Sharing a Pregnancy
By Ellen Glazer, Boston Sunday Globe, MA,
June 10, 2001
What is it like for a women to bear another woman's
child? It is easier than you might expect
certainly hope no one thinks that this route is chosen
out of convenience. I would give anything to be carrying
my babies.’ Marla Culliton (with the woman carrying
the Cullitons’ twins).
Marla Culliton is a dental hygienist
with many loyal patients, and she knows they don’t
like surprises. So rather than wait until the last
minute to tell them she will be on maternity leave
later this summer, she began letting patients know
in the spring that she and her husband are expecting
“Their responses were all over the place. There
were patients who quickly said, ’ I knew it!
I could see that you were gaining weight around the
hips.’ Then there were others who gazed at me
from top to bottom and seemed totally baffled. The
most that these people could say was, ’ But
you are carrying so small.’”
Marla Culliton is neither gaining weight nor “carrying
small.” The twins that she and her husband,
Steven, are expecting – their full biological
children – are being cared for in utero by another
woman, a “gestational carrier” named Melissa.
When the twins are born, they will come from Melissa’s
body, but the names on the birth certificates will be Marla
and Steven Culliton.
One of the many ways that in vitro fertilization has revolutionized
human reproduction is that it made possible for one woman
to carry and deliver another woman’s biological offspring.
Women otherwise unable to bear children – perhaps
because of a hysterectomy, perhaps because of a medical
condition that made pregnancy dangerous – are now
able to have their own, genetic children born from an embryo
that is transferred to, grows inside, and is delivered by
a gestational carrier. Unlike in surrogacy, the woman who
gives birth has no biological link to the baby.
“Shared” or gestational carrier pregnancies
are by no means common. Although precise numbers are hard
to come by, it’s a good bet that about 1,000 babies
are born each year to gestational carriers in the United
The treatment is reserved for those women who can produce
healthy eggs, but who are clearly unable to carry a pregnancy.
They are women like Marla Culliton, who spent seven years
in a maze of infertility treatments, who lost six pregnancies
before seeking a gestational carrier. Or Monica Vachon,
who had a hysterectomy when she was 12 because of cancer,
and is now a mother. Or Patty Cunha, whose two surgeries
to remove her fibroid tumors left her with scar tissue so
extensive that it was likely to prevent pregnancy –
and whose first baby is due soon. They are but three of
the many Boston area women who have experienced a shared
New technology – especially when it involves the
intensely personal matter of human reproduction –
raises a host of new questions. How do would-be parents
and gestational carriers find each other? How does one woman
allow another woman – often a stranger – to
care for that which is most dear to her? But the perhaps
most important question is, how can two women manage the
complex feelings that a shared pregnancy produces.
The short answer is this: Gestational carriers try hard
not to bond with the child they carry – which, while
made easier by the lack of biological tie, can still require
some emotional acrobatics. At the same time, the waiting
mother and father find ways to bond – sometimes very
“Hi, baby, this is your mommy talking. I am going
to read you a story. I hope you like it,” says the
tape-recorded voice of Patty Cunha, whose gestational carrier,
Carol, plays the message each morning as she dresses, so
the baby inside her can get used to her mother’s voice.
By contracts, Carol never speaks as a mother to the unborn
child whose presence she feels every moment of every day.
While gestational carriers may grow fond of the babies
they carry, they are careful to maintain an emotional distance.
“My feelings during the pregnancies were not at all
like my own pregnancies. I never wondered what the baby’s
feet would look like. I never thought of what their names
would be,” says Linda Reynolds, of La Mesa, Calif.,
who has twice been a gestational carrier. “Those children
need me to walk them across the bridge to their parents.
They came through me but are not part of me.”
Says Paula Dill, another gestational carrier in California,
of the twin boys she gave birth to, “It felt more
like a friendship with the boys than a bond.” At the
same time, Dill says she felt quite close to the boys’
intended mother (or IM, as they are known).
“It was an indescribable feeling,” Dill said.
“She and I were on a common mission, and now share
a common bond.”
Gestational carriers try
hard not to bond with the child they carry…At
the same time, the waiting mother and father find
ways to bond – sometimes very creative ways.
Marla and Melissa have also grown close. One small
gesture says much: Melissa, a lifelong consumer of
hamburgers and French fries, recently telephoned the
more health-conscious Marla (who was privately fretting
about Melissa’s prenatal diet, and struggling
to accept the fact that she could not control it)
to tell her that she is now craving salads.
Marla was enormously grateful. “I don’t know
if it’s true or not, but it doesn’t matter.
What meant so much to me is that it was yet another example
of Melissa’s efforts to include me in any and every
way that she can.”
Last month, Marla and Melissa included Marla’s mother
– the expectant grandmother – in a doctor’s
visit. Watching her mother’s face as she met her grandchildren
on ultrasound meant a great deal to Marla. “I realized
that even if I was carrying the pregnancy, my mother would
be an observer. What mattered now was not where the babies
are now, but that they are a part of our family and our
Melissa was also a good sport about visiting Womb with
a View in Stoughton, where 3-D ultrasounds of the twins
gave Marla and Steve a good view of the babies’ faces
– not to mention a videotape, a compact disc, and
two 4-by-6 glossies to bring home.
“Melissa doesn’t want to bond with the babies
so she is not especially interested in three-dimensional
pictures of them,” said an appreciative Marla. “But
she knows how much I want it and, as always, she says that
it is my pregnancy and I should have what I want.”
Gestational carrier pregnancies begin in many ways. Sometimes
a friend or family member makes an offer. More often, a
woman will identify a potential carrier and cautiously approach
her with the request. Others decide, for a variety of reasons,
that they had best seek a stranger.
“I never would have imagined going on the Internet
to find the woman who would carry our child. Think of it:
we all grow up believing ‘first comes love then comes
marriage, then comes the baby carriage.’ The jingle
doesn’t include the Internet, the surrogacy chat rooms,”
says Patty Cunha.
“Nothing earlier in my life prepared me for e-mailing
and talking with a stranger” about carrying my child.
“Nor for entrusting my child to another woman at the
most important part of his or her life.”
Despite her reservations, Patty ventured into cyberspace.
There she met Carol, a married mother of two, living in
Florida and eager to carry a child for another couple.
Although contractual gestational carriers, including Carol,
receive payments for all that is involved in the process
of becoming and being pregnant, these payments – usually
between $13,000 and $17,000 – rarely appear to be
a woman’s’ only incentive for becoming a gestational
carrier. They say they are also motivated by the desire
to help another couple feel the joy of parenthood. Such
was the cases with Carol, who is now pregnant with Patty
and Kirby Cunha’s baby.
Indeed, while in vitro fertilization revolutionized reproduction,
the Internet has revolutionized introduction – in
this case, to potential gestational carriers. Women seeking
to carry a child for an infertile couple can reach their
prospective “IPs” (intended parents) through
the Web, often through the site maintained by the Organization
of Parents Through Surrogacy, or OPTS. It is the only nonprofit
organization dedicated to providing support and information
to people involved in both surrogacy and gestational carrier
A recent visit to www.opts.com
yielded several ads including the following:
“Happily married mother of four, 36, 120 pounds,
wants to be a gestational surrogate for a deserving couple.
Must be willing to do embryo transfer in Missouri or a nearby
state. Flexible, loving, ready to help.”
And this: “Gestational surrogate in Illinois is a
single woman who has a sit down job and also sews at home.
She is busy raising her son, but wants to help a deserving
couple build their family.”
Couples and carriers who have met via the Internet describe
a process not unlike Internet dating. People introduce themselves,
talk about what they are looking for, determine if they
have common goals and usually begin to talk by phone. If
they decide to proceed, it’s on to physicians and
Internet introductions are not for everyone. Many couples
and many prospective carriers prefer a more personal matchmaking
process. Others turn to a “full service” program
like the Center for Surrogacy and Egg Donation in Beverly
Hills, where would-be parents can not only be matched with
a carrier but also can have their legal and medical services
coordinated. Still others seek lawyers who are experienced
in these arrangements, offering to locate gestational carriers,
match the couples, and provide introductions.
Pursuing a gestational carrier pregnancy is not for the
faint of heart, and cannot be done casually. It is a complicated
journey, from legal contract to medical evaluations, to
counseling sessions and, if all goes well, the careful coordination
of a fertility cycle and in vitro transplantation.
Dr. Steven Bayer, a reproductive endocrinologist at Boston
IVF-Watham, emphasizes how seriously he and his colleagues
consider each situation that comes to them. He recalls recalls
months of conversations with a medical ethicist before taking
on his first case six years ago. Now, several successful
gestational carrier pregnancies later, he is a cautious
supporter of this process.
“We need to carefully evaluate both the intended
parents and the women who volunteer to carry their babies.
We won’t work with a couple if there isn’t clear
evidence of medical need and we won’t work with carriers
if we have concerns that they are taking undo risks medically
He notes that would-be parents and potential carriers often
weigh risk differently. “My infertile couples are
willing to assume risks of pregnancy because they will have
a baby to take home if all goes well. Obviously the situation
with a gestational carrier is quite different, and it is
my responsibility to make her aware of the risks of pregnancy
which could prove hazardous to her health.”
Dr. Susan Cooper, a psychologist at the Reproductive Science
Center in Waltham and coauthor of “Choosing Assisted
Reproduction: Social, Emotional and Ethical Considerations,”
counsels many gestational carriers and couples. “I
feel it is important that I see the participants separately
and then together so that I can raise several issues with
them,” she says.
feelings during [gestational] pregnancies were not
at all like my own pregnancies. I never wondered what
the little baby’s feet l would look like. I
never thought of what their names would be.’
Linda Reynolds Gestational carrier
“When I meet with prospective gestational
carriers I ask them how they think their children
will feel about this, how they plan to tell them,
whether they are prepared to carry multiples, and
how they will manage if the pregnancy is a difficult
one. When I see them with the couples I try to confirm,
among other things, that people are on the same page
about decisions regarding amniocentesis, fetal reduction,
and abortion for a genetic problem.”
An occasional role of physicians and mental health counselors
is to provide an “out” for people who want it.
Every so often someone will volunteer to do this –
or be asked – and then have a change of heart. The
carrier may encounter objections from her husband, or from
others, and decide that she is unable to go ahead. Practitioners
see it as their job to help these people out in a difficult
situation. This can be accomplished simply by informing
the participants of “medical and/or psychological
reasons for not proceeding.” No further information
For those who go ahead, lawyers become very much a part
of the process, and a contract is essential. It “forces
all the parties to think carefully about what is important
to them,” says Susan Crockin, herself a lawyer and
editor of the book “Adoption and Reproductive Technology
Law in Massachusetts.” “It also serves to avoid
future misunderstandings and ill feelings.”
Such a contract also makes clear just what role the intended
parents have as the pregnancy develops. “I’ve
had a lot of very worried expectant parents, [and] their
anxiety can be a burden for the carrier,” she says.
By giving parents the contractual “right” to
talk directly to the carrier’s doctor, Crockin says,
their anxiety is alleviated.
Although the legal, psychological, and social steps leading
up to in vitro fertilization and embryo transfer are complicated,
the medical procedures have become almost routine. Intended
mothers undergo ovulation induction for several days, injecting
themselves with medications intended to ripen a number of
eggs. During this time they are closely monitored with blood
tests and pelvic ultrasounds.
When it is evident that several ovarian follicles have
matured, the eggs are “harvested” from her body
and mixed with semen specimens produced by her husband.
A few days later, one or more of the resulting embryos is
carefully implanted in the gestational carrier’s uterus.
Although the procedure is designed to create just one fetus,
the use of several embryos (to increase the odds that at
least one “takes”) often results in twins –
usually not an unwelcome outcome.
Would-be mothers who have shared a pregnancy get angry
when they hear people say that women turn to gestational
carriers out of privileged convenience, a way to get around
the discomforts or pregnancy. “I certainly hope that
no one thinks that this route is chosen out of convenience.
I would give anything to be carrying my babies,” says
Indeed, women pregnant “out of body” long to
feel life within them. As one Boston area expectant mother
whose two sons each died within hours of their severely
premature births put it, “I look at my gestational
carrier’s belly and feel envy…I envy the fact
that she can feel my child inside her. I am grateful to
her and certainly don’t resent her. I just wish it
Many gestational carriers and their intended mothers observe
that they start to feel just like sisters. For Monica Vachon
and Helen McLaughlin – real-life sisters – their
gestational carrier experience was a very important part
of their lifelong commitment to each other.
Long before Monica knew anything about
in vitro fertilization, her older sister, Helen, was
reading about the procedure and figuring out how she
would carry a baby for her sister. Although Monica
had had a hysterectomy at age 12 because of cancer,
a portion of one ovary remained intact. Helen knew
that meant Monica could still produce eggs.
McLaughlin (right) tried twice to carry her younger
sister Monica Vachon’s child. The first baby died.
Amy, 5, is the doubly beloved success.
Soon after Monica and her husband, Steve, were married
in 1992, Helen made the offer. Or, as Monica recalls it,
“perhaps it is better to say she insisted. She told
us that this was something that she wanted to do and was
going to do and that we’d better not argue with her.”
The first pregnancy ended in tragedy. The baby, Natalie,
was born prematurely and did not survive. Although the Vachons
were devastated, they longed all the more for a child. So
did Helen. “We had come so far. I was crushed, but
I did not want to give up hope of delivering a healthy baby
for my sister.” When she suggested they try again,
the Vachons agreed.
Helen’s second pregnancy brought with it a host of
challenges. In addition to the cervical problems that had
caused Natalie to be born prematurely, and which meant Helen
would now require a cerclage (stitching of her cervix),
Helen developed gestational diabetes. All of which made
Monica feel especially helpless.
“I couldn’t believe that anyone could be willing
to do so much for another person. Not only did she go through
all sorts of physical discomforts, but she did it in a most
generous way. If we were out and would meet someone who
commented on the pregnancy, she would always tell people
that I was the one expecting. She didn’t seem to care
at all if they were confused. She was simply so happy for
The happiness has continued. The Vachon’s second
daughter, Amy, was born without complications. Monica’s
eyes fill with tears when she remembers the birth of Amy,
and the days that followed. Although Monica, Steve, Helen,
and Amy spent the first few days together in the hospital,
Helen insisted on leaving the hospital alone. “She
wanted us to be able to go home with our daughter. I couldn’t
believe that, even then, she thought only of us and our
Although Amy is now a regular 5-year-old and Monica a regular
mother, their unusual beginning as mother and child remains
an important part of their relationship. Amy knows that
she grew inside of her Aunt Helen, and for many reasons,
they have a very special relationship.
“Amy will always know how much she was wanted and
how deeply she is loved. But at the same time, I don’t
want her to feel different, “says Monica. “I
will always remember what [the doctor] told me shortly after
Amy was born, ‘Never forget how special she is, but
try not to treat her that way.’”
Marla and Steve Culliton’s babies are due early in
September, but because Melissa is carrying twins, they are
likely to arrive at least a few weeks early. So the Cullitons
are beginning to prepare for their arrival. In addition
to buying furniture and setting up a nursery, there are
some special tasks associated with gestational carrier birth.
Melissa Brisman, the New Jersey lawyer specializing in
reproductive law who represents them, has taken the legal
steps necessary to ensure that the Cullitons’ names
will be on the birth certificates. (During the sixth month
of gestation, a lawyer can petition the court to establish
that the genetic parents are the legal parents.) Now they
must take the court documents to the hospital and make sure
that the staff knows that they are the twins’ parents,
and will be making all the decisions about the babies. They
also want to be sure the hospital staff will be sensitive
to Melissa’s feelings.
In the coming weeks Marla and Melissa will be taking childbirth
classes together. As with the 3-D ultrasound, this was Marla’s
idea. “I’ve always wanted to give birth and
this is the closest I’ll be getting. I want to be
as much a part of labor and deliver as I can,” she
says, “going to childbirth class is another time that
I can enjoy this unique pregnancy rather than feel outside
That’s not all. She plans, with the help of such
herbs as fenugreek and blessed thistle, to induce lactation
and “breast feed my babies as best I can,” she
Because Marla is Jewish, she has grown up with religious
tradition that advises parents to wait until after a baby’s
born to celebrate. It’s not been easy.
“I try, but I can’t rein in my excitement,”
she says. “We’ve waited too long to be parents
and I’m enjoying every minute of this experience.”
What’s in a name?
By Ellen Glazer
This is a case of language lagging behind medicine
Although women have been carrying other women’s
babies for nearly two decades, there is no agreed-upon
language to describe the process or its participants.
Some people regard this as a form of surrogacy, the
widely used term for when a woman is artificially
inseminated, gives birth to a child (biologically
hers), and by prior agreement, places it with its
biological father and his spouse or partner. In short,
the mother produces a child as part of a pre-conception,
step-parent adoption plan.
But that differs in important ways from the process
by which an embryo – the product of a couple’s
egg and sperm – is placed in the uterus of a
third, unrelated woman, to grow. In this case, this
third woman functions for nine months as caretaker
for the couple’s child-to-be, but has no biological
connection to it. (One recent high-profile case: the
twins born to singer James Taylor and his wife, Kim
Because each process involves a woman pregnant with
a baby she does not intend to parent, some practitioners
and parents treat the two processes as related, and
refer to them both as forms of surrogacy – the
first “traditional,” the second “gestational.”
The organization for Parents Through Surrogacy, a
national nonprofit advocacy group, serves both constituencies
and makes little distinction between them. And, defenders
of this view note, in both cases the children wanted,
planned for, and deeply loved.
But professionals working in reproductive medicine,
as well as many of the people involved in the undertaking,
feel that the processes are so different that the
gestational arrangement warrants its own name. The
first term considered, “host uterus,”
was, fortunately, deemed unsuitable. It was replaced
by “gestational carrier,” whish, while
serviceable, is an uninviting, awkward term that few
are fond of. But nothing better has come along.
We are still without a term for the process gestational
carriers and intended parents engage in. Some physicians
call it “gestational carrier treatment.”
Other professionals, even those respectful of the
distinction with surrogacy, have grown weary of the
semantics and fall back on “gestational surrogacy.”
Once again, neither seems adequate.
An emerging alternative, “gestational care,”
has much to recommend it. With luck, it will catch
Ellen Glazer, a clinical social worker and writer
who lives in Newton, is coauthor of “Choosing Assisted
Reproduction: Social, Emotional and Ethical Considerations.”