Although surrogacy was legalised in Queensland in 2010, limited guidelines and standards exist for managing surrogate pregnancies along with associated psychosocial complexities in the public health system. Increasingly, hospital staff must navigate complex ethical and practice dilemmas arising from surrogacy, particularly relating to the management of pregnancy and birthing when the needs and wishes of the birth mother and the intended parents do not concur or cannot be accommodated by the organisation. Of further concern are unanticipated antenatal complications and maternal health risks such as premature birth or medical emergencies which may result in decision-making for situations not considered in the original birth plan developed at the time of the surrogacy agreement. In these situations, birth plans may need to be revised, raising the potential for conflict between the birth mother and intended parents. The vulnerability of the birth mother may become evident in these situations with the risk that her needs are overlooked in favour of the child. Hospital regulations are further factors that may impact on the ability of the health system to meet the needs of the birth mother, such as resource limitations if she requests to be accommodated separately to the baby during admission to support her emotional well-being.
Limited empirical knowledge is available on the pregnancy and birthing experiences of women who have been a gestational surrogate, with most research focusing on motivations for altruistic surrogacy or the surrogate’s psychological well-being post-birth. In this presentation, case studies will be presented that highlight some of the key ethical and practice dilemmas facing maternity staff trying to balance the needs of both surrogate mothers and intended parents during the birth. Areas for future research will be identified and key learnings shared, including the need to ensure that the voice of the birth mother is heard and prioritised.