@HugTrees I was a midwife for twenty years but am no longer on the register and work in another area of the NHS. I am sure, however, that I could manage to work professionally if presented with a surrogate mother to care for. That would mean ensuring her needs and safety and welfare were the focus of my care, as well as making sure I was working within the law and hospital guidelines.
Here is a section from the WPUK letter regarding midwifery care:
Even without the risk of health complications for the surrogate mother or the baby, the experience of being pregnant and giving birth is often challenging and frightening. A relationship of trust between the pregnant woman and the midwife is crucial. In relation to Paragraph 17.76 of the consultation document, it should be noted that midwives are trained to identify not only health issues but also mental health issues, and social issues such as poor quality housing, poverty and lack of nutrition, domestic violence, and trafficking throughout the care pathway.
As much as intended parents may wish to be involved in antenatal appointments, scans, and the actual birth (indeed, in some cases the surrogate may want this too), the midwife’s relationship and primary concern must be with her patient, the surrogate mother. This is an important opportunity for midwives to identify risk factors or safeguarding issues, including the possibility of coercion or undue pressure being placed on the surrogate mother by the intended parents.
WHO guidelines, which have been adopted by the Royal College of Obstetricians and Gynaecologists, state that “all care settings must protect and promote women’s privacy and dignity, respecting their human rights.[10]”
It is not uncommon for women to change their mind about who they wish to have present at the birth once they are in labour. The wishes of the intended parents should carry no more weight than the wishes of a partner or the surrogate’s parents who may have planned to be present but who the surrogate may decide she does not want to be present once she is in labour.
There are many circumstances in which it would be undesirable for the intended parents to be present when the surrogate mother is attending healthcare appointments. For instance, in cases where complications may mean there is a risk to the mother’s health or life if she continues with the pregnancy. For instance, it is not difficult to imagine a scenario where the mother may find it difficult to make choices which prioritise her own health and wellbeing if the intended parents are in the room with her, even if they do not actively put pressure on her to prioritise the welfare of the fetus. Or in a scenario where a scan reveals a fetal anomaly, the pregnant woman may feel unduly pressured to conform to the intended parents’ wishes regarding continuing or terminating the pregnancy if they are present in the room when the scan takes place.
At all times it should be remembered that the patient in this context is the surrogate mother and it is her relationship with healthcare professionals and her human rights, dignity, and bodily autonomy which are at stake. The wishes and desires of the intended parents are no more than wishes and desires. They must not take precedence over the wishes and desires of the pregnant woman or the professional requirements of the healthcare professionals charged with caring for her.
As it says, the wishes and desires of the intended parents are no more than wishes and desires. This contrasts with complaints from intended parents, which the law commissioners appear to support, such as that staff would not allow the baby to be discharged from hospital independently from the surrogate mother. The surrogate mother is also the legal mother and safeguarding and the law would mean that no, a couple waving their contract which is unenforceable and meaningless in law, do not get to announce themselves parents of a newborn and remove it from hospital.