OB Care in a Surrogacy Journey
A Guide for Intended Parents
When you pursue surrogacy, obstetric (OB) care is an important part of the journey. While the medical care itself looks much like any other pregnancy, there are some key differences in how care is structured and how intended parents are involved.
This guide explains what to expect.
1. Who Receives OB Care
The surrogate is the OB’s patient, as she is the one carrying the pregnancy. The surrogate can fill out a HIPPA form to release information to the intended parents. This may happen with contracts, directly with specific providers, or both.
All medical decisions and consents are made by the surrogate.
Intended parents are involved with the surrogate’s permission and in accordance with medical privacy laws.
The OB and the practice determine how much time outside of appointments is given to Intended Parents or if Intended Parents are allowed to video or speaker call into appointments. *Typically, midwives and doulas are much better about communication and involving the Intended Parents, especially if they are with a birth center or hired separately from an OB practice.
OB offices generally communicate medical information directly to the surrogate which means intended parents often receive updates from the surrogate or agency rather than directly from the provider.
This structure is standard and protects everyone involved.
2. Transition to OB Care
Early pregnancy care is typically managed by the fertility clinic through the first 8–10 weeks of pregnancy. There is much more communication with the fertility clinic then there typically is with the OB, and the communication from the fertility clinic is much for Intended Parent focused (as you were their patient first). Some fertility clinics may want OB care already established before the pregnancy so that the OB can do some of the earlier ultrasounds especially if the GC is not local to the clinic.
While this is an ideal for these fertility clinics, not all OB providers are willing to see a pregnant person before 10-12 weeks or to conduct earlier ultrasounds.
After pregnancy is confirmed and stable, care transitions to an OB or midwife.
Medical records are transferred so care continues seamlessly.
3. What Routine OB Care Looks Like
The surrogate’s OB care follows a typical pregnancy schedule:
Appointments every 4 weeks (early pregnancy)
Every 2 weeks in the third trimester
Weekly visits close to delivery
Care usually includes:
Ultrasounds (typically one at approximately 14 weeks and the anatomy scan around 20 weeks. It is NOT usual and customary to have weekly ultrasounds, although your GCs OB choosing to do them weekly is also not a cause for alarm)
Routine prenatal labs and screenings
Monitoring maternal and fetal health
Planning for delivery and hospital care
The surrogate may not see the same OB each visit, they may see a NP or PA instead of an OB for some visits, and an OB unknown previously to you and the GC may deliver the baby (whoever is on call at the hospital).
The OB may establish MFM care, even if an MFM is not necessarily needed yet. This is routine for some OBs due to the IVF pregnancy. This is not always a red flag that something is wrong with the pregnancy.
4. Intended Parent Involvement
In many journeys, Intended Parents may:
Attend appointments in person or virtually (with surrogate consent and clinic permission)
Receive ultrasound images and updates, many times this is from the surrogate directly not the OB
Please note that many ultrasound facilities will not allow virtual attendance or recording of appointments. A call in advance to find out these policies is advised.
Participate in delivery planning discussions, attend the birth if all parties give consent and the hospital policies allow
Important to know:
Intended parents do not sign medical consents
Providers always defer to the surrogate on medical decisions during pregnancy
5. Delivery & Hospital Stay
Before delivery:
A birth and hospital plan is shared with the care team (delivery preferences, rooming, infant feeding, photography, etc.). Our team drafts a letter we send to the hospital that breaks down most of these details, however most hospital administration and L&D staff will have additional questions they will ask to assist in preparing for your upcoming birth.
Legal parentage documents are coordinated (state-dependent ; may include pre-birth orders or post-birth paperwork)
· Hospital administration and L&D staff are notified of the surrogacy arrangement in advance
At delivery:
The surrogate gives birth and remains the patient of record for delivery and postpartum care
Intended parents may be present if agreed upon and permitted by the hospital policy
· Immediate newborn care follows standard hospital protocol
After Birth / Hospital Stay:
· The baby is typically roomed with the intended parents, when possible, per hospital policy
· Newborn medical decisions are made by IPs
· Hospital pediatrician connection with IPs
· Birth certificate and legal paperwork are initiated according to state law, typically by hospital staff.
· Lactation support is provided as planned (including pumping instructions if applicable)
· Discharge planning accounts for:
o Separate discharge timelines for surrogate and baby
o Newborn discharge with (no longer intended – actual!) parents
Medically, a surrogacy pregnancy looks much like any other. What’s different is the added coordination, communication, and respect for clear legal and medical boundaries all designed to protect the surrogate, the baby, and you as intended parents.
If you have questions about OB care, insurance, or hospital planning, we are here to help guide you through each step.