On May 1, CNN news anchor Anderson Cooper announced the birth of a son, Wyatt. As a single gay man, Cooper was for obvious reasons unable to have a baby himself – Wyatt was conceived using eggs which had been harvested from one woman, fertilised (presumably using Cooper’s sperm), and then implanted into another woman who gestated and birthed him. This photo has over 1.1 million likes on instagram:

 

The topic of surrogacy and its position in the fertility industry is extensive; I couldn’t possibly in a single post cover the history, global practices or bioethics – at the bottom of the page you’ll find some resources which are an excellent starting point for anyone wanting to take a closer look at surrogacy. In this post, my intention is to briefly examine surrogacy through a lens of breastfeeding and the interdependence of the mother-baby dyad at birth and beyond.

Those who follow this blog on Facebook will know I’ve been thinking about surrogacy for a while, but I decided it was time to get in to a bit more detail after seeing the above photo shared on a number of Facebook pages focused on breastfeeding. Discussion mainly centred on the awkward way Cooper is holding baby Wyatt for the feed, and the featured branding on the formula bottle. One prominent breastfeeding advocate posted the photo, which she described as “heartwarming”,  asking “does anybody familiar with surrogacy births know what the protocols usually are for the mother’s milk? Is it that no contact is allowed after birth and the infant doesn’t get colostrum? Very interested in learning more.” Her post was inundated with comments from (predominantly US based) lactation and birth professionals describing surrogacy situations they had ‘supported’ and the various legal arrangements and choices available in surrogacy arrangements when it comes to providing milk to the baby (summary- it depends on the contract agreement, baby may receive colostrum and some early breastfeeds, most surrogate mothers suppress lactation, some families seek donor milk).

I wasn’t particularly surprised that surrogacy per se wasn’t being interrogated – but in groups of women who have a better than average understanding of breastfeeding and why it matters, it was profoundly disturbing that nobody seemed interested in at least acknowledging that the reason this discussion about how to feed the baby was taking place, was because he had been taken away from the most obvious and available source of milk. Instead, we had a jostling performance of who was The Most Supportive and Knowledgeable about contractual agreements, suppressing and inducing lactation, sourcing donor milk, etc.

While what a baby is fed and how they are held matters, infant feeding encompasses far more than the variety of methods by which we can get milk or milk substitutes into a baby. A key function of breastfeeding (i.e. the biologically normal ‘system’ of infant feeding) is to facilitate the ongoing interdependent and dynamic relationship between a mother and her baby. This relationship exists on a continuum extending from before conception, through birth, to the early years of life and beyond.*

A newborn baby’s mammalian instinct to seek their mother’s milk is enmeshed with their instinct to seek their mother’s body. Babies need food, but they also need touch – and maternal contact is unique. The infant nervous system is immature; proximity to their mother (ideally skin to skin contact) enables regulation which cannot be achieved solo. Babies who are separated from their mother have measurably high levels of the stress hormone cortisol and do not as effectively regulate their heart rate, temperature, or breathing. The longer the frequency or duration of the separation, the higher the risk that the intensity of stress may imprint as longer term trauma. Being cared for by another person can reduce baby’s stress – it’s why fathers are typically encouraged to have skin to skin contact with baby in obstetric emergencies- but it is not quite the same.

The 10 steps of the Baby-Friendly Hospital Initiative, which directs birth care practices to optimise normal breastfeeding, are founded in the principle of keeping mother and baby together as much as possible, including prioritising skin to skin contact and initiation of breastfeeding in the ‘golden hour’, unless absolutely necessary not to. During COVID-19, one of the biggest battles fought for birthing mothers has been opposing fear-based routine separation of mothers and babies. The risks of separation are known, and in the majority of births, even surgical birth and emergencies, they can be avoided or minimised.

Because of the specific disruptions to breastfeeding and bonding which are risked when mother and baby are not kept together, among birth and breastfeeding rights activists:

  • We accept the international body of evidence regarding the risk of physiological and psychological harms associated with separating the motherbaby in pregnancy and birth;
  • We object to the unnecessary separation of mother and baby during routine birth practices eg premature cord clamping, taking newborns to be cleaned and weighed before giving them to their mother, administering synthetic oxytocin to induce the 3rd stage of labour, removing baby while mother is in recovery or having stitches, putting newborns in nurseries, and so on;
  • We respect a mother’s right not to breastfeed, while holding this in balance with a baby’s right to breastfeed and the risks to both mother and baby of not breastfeeding. We therefore advocate informed decision making pathways which encompass empathic counselling and unbiased discussion of risk and risk mitigation;
  • We advocate for proper provisions of paid maternity leave;
  • We oppose the removal of babies from incarcerated mothers;
  • We support apologies and reparation for the historical and ongoing injustice of the state removal of babies from young mothers and indigenous mothers.

So what about surrogacy means that all we know to be true about the sanctity of the motherbaby and the various risks of separation, somehow does not apply?

Surrogacy (both commercial and ‘altruistic’) is widespread and global numbers appear to be increasing annually, despite tightening of regulations in a number of countries where international commercial surrogacy has been a profitable industry. For some time now, I have observed popular social media accounts of birth workers and groups dedicated to mothering, birth and breastfeeding sharing images of surrogate births with increasing frequency and gushing celebration:

 

Birth is an amazing rush even from the sidelines, and for those who love it, seeing families who have not been able to have their own baby finally have a longed-for child in their arms intensifies the oxytocin hit. But we have to stop lying to ourselves and each other. It’s time to look beyond the connection to the separation, for that is what surrogacy fundamentally is. The entire purpose of surrogacy is for a baby to be taken away at birth. And this practice deeply harms not only the women whose bodies are used to create the babies, but also the babies themselves.

Adoptee rights advocates have, on the basis of research into the normal continuum of early mother-baby relationship, described the disruption of the ‘fourth trimester’ as profoundly stressful for both mother and baby, with each experiencing a form of embodied grief and trauma akin to if the other had died. The propaganda from the fertility industry is that the baby knows only love in their new home. The reality is that in the USA, even dog breeders aren’t allowed to send a puppy to a new home before 8 weeks of age – but it is not considered inhumane to place a newborn baby with their new family even as the umbilical cord is still attached and pulsing.

The core lie of surrogacy is not simply that it’s OK to separate the motherbaby – it’s that the motherbaby does not even exist. The woman whose eggs are harvested, whose DNA is in every cell of the baby’s body, is not the mother. The woman who carries and births the baby, whose body contains that baby’s microchimeric cells for decades, is not the mother. The baby’s true mother is the one who commissioned and paid for them.**  This is exposed the moment we look at surrogacy from the baby’s perspective, for what use does a baby have for legal fictions? We can talk all we like about gestational carriers and intended mothers and forever families. But to a baby, their mother is the voice they know, the smell they recognise, the rhythm of the hips that have swayed them to sleep for their entire life in utero. Interrupting the sequence of mother-baby connection to hand a baby to a new and totally unfamiliar family is a callous violation of a baby’s right to their mother’s presence and milk, an active and deliberate infliction of harm on some of the most vulnerable members of humanity.

The average citizen, having seen only a facade of childless families finally receiving joy, can be forgiven for buying in to the surrogacy-as-a-beautiful-gift narrative. But among those who truly understand birth and breastfeeding, and who name ourselves as advocates and supporters, we have an obligation to ask if – given what we know about the importance of keeping mothers and babies together – we can support a practice which by definition requires ripping them apart.

 

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for more information on the high risks and harms of egg harvesting and surrogate pregnancies:

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*Because I know this will come up – I’m NOT saying that that breastfeeding is some kind of guarantee of perfect health and wellbeing or that without breastfeeding a mother and baby are all wrong or broken. Of course the mother-baby relationship can flourish in the absence of breastfeeding! Mothers and babies are robust – it’s necessary for the survival of our species – but why test the limits of that strength? What this information means is that we can know that if breastfeeding can’t or doesn’t work out, the needs it is biologically designed to fulfil don’t go away, and may need to be met in different ways. Support which gently respects what has been been lost when breastfeeding can’t or doesn’t work out, can enable mothers who don’t breastfeed to meet their baby’s and their own needs in other ways to maximise responsiveness and attachment.

**commercial surrogacy is not legal in all countries and states however most ‘altruistic’ surrogacy arrangements involve some form of payment in kind, from financial coverage of medical and living costs through to generous gifts.