‘Four parents and a baby’: when surrogacy meets the neonatal unit

Abstract

<h3>Aims</h3> Each year in the UK there are an estimated 50-70 surrogate pregnancies. The majority of these babies will not require any specific medical interventions in the neonatal period. However, when a baby does require admission to the neonatal unit, there is limited guidance for the medical professionals caring for them. We describe a case, and explore the ethical and legal dilemmas that were encountered. Our aim is to raise awareness of a situation that may become more prevalent in the UK. <h3>The Case</h3> We present the case of a twin IVF surrogate pregnancy. A number of complicating factors were encountered, including the intrauterine death of twin one, premature delivery at 31+3 weeks gestation, congenital malformation of twin two, and delivery in a Scottish hospital far from the intended parents9 home in England. <h3>Results</h3> Parental responsibility at the time of birth lies with the surrogate parents. This can only be transferred to the intended parents after 6 weeks and on application to the court to obtain a Parental Order, under the Human Fertilisation and Embryology Act 1990. The situation may be complicated by subtle differences in Scottish and English law. It therefore relies on a good relationship between all the parents to prevent conflicts regarding medical consent. In our case, the decisions ranged from simpler aspects such as visiting rights to the Neonatal Unit, to the more complex and controversial issue of transfer of care to a Neonatal Unit local to the intended parents, but distant from the surrogate (and current legal) parents. Agreement on financial implications for the neonatal units and transport involved, was also challenging to negotiate. The strategies employed by the Neonatal Unit included formal clarification of legal rights, written consent for any potentially controversial management decisions, and frequent, open communication with all four parents. <h3>Conclusion</h3> Medical care for babies born to surrogate mothers in the UK poses unique challenges. Current formal guidance for the post-natal period is minimal, and further discussion and debate would be useful for this to be improved.