Surrogacy pregnancy and birth in the US

Once a positive pregnancy has been confirmed by the fertility clinic, a US surrogate will usually attend an early pregnancy ultrasound scan at around 5-9 weeks. If all is well, she will graduate from the fertility clinic and then be cared for by her local OBGYN for the rest of the pregnancy.  A US surrogate’s antenatal care will usually include a 12 weeks scan, a foetal anatomy scan at around 16-20 weeks and continued growth scans during the third trimester, with OB appointments and other tests and scans as needed along the way.  

The US surrogacy agency will be involved at every step, keeping the intended parents updated about key antenatal appointments and any issues that arise, as well as how the surrogate is feeling and any extra support she needs.   

What happens during the pregnancy between the intended parents and a US surrogate?

Most US surrogates expect to be in regular contact with their intended parents via messages and video calls during the pregnancy.  As well as communication about the pregnancy, it is typical for a broader relationship to develop in which both sides get to know each other and share information about their lives and families.  Surrogacy arrangements always involve everyone working together as a team, and for many this extends into a much longer – and often lifelong – friendship. 

Many intended parents also build in time to visit their surrogate in person during the pregnancy, often travelling to the US for the 20 week scan.  Most surrogates love the chance to meet in person and to introduce their families.  It is also a good opportunity for intended parents to familiarise themselves with the local area in advance of the birth, and look at local accommodation options and amenities as well as visiting the hospital where their baby will be born.    

The US legal process

The second half of the pregnancy typically involves some US legal work. US surrogacy law in respect of parentage is state-specific, and there is typically a legal process to follow in the state of birth (either a court or administrative application) to confirm that the gestational surrogacy agreement validly grants parenthood on the intended parents. The US attorney will manage the process, usually without the intended parents needing to attend the court hearing (if there is one).  

The resulting court order or paperwork tells the delivery hospital and state authorities to recognise the intended parents as the legal parents of their child and to register their names on the child’s US birth certificate.   

Birth planning for US surrogacy 

Planning for the birth in the USA starts in earnest during the third trimester of pregnancy, with guidance and support from the US surrogacy agency. Intended parents should continue to discuss birth planning with their surrogate to ensure that everyone is clear and feels comfortable with what has been agreed about where the birth will take place, who will attend and any other specifics.  

The US attorney or surrogacy agency will also ensure the delivery hospital has all the legal paperwork required to support everyone when the baby arrives. 

What happens on the day of the birth?

Most intended parents travel to the US at least two weeks before their baby’s due date.  Parents are normally present at the birth, and can cut the umbilical cord, have skin to skin contact and to feed their baby for the first time, if this has been agreed with the surrogate. 

Hospitals in the US are supportive of surrogacy and typically arrange private rooms for the surrogate and separately for the intended parents and their baby, often close to each other if that is requested.  

Nurses in hospital give parents a lot of support in the early hours after their child’s birth, teaching basic baby care before the baby is discharged from hospital.  If all is well, the baby will normally be discharged from hospital within a day or two of the birth. If the baby has any medical difficulties, specialist care can be provided, either at the hospital or at a specialist centre elsewhere.  Some hospitals offer continuing post-birth check ups for babies while they remain in the US.