NATION NOW

Making the match: How women become surrogates

Mary Bowerman
USA TODAY Network
A married couple sits with their surrogate.

After her friend had several miscarriages, Tina Dettlaf said she jokingly offered to use her “German birthing hips” to have her child.

While the friend was ultimately able to conceive on her own, Dettlaf said the conversation sparked something inside her, and she began the quest to become a surrogate. After carrying two children as a surrogate, Dettlaf now works for The Surrogacy Experience, an agency that assists couples throughout the surrogacy process.

There are no concrete numbers on how many surrogate births occur in the United States, because there is no federal agency tracking the industry. Dettlaf said the lack of information can lead to many misconceptions about the women who choose to become surrogates.

“People wonder who are these women who want to do this – do they need money, are they taken advantage of, or are they just low-income baby makers, and that’s so far from the truth,” Dettlaf said. “These women just want to help, and I don’t think it should be shied away from that they are making money, but that is... a bonus, not a motivator.”

But those opposing surrogacy say "womb renting" isn't ethical.

The Catholic Church believes surrogacy "depersonalizes the woman who is carrying the child and depersonalizes the child she carries because the child becomes a bargaining chip," according to John Grabowski, director of moral theology and ethics at The Catholic University of America.

Here's a look at how the process works:

How do women become surrogates? 

Becoming a surrogate for a legitimate agency is no easy task. A woman must have already successfully given birth to a child before she is even considered for surrogacy.

Teo Martinez, CEO of Growing Generations, said his agency receives up to 200,000 applications a year, but only accept 1% of those.

“All of our surrogates come to the website, fill out a brief questionnaire, and from there they are qualified or disqualified by a number of factors,” he said.

If a woman wishes to become a surrogate, but lives in Washington, D.C., or New York they are immediately disqualified because those states and a handful of others do not allow surrogacy, Martinez said.

Those who pass the questionnaire, are contacted by staff for a phone interview. From there, agencies require a criminal background check, medical file review and psychological screenings.

Once a woman has passed through the screening process, staff find out what preferences she has about her experience, Martinez said.

“We might have a case from China, and they don’t speak English, and the surrogate would prefer to be matched with someone she can speak with more freely, so we know that’s not a good match,” he said.

Carey Flamer-Powell, the founder and director of All Families Surrogacy, said her agency's screening process can take up to four months. She said the hardest part is getting the potential surrogate's medical records approved to carry another pregnancy, because doctors want to ensure that the pregnancy is not risky.

Flamer-Powell said her agency also sends a social worker to the potential surrogate's home to ensure that the woman lives in a healthy situation and her children are well taken care of.

"It takes lots of time, money and so many hopes and dreams are invested in this person that there can't be any issues whatsoever," Flamer-Powell said.

How are surrogates matched with couples? 

At The Surrogacy Experience, Dettlaf said she views matching couples with a surrogate like a "Match.com-service," where surrogates need to be matched to couples with whom they're compatible. 

“I get to know my carriers and their values, their beliefs and expectations for this journey, the same as the parents,” Dettlaf said. “That relationship is important. So, we believe in mutual matching.”

After learning about the carrier and the parents, the agency introduces the parents and surrogate to each other through a profile, where each can see pictures, a biography and information about the family.

“If they feel there can be a connection, we have an introductory phone call with all of them, which I facilitate because they may have butterflies or not know what to ask,” Dettlaf said.

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Flamer-Powell, who was a surrogate like many of her staff members, said they allow the surrogate to look at the parent's profile before ever introducing the surrogate to the parents.

"We want her to have the opportunity to chose first, and if she is interested then we send her profile to the parents and set up a meeting or a call if they aren't close enough," she said. "It's basically a first date to talk and see if there is chemistry."

Tio said the Growing Generations uses personality matrixes to match the surrogate to the parents, noting that it’s a logistical journey, but also an emotional one.

“I don’t believe you can take any surrogate and give her to someone and it’ll work out,” he said. “You’ll be with this surrogate, this woman, for at least a year and you want a relationship that will endure that time and possibly the obstacles — like if you don’t get pregnant the first time.”

What legal steps are involved? 

There are different legal requirements to pass in each state. In Oregon, where Flamer-Powell's All Families Surrogacy is located, typically a same-sex couple would need a lawyer to draft a legal agreement with the egg donor, according to Robin Pope, a family foundation attorney and a board of trustee for the American Academy of Assisted Reproductive Technology Attorneys.

A same-sex male couple typically starts a gestational surrogate process by finding an egg donor in order to create several embryos for possible transplantation in a surrogate.

Once an egg donor is found, a lawyer drafts a legal agreement with the egg donor to ensure that the donor gives up any rights she might have, according to Robin Pope, a family foundation attorney and a board of trustee for the American Academy of Assisted Reproductive Technology Attorneys.

While some states have sperm donor statues preventing those donors from claiming parental rights, many states do not have the same statues to cover egg donors, she said.

What's in the gestational surrogate contract? 

A gestational surrogate contract is typically 50-60 pages long and covers everything from what the gestational surrogate eats during her pregnancy to finances and creating parentage, according to Pope.

The contract covers the medical decisions that should be made in the case or problems with the fetus or if any issues arise that put the gestational surrogate's life in danger. Pope notes that there is typically a "micromanaging" section, where potential parents can specify certain request.

"The surrogate agrees she is going to follow the rules in the contract," she said. "We talk about lifestyle restrictions like don’t clean the litter box. It's trying to say we want this to be as healthy a pregnancy."

Do surrogates become emotionally attached to the baby once he or she is born? 

One of the greatest misconceptions about surrogacy is that the surrogate becomes attached to the baby, Flamer-Powell said.

"This is not our baby, we have our own," she said. "This is biologically and physically someone else's child."

She likens asking a surrogate if they became attached to the baby to asking a nanny or babysitter whether it was hard to say goodbye when the parents returned.

"For us, the hardest part is that this is a minimum one year ... two years out of your life and it's a very big time and emotional commitment for not just you, but your family," she said.

What rules do the surrogates have to abide by while carrying the baby? 

The surrogate and the clients each have a lawyer, who works on their behalf to draft a "surrogacy contract," which lays out the rights and responsibility of each party, according to Martinez. 

The contract ranges from financial aspects like if the future parents want to give their surrogate a stipend to eat organic food, to the surrogate's commitment not to smoke.

Martinez said it's important for intended parents to know that when it comes to regulating food it's "not going to be 100% this or that in terms of how they eat." Pregnant women may have nausea and sometimes it's a cheeseburger instead of a bag of kale, he said.

"I’ve been doing this over 18 years, and my professional advice is pick your battles," he said. "You can try to control this process as much as possible and you'll likely go crazy."

How much money do surrogates make? 

The amount a surrogate makes depends largely on the state in which she lives and whether she has insurance that will cover parts of her care. Dettlaf said surrogates make between $25,000-$30,000, but can make more if they carry twins.

Likewise, Flamer-Powell said it can range from $30,000 to $40,000 for multiples.

How many times can a woman be a surrogate? 

Flamer-Powell said most of the surrogacy clinics set guidelines on how many babies the surrogate can give birth to. She said her agency's limit is five births, so if the woman already has three children of her own, she would only be able to give birth two additional times.

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Follow Mary Bowerman on Twitter: @MaryBowerman