SOMS AND SURROGACYPresentation 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 towork 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

Midwives• Establish contact with midwives

involved

• Support and guide the midwife to provide optimum care

• Assist with plan of care: antenatal, intrapartum, postnatal

• Maintain contact with midwives throughout

• Ensure confidentiality is maintained

Mothers

• establish and maintain contact with surrogate mother re plan of care

• Clarify arrangements with intended parents

• Explain the SOM role and the professional responsibilities of midwives

• Advocate for the woman

• 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 casehttps://www.youtube.com/watch?feature=player_embedded&v=Eqk9ReuSd48 • Surrogate finder website

http://www.surrogatefinder.com/findsurrogates/