Physical recovery after a surrogate birth
Physically, postpartum after a surrogate birth is the same as after any birth. Your body does not know the baby went home with someone else. Your uterus shrinks back, you bleed for several weeks, and your milk comes in a few days after delivery whether or not you plan to pump.
What to expect in the first weeks:
- Bleeding and cramping. Bleeding is heaviest in the first days and tapers over several weeks. Cramps are strongest in the first days, especially when you pump.
- Healing. After a vaginal birth, soreness in the perineum. After a C-section, a healing incision and limits on lifting and driving set by your OB.
- Your milk coming in. Your breasts may become full, firm and sore. This happens even if you do not pump.
- Tiredness. Pregnancy and delivery take a lot out of anyone.
Your OB sees you for a postpartum visit and clears you for normal activity. Follow your OB's instructions, not a calendar you read online.
Private Label Surrogacy contracts cover six to eight weeks of lost wages for recovery. Under typical PLS terms, that is six weeks after a vaginal birth and eight weeks after a C-section. Your insurance covers you through at least eight weeks postpartum.
| Item | Amount or duration | Who provides it |
|---|---|---|
| Lost wages for recovery | Six weeks after a vaginal birth; eight weeks after a C-section | Intended parents, paid from escrow |
| Insurance | Through at least eight weeks postpartum | Your health plan, or a dedicated surrogacy policy paid for by the intended parents |
| Pumping pay | $200 per week, if you pump | Intended parents, paid from escrow |
| Pump, supplies and shipping | Covered in full | Intended parents |
| Postpartum nutrition consult | One consult, the last of at least six | Julie Bendix, MPH, RD, LD, CLC |
| Counseling | Available as you need it | Independent licensed mental health professional, paid by the intended parents |
| Check-ins | Through recovery | Your PLS case manager |
Emotions after delivery: what surrogates report
Emotionally, postpartum is different. Your body has just had a baby, and there is no newborn at home.
Surrogates describe a mix. Pride and relief are common: you did what you set out to do, and you watched a family begin. So is tiredness, and for some, a quiet sadness in the first days. Hormones drop sharply after any birth, and many mothers have a few days of weepiness or mood swings, often called the baby blues. Surrogates are not exempt.
Other things surrogates mention:
- Missing the pregnancy and the parents. For nine months you were in regular contact with the intended parents. When the messages slow down, it can feel like a loss, even when the relationship is good.
- Your children's reactions. Your kids may have questions or feelings about the baby leaving. Talk with them, and with your partner.
- A sense of having your body back. Many surrogates enjoy that part.
Both case managers at PLS have been surrogates. Natalie Gaudio-Fricano delivered in 2016, and Jenni Symons delivered in 2019 and 2021. They know what the first weeks feel like.
Should you pump for the baby?
Pumping is optional. You decide whether to pump and agree on it with the intended parents in advance, usually at the match meeting and in the contract.
Some surrogates pump colostrum for a few days. Others pump for several months. Some do not pump at all. All three are fine. Things to think about:
- Your time. Pumping takes several sessions a day, including at night at first.
- Your work and family. Pumping on a schedule while caring for your own children is real work.
- Your body. Some surrogates find pumping helps with recovery and mood. Others find it keeps them tied to the pregnancy longer than they want.
- The parents' plans. Some parents want breast milk for as long as possible. Others plan to use formula.
If you pump, PLS contracts pay $200 per week.
How pumping and shipping milk works
If you pump, you follow a routine like any pumping mother. You pump on a schedule, label and freeze the milk, and send it to the parents.
The intended parents cover the pump, supplies and shipping. If they live nearby, they may pick up the milk. If they live farther away, frozen milk is shipped in insulated containers with dry ice, using kits sent for the purpose.
Agree in advance on:
- How long you will pump, with a check-in date to revisit it.
- How milk is stored, labeled and handed over.
- What happens if your supply drops. Supply changes are normal and not a failure.
- How and when you will stop.
Julie Bendix is a certified lactation counselor. She can help with a pumping schedule, with supply and with comfort.
Suppressing milk supply if you do not pump
If you do not pump, your milk still comes in. Without regular removal, your body slows and then stops making milk. For most women this takes one to two weeks.
Julie advises on suppressing supply safely. Common, comfortable approaches include:
- A supportive, well-fitting bra worn day and night.
- Cold packs on the breasts for short periods.
- Avoiding stimulation, including hot showers on the breasts.
- Expressing only a small amount by hand if you are very uncomfortable, just enough to ease pressure.
- Over-the-counter pain relief, with your OB's approval.
Call your OB if a breast becomes red, hot and painful, or you develop a fever. Those can be signs of mastitis, an infection that needs treatment.
Nutrition for recovery and milk supply
Every PLS surrogate has a postpartum nutrition consult with Julie Bendix, MPH, RD, LD, CLC, a registered dietitian and certified lactation counselor. It is one of at least six consults Julie holds with each surrogate across the journey. Read about the nutrition program.
The postpartum consult covers:
- Recovery nutrition. Protein and nutrients for healing, especially after a C-section.
- Iron. To replace what you lost through bleeding at delivery.
- Calories and hydration if you pump. Making milk takes extra energy and fluid.
- Your prenatal vitamin. Whether to keep taking it.
Julie coordinates with your OB if your labs need action.
Postpartum mood and when to call
Postpartum depression is more than the baby blues. It affects about one in eight mothers, according to the CDC. Surrogates are not exempt.
Your case manager checks in on your mood after delivery. Counseling with an independent licensed mental health professional is available and paid for by the intended parents. See mental health support.
Call your case manager, and your OB, if any of these last beyond the first couple of weeks after birth:
- Sadness, emptiness or hopelessness most days.
- Trouble sleeping even when you have the chance, or sleeping much more than usual.
- Loss of interest in things you normally enjoy.
- Anxiety or panic that will not settle.
- Trouble caring for yourself or your family.
If you have thoughts of harming yourself, call 911 or go to the nearest emergency room now.
Staying in touch with the intended parents
How much contact you have after the birth is something you set in your wish list and agreed with the parents at your match meeting. Some surrogates get photos and updates for years. Others prefer a clean, kind goodbye. Both are respected.
The first weeks often feel different from the pregnancy. The parents are learning to care for a newborn, and messages may slow down. That is usually exhaustion, not distance. If the change is hard for you, tell your case manager.
Read what happens at the hospital, or see the full surrogate process. If you are ready to begin, start with the prescreen: see if you qualify.
Sources
- Centers for Disease Control and Prevention (CDC), depression during and after pregnancy. https://www.cdc.gov
- American College of Obstetricians and Gynecologists (ACOG), patient information on postpartum care and breastfeeding. https://www.acog.org