowadays recognized as one of the stages of delivery, because of its hormonal effects. Instinctively the newborn knows that the mother is its source of nourishment. They have known each other long before birth, as even the infamous Report on surrogacy made to the European Parliament recognizes:
It has been well documented that important biological bonds[66] are developed during pregnancy. The odour of an infant is attractive to the mother, while sight and skin to skin contact further promote psychological and physiological bonding as important hormones like oxytocin are in operation. Surrogacy interrupts the process of bonding that starts during gestation and continues after birth and this is a very important reason why many surrogates refuse to relinquish the child. (European Parliament 2013, quoting Tieu 2009)
Immediately after birth, the newborn reaches for a nipple, and when she or he suckles for the first time, the mother responds with an hormonal reaction that makes it easier for the placenta to detach itself (this could even happen in a hospital, should the personnel allow it). Judith Lothian describes their first meeting on the website of the World Health Organization:
With her baby in her arms, the mother is engrossed, excited, at peace, proud, and astounded at the miracle she has produced. No one tells her what to do. They know that she knows what to do—not because she and her baby have read the books or attended Lamaze class, but because their journey has physically and emotionally prepared them both for this moment. The weight of her baby on her belly helps her uterus contract and expel the placenta. Baby stays warm in his [sic!] mother's arms. Baby knows just what to do to survive in the world he has entered. He is awake and looks around. Within seconds or minutes, he has his hands in his mouth and is smacking his lips. Unpressured, he slowly but methodically crawls to his mother's breast and self-attaches. As he nurses, his mother's uterus contracts, insuring that bleeding will not be excessive. The two greet each other unhurried, confident, and unpressured. Together, over the next hours and days, they will get to know each other and fall in love. (Lothian 2000)
Or maybe not. In cases of surrogacy, this depends on the will of the mother, but generally also on what has been agreed upon by the mother long before birth, before even getting pregnant. Maybe her will is not paramount anymore. The agreement—in some strange places protected by the law as a contract—must specify if the mother is going to have the baby in her arms at birth, if she will feed it, if her milk will be accessed and bottle-given by the (ex-intended) parents, how often they will see each other again. Can this agreement be respected? Must it be?
The woman made a promise. The baby that she bore is now alive and kicking, and admittedly it would not be there if the pregnancy did not start with the very intention of separating child and birth mother. Can she do it? What will happen in the delivery room? Who will act? Is she pressured to relinquish the baby? What does she really want? What about the reassurance of the newborn by maternal presence? What about mother's milk? It is all in the agreement. But can she really act like a machine that delivers a product? In fact this is how she has been treated during the whole process starting from "antenatal care" to the final stitching up: women have been expropriated of their birthing power. Women are all taught to be just a fetal container to be acted upon.[67] Surrogacy is only one extreme, where the women themselves fully embrace this vision.
If the birth mother relinquishes her baby, what will she think and feel after having complied with the agreement? She has severed the ties that the newborn has developed with the only part of the world that s/he knows—her body, voice, physiological rhythms—what is the child's reaction going to be? Will it miss her? For how long? Babies forget, the pain—or just discomfort—will go away. But again—without wanting to generalize some perhaps very peculiar situations—some babies can't calm down if kept away from their birth mother. A birth mother who fought to keep her baby appears in the documentary Breeders by Jennifer Lahl (2014). Heather says that her daughter, a very pacific baby during the first days together with her, after having been taken into the care of the intended parents could not be calmed down for months (see chapter 3). And of course it is well known from the popular press that Zac, the child of Elton John and his husband, spent his first five months desperately crying. (According to the press, the music star and his husband had the idea of trying to calm him down by fetching his mother's milk daily from 10,000 miles away by their private jet. It did not help.)
But of course newborns are flexible, they must be. They will adapt to the new circumstances. They will grow and make up their own minds about the procedure that brought them into the world, into a particular family. As adults, some of the "surrogacy babies" are already campaigning in order to be able to know their birth mothers, as a part of the movement of young people who have been generated with a donor's contribution and want to know their genetic parents, organizing "Anonymous father's day" and demanding the legal possibility of anonymity to end. They might be a tiny minority among all people "born this way," but they do exist.
What about the birth mother? The original "birth mothers" on the other hand, are the women who chose this name to define themselves: they gave up their babies for adoption but now are fighting to see them again. They also fight against the "adoption industry," both private agencies and social services, that fosters it by persuading women to give up their newborns, which young mothers usually do in order to get back to their teenage lives—and/or for economic reasons. This transaction is minimized, too, by agencies, doctors, social workers, and lawyers, who do not recognize the difficulty in breaking the mother-child relationship and the possible future regret. Claude, one of these birth mothers, keeps a well-known blog where she writes about her experience and her fight, hoping to discourage young women from making the same choice that she did, and to avoid the continuous pain and regret this has caused her.[68] She writes me:
One of my earliest "online" friends was a surrogate, so I have always seen a direct correlation between a surrogacy situation and adoption relinquishment. I strongly believe the same long term risks apply to surrogacy and the children will likewise be affected like the adoptee now. If anything the whole assisted reproduction industry has completely ignored all the evidence from adoption and they have literally NO excuse for making the errors they are with humanity. But if anything they have seen what has "worked" in adoption and used the worst to make surrogacy work. For instance the whole "family builders" mindset of a "good deed" taken on by a surro is a version of a birthmother kool aide on steroids. That said, there does seem to be a distinction within the surro community and they do NOT align themselves often with birth-mothers.[69]
The situation is certainly different, as many more birth mothers in adoption than in surrogacy regret it. The team led by Susan Golombok, director of the Centre for Family Research at the University of Cambridge found no damage to the psychological health of surrogates followed for ten years after their experience (Jadva et al. 2003, Golombok and Murray 2003, MacCallum et al. 2003, Golombok et al. 2004, 2006, 2011, Imrie et al. 2012, Jadva et al 2012). But regret does exist for a minority. There are still no systematic studies on possible long-term effects of this experience on the children, but the Cambridge team found more adjustment problems of 7-year-olds born out of a surrogacy agreement (when they know it) than in those born from donated eggs and sperm—clearly not a definitive result given the precocious age of the subjects (Golombok et al. 2013). For intended parents, in addition to the insecurities common to all gestations, one point must be added: to obtain a child in a guaranteed way from this process and agreement is only possible if a law affirms that the mother of the child is not the woman who bore it. Now is the moment for the law to make its appearance.