SOMS AND
SURROGACY
Presentation by South Eastern Trust SOMs:
Betty Cameron and Lorna Lawther
Structure
• Introduction to surrogacy: legal and professional
aspects of midwifery practice
• Antenatal and intrapartum care: the role of the
SOM
• Postnatal and community care: the role of the
SOM
• Reflection and conclusion
Surrogacy: UK Law
Surrogacy Arrangement Act (1985)
• " Surrogate mother " – a woman who carries a child on
behalf of another person or other persons
- The agreement is made before conception
- The agreement is made with the intention of handing the
child and all parental rights to another person or other
persons.
• No person shall on a commercial basis
- advertise as a surrogate or act as an agent for a
surrogacy arrangement or provide literature or compile any
information with a view to its use in making, or negotiating
the making of surrogacy arrangement
HFEA Act (2008)
Clarifies parental orders and payments for surrogacy
Parental order: enables intended parents to have parental
rights without applying for adoption
Payments for surrogacy: non profit organisations can
charge a fee to advertise and match surrogates with
commissioning parents (Both parties sign a surrogacy
agreement which is lawful but legally unenforceable)
Definitions related to surrogacy
• Traditional/ partial / straight: biological mothers egg;
donated sperm either from intended father or other sperm
donor; surrogate mother has a genetic link with the child
• Gestational/full/ host: donor egg (can be from intended
mother); donor sperm (can be from intended father);
involves IVF; surrogate mother has no genetic link with
child
• Intended parent (commissioning parent): the person
who will have parental responsibility
Provenance of Surrogate Pregnancy
Paternal Genes
Maternal Genes
Conception
Intending Father
Surrogate mother
Artificial Insemination
Intending Father
Surrogate mother
Sexual Intercourse
Donor
Surrogate mother
Artificial Insemination
Intending Father
Intending Mother
IVF & Embryo Transfer
Donor
Intending Mother
IVF & Embryo Transfer
Intending Father
Donor
IVF & Embryo Transfer
Donor
Donor
IVF & Embryo Transfer
Midwifery supervision aims to:
• Offer support and guidance to every midwife practising in the united
kingdom.
Protect women and babies by actively promoting a safe standard of midwifery
practice.
Support midwives to practise with confidence, therefore preventing poor
practice.
Promote childbirth as a normal physiological event and to
work in partnership with women;
Ensure that women influence the development of maternity services and also
ensure that midwifery care is responsive to local needs.
Provide a role in advising and supporting women who use midwifery services;
advocating for the right of all women to make informed choices and providing
additional advice to women who are experiencing difficulty in achieving care
choices.
Local supervision in action (2009)
Karen is a para 2 . Her friend Tanya cannot have any
more children due to cancer treatment following the
birth of her first child. Karen knows how much her
friend would like to have another baby and offers to
carry a child for her.
Karen becomes pregnant with Tanya’s husband’s
donated sperm and attends her GP with Karen to
make arrangements for antenatal care. The friends
have both had antenatal care in this locality before and
the GP is supportive of them.
The women have midwifery care with the members of
team who previously cared for them in their respective
pregnancies.
Antenatal care: SOM perspective
Mothers
• establish and maintain contact
with surrogate mother re plan of
care
Midwives
• Establish contact with midwives
involved
• Support and guide the midwife
to provide optimum care
• Clarify arrangements with
intended parents
• Assist with plan of care:
antenatal, intrapartum, postnatal
• Explain the SOM role and the
professional responsibilities of
midwives
• Advocate for the woman
• Maintain contact with midwives
throughout
• Ensure confidentiality is
maintained
• Ensure confidentiality
maintained
The pregnancy progresses without problems and Karen
presents at T+9 to the MLU in labour. The handover to
the midwife is that ‘Karen is in labour, and she is giving
her baby to Tanya’. The attending midwife has no prior
knowledge of this woman or her circumstances but
provides care according to Karen’s wishes.
Following the birth a 6 hour discharge is organised and
Karen goes home with her husband and the baby goes
home with Tanya and her husband (the baby’s father).
Postnatal care is provided by the members of the
midwifery team that the women know.
Intrapartum care: the role of the SOM
Midwives
• Be a source of advice
guidance and support
•
•
• Act as a role model
•
• Ensure high standard of
clinical and professional
practice
• Ensure that the
professional responsibility
of the midwife is clear
• Maintain confidentiality
•
Mothers
Ensure that the wishes of
the mother are prioritised
Maintain contact until after
the birth
Enable the plan of care to
be fulfilled within the
wishes of the mother
Where deviation from the
plan is required support
the midwife to achieve this
• Maintain confidentiality
Both couples were present, not in the same room, when
discharge observations and information of mother and
baby was being completed.
The surrogate mother and her husband and the intended
mother and her husband and baby, went home with
information that the community midwife had their
addresses and telephone numbers and also informed that
the community midwife would be calling to their houses for
routine postnatal care visit, starting the following day. The
visits would continue until both c/m and families felt a
suitable time for it to end, up to 28days
The intended parents were delighted but apprehensive.
Postnatal care: role of SOM
• Enable midwives to support the families with
unconditional respect
• Ensure that midwives are able to provide the
information required for care should any
complications arise and provide appropriate
literature.
• Support the midwives involved in their care who
may have professional or personal issues in this
situation.
The community team took over the care of these families and we
acknowledge the input from the community team leader and
community midwives involved.
The families were known to the community midwives, health
visitor and GP teams. They were allocated to specific members
of these teams to minimise and avoid duplication of information.
Both women had previously been cared for individually by the
teams during previous pregnancies.
The women were friends and were open and gave information
freely.
They intend to make the child fully aware of the circumstances of
conception and birth.
They were in touch with their Legal advisor, who had been
previously involved with surrogacy and had knowledge of
different aspects of surrogacy.
Post natal and community care: the role
of the SOM
• Support for community midwives to carry out the post natal care for both
women in their own homes in a professional manner
• ensure confidentiality maintained for each woman
• Recognising that mother may require additional emotional support during
the post natal period and facilitating the provision of this
• Be a source of information and support to midwife and mother regarding
legal issues e.g registration of the birth, requirements of parental order.
• Ensure the multidisciplinary team work together to meet the needs of the
surrogate mother, her family and the intended parents
• Ensure a high standard of documentation of care for mother and baby
(separate notes)
In conclusion: the role of the SOM
• Make parents aware that there is 24/7 availability of the services of a
supervisor of midwives via hospital switchboard
• Protect mothers and baby.
• Continuity of care: giving right care to right person at the right time
• Community midwife able to assess capability of parenting and offer
help as required.
• Provide emotional support for midwives both personal and
professional.
• Provide education for staff on surrogacy.
• Ensure local policies are in place and assist in their development
On Reflection
• Every situation within surrogacy is different and
challenging
• The role of the supervisor is to be responsive to
the needs of women and support women, families
and midwives within the law of the land, Trust
policy and within NMC Rules and Standards.
• The surrogate mother is responsible for consent
for all treatment of the baby until parental order is
granted (can be between 6 weeks and 6 months)
• Need national guidelines for midwives on caring
for parents undergoing surrogacy.
Thank You
Reference list:
• Burrell, C. Edozien, L.C. 2014 review - Surrogacy in modern obstetric practice: Seminar
in foetal and neonatal medicine 2014
Burrell,C. O`Connor, H. 2013 Surrogate pregnancy : ethical and medico legal issues in
modern obstetrics. pp 1113-119 -Royal College Obstetrics and Gynaecology.
• Imrie, S. Jadva, V. 2013
Children of surrogate mothers: Psychological well-being, family relationships and
experiences of surrogacy Human reproduction vol. 29, No1 pp90-96 2014
• Imrie, S. Jadva, V. 2014
The long term experiences of surrogates: Relationships and contact with surrogacy
families in genetic and gestational surrogacy arrangements
Reproductive Biomedicine Online 2014 pp 424-435.
• Nursing and Midwifery ; Rules and Standards NMC 2012
• Local Supervising Authority
• Local Supervising Authority Midwifery Officers’ Forum, United Kingdom Strategic
Direction 2012-2015
Useful Links
BioTexCo
- http://biotexcom.com/
Relevant video on this website – Successful surrogacy case
https://www.youtube.com/watch?feature=player_embedded&v=Eq
k9ReuSd48
• Surrogate finder website
http://www.surrogatefinder.com/findsurrogates/