Who provides mental health support and why they are independent
Private Label Surrogacy surrogates have access to an independent licensed mental health professional experienced in third-party reproduction, at every stage of the journey. The intended parents pay for it. You do not.
PLS does not employ its counselors. That is a deliberate choice. Guidance from the American Society for Reproductive Medicine (ASRM) and the ethics standard of SEEDS, the Society for Ethics in Egg Donation and Surrogacy, call for independence, so that the person assessing or supporting you does not answer to the agency. Nancy Block, RN, who founded PLS, is a former President of SEEDS.
Here is why that matters to you. A counselor employed by an agency evaluates candidates the agency needs to place, and supports surrogates the agency needs to keep on schedule. An independent professional has no stake in either. What you say in a session is about you, not about the agency's calendar.
The same rule applies to attorneys and escrow at PLS. No one who evaluates, advises or pays you works for the agency.
Support before matching: the evaluation
Before you are matched, you have a psychological evaluation with the independent professional. It is a required step in screening. Read what the psychological evaluation involves.
The evaluation is not a test you pass by giving the right answers. It is a conversation about:
- Why you want to be a surrogate, and what you expect.
- Your support at home: your partner, family and friends.
- How you handle stress, and how you have handled hard times before.
- Your past pregnancies and postpartum periods.
- How you will explain surrogacy to your children.
- How you feel about attachment, and about handing the baby to the parents.
Surrogates describe attachment to the pregnancy and the parents more than to the baby. The evaluation addresses this directly, so you go in knowing what to expect.
If you take medication for your mental health, read about the mental health medication requirement. PLS currently requires that surrogates not be taking antidepressants.
The joint session with intended parents
After you match, you and the intended parents have a joint session with the mental health professional. The purpose is to set expectations before the pregnancy begins.
Topics usually include:
- How often you will talk, and how.
- Who comes to appointments and to the birth.
- What happens if a transfer fails or a pregnancy is lost.
- Contact after the birth.
- How each side will raise a concern if something feels wrong.
Agreeing on these early prevents most of the friction surrogates and parents report later. The professional is neutral. If you feel unheard, say so in the session.
Support during the cycle and the two-week wait
During the medication cycle and the pregnancy, sessions are available on request. Your contract sets how many sessions are included.
The two-week wait is one of the hardest stretches. After weeks of injections and a trip to the transfer, you wait 9 to 11 days for a blood test. You cannot change the result, and you feel every twinge. Surrogates describe it as the most anxious part of the cycle.
What helps:
- Keeping your normal routine, with light activity.
- Deciding in advance whether you will take home pregnancy tests, and sticking to it.
- Agreeing with the intended parents how the result will be shared.
- A session with the counselor, or a call with your case manager, during the wait.
Support after a failed transfer or loss
A negative pregnancy test, a miscarriage or a loss later in pregnancy is hard for surrogates as well as for intended parents. Many surrogates feel they let the parents down, even though nothing they did caused it.
After a failed transfer or a loss, counseling is available and paid for by the intended parents. You do not have to ask in a particular way or wait a particular time. Your case manager offers it, and you can take it up when you are ready.
You also have time to decide what comes next. Whether to try another transfer is a conversation, not an assumption. Read how compensation works after a miscarriage or failed transfer.
Postpartum mental health
The weeks after delivery are the third point surrogates describe as hard. Your body has had a baby, hormones drop sharply, and there is no newborn at home. Many mothers have a few days of weepiness or mood swings, often called the baby blues. Postpartum depression is longer and deeper, and surrogates are not exempt.
Postpartum check-ins with the mental health professional are part of PLS support, and counseling is available if you need it.
Signs to call about, especially if they last beyond the first couple of weeks after birth:
- Sadness, emptiness or hopelessness most days.
- Anxiety or panic that will not settle.
- Trouble sleeping, or sleeping much more than usual.
- Loss of interest in things you normally enjoy.
- Trouble caring for yourself or your family.
Your partner may need support too. Partner sessions are available through the same professional.
How your case manager fits in
Your case manager is the first call for ordinary worries. Natalie Gaudio-Fricano and Jenni Symons, the PLS case managers, have both been surrogates. Jenni, who wrote this page, delivered in 2019 and 2021. They have been through the two-week wait, the heartbeat ultrasound, the delivery and the weeks after.
A case manager is not a therapist, and does not try to be one. What she does:
- Answers the question behind the worry: "Is this normal?"
- Notices when you sound different from usual.
- Checks in at the hard points: the two-week wait, a negative test, and after delivery.
- Connects you with the counselor, and helps you make the first appointment.
- Speaks to the intended parents for you, if a conversation is hard to have directly.
| Stage | Type of support | Who provides it | Who pays | How to access |
|---|---|---|---|---|
| Before matching | Psychological evaluation | Independent licensed mental health professional | Intended parents | Scheduled by PLS during screening |
| After matching | Joint session with the intended parents | Independent licensed mental health professional | Intended parents | Scheduled after match |
| Cycle and pregnancy | Sessions on request | Independent licensed mental health professional | Intended parents | Ask your case manager |
| Two-week wait | Check-ins | Your case manager; counselor on request | PLS; intended parents for sessions | Your case manager calls you |
| Failed transfer or loss | Counseling | Independent licensed mental health professional | Intended parents | Offered by your case manager |
| Postpartum | Check-ins and counseling | Independent professional and your case manager | Intended parents | Scheduled after delivery |
| Any time | Ordinary worries | Your case manager | PLS; no cost to you | Call or message |
When to ask for help and how to reach someone
Ask early. You do not need to be in crisis to talk to someone. A worry that keeps you awake is reason enough.
- For everyday worries: call or message your case manager.
- For a session: ask your case manager to set it up, or contact the counselor directly if you already have the details.
- After hours: the PLS after-hours team answers. Pregnancy does not keep office hours.
- For a general question about surrogacy: ask SurrogacyHotline.com, the free expert Q&A sister site to PLS. Answers come within 24 to 48 hours.
If you have thoughts of harming yourself, call 911 or go to the nearest emergency room now. You can also call or text 988, the Suicide and Crisis Lifeline, at any hour.
For the full picture of what PLS provides, see surrogate support. To start, see if you qualify.
Sources
- American Society for Reproductive Medicine (ASRM), recommendations for practices using gestational carriers, including psychological evaluation and counseling. https://www.asrm.org
- SEEDS, Society for Ethics in Egg Donation and Surrogacy.
- Centers for Disease Control and Prevention (CDC), depression during and after pregnancy. https://www.cdc.gov