Tips for a Painless Surrogate Mother Process

First and foremost, congratulations and thank you. It is a generous, selfless act to become a surrogate mother and give your time, energy, and body to conceive and nurture a child for another family. You have chosen to give a precious gift to parents who wish to start a family and yet cannot do so biologically.

As many other women who have walked this path before you will testify, the surrogacy process is a beautiful journey. Your sacrifice will bring deep happiness to the intended parents and allow them to experience the same joys of parenthood that you have experienced.

However, just because surrogacy is a noble cause does not mean it comes without a unique set of challenges. To make your surrogacy process as smooth as possible, Bionix Health at Home has composed a list of insider tips for easing your discomfort every step of the way.


Mental and legal preparation for the surrogate mother process

Once you have decided to become a surrogate mother, there are many factors to take into consideration to make the surrogacy journey the best fit for you as well as your intended parents.

Agency or independent?

The first big decision to make is whether you will hire a surrogacy agency to facilitate your journey or if you will take the independent route.

Surrogacy agency


  • An agency does all the work of matching you with a suitable couple.
  • Its staff will support and guide you through the entire surrogacy process.


  • There is less freedom with an agency than with an independent surrogacy.

Independent Surrogacy


  • More freedom for certain aspects.
  • It is more likely you will have had a relationship with the intended parents before the surrogacy.


  • You must do the work of finding intended parents yourself. You could find a suitable couple by asking friends, family, and social networks.
  • There is a greater risk of problems with protection and legalities. An agency has extensive experience with legal situations of this sort.

Surrogate pregnancy type

Next, you must decide the type of pregnancy you wish to carry. There are two types of surrogate pregnancies:

  1. Traditional, in which the surrogate mother is inseminated with only the sperm of the father.
  2. Gestational, in which the sperm of the father and the egg of the biological mother are implanted in the surrogate mother.

With gestational surrogacy, the surrogate mother has no biological relationship to the child. The intended mother goes through a traditional in-vitro-fertilization cycle (IVF) during which the sperm of the intended father (acting as a sperm donor) is used to create embryos that then are transferred to the surrogate. If at least one member of the commissioning couple is the genetic parent of the child, the commissioning couple are presumed to be the natural parents of the child gestated by the surrogate.

As for traditional surrogacy, the sperm can either be the sperm of the intended father or that of a donor. Even though the surrogate mother has a genetic connection to the child, all intentions are for her to grant parental rights to the receiving couple. A legal agreement is signed at the beginning of the cycle to assist in a smooth transition when the child is handed over to the other party immediately after birth.

Legal aspects of becoming a surrogate mother

Surrogacy laws vary from state to state. It is crucial that you understand them clearly so there are no issues with the pregnancy or the guardianship of the child. For example:

  • You must do all you can to facilitate a healthy pregnancy.
  • You may not terminate the pregnancy without legal approval from the child’s parents
  • You need to hand over the child after birth.

Make sure that you have good legal representation who is familiar with the surrogate mother process, whether it is through your agency of choice or a personal lawyer.



Medical preparation

When becoming a surrogate, you need to prepare your body for accepting and carrying an embryo that has already started developing. There are risks and side-effects associated with the surrogacy process that you should discuss with your physician at the outset.

Blood draws

Blood draws needs to be done at the beginning of your journey to ensure that you are healthy enough to be a surrogate. There will be minimal discomfort with this; just the pain of the prick as well as some mild bruising at the needle site. To prevent bruising, apply firm, steady pressure for 3 to 5 minutes after the catheter or needle is removed. You can also use a cold compress for comfort.

Surrogate injections of hormones

One of the least pleasant aspects of medical preparation to receive the embryo are the hormones and surrogacy medications the mother must take to receive the embryo. There are three main medications that are common for surrogate injections:

  • Lupron – subcutaneous injection. Lupron prevents the surrogate’s menstrual cycle from interfering in the pregnancy process.
  • Estrogen – intramuscular injection. Estrogen is generally taken via pill or patch, although it can be given as an injection, as well. It artificially thickens the lining of the uterus wall to prepare for embryo implantation.
  • Progesterone – intramuscular injection. Progesterone is generally injected, although it can be given via vaginal suppository or pill. Progesterone is administered several days before the embryo transfer, after the uterine lining has reached its critical thickness. It induces the uterus to produce the proper nutrients to support the embryo and improves implantation success.

These three injections can be self-administered and are taken over the course of several weeks to prepare for the embryo transfer.

There are some discomforts associated with these surrogate injections. Regarding the shot itself, you can reduce the needle pain by using ShotBlocker®. The small, c-shaped plastic device has bumps on the back. When pressed firmly against the skin, the ShotBlocker saturates sensory nerves in that area. The needle is inserted in the center opening and most users say they feel no pain at all. The medications can also cause side effects such as cramping, mild bloating, hot flushes, fatigue, headaches, irritability, breast tenderness or nausea.



Surrogacy process step-by-step

Once the hormone treatments have been completed and the body is ready to receive the embryo, the exciting journey of the pregnancy process can begin. Our list will help walk you through the surrogacy process step by step.


The implantation appointment will likely be coordinated so the intended parents can be there. On her blog “My Pod, Their Pea,” surrogate Leslie Mattern describes the transfer appointment of her first surrogacy. She arrived at the venue and had some lab tests done to confirm numbers immediately before the transfer. Her provider took her back for acupuncture, which is supposed to relax the surrogate and the uterus. The intended mother was present at the appointment and was able to sit with Leslie while they waited.

A doctor came in to explain the procedure and the men (Leslie’s husband and the intended father) could enter the room at that time. The group got to see the embryos on a screen before the transfer.

The actual transfer only took five minutes. The intended parents could watch the transfer happen via an ultrasound machine, and Leslie loved seeing the excitement on their faces. Leslie had to lay still for 30 minutes afterward to aid the transfer, then she underwent a second round of acupuncture that lasted 45 minutes. She was wheeled to the car and put on bed rest for two days. While complete bed rest for two days is not always recommended, some kind of modified bed rest is required for 24 to 36 hours post-transfer to aid in implantation.

After nine days, the surrogate returns to the doctor for a blood test to confirm that the pregnancy took. For Leslie, the transfer was a success and on October 26, 2015 she delivered twins – two beautiful babies, one boy and one girl.

Regular check-ups

Invite intended parents to your regular check-ups if possible. For a healthy pregnancy, your doctor will likely want you to have prenatal visits on the following schedule.

  • 1 visit per month in weeks 4 to 28
  • 1 visit every 2 weeks in weeks 28 to 36
  • 1 visit every week in weeks 36 to 40

The intended parents will likely want to attend the ultrasound appointments, as well. The first ultrasound will be a transvaginal ultrasound, which will be performed 4 to 6 weeks post transfer. The purpose of the transvaginal ultrasound is to detect the baby’s yolk sac, gestational sac, and early signs of heartbeat.

The second ultrasound appointment will occur at approximately 20 weeks post-transfer. This appointment is the big one, including full anatomy scans. This is the appointment during which the baby’s gender can be identified, if the surrogate or intended parents want to know. The baby’s heart, brain, bones, and internal organs will be looked at as well.

Good emotional support

Surrogacy can be emotionally draining during many parts of the process, from getting matched with a couple to presenting the gift of life to your IPs. Gestational carriers will go through the side effects of the pregnancy while still attending work, school, or other activities. It is especially important for you to find emotional support since you will undoubtedly experience the unpleasant symptoms of pregnancy (morning sickness, etc.) knowing that you’ll give the baby or babies away at the end of the pregnancy.

Emotional support can be found through a variety of means:

  • Find a support group of surrogate mothers, or even one other surrogate mother who you can chat with and vent to.
  • Keep all mental health appointments. It might even be helpful to schedule therapy during your pregnancy, even if you were not seeing a therapist prior to the surrogacy, to process conflicting or heavy emotions.
  • Get help from your partner or other family members to handle household responsibilities and childcare.
  • Take the time to rest whenever possible.
  • Be intentional in your communication with IPs. Maintain open communication with them. Some surrogates even try to build a friendship with the intended parents, which can serve as a reminder of why they are making the sacrifice.

Understand the risks of carrying multiples

Since multiple embryos are created during in-vitro fertilization (IVF) and transferred, it is common for a surrogate mother to carry twins, triplets, or even more babies. While there is no guarantee that all the embryos will take, there is a heightened possibility. Both the surrogate and the intended parents should be aware of the potential risks of multiple babies:

  • Premature birth The babies are not quite ready for the world outside the womb and may experience health problems.
  • Low birth weight These little ones often have trouble breathing on their own. They might not be able to control their temperature or put on weight easily.
  • Gestational diabetes The surrogate mother is much more likely to experience gestational diabetes with multiples. It can be kept under control with proper diet, exercise and insulin shots if needed.
  • Preeclampsia The surrogate mother might experience high blood pressure and excess protein in the urine, and the condition can cause damage to organs (liver, kidneys, brain) if left untreated.
  • Placental abruption This condition occurs when the placenta detaches from the uterine wall before delivery. It can lead to growth problems, premature deliveries, abruption is common after the first baby has been delivered vaginally. It could mean that the other babies need to be delivered via cesarean section.

Possibility of miscarriage

The excitement, joy, and satisfaction of carrying a child for another parent are some of the main reasons of choosing to become a surrogate mother. However, considering increased risks associated with surrogacy, that joy can quickly turn to sorrow when the unthinkable happens.

Miscarriage is the loss of an unborn child up to the 20th week of pregnancy. (If the loss occurs after the 20th week of pregnancy, that qualifies as a stillbirth). Miscarriage that occurs during the first two to three weeks of pregnancies occurs because the embryo does not implant correctly. After that time, the cause could be any number of things:

  • Genetic irregularities
  • Malformation or scarring of the uterus
  • Diseases that affect the mother (e.g. measles)
  • Chronic illnesses

Contrary to popular myths, miscarriages are not caused by everyday functioning, engaging in sexual intercourse or extensive exercising.



Tips for easing pregnancy side effects

You are taking on a noble task in being a surrogate, and having to endure the less-than-desirable side effects of pregnancy on behalf your intended parents. Side effects are radically unique to each woman’s journey, but some common ones are exhaustion, nausea, indigestion, constipation, bloating, backaches, difficulty sleeping, higher blood pressure and hormonal mood swings.

Here are some quick tips for easing two of the more common pregnancy side effects:

 Morning Sickness Back pain
1.    Ginger products such as ale, candy, and ginger tea 1.    Strengthen your back muscles from the get-go.
2.    Snacks every 1-2 hours 2.    Practice good posture.
3.    Plain and/or dry foods 3.    Choose alternative care, such as chiropractic care.
4.    Hard candy 4.    Try different yoga poses and proper stretching.
5.    Vitamin B6 supplements or foods 5.    Foam roll your lower back
6.    Acupressure 6.    Wear a supportive bra and supportive shoes.




Pregnancy exercises

Exercising when you are pregnant is just as important as getting exercise at any other point in your life. As a surrogate, there is even a bigger impetus for you to stay fit as you have a legal obligation to do everything you can for the health of the baby.

Due to the excess strain on your body, not all workouts are recommended for pregnant women. A pregnancy workout routine should include activities that are fun yet simple. That way, you can work them into your schedule, you can stick with it for the entire term of the pregnancy and you do not risk straining yourself, which can lead to health threats for you and your little one. Here are a few ideas for exercise during pregnancy:

  • Walking – low-impact and no learning curve
  • Swimming – works both arms and legs and counteracts the increased back strain from your extended belly
  • Stretching – enhances blood circulation, which boosts mineral transport and the elimination of waste from the body
  • Yoga – builds strength and flexibility and can be done at home with yoga videos

In addition to physical activity, it is also crucial for you to eat a balanced diet. A diet rich in proteins, simple carbohydrates and complex carbohydrates is ideal for surrogate mothers. With both exercise and a healthy diet, you keep yourself at a healthy pregnancy weight and you ensure the baby gets all the nutrition it needs.



Postpartum depression after delivery for surrogates

According to Infertility Answers, 10-20% of all women who give birth experience postpartum depression. The causes of postpartum depression are primarily hormones followed closely by mental health issues such as having a poor support system at home or conflict in relationships. Therefore, postpartum depression can affect any mother: surrogates, those who give their children up for adoption and even women who have planned their pregnancies for a long time and raise the children.

When does postpartum depression start?

It usually starts within a few months of delivery.

How long does postpartum depression last?

There is no one simple answer to this question. The length of postpartum depression depends on the severity of symptoms and the speed with which you receive treatment once you recognize the symptoms. For some women, postpartum depression only lasts for a few weeks, for others it is a few months, and sometimes it can last up to a year.

What are postpartum depression symptoms?

Common symptoms are as follows:

  • Depressed mood
  • Tearfulness
  • Inability to enjoy pleasurable activities
  • Trouble sleeping
  • Fatigue
  • Appetite problems
  • Suicidal thoughts
  • Feelings of inadequacy as a parent
  • Feelings of rejection
  • Impaired concentration

How can I prevent or reduce the symptoms of postpartum depression?

  • Set realistic expectations for yourself and your recovery
  • Try to avoid isolation
  • Surround yourself with supportive friends and family
  • Make time for yourself
  • Talk to other surrogates about their experiences; they very well might be going through the same thing.

If your depression lasts for longer than two weeks, you should talk with your OB or midwife for recommendations.

Most importantly for surrogates, the presence of postpartum depression does not mean that the match with intended parents was flawed or that handing the baby over was in any way a “mistake.” It is a medical side effect that can occur in any birth situation, and with the right care and support you can recover and get back to your life.




Surrogacy is a unique, joyous calling for those who choose to undertake it. The journey comes with its own unique set of challenges that make the sacrifice all the more admirable. Bionix Health at Home hope these tips will provide relief when you need them and allow you to focus on your “why.” Whatever momentary discomforts come your way, nothing can outweigh the joy and delight that you will give your intended parents by letting warm, tiny kisses and childhood laughter fill their home.