What does a surrogacy birth plan include?
A surrogacy birth plan is a short written document that tells the delivery hospital how this birth differs from an ordinary one. Hospital staff read it at admission, often in the middle of the night, so it should be clear and specific.
A complete plan covers:
- Who the intended parents are, with names, phone numbers and a copy of the pre-birth parentage paperwork.
- Who may be in the delivery room, for a vaginal birth and for a cesarean.
- Who makes which decisions, for the surrogate and for the baby.
- The first minutes after birth: who holds the baby first, who cuts the cord, and whether the surrogate wishes to hold or see the baby.
- Feeding: formula, or breast milk pumped by the surrogate if she has agreed.
- Rooms: whenever possible, a separate room for you and your baby while the surrogate recovers in her own.
- The baby's care: your pediatrician's name and the newborn's health insurance details.
- Visitors and photos: who may visit her room and yours, and what may be photographed or shared.
- Contacts: both attorneys and your PLS case manager.
Your PLS case manager drafts the plan at about 28 to 32 weeks, with you, the surrogate and the hospital.
| Item | Who decides | Deadline |
|---|---|---|
| Labor, pain relief, delivery method | Surrogate, with her OB | Draft by 28 to 32 weeks |
| Who is in the delivery room | Surrogate, within hospital policy | Draft by 28 to 32 weeks |
| Who holds the baby first; cord cutting | Intended parents, with the surrogate's agreement | Draft by 28 to 32 weeks |
| Newborn medical care | Intended parents, with the pediatrician | Draft by 28 to 32 weeks |
| Feeding plan and pumping | Intended parents and surrogate together | Draft by 28 to 32 weeks |
| Rooms after delivery | Hospital, based on availability | Requested when the plan is filed, before 36 weeks |
| Visitors and photos | Each side for its own room; shared moments by agreement | Draft by 28 to 32 weeks |
| Filing with the hospital | Case manager and attorneys | Before 36 weeks |
Who decides what during labor and after birth?
The line is simple. The surrogate decides everything about her own body. You decide everything about the baby.
During labor, that means her pain relief, her position, whether to accept an induction and every other medical choice about her care. Her OB advises her. You do not have a vote, and a good birth plan says so plainly so no one in the room is confused.
From birth, decisions for the baby are yours. That includes newborn exams, any NICU care, feeding and anything the pediatrician recommends. The pre-birth parentage paperwork is what gives the hospital the legal basis to treat you as the parents from the moment of birth. Reviewed by counsel. See the pre-birth order.
Most of the plan is a conversation, not a negotiation. By the third trimester you and the surrogate know each other well. The plan writes down what you have already agreed.
Who can be in the delivery room?
The surrogate decides, within hospital policy.
Many surrogates want the intended parents present. Some prefer their own partner and one intended parent. Hospitals often limit how many support people are allowed, so ask about the policy early. A cesarean is usually more restricted than a vaginal birth.
Write down both scenarios. If only one support person is allowed in an operating room, the plan should say who that person is. Settling it at 30 weeks is much easier than settling it at 2 a.m.
How is the hospital informed and when?
In two stages.
First, your case manager contacts the hospital while the plan is in draft. Many hospitals route surrogacy births through the social work office or the legal or risk management office. That office explains its own forms, its rooming policy and how it handles the birth certificate.
Second, the finished plan and the pre-birth parentage paperwork are filed with that office. PLS sends both to the hospital before 36 weeks. Confirm the week at which PLS files the plan. Filing early matters because babies do not always wait for the due date. About one baby in ten in the US is born before 37 weeks, according to the CDC.
The surrogate also brings a copy to admission, and so do you.
What happens if the baby arrives early or by emergency C-section?
The plan should already cover it.
If the baby comes early, the paperwork is the first concern. If it was filed before 36 weeks, the hospital has it. If not, your case manager and attorney get it there the same day. A premature baby may go to the NICU, and NICU decisions are yours as the parents.
If the surrogate needs an emergency cesarean, her medical team decides, quickly. Operating-room rules about support people usually apply. The plan should say who goes in with her, and who waits for the baby. Afterward she needs a longer recovery, and her own support person should stay close.
In both cases, your case manager is your first call. She keeps both families informed and handles the hospital's questions.
How do international parents handle the birth plan?
The same plan, with three additions.
- Language. If English is not your first language, decide who will interpret at the hospital.
- Travel. Plan to arrive in the US several weeks before the due date. PLS helps with arrangements for travel for visits and delivery.
- Documents. Your baby needs a US birth certificate, a passport and travel documents for your home country. PLS refers you to assisted reproductive technology attorneys who handle parentage paperwork, visas and passports.
A federal executive order dated August 6, 2026, on citizenship for children born through compensated surrogacy to two non-citizen parents is under litigation. Status as of [date], reviewed by counsel.
For the days in hospital and after, see hospital and delivery and bringing your baby home.
Sources
- ACOG (American College of Obstetricians and Gynecologists), guidance on labor and delivery. https://www.acog.org
- CDC (Centers for Disease Control and Prevention), data on preterm birth in the United States. https://www.cdc.gov
- Illinois Gestational Surrogacy Act (2005), on parentage before birth. Pending review by counsel.