Surrogacy & Inclusive Care With Dr. Shelton
Tessa Coffey
Surrogacy & inclusive care: A conversation with Dr. Shelton on supporting surrogates and intended parents through pregnancy.
We sat down with Dr. Shelton, a board-certified OB/GYN at the Woman’s Health Center of Southern Oregon, to discuss his experience working with surrogates. Dr. Shelton has cared for many gestational carriers, including some of our own NWSC surrogates. His insights into surrogate pregnancy, the delivery experience, and the unique joy surrounding these births offer a valuable perspective on the journey for both surrogates and intended parents.
Dr. Shelton is committed to providing exceptional, inclusive care to all patients, including international and LGBTQ families pursuing surrogacy. At Northwest Surrogacy Center, we partner exclusively with surrogates in states that ensure access to comprehensive, life-saving medical care. The Woman’s Health Center of Southern Oregon shares these values, providing exceptional, inclusive care for all.
In our conversation, Dr. Shelton describes the incredible sense of joy in the delivery room, particularly during surrogate births, where intended parents get to meet their child for the first time. Looking ahead, he hopes to continue working with surrogates, ensuring they receive the highest level of support and care throughout their journey.
Join us as we explore the journey of surrogacy from the first appointment to delivery, gaining insight into both the surrogate’s and intended parents’ experiences. Dr. Shelton’s expertise, and unwavering dedication to compassionate, inclusive care makes this conversation one you won’t want to miss.
How do you feel about caring for a surrogate, or gestational carrier, at your practice?
We feel excited to care for these types of patients. It’s a unique opportunity to be involved in the care of a person who is carrying a child for another family and it’s always very rewarding.
Do you support a surrogate helping an LGBTQ family?
Absolutely, yeah. I feel like we find in most cases our surrogates are helping LGBTQ families. And from a personal standpoint, they are probably the most rewarding deliveries, just with the sheer joy you see on everyone’s face.
What should intended parents know about first-trimester screening?
Whether you’re intended parents or carrying your own child, you should expect similar counseling. We do genetic screening as well as structural screening.
With genetic screening, we look at certain blood tests to see if the baby has an elevated risk for chromosome abnormalities, whether that be an extra copy of a chromosome or a deletion that could affect the outcome of the baby.
Meanwhile, structural screening is usually done by ultrasound. Even in a low-risk pregnancy, folks are more likely to have a baby with a structural abnormality than a genetic abnormality, so we always encourage doing an ultrasound.
What do prenatal appointments include?
Typically, there are around 13 prenatal care appointments, included from the first month to a full-term delivery. Usually, in the first two trimesters, these appointments happen every four weeks and then more frequently during the third trimester. Baby is growing more rapidly at this point and we’re monitoring conditions that could arise. At 36 weeks, we’re closer to delivery and appointments happen weekly until we have a baby.
Some of the things we are checking on in these last few weeks leading up to delivery are blood pressure, testing urine for infection, monitoring baby’s growth, fetal heart rhythms and providing education at every appointment as to what to expect as you continue further along.
How can intended parents be involved if they are unable to attend appointments in person?
This is unique to every person and their arrangement that they have with the surrogate. At our personal practice, we encourage as much participation as the surrogate and the parents would like, so long as it protects the surrogate’s personal health information. The primary condition is that the patient always comes first.
If the patient feels comfortable with their personal health information being shared with the intended parents, then we have no problem if they want to be at the visit whether that be in person, on the phone or on facetime during that appointment.
How do you think intended parents can support their surrogate through pregnancy? What advice would you give?
Communication is key as with any relationship. Asking your surrogate what they need is a good start. Do they need rides to their appointment? Or maybe they need to have medication picked up for them because they just don’t feel well. What kind of groceries do they need help getting? Making sure they have meals and things like that is helpful.
Additionally, is there anything that their OB has suggested that you could help with? Those are all great things intended parents can incorporate into their relationship with their surrogate. If intended parents are able to attend those appointments, whether virtual or in person, then folks are all getting information first hand which helps support the surrogate.
How hard is it to predict a birth date?
Very, because there are so many variables that go into determining when they’re going to deliver. When we say when your estimated due date is, the only reason we have that date is so that we can follow your pregnancy from a gestational standpoint. It’s purely just to reach those milestones through your pregnancy, it doesn’t mean you’re actually going to deliver on that day.
Depending on whether it’s your first pregnancy has a variable on when you will deliver. Sometimes your body will just go into labor naturally quicker if it’s not your first pregnancy. Then there’s other medical things that indicate whether you may deliver sooner or later. The best piece of advice is just to stay fluid and have an open mind during that process, especially as we get closer to the due date. The last month is pivotal as far as timing is concerned. I often say, “Here’s your due date, the month surrounding that due date is when you want to be quite fluid and keep an open schedule.”
Do you typically see intended parents in the delivery room if the surrogate requests it?
Yes, I don’t think I’ve had a surrogate delivery where the intended parents haven’t been in the room, unless timing and other things don’t work out. For example, if she goes into delivery early and they’re very far away. But typically, most surrogates encourage the parents to be in the room. Our hospital encourages them to be there and depending on the intended parent’s and the surrogate’s arrangement, we usually have a separate room for the intended parents to stay in after the baby is born so that the surrogate can get some rest and recover from the delivery.
Can you describe what surrogacy deliveries are like?
From my experience, there is an overwhelming feeling of joy in the room, not only from the intended parents and the surrogate, but from the nurses and the delivery clinician as well. It’s just such a gift that you’re giving that there is no sad face in the room. Everyone walks away smiling because you’ve done such an incredible thing for a person, or people, and I think that’s one of the highest goals you can attempt to achieve as a clinician.
“…there is an overwhelming feeling of joy in the room, not only from the intended parents and the surrogate, but from the nurses and the delivery clinician as well. It’s just such a gift that you’re giving that there is no sad face in the room.”
What should intended parents expect in the hospital after the baby is born?
For the newborn, what most folks can expect is that for the first 24 hours the baby is working on feeding cues, maintaining their temperature and metabolism. Additionally, their output is being monitored meaning peeing and dirty diapers, so pooping. At 24 hours is when most of that newborn testing occurs seeing how well they’re metabolizing, checking their blood, as well as their hearing screening, and their car seat fit test.
For surrogates, the first 24 hours as long as there wasn’t an arrangement for breastfeeding, they can get quite a bit of rest those first 24 hours. They can expect bleeding, perineal care if they delivered vaginally, wound care if they delivered by C-section. Staying up on comfort measures, making sure pain is well controlled, making sure they’re able to walk and do their daily functions after going through such a big event.
Have you noticed any unique challenges working with surrogates?
I think the most unique challenge is timing. The timing of delivery and giving that expectation because we don’t have crystal balls unfortunately, and we don’t know what’s going to happen in the future, so we kind of lean on that experience and the gestational carrier’s prior pregnancy experience to say, “Hey, you know, this might lead us to deliver at this time.” But, the biggest advice we give is to keep an open mind and an open schedule at the month surrounding the due date.
What resources do you recommend to intended parents and surrogates?
For resources, most things are online. We used to recommend the book What to Expect When You’re Expecting ,but as we get more medically advanced, this is kind of became an outdated resource and we are recommending sticking to more online resources that are updated. Some of these include The American College of Obstetricians and Gynecologists website as well as The Academy of Pediatrics.
For local resources, online Facebook groups and other forums where you can communicate and create that community with other families are helpful. Kids don’t come with instruction manuals, so I recommend any books that are comedic because you just need some relief. We put a lot of pressure on ourselves as parents to make them perfect and I think that making sure that we have that relief or see the comedic side of things takes a lot off our plate
Do you have any advice for first time parents?
It takes a village; you can’t do it all on your own. So reaching out to family and friends, even if it’s just, you know, “can you load the dishwasher for me”, or, “can you vacuum the carpet for me? I’d really appreciate having one less thing to do during the day while I’m focusing on feeding or getting a nap in to recover.” For that first 1-2 months, it’s very critical to have that support from not only your family and friends but from your community as well.
Do you find it any different working with surrogates versus non-surrogates?
I think the only difference is that we must keep in mind that there are intended parents involved so we should keep that line of communication open between those groups as well as educate both of those groups at the same time. I think if the intended parents are available to conference in or come to the appointments, that’s where we see the most benefit.
What inspired you to want to work with surrogates and with pregnancy in general?
I think being an OBGYN is a unique specialty as no day is the same. It is a very versatile field. We not only deliver babies, we also care for patients in the office from the teenage years all the way up to patients in their 80’s and 90’s. And then we are surgeons as well, taking care of gynecological conditions. The versatility and that no day is the same is what drew me to the field in general.
Delivering babies doesn’t get old. That miracle that happens in front of you and the sheer joy you see on everybody’s face, whether it be a surrogate pregnancy or not, that’s truly a special moment in everybody’s life.
Ready to see if you qualify as a surrogate?
If you are a healthy, nonsmoking woman between the ages of 21 and 41 years old and have had previous healthy, full-term pregnancies, we would love to hear from you!
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