Picture this: you are on a FaceTime call from a clinic lobby while your gestational carrier finishes the lab work. An attorney emails contract edits. Your insurance broker flags an exclusion you did not know existed. Your heart is in your throat, and this is also the path to your child. Surrogacy evokes profound hope, and it requires careful planning and preparation.
The Centers for Disease Control and Prevention reports that in 2022, U.S. clinics recorded hundreds of thousands of assisted reproduction treatment cycles, resulting in tens of thousands of babies, which represents a significant share of all births.
If surrogacy is part of your story, the safest and sanest way through is a true village. This guide names who belongs in it and how to organize support at each step.
Why surrogacy takes a team
Surrogacy can be medically safe when thoughtfully planned, yet it is also ethically and relationally complex. The most protective approach includes independent legal counsel for each party, psychological screening with access to ongoing counseling, and clear consent processes for the gestational carrier and intended parents.
The legal landscape matters. Surrogacy is regulated at the state level in the United States, and laws and procedures for establishing parentage vary. Some places use pre-birth orders while others finalize parentage after delivery. Because policies can change, it is essential to have an experienced attorney who specializes in assisted reproduction.
“Surrogacy is not a transaction. It is a relationship that needs structure, respect and shared care.”
Who belongs in your village
Think of your village as a circle of safety around the gestational carrier, the baby and you.
- Clinical team. A reproductive endocrinologist and nurses lead the early steps, with maternal–fetal medicine as needed and an obstetric provider chosen by the gestational carrier.
- Mental health professionals. Separate licensed therapists for the gestational carrier and intended parents, plus psychological evaluations before, during and after the journey.
- Legal team. Independent attorneys for each party who understand parentage orders, insurance contracts and what to do if plans change.
- Insurance and finance specialists. A pro who can spot surrogacy exclusions, verify newborn coverage and arrange escrow for medical bills and allowable expenses.
- Birth and postpartum support. A doula, if desired by the gestational carrier, provides lactation support for the feeding plan you choose and a pediatrician selected before delivery.
- Community care. Trusted friends and relatives who can manage meals, childcare for the carrier’s family if needed and travel logistics for intended parents.
What to set up before embryo transfer
- Clear contracts and counsel
Contracts should address medical decision-making, activity preferences, compensation and expenses, pumping plans if any, privacy, communication, travel and a dispute process. Each party needs their own attorney. Your attorney will map the parentage route in the carrier’s state and in your home state. - Psychological evaluation and education
Psychological assessment and ongoing access to counseling support everyone in navigating boundaries, expectations and the real emotions of a shared pregnancy. This is not a checkbox; it is core care. - Insurance verification
Ask an insurance specialist to read the entire policy. Some plans exclude surrogate pregnancies or delay newborn coverage until parentage is established. If needed, plan for a temporary newborn policy or self-pay funds to avoid scrambling at discharge. - Medical plan
Confirm prenatal care, the delivery hospital and any high-risk consults. Align on a singleton-first plan if recommended, use your clinic’s data to set realistic expectations and reduce pressure for multiples.
Support during pregnancy: practical ways to show up
- Communicate on purpose. Agree on preferred channels, how often to check in and who initiates updates after appointments. Revisit the plan each trimester, ideally with the support of a therapist.
- Honor the carrier’s autonomy. The gestational carrier makes her own medical choices. That clarity reduces conflict and protects her well-being.
- Plan travel and contingencies early. Decide when intended parents will arrive, what happens if labor starts early and who is on call for the carrier’s older kids if she has them. Ask your attorney how to handle crossing state lines with the baby if the parentage is not yet finalized.
- Consider feeding plans now. Some families arrange for the carrier to pump briefly or for intended parents to induce lactation. Others use donor milk or formula. Your pediatrician can help you choose an option that fits your family. Fed is best.
“The healthier the team, the smoother the journey.”
The first weeks after birth: wraparound care
- Safe sleep and newborn basics. If you are traveling home, create a safe sleep setup wherever you are staying. Place the baby on their back on a firm, flat surface, in a clear crib or bassinet, and share a room without bed sharing. These steps align with current pediatric recommendations.
- Mental health check-ins for everyone. Depression and anxiety can affect gestational carriers and intended parents. Ask every adult in the circle to be screened, and keep screening beyond the six-week visit. Reach out to a trusted healthcare professional if symptoms appear at any point during the first year.
- Parentage paperwork. Follow your attorney’s instructions for birth certificates and court orders. In some places, a pre-birth order may become effective at the time of delivery; elsewhere, the court finalizes parentage after the child is born.
- Pediatric care. Establish care with a pediatrician before delivery, if possible and then schedule the first visit within the recommended timeframe.
Scripts for asking your village for help
- For friends and family: “We are welcoming our baby through surrogacy. Our biggest needs are meal drop-offs and airport runs. If you want to help, here are sign-up dates.”
- For your carrier’s circle: “During late pregnancy and the first week postpartum, can you be on call for school pick-up or dog walks if she needs to rest?”
- For your workplace: “We are expecting a baby via gestational carrier on or around [date]. I will be on leave starting [date]. Here is my coverage plan and who can make urgent decisions while I am offline.”
When to call a pro
- Any sign of depression, anxiety or intrusive thoughts for the carrier or intended parents
- Questions about parentage outside your lawyer’s written guidance
- Insurance denials or surprise bills
- Feeding challenges beyond basic troubleshooting
You are not meant to hold this alone. The village is not a luxury in surrogacy. It is the operating system that keeps everyone informed, cared for and ready to welcome a new human with steadiness and joy.