Surrogacy Counselling

 

Surrogacy Implications Counselling:

If you are thinking about becoming a surrogate, or you are currently looking for someone to be your surrogate, there is LOTS to think about. There is a mandatory counselling process built into the Surrogacy legislation for each state, but it can also be helpful to have a place to talk about what surrogacy would mean for you and your family well before you commence the formal process.

Narelle really knows surrogacy. Over the past 10 years, she has supported over 70 surrogacy arrangements. She has been there with families as they prepare for surrogacy and after their babies are born – she has even been thrilled to help a few families welcome their second surrogacy baby into the world!!

Narelle has also had the quite unique experience of travelling around the world investigating the implications of cross-border surrogacy for Australian families (you can read her blog here or access the complete report she wrote for her Churchill Fellowship here) so she really understands the issues you need to consider – whether you are contemplating becoming a surrogate, or whether you are exploring using a surrogate – either in Australia or overseas. Narelle is based in Brisbane, but can offer Telehealth consultations – wherever you are based in the world.

 

Surrogacy Support Counselling:

It is always recommenced that both intended parents and surrogates undertake regular counselling during the fertility treatment and pregnancy and after the birth of the baby – just to make sure everything still feels ok. It can be a really good way of making sure that little “niggles” don’t turn into big problems in your surrogacy. Narelle recommends regular sessions during the pregnancy (individual or joint sessions) to address unspoken issues that may arise as the arrangement progresses, and help eliminate, or at least minimise, any potential stresses before the birth.

Narelle is a 2015 Churchill Fellow Recipient, investigating the risks and implications of cross border surrogacy for Australians. She is sought after as a presenter at conferences and workshops across Australia and internationally, and has held lecturer and clinical supervisor positions with a number of postgraduate Psychology programs. She is regularly sought after by media to provide opinion in the area of fertility and surrogacy and has provided interviews to radio, TV and print media outlets.

Narelle is currently a Director of the Fertility Society of Australia, a member of the Clinical Advisory Council for the Brisbane South Primary Health Network, and in 2020 accepted invitations to become an Executive Committee Member of the Australia and New Zealand Infertility Counsellors Association and a member of the Advisory Group to the Healthy Male Plus Paternal Health Project. She has previously held Board or committee member positions with the Psychology Board of Australia, the Churchill Fellowship Association of Queensland, the Queensland Mental Health Association, the Australian Psychological Society Health College, the Australian Psychological Society Perinatal Special Interest Group, and the Australian Association of Cognitive Behavioural Therapy.

It is also recommended that counselling support be accessed at specific times during the arrangement such as:

  • should the embryo transfer be unsuccessful
  • if the pregnancy miscarries
  • if additional prenatal testing is recommenced
  • if complications arise during the pregnancy
  • if complications arise during the birth.
  • if there is relationship change/strain for either IPs or surrogate
  • if there is a death of any party to the arrangement
    It is also recommended further support be accessed following the birth, to assist with the transition of role for the IPs , and to ensure the healthy mental health of the surrogate.

Mandatory Surrogacy Counselling

Have you found your surrogate and you are ready to undertake the mandatory counselling process?  Narelle is one of Australia’s most experienced surrogacy counsellors and can provide your surrogacy counselling (either pre or post surrogacy) and the accompanying report (please note that some states have special requirements for counsellors – make sure you know the legislation in your area!).

What is the process for surrogacy counselling?

Surrogacy legislation around Australia requires the preparation of a Pre-Surrogacy Independent counselling report (undertaken prior to the surrogacy being commenced) and a Surrogacy Guidance Report (completed after the birth of the surrogacy baby) by an independent and appropriately qualified counsellor. The 2 reports must be completed by DIFFERENT counsellors and will include the counsellors’ opinion formed as a result of counselling interviews. Various issues can be discussed during the counselling interview to determine:

  1. each relevant person’s understanding of the social and psychological implications of the making of a parentage order on the child and relevant persons;
  2. that openness and honesty about the child’s birth parentage is for the wellbeing, and in the best interests, of the child;
  3. what care arrangements have proposed for the child;
  4. whether the making of a parentage order would be for the wellbeing, and in the best interests, of the child.

Australian surrogacy legislation requires that ALL parties to the surrogacy arrangement participate in counselling, therefore any partners of IP or surrogate MUST attend.  We understand that it can be difficult to co-ordinate lots of appointments around work, however, attendance to counselling has to be prioritised before the surrogacy arrangement can commence.

We will try to be as flexible as possible in offering times that accomodate everybody, but are unable to offer weekend sessions. Dependent on your location, Narelle may be able to travel to your home to undertake the counselling sessions. This does tend to be a really relaxed environment for such long sessions and it is the recommended option.  Travel exceeding 30 minutes will incur an additional fee.

Sessions can also be undertaken in Narelle’s rooms at Greenslopes Obstetrics and Gynaecology (at the Greenslopes Hospital) but please be prepared that there is minimal space for children within the clinical room.

Telehealth sessions may be possible for people who live in geographically distant locations, however counselling works far better in a face to face session and you will be requested to attend in person wherever possible.  If Telehealth sessions are to be the only mode of delivery, please confirm that your fertility clinic will be happy to support the arrangement if counselling has been undertaken by teleconference (there are variations about what the clinics will accept!!)

Please advise prior to booking sessions if any party to your arrangement has previously been involved in a surrogacy arrangement, or has undertaken surrogacy counselling, as we will require copies of all relevant reports to that arrangement.   The process for counselling and assessment may also be slightly lessened if counselling has been undertaken previously.

Pre Surrogacy: Independent Psychological Assessment Counselling Process:

Pre-surrogacy Implications counselling considers the general implications of engaging in surrogacy, and also the more formal pre-surrogacy counselling process required by the clinic and legislation. These issues must be considered by all parties prior to commencing the pre-surrogacy counselling, and will be reviewed at counselling following the birth of the child. Pre-surrogacy Counselling is an assessment process, with recommendations made from a psychological perspective. Pre-surrogacy counselling also entails personality and mental health assessment and review of all parties using standard testing procedures.

Prior to the counselling sessions, IPs and surrogates will be asked to complete a registration form and a series of questions which explore the issues surrounding surrogacy. You will also be asked to complete a brief mental health assessment and a lengthier psychometric assessment (completed online). Your responses to these written questions comprise a very important component of the counselling process and may be used directly within the report. Delays in completing these documents are likely to result in the final report also being delayed.

  • Appointment 1: Individual session with the intending parent(s). Any children of appropriate age to attend. Total time required: 2-3 hours.Appointment 1: Individual session with the intending parent(s). Any children of appropriate age to attend. Total time required: 2-3 hours.
  • Appointment 2: Individual session with the surrogate (and partner if relevant). Any children of appropriate age to attend. Total time required: 2-3 hours.
  • Appointment 3: Appointments with each adult individually to report on the PAI and discuss some issues and (if appropriate) with each couple. A joint counselling session with all adults. Total time required: 2-3 hours.

A report will be available for you to your doctor/clinic and lawyers within two weeks after the second appointment. A copy of the information in this report is forwarded to the intending parent(s) and to the surrogate (and partner).

The fee charged for pre-surrogacy counselling assessment process is calculated according to an estimated 6 hours of counselling following completion of all written documentation by IP(s) and surrogate, and a fee for producing a pre-surrogacy counselling report. Additional costs may be charged if the counselling time exceeds the estimated total of 6 hours.

Post Surrogacy: Independent Psychological Assessment Counselling Process:

A surrogacy guidance report is required by the Court as additional information for the Court to make a judgment about a surrogacy application. In order to complete such a report, all parties to the surrogacy agreement will need to attend an interview, with the relevant child also present and available.  A surrogacy guidance report is required by the Court as additional information for the Court to make a judgment about a surrogacy application. In order to complete such a report, all parties to the surrogacy agreement will need to attend an interview, with the relevant child also present and available.

Prior to the counselling sessions, IP(s) and surrogates will be asked to complete a registration form and a series of questions which explore the issues surrounding surrogacy. Your responses to these written questions comprise a very important component of the counselling process and may be used directly within the report. You will also be asked to provide copies of your draft surrogacy agreement and the pre-surrogacy counselling report that was undertaken prior to commencing the arrangement. Delays in returning these documents is likely to result in the final report also being delayed.

  • Appointment 1: Individual session with the intending parent(s). The surrogate baby to be in attendance.  Any other children of appropriate age to attend. Total time required: 1 hour.
  • Appointment 2: Individual session with the surrogate (and partner if relevant). Any children of appropriate age to attend. Total time required: 1 hour.
  • Appointment 3: A joint counselling session with all parties to the surrogacy arrangement in attendance. Total time required: 1 hour. (All sessions would be generally undertaken on the same day).

A report will be sent to referring person or agency within two weeks after the final appointment. A copy of the information in this report is forwarded to the intending parent(s) and to the surrogate (and partner). The fee charged for the post surrogacy counselling assessment process is calculated according to an estimated 3 hours of counselling, and a fee for producing a surrogacy guidance report. Additional fees may apply if additional time is required or paperwork is not completed.
Further appointments after the initial assessment consultations will be costed on an as used basis. Future court documentation and attendance will incur additional costs.

 

Issues to consider prior to commencing a surrogacy:

If you are thinking about becoming a surrogate, or you are currently looking for someone who could be your surrogate, there are LOTS of things to think about. I suggest you look through this (really long) list of considerations and questions. Use it to help get to know each other (if you have recently met) and guide your conversations about the surrogacy.  It will really help clarify if you are well matched and make sure the surrogacy counselling proceeds super smoothly!

Family and personal circumstances
  • Interesting things to know about you?
  • Who are the main people in your lives?
  • What are your interests? Music, sport, hobbies etc?
  • What is your current relationship status and relevant relationship history?
  • What is your family situation? Partner? Children? Extended family?
  • Have you told your children about your surrogacy plans? If they have been informed, how have they responded? If they have not yet been informed, how would this occur, when and how do you feel they will respond?
  • Are your parents / step parents still alive? Are they in good health? If no longer alive, when did they pass away?
  • Are your parents / step parents still together/divorced/remarried?
  • Do you have any siblings or step siblings? If so, what is their marital status, and the ages of any children they may have
  • Are you genetically related to your parents and any siblings?
  • What level of schooling did you complete? Have you completed any further study or achieved any additional qualifications?
  • Do you work outside the home? What is your current occupation? How long have you been in this role?
  • How flexible is your workplace if you need to take time off?
Response to surrogacy plan
  • Have you told your family about your surrogacy plans? If so, what was they response?
  • Is your family comfortable with you doing this? How might it affect them? Are they willing to support your decision if you choose to do this?
  • If you haven’t told people, do you intend to? If so, when might you do this? How might you explain your pregnancy to others including your children, friends, family, and people in the supermarket?
  • Outside of your family, who have you told about your surrogacy plans? How have they responded?
  • Are you a member of any surrogacy related support groups?
Health and wellbeing
  • Have you experienced or been diagnosed with any mental health issues in the past? If so, how were you treated or helped? Eg depression, anxiety, psychosis or any serious psychological conditionsHave you experienced or been diagnosed with any mental health issues in the past? If so, how were you treated or helped? Eg depression, anxiety, psychosis or any serious psychological conditions
  • Are you currently undergoing any treatment for a mental health issue or experiencing any mental health issues which you do not receive or seek treatment for?
  • Do any of your family members suffer from or have experienced a mental health issue?
  • Do you smoke cigarettes or other tobacco products?
  • What is your usual weekly alcohol consumption?
  • Do you use recreational drugs? If so, how often?
  • How often do you gamble?
  • How would you rate your health?
  • What do you do to stay healthy?
  • Do you have any health or medical issues?
  • Do you or your extended family have any medical conditions that might affect the pregnancy?• Did you enjoy your previous pregnancies?
  • Can you tell me about your previous pregnancies? Have you ever had a termination, miscarriage, stillbirth or relinquished a child for adoption? What were your previous births like?• Do you wish to or plan to have any more children? Did you have any health concerns during previous pregnancies e.g. serious morning sickness, gestational diabetes, pre-eclampsia etc?
  • Did you experience any Post Natal Depression or anxiety or any other mental health concerns during or following previous pregnancies? If so, what did you do?
  • What do you know about the medical procedures involved in being a surrogate?
  • Are you comfortable with having injections, internal ultrasounds and embryo transfer procedures and the possible risks they entail?
Stress and coping
  • What do you do to relax or unwind? 
  • What are the sources of stress in your life? How do you cope with them?
  • What strengths and support do you have that will help you navigate the surrogacy journey?
  • How would you manage with treatment and work including looking after your own children?

 

Experience and motivation with surrogacy
  • Surrogates motivations: What makes you interested in carrying for your IPs?
  • Surrogates motivations: How long have you been thinking about being a surrogate?
  • Surrogates motivations: What attracted you to your IPs?
  • Surrogates motivations: Have you ever been a surrogate for anyone else?
  • Surrogates motivations: Is this the right time for you tp be a surrogate? What else is going on in your life right now?
  • Have you ever donated eggs or embryos before?
  • What are your motivations for being a surrogate?
  • What do you think will be the most challenging aspects of the surrogacy journey for you and your family?
  • What do you think will be the most rewarding aspects of the surrogacy journey for you and your family?
  • How do you think you would cope if surrogacy was unsuccessful?
Legal issues
  • Are you aware that either party can change their minds at any time during the surrogacy arrangement?
  • Have you obtained legal advice yet?
  • Are you aware of the non-legal binding of a surrogacy arrangement?
  • What would be the plan for the child if before the birth the IPs relationship broke down and they separated? Have you discussed this with surrogate/IPs?
  • What would be the plan for the child if before the birth one or both of the IPs became seriously ill? Have you discussed this with surrogate/IPs?
  • What would be the plan for the child if before the birth one or both of the IPs died? Have you discussed this with surrogate/IPs? Who decides the fate of the child? Will the child be for “open adoption” or “family adoption”?
  • Are you aware that at birth the surrogate is the legal parent until parentage is transferred to the IPs at a later stage?
Communicating with others
  • When & how will you tell family about transfer?
  • When & how will you tell friends about transfer?
  • When will you announce pregnancy to the wider community/facebook/publicly?
  • When& how will you make milestones public?
  • When & how will you announce pregnancy to family?
  • Do you want to attend birthing classes? (eg Calmbirth)
  • Your ideas for three people that can look after the children?
  • Do you imagine there will be any future contact between the child and the surrogate’s children?
Parenting differences
  • What qualities and abilities do the IPs have that would make them good parents?
  • What are the differences in your parenting styles and attitudes (between the IPs & surrogate)? Do you see this having any future impact?
  • Have you discussed your attitudes to any religious or cultural practices e.g. circumcision?
Costs and reimbursements (NB, only altruistic surrogacy is legal in Australia, but reimbursement of reasonable expenses is expected)
  • What are your thoughts about life insurance?
  • What are your thoughts about private health insurance?
  • Who will purchase pregnancy tests & any other equipment needed throughout?
  • Who will purchase maternity clothes?
  • How often are you happy to provide/pay for a babysitter for appointments if family are not available?
  • Would your family be happy to babysit so we can all attend appointments? If not how will you arrange childminding for your surrogate to attend appointments.
  • If appointments are booked on her day off from work how will you compensate the time she misses out on running errands or other domestic duties? How often are you happy to provide/pay for a babysitter to allow time to rest?
  • What are your thoughts on using alternative therapies and which ones would you be happy to use?
  • Do you have a budget for alternative therapies / how do you feel about covering the cost for these services?
  • How do you feel about covering travel expenses to/from appointments? (petrol & parking)
  • Are you able to cover wages of surrogate (& partner if they need to take time off to care for surrogate/children) if it is necessary during pregnancy to stop working? Is there a cap on this?
  • Are you able to cover wage post birth if it is necessary due to surrogacy related medical issues? Is there a time frame / budget cap on this?
  • What arrangements made regarding childcare during pregnancy and confinement if required?
  • How will expenses be paid for? By whom? How will you monitor expenses?
Expectations for pregnancy
  •  It can take a long time to compete all the steps before we commence treatment (medical, legal and counselling appointments and approval from the Patient Review Panel). How much time are you prepared to commit to this?

  • Once the surrogacy application has ben approved – is there a limit to the number of treatment cycles the surrogate will undertake?

  • How many transfers are you comfortable with? If the first or second embryo transfer were not successful would you be prepared to try again? The IVF process may not be successful. How would you feel if you do not become pregnant or miscarry?If an egg and/or sperm donor are being used – are you comfortable with this?

  • Are you aware there are health risks to you during the pregnancy and the birth?• How would the surrogate conduct herself during the pregnancy in relation to alcohol consumption, smoking or other drug use

  • How would the surrogate conduct herself during the pregnancy in relation to lifestyle factors such as diet or exercise

  • Are there any medications or health supplements  the surrogate may be taking during the pregnancy? Is there any potential impact from these on a foetus?

  • Have you discussed who will attend routine medical appointments with the surrogate during the conception and pregnancy?

  • Have you discussed and planned how many embryos are to be transferred and/or how many attempts will be made? (may depends on clinic or state legislation)• Who will attend appointments?

  • How would you feel about a multiple birth? What is your position on selective reduction?

  • How involved does the surrogate want the IPs to be during the pregnancy? How involved do the IPs want to be during the pregnancy? Do you want to attend all appointments together?How will you all get to appointments? What if one person can’t drive (eg in third trimester)?

  • Who will accompany (if anyone) surrogate to clinical appointments / procedures etc?

  • Does the surrogate want the IPs in the consultation / procedure at the same time?

  • What is your attitude towards prenatal screening? How do you feel about the Harmony/NIPT test?

  • What tests regarding the baby’s health and wellbeing would you consider having?

  • Does the surrogate give consent for the clinic to give results etc to the IPs? Written consent will be required.

  • Would you like to find out the gender of the baby? Would you be disappointed if it were to remain unknown? What are your thoughts on one or two knowing and not the other/nobody else?

  • What is your attitude towards termination of the pregnancy if a child is diagnosed before birth with a disability or abnormality? Who decides upon a termination?

  • If the IPs wished to legally terminate the pregnancy in the case of disability or abnormality, and the surrogate refused, what would be the plan for the subsequent care of the child?

  • What if the surrogate thought there should be a termination and the IPs disagreed? • What would be the plan for the child if a child was born disabled or with a serious medical condition and the IPs were unwilling or unable to take them on?

  • Have you discussed the possibility that for a health child the surrogate may refuse to relinquish the child? How would this situation be handled?

  • Have you discussed the possibility that for a health child the IPs may refuse to take on the child? How would this situation be handled?

  • How do you feel about Whooping Cough/Influenza/other vaccinations?

  • Have you discussed the possible medical complications that may occur for both the surrogate and the child?

  • How would the surrogate manage with pregnancy and work including looking after her own children?

  • If the surrogate became sick during the pregnancy and needed bed rest or hospitalisation, how would this be managed? What support would be provided?

  • If miscarriage occurs, where will procedure (d&c) be undertaken?

  • What are your agreed arrangements in the case of a stillbirth? Who will make decisions regarding autopsy, funeral etc

Counselling and support
  • How often would you like to have group counselling, at a minimum? (Recommendation: once monthly/minimum once every 3 months)
Leadup to the Birth
  • How do you feel about having a baby shower, gender reveal, etc?
  • How do you feel about the weeks leading up to the birth?
Birth plan
  • What is your ideal birth? Where would you want baby to be delivered? What is the surrogate’s preferred birth plan?
  • Where will the birth will occur? Eg. home birth, natural birth, hospital etc. Is everybody comfortable with this?
  • Choice of obstetrician & hospital you would prefer?
  • Discussion regarding type of delivery?
  • Medications during labour?
  • Who will pack hospital bags?
  • Who will be contacted with information regarding commencement of delivery? Grandparents, aunts, uncles, children etc……Who would you like to attend the birth? (In addition to IPs & surrogate, surrogate’s partner)
  • Your thoughts on photography during pregnancy?
  • Your thoughts on photography & video during labour?
  • Your thoughts on delayed cord clamping?
  • Who will cut the cord?
  • How do you feel about Syntocin injection to induce the birth of the placenta?
  • Immediately post birth, who will baby go to? Have you discussed who will hold the baby first?
  • Have you discussed and planned how and when the surrogate will separate from the child and the IPs will take over the care of the child?
Immediately after the birth
  • How do you feel about breastfeeding? How do you feel about expressing?
  • What are the arrangements for the remainder of the “rooming in” period? (discussion with hospital/birth centre may be required regarding this)
  • IPs to have additional room?
  • If a hospital stay is required who will look after the children & help keep surrogate’s house running? What happens if she is out on extended bed rest?
  • What are the arrangements for the discharge of baby from the hospital? Including in the scenario where the surrogate needs to stay, will the IPs take baby home before the surrogate is discharged? Is the hospital okay with this?
  • Has the surrogate made any special requests regarding the separation process? Are the IPs happy to accommodate these requests?
  • Has the surrogate imagined what it will be like handing over the baby to the IPs? Does she have any concerns about her ability to do this?
  • How would the surrogate deal with the possible grief that she may experience due to her body’s hormonal response?
  • Have you thought about possible complications occurring at birth or if the child was delivered and was very sick or disabled?
  • Where will everyone sleep on the first night and for the few nights there after?
  • Who will help surrogate out for 6 weeks after birth, and help her with her children?
  • How do you feel about immunisations/injections for baby? (Vit K / Hep B etc)
  • How do you feel about surrogate baby cuddles in the first few days? And thereafter? How will you arrange this? And how often? How does the surrogate think she will feel in the first few days and weeks following the birth?What contact is it planned the surrogate will have with the child in the immediate period (weeks/months) following birth?
  • How often would you like to have contact after the birth? In the first few days? Weeks? Months? And thereafter? And what type of contact?
  • If caesarian birth is required, what arrangements will be made to support the surrogate at home after the birth?
Long term contact
  • What ongoing contact and communication is it planned there will be between the child and the surrogate and her family?
  • How will this contact and communication be managed?
  • What relationship and role does each person plan to play in the child’s life?
  • What role do you imagine the surrogate having in the child’s life?
  • What will the child call the surrogate?

 

Conflict resolution
  • Have there been any conflicts that have arisen during the surrogacy process so far? If so, what were they? And how were they resolved?
  • Have you agreed on how any future conflicts related to the pregnancy or during the pregnancy would be addressed? If so, what process would be followed?