Science Says: Being a GC During the Pandemic was Very Hard
This is the continuation of the BabyMoon Family journal club.
In our first ‘Science Says’ article, a study was reviewed whose results showed that gay parents out performed straight parents in every aspect of parenting, child well-being, relationship, and family dynamics (https://www.babymoonfamily.com/original-articles/gay-fathers-better-than-straight-parents or https://medium.com/@babymoonfamily/science-says-gay-parents-are-better-than-straight-parents-0d5846686af6).
This article is entitled A qualitative analysis of gestational surrogates’ healthcare experiences during the COVID-19 pandemic (1). This study is significant because it includes the largest sample size in the current body of gestational carrier (GC) research, and it is the first study to investigate GCs’ healthcare experiences during the COVID-19 pandemic.
This study demonstrates what went badly during the pandemic for GCs, not only to prepare for the next pandemic, but also to improve the experience of being GC during regular times in the future.
This article will cover the following:
Methodology of how the study was conducted.
Main results of the analysis.
How the experience of GCs can be improved in all future surrogacy journeys
Methodology
The study recruited GCs at a Canadian academic IVF center located in Toronto (CReATe Fertility Centre) between March 2019 and February 2022. This time frame allowed for a variety of GC experiences to be captured during various waves of the pandemic, including embryo transfers, prenatal care, and delivery.
Interestingly, the paper also highlighted the historic trends in surrogacy in Canada from 2013 to 2021, which showed that the number of GC cycles increased from 413 in 2013 to a pre-pandemic peak of 949 in 2018.
The study developed an 85 item survey that had five sections: Socio-demographics, COVID-10 impact and risk tolerance, surrogacy characteristics and experiences, social support system, and mental well-being. There were also free text boxes for GCs to provide descriptive comments.
Results
338 surveys were collected with a response rate of 50.7% (338/667). After excluding 18 partially completed and aborted surveys, 320 surveys were used for data analysis. A total of 609 comments were collected from 206 respondents who entered at least one free-text comment to the open-ended questions.
Demographic tables in the paper detail all the GCs sociodemographic information. These are a few highlights and commentary in parentheses:
85% were Caucasian (This is higher than the 2021 Canadian census in which 69.8% identified as Caucasian (2)).
54.8% worked with international intended parents (IPs) (This seems high considering this is during the pandemic, but given the lead time for a surrogacy journey, many of these IPs likely started this process years before getting matched with a GC).
60.7% were same sex male couples (This is higher than I would have expected, but it’s great to see this number of gay, bi, queer men having children).
81.3% worked with an agency (This seems higher than I would have expected as Canada only allows for altruistic surrogacy, and so I assumed more IPs would go independent for their jouneys).
The remainder of the results were grouped according to three main time frames for the GC experiences: Fertility treatment, pregnancy care, and birth.
Some themes that overlapped these time frames include the following:
Fears about COVID exposure and infection. GCs’ fears were compounded by concern about infection for themselves, the unborn child, and their own family throughout the experience. There was additional stress when the IPs and GCs had conflicted views on vaccination. Even though vaccination was not yet available for 51% of first embryo transfers, about 9.2% of IPs and GCs had conflicting views on vaccination during the study, which was made even more challenging as the information on vaccination in pregnancy was not yet known when vaccines first became available.
COVID restrictions scaled down care. GCs noted that the virtual appointment with providers during the fertility treatment and pregnancy care offered less support and interactions with the IPs. While this type of appointment minimized infection risks, they added stress in that they often required the GCs to then separately communicate with IPs on what had transpired, with one GC stating:
“Not being able to have any support during appointments, doing everything alone and not able to include my IPs was certainly frustrating.”
Going through treatment and childbirth with limited or no support. This was a huge factor for GCs negative experiences, especially during pregnancy care and birth. GCs lamented that IPs were ‘missing out’ on the pregnancy process, and they didn’t get to experience the ‘togetherness of family creation with the IPs.’
“Intended parents miss the key thing about being pregnant, and that is the carrying part. The closest they have to it is to be there with their surrogate along the way. When they miss out on that and visually along the way, they miss a lot. […] Especially, when the surrogate is going through it all on her own. Having that company and support feels a whole lot better than doing it alone and trying to get everything for the parents to see afterwards.”
This was most acute during the birth experience, when GCs either had to give birth alone or choose between the IP and their own partner as an accompanying support person.
“I was forced to give birth alone. Neither my husband nor the intended parents were permitted to see me until my release from the hospital. I was also not permitted to see the child I gave birth to until he was released from hospital, citing COVID-19 restrictions.”
When a support person was allowed in the delivery room, many GCs opted to have one of the IPs with them in order for at least one parent to be present for the birth of their child. However, this led to subsequent resentment from GCs of not having their partner by their side in the delivery room.
“During labour, I was only allowed to choose one person to be in the room. The choice was between the person I needed there for my support and one of the parents. I felt guilty for the parents possibly missing the birth of their child, and I chose one of the dads. It ended up being my longest, hardest labour, and I almost ended up in c-section. I had signed off on c-section and was even brought to the OR and delivered in the OR. Crying for my husband, who was not allowed in the hospital.”
These results demonstrate the significant challenges GCs faced during the pandemic: Fears of infection, reduced care from providers, and significantly less opportunities for support from IPs and their own families.
Future Improvements for GCs
While the pandemic was an extremely unique time for healthcare and surrogacy journeys, there are definitely learnings from this study to improve future experiences for GCs and IPs.
Most importantly is support. GCs would benefit from as much communication and support as possible. This support can and should come from all parties involved, including the healthcare teams, IPs, and their own families. Although sometimes unavoidable and perhaps more convenient, virtual appointments for GCs should be minimized. Even with international IPs, of which there were many in this study and in surrogacy in general, they should make every effort to attend — in person — as many appointments as possible. GCs want to share this experience with the IPs, and having to attend appointments and then communicate results to IPs adds an extra burden and detracts from the communal endeavor. Lastly, GCs own families should be involved in as much of the process as possible. The partner of the GC is living this experience with them, so he or she should be present and involved with the IPs, appointments, and journey as much as they can.
While every GC and experience will be unique, with some wanting less interactions with healthcare and the IPs compared to others, it does seem like communication and alignment of expectations are integral to the success of any surrogacy journey. GCs and IPs should be completely honest about what they want out of the experience, how they communicate, and what they need from each other as well as their other support systems. This is easier said than done, but it is imperative that there be this honest and forthright exchange as early and often as possible during the journey.
While this study does have the limitation of it being conducted only at one clinic in Canada, it is a large sample of GCs that spanned various waves and phases of the pandemic as well as the surrogacy journey. These results can be extrapolated to GC experiences in other countries who had similar pandemic conditions as Canada, and the insights during the pandemic should be applied to surrogacy journeys that are occurring post-pandemic around the world.
It’s great that there are studies focusing on the experiences of the GCs. The scientific community should continue to research and publish work that focuses on this amazing group of women around the globe.
References:
https://www.sciencedirect.com/science/article/abs/pii/S0266613823002917 [Note the article is not free, but if you want a PDF, please email me at bryan@babymoonfamily.com, and I will share a copy with you].