The other way to be a mother

Catherine Bright's third pregnancy was very different from the two that went before. During the first two, whenever the baby moved she placed a comforting hand on her abdomen to feel her growing infants. But not this time. It wasn't, as she is quick to point out, a case of being uncaring. It was simply a way to keep a distance between herself and the twins growing inside her.

She needed that detachment because the twins in her womb were not hers. She was not the mother, and nor was her husband, Kevin, the father, and days after they were born, the babies were handed over to another couple, the genetic parents of the twins. Catherine, 28, and the couple she gave birth for are among a small but growing number of people in the UK involved in surrogacy: last week, campaigners celebrated the 500th surrogate birth in this country.

To some, surrogacy is a highly risky business, a moral and ethical minefield, with few, if any, happy endings. But for others it's a positive, fulfilling enterprise that brings joy to infertile couples who would otherwise be denied the children they long for.

Horror stories of money-grabbing surrogate mums refusing to hand over the new-born baby, bitter courtroom wrangles over custody, and commissioning mothers unable to bond with their new child, have contributed to surrogacy's bad image. In the past, psychologists have even warned of the possibly damaging long-term effects on children with two mothers - or three where a donor egg from a third woman is used. And those cases that really did run into difficulties, such as the Baby M case in the New Jersey Supreme Court in 1988, where the surrogate mother sought custody of the child, only served to fuel the moral panic.

But new research, by City University, London, shows that such cases are very much the exception, at least in Britain. In the vast majority of cases the arrangement works, and often relationships are so good that both mothers are present at the birth - sometimes even dads, too. The two mothers often go to prenatal appointments together, and in only one in 10 cases does the relationship end with the birth.

In the biggest study yet of surrogacy in the UK, the City University researchers looked at 42 couples with a one-year-old child born through surrogacy. The research was focused on the experiences of commissioning couples, and shed fascinating new light on how surrogacy is arranged, and the relationship with the birth mother.

Just over half of the couples had the traditional form of surrogacy, where the surrogate mother and the commissioning father are the genetic parents of the child, and where conception is through artificial insemination. Sixteen of the couples had full surrogacy, a technique made possible by IVF, where the surrogate mother is implanted with an embryo created by the commissioning couple. In full surrogacy, the role of the surrogate mother is purely gestational and the child is genetically related to both commissioning parents.

The research shows that the typical age of the commissioning mother in the UK is 35, and that, on average, they and their partners have been trying for more than seven years to have a child before turning to surrogacy. The most common reason given for opting for surrogacy was repeated IVF failures, experienced by 43 per cent of the women. The second most cited reason was that the woman had no uterus, sometimes as a result of an emergency hysterectomy.

Crucial to the success of surrogacy is the relationship between the commissioning couple and the surrogate. Of the 42 couples, 69 per cent had not known the surrogate mother prior to the arrangement, and all but one had met through the UK surrogacy agency, Childlessness Overcome Through Surrogacy (Cots). Seventeen per cent were relatives of the commissioning mother, and 14 per cent were friends of the couple.

Some have argued that that surrogacy with a stranger is potentially hazardous because of the levels of trust needed between people who are essentially strangers. But others have argued that opting for a relative or friend may put undue pressure on them, and in Israel it is illegal for the surrogate mother to be a relative.

The research also shows that commissioning couples and stranger surrogate mothers meet on average six times, and know each other for about 17 weeks, before the first attempt to conceive. It is also clear that commissioning mothers seem to be more involved than fathers with the surrogate during the pregnancy, in that they see her more frequently, often accompanying her to medical appointments."It is possible that sharing the pregnancy in this way can help the commissioning mother to feel connected to the unborn child and, in the case of partial surrogacy, to come to terms with the fact that she is not the genetic mother,'' say the researchers.

Of the relationships they saw, most were good, with little sign of conflict during the pregnancy, and no evidence of any serious friction. There was only one case of a surrogate mother having slight doubts about handing the child over, with all the others showing no problems at all. (Other research, however, has shown higher levels of concern: one study of 19 surrogate mothers in the Journal of Reproductive and Infant Psychology found that five were distressed about parting with the child.) In addition, all but one of the commissioning mothers had no difficulty in accepting the baby.

A key factor in the arrangements is the future role of the surrogate mother. In the surrogacies where the mothers were strangers, two-thirds involved the surrogate mother having occasional contact with the child, and in one in 10 cases, the couples wanted her to play a special role in the child's life by, for example, going to birthday parties. Conversely, in one in 10 cases there was an arrangement that the surrogate would not be involved after the birth.

"There is little evidence in support of the theory that commissioning mothers may feel insecure about the surrogate mother's involvement with the child. Nearly all of the commissioning mothers were positive about this and felt that their child would benefit from it,'' say the researchers.

"In spite of the concerns that have been commonly voiced about surrogacy," they continue, "the commissioning parents... generally perceived the surrogacy arrangement as a positive experience and one that they would recommend to other people.''

Bright was drawn to become a surrogate mother by a desire to help others. "I first thought about being a surrogate mother four years ago," she says. "With my first daughter, I fell pregnant naturally but they then told me that I had polycystic ovaries and that I might need IVF treatment.

"That worried me a lot. If I had been unable to have any more children I would have been very unhappy. Fortunately, I fell pregnant naturally with my second daughter [she has since also had a third], but that fear spurred me to help other people, and I got in touch with Cots. They did an assessment, pointed out the pros and cons, and explained everything. They then sent us details on three couples and we chose one of them - really because of their bad luck with previous pregnancies.

"We spoke to them on the phone, and then about six weeks after we chose them, we met. We then decided to go ahead, and I had twins. During the pregnancy, the commissioning mother came to all the medical visits because she wanted to be involved. The twins were born eight weeks early and went into the special care baby units, but I saw them the next day.

"When it came to [the commissioning parents] taking the twins, I had no change of heart at all. I will see them on birthdays and at Christmas, and we keep in touch. We were paid expenses, but for me the real satisfaction was helping someone to complete their family. I am working with another couple now - I want to do it four times.''

Susan Rosenwasser and her husband Oliver had tried for 10 years to have a child before turning to surrogacy. "I had miscarriages, failed IVF, failed egg donor, and really surrogacy was the last resort," says 48-year old Susan. "About a year and a half ago we joined Cots, and Gill was the first surrogate who decided to take us. Gill conceived at home with my husband's sperm, and it was her sixth surrogate birth.

"Baby Alexandra was born six weeks ago. We paid £12,000-plus for the surrogacy, but you can't put a price on a baby that you have been trying for 10 years to have.''

Cots, Lairg, Sutherland, IV27 4EF (0844 4140181 or 01549 402777)