Surrogates

Surrogacy Contracts and Medical Decisions

Understanding how medical decisions are handled in a surrogacy contract is the most effective way to protect your health and your autonomy throughout the pregnancy.

When you establish clear legal boundaries and medical expectations before the process begins, you can move forward with total peace of mind, knowing exactly what to expect in almost any medical situation.

This guide will explain how gestational carrier agreements (GCAs) manage doctor selection, birth plans, medication protocols, and your right to medical privacy.

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Who Makes Medical Decisions in a Surrogacy Contract?

One of the most common questions for prospective surrogates is who holds the power to make medical choices.

In a standard GCA, your bodily autonomy is a protected right. The contract is designed to create a collaborative framework rather than a hierarchy of control.

Typically, you retain the final word on any medical procedure that affects your own physical health and safety, while the intended parents have the authority to make decisions that primarily impact the well-being of the fetus.

By addressing these scenarios during the legal stage of surrogacy, you and the intended parents create a shared roadmap long before any medical events occur. This legal preparation involves discussing various “if/then” scenarios, ensuring that everyone is on the same page regarding prenatal care, delivery, and potential complications.

This proactive approach prevents conflict during the pregnancy and allows you to focus on the joy of the experience while knowing your boundaries are legally documented and respected.

Balancing surrogate autonomy and parental rights

The GCA serves as a bridge between your right to bodily integrity and the intended parents’ legal rights as the parents of the child. The contract explicitly states that your life and health are the priority in any medical situation.

It also provides a framework for communication, requiring that all parties consult in good faith when decisions arise that affect the pregnancy.

This structure ensures you are never forced into a medical procedure against your will while respecting the intended parents’ role as the legal guardians of the future child.

Can Surrogates Choose Their Own Doctor?

Most surrogates prefer to work with an OB/GYN they already know and trust, often the professional who delivered their own children. In the majority of surrogacy arrangements, you can continue seeing your own doctor, provided they meet specific criteria.

Choosing an OB doctor for surrogacy is a joint effort that happens during the matching phase, where the intended parents review your medical team to ensure they can handle the unique aspects of a surrogate pregnancy.

The IP approval of doctors is a standard clause intended to ensure that your medical provider is experienced with IVF pregnancies and is comfortable working with intended parents. While you have the right to select your provider, the intended parents and the insurance company must also feel confident in that choice.

If your preferred doctor does not meet the necessary requirements, your agency and attorney will help you find a new provider who makes you feel supported and safe.

Common medical provider restrictions

To maintain a high standard of care, several medical provider restrictions are standard in most surrogacy agreements. These focus on the doctor’s credentials and their ability to work within the specialized surrogacy framework:

The physician must be a board-certified OB/GYN.

The provider must carry adequate insurance to cover surrogacy-related medical care.

The doctor usually needs to be an \"in-network\" provider for the specific health insurance policy being used for the surrogacy.

The doctor must have delivery privileges at a hospital that meets the safety and NICU standards outlined in the contract.

Hospital or Home Birth? How the Contract Defines Birth Plans

A birth plan in surrogacy is more than a list of preferences; it is a legally binding blueprint for your delivery day. This plan covers your hospital choice for surrogacy and specifies exactly who is permitted in the delivery room.

Because IVF pregnancies can involve higher medical risks, such as premature birth, most contracts include strict NICU requirements in the contract.

These requirements typically mandate that you deliver at a hospital with at least a Level III or Level IV Neonatal Intensive Care Unit. This ensures that if the baby arrives early or needs immediate specialized medical attention, they are already in the right facility with the necessary equipment.

Settling these details early allows the intended parents to stay with their child from the moment of birth without the stress of an emergency medical transfer to another hospital.

Find out more about labor and delivery for surrogacy

Why home birth surrogacy is an option

Home births or standalone birth centers are an option if that’s what would make you more comfortable.

Although the conversation with the intended parents may lead to a delivery at the hospital, home births for surrogacy are a viable path if you and the intended parents are in agreeance.

Considering midwife birth options

If you prefer a more natural, low-intervention care model, you can often include midwife birth options in your plan, provided the midwife is based in a hospital.

Many modern hospitals offer midwifery suites that provide a natural environment while remaining seconds away from a full surgical and NICU team.

This allows you to have the delivery experience you want while meeting the safety standards required for the intended parents’ child.

Talking to Your Doctor: What You Can (and Should) Share

Building a transparent relationship with your medical team is essential for a safe surrogacy journey. Discussing records with a doctor is a standard part of prenatal care, but as a surrogate, you have additional information to share.

It is important that your OB/GYN knows from your first appointment that you are a gestational carrier, as this status impacts everything from your medication schedule to how the hospital handles delivery day logistics.

When your doctor is fully informed, they can act as your advocate. They will understand why certain tests are required by the fertility clinic and how to handle the presence of the intended parents at your appointments.

Transparency with your medical team also ensures that any advice they give you is compatible with the legal obligations outlined in your surrogacy contract, such as travel restrictions or specific health protocols.

What Medications and Supplements Need Approval?

When you are carrying a baby for someone else, your daily health routine is structured to ensure the best possible environment for the fetus.

This involves a formal medication approval process that goes beyond what you might expect in a traditional pregnancy. Because the fertility clinic manages the early stages of an IVF pregnancy with a specific hormonal protocol, even common substances require oversight.

Navigating OTC medication restrictions

Your surrogacy contract will include OTC medication restrictions that require you to check with the fertility clinic or your OB/GYN before taking anything new.

This includes common cold medicines, pain relievers, and topical creams, as some ingredients can interfere with blood flow or hormonal balances.

These restrictions are in place to prevent any negative interactions with the IVF protocol and to protect the health of the developing fetus.

Supplement approval requirements and lifestyle choices

Beyond prescriptions and OTC drugs, you will also need to manage supplement approval requirements. This includes:

Herbal products and vitamins: Many “natural” supplements have not been tested for safety during IVF pregnancies and require medical clearance.
Caffeine restrictions in surrogacy: Most agreements limit caffeine intake to about 200mg per day (roughly one cup of coffee) to maintain a healthy environment for the baby.
Alcohol before pregnancy: You will agree to avoid all alcohol starting from the beginning of your medication cycle through the conclusion of the pregnancy.

How Are Emergency Medical Situations Handled in the Contract?

While everyone hopes for a smooth and routine pregnancy, a professional surrogacy contract must account for rare medical emergencies. Your GCA will detail who makes decisions if a situation arises where you are unable to speak for yourself.

These complications and emergencies protocols are established during the legal phase to ensure there is no confusion in the heat of a medical crisis.

Emergency protocols typically include:

A Surrogate Agent
You will name a health care proxy—usually a spouse or a close family member—to make medical decisions on your behalf if you are incapacitated.
Advance Directives
You may be asked to sign documents that explain your wishes regarding life support and other extreme medical interventions.
Life and Health Priority
Standard contracts explicitly state that in any life-threatening emergency, the surrogate’s life and health are the absolute first priority

How Surrogacy Contracts Handle Medical Privacy and Boundaries

Protecting your personal privacy is a top priority for any surrogate. You want to be transparent with the intended parents about the pregnancy, but you also want to keep your personal medical history private.

A surrogacy contract uses a HIPAA release to define exactly what IP access to medical records looks like. This legal document draws a clear line between information about the baby and your own private health data.

The intended parents will have medical records access rights specifically for updates that pertain to the pregnancy and the health of the child, such as ultrasound results and lab reports. However, they do not have the right to access your unrelated past medical history or mental health records.

Setting these privacy standards through a formal medical information sharing agreement helps build a relationship of mutual respect, where your boundaries are honored throughout the process.

How to Make Sure You’re Comfortable With the Medical Plan in Your Surrogacy Journey

Your comfort and health are the foundation of a successful surrogacy experience. A well-written contract does not just list restrictions; it provides a framework for a healthy, collaborative relationship between you and the intended parents.

By reviewing every medical clause with an independent attorney and an experienced agency, you can ensure that your rights are fully protected and that you are never asked to do anything that violates your values or health needs.

When you feel secure in your legal protections, you can focus on the incredible impact you are making. Imagine moving forward with your surrogacy goals feeling completely confident in your legal and medical safety every step of the way.

You can start that process with confidence by filling out our contact form to connect with our team and learn more about how we advocate for your rights today.

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