Understanding Prenatal Care During Surrogacy
(IP Edition).

Understanding what to expect when it comes to your surrogate’s prenatal care can help you feel safe, connected and informed about your baby’s health.  While every Prenatal Care Provider sets up their own course of care, and there may be variations, we can help you understand what is a typical prenatal care schedule and what happens at each stage of pregnancy.  

Remember, this is just to give you an idea of what typical prenatal care may be, and your surrogate’s schedule may look different!

Notes:

• Prenatal care appointments begin after your surrogate has been released from the care of her Reproductive Endocrinologist, typically between 10 and 12 weeks of pregnancy.
• Prenatal Care Providers are typically a Midwife or Obstetrician.  If the pregnancy is high risk, like in the event of multiples, your surrogate may also see a Perinatologist or Maternal Fetal Medicine doctor.
• Please note that in the United States, we typically do not receive physical proof or results of any testing, screening or ultrasounds. Prenatal Care Providers discuss results with patients, but do not provide paper copies of the results.
• Additionally, although your surrogate may ask for permission to take photos or video during ultrasounds, please be aware that she may not be allowed to do either.

First Prenatal Care Appointment (9-12 weeks of pregnancy): 

• Your surrogate and her prenatal care provider (PCP) will go over the surrogate’s medical history and IVF records for the current surrogacy pregnancy.
• The Prenatal Care Provider will offer Cell-free Fetal DNA testing (also called cfDNA or Noninvasive Prenatal Testing/NIPT)
  • Looks for markers for Down Syndrome (Trisomy 21) or Edward’s Syndrome (Trisomy 18), and Trisomy 13, Sex Chromosome Aneuploidies
  • Can be done any time after 10 weeks of pregnancy
  • Even if embryos were genetically tested, it is routine care to do the cfDNA screening
• The Prenatal Care Provider will also check: 
  • Blood Pressure
  • Weight
  • Urine screen for protein and sugar (They are looking for early signs of preeclampsia and/or gestational diabetes.) 
  • May also order an ultrasound.  This is not required and is done by at the prenatal care provider’s discretion.  

Second Prenatal Care Appointment (12-14 weeks of pregnancy):

• The Prenatal Care Provider will: 
  • Go over any questions or concerns you and/or your surrogate may have 
  • Discuss the results of the cfDNA/NIPT
    • You likely will not get a copy of the results.  It is typical in the United States that the results are only discussed.
  • Check Blood Pressure, Weight, Urine screen for protein and sugar

Third Prenatal Care Appointment (16-18 weeks of pregnancy):  

• The Prenatal Care Provider will: 
  • Instruct your surrogate to schedule an appointment for the anatomy ultrasound.
    • The anatomy ultrasound:
      • Is typically completed between 18 and 22 weeks
      • Takes 1-2 hours 
      • Measurements are taken of the baby and recorded
      • Results are discussed at the next prenatal care appointment
      • This is a wonderful time for you to attend a prenatal care appointment!
  • Check Blood Pressure, Weight, Urine screen for protein and sugar
  • Measure your surrogate’s abdomen to check Baby’s growth
  • Listen to Baby’s heartbeat with a doppler

Fourth Prenatal Care Appointment (20-22 weeks of pregnancy): 

• The Prenatal Care Provider will: 
  • Check Blood Pressure, Weight, Urine screen for protein and sugar
  • Measure your surrogate’s abdomen to check Baby’s growth
  • Listen to Baby’s heartbeat with a doppler

Fifth Prenatal Care Appointment (24-26 weeks of pregnancy):

• The Prenatal Care Provider will:
  • Provide results of the anatomy ultrasound and discuss any questions or concerns 
  • Instruct surrogate to complete the Gestational Diabetes test
    • Gestational Diabetes test will:
      • Be completed at a lab
      • Take 1-3 hours 
      • Require 2-4 blood draws after drinking a very syrupy, sugary drink
  • Check Blood Pressure, Weight, Urine screen for protein and sugar
  • Measure your surrogate’s abdomen to check Baby’s growth
  • Listen to Baby’s heartbeat with a doppler

Sixth Prenatal Care Appointment (28-30 weeks of pregnancy):  

• The Prenatal Care Provider will:
  • Give your surrogate the Rhogam shot if she is RH negative (which is not common)
  • Discuss the gestational diabetes testing results and address any questions or concerns about the pregnancy or the gestational diabetes results
  • Check Blood Pressure, Weight, Urine screen for protein and sugar
  • Measure your surrogate’s abdomen to check Baby’s growth
  • Listen to Baby’s heartbeat with a doppler
  • Feel for baby’s position in belly
• Note: At this time, your surrogate will need to register at her delivery hospital or birthing center so that all of her information is in their system

Seventh and Eighth Prenatal Care Appointments (32-36 weeks of pregnancy): 

• Your surrogate will now see her Prenatal Care Provider every 2 weeks
• The Prenatal Care Provider may: 
  • Perform the Group B strep test
  • Check your surrogate’s cervix to identify if there is any change in cervix length
• The Prenatal Care Provider will:
  • Check Blood Pressure, Weight, Urine screen for protein and sugar
  • Measure your surrogate’s abdomen to check Baby’s growth
  • Listen to Baby’s heartbeat with a doppler
  • Feel for Baby’s position in belly

Ninth to Delivery Prenatal Care Appointments (36-42 weeks of pregnancy): 

• Your Surrogate will now see her Prenatal Care Provider every week
• The Prenatal Care Provider will:
  • Check Blood Pressure, Weight, Urine screen for protein and sugar
  • Measure your surrogate’s abdomen to check Baby’s growth
  • Listen to Baby’s heartbeat with a doppler
  • Feel for Baby’s position in belly
  • May check cervix but not mandatory and only at the request of your surrogate
• If your surrogate carries past 40 weeks of pregnancy: 
  • She may be asked to have additional monitoring
  • Your surrogate and her Prenatal Care Provider will discuss a possible new birthing plan and talk about the possibility of an induction with surrogate
    • Inductions are a medical decision discussed between the surrogate and her Prenatal Care Provider
      • Learn more about induction here.

Final Thoughts

Prenatal care is a critical part of a safe and healthy pregnancy, and understanding this process can help you feel more connected to your surrogate and babt. While the details may vary slightly based on the provider or individual circumstances, this guide outlines the key milestones and what you can expect along the way.

If you have questions or concerns, your Case Manager is always available to provide support and guidance. 

Soon your baby will be in your arms!