Intended Parents have several concerns before, during and after they have a baby through surrogacy. Some, but not all, have a great relationship with their surrogate and worry how she is going to react once the baby is born. Is she going to feel attached to the baby? Is she going to want to bond with the baby? Is she going to feel used and lonely once she is no longer pregnant? These are very valid concerns for the Intended Parents. These questions are part of the reason a psychological evaluation is required before any medications or embryo transfers take place; to allow the potential carrier to think about these issues. However, even when IP's are at home with their newest family member, it's important that they show their concern for their (now) past surrogate.
Although a surrogacy pregnancy is very different from having your own baby, some of the same issues regarding Postpartum Depression are often magnified by the surrogacy arrangement. A surrogate may not be worried about feeling detached from the baby but may, instead, feel lonely for her IP's. Remember that Intended Parents and the surrogate, along with her family, have spent a huge amount of time building a relationship via phone, e-mail, and face time. Personal details and intimate experiences have been shared. (What is more intimate then carrying a baby for someone else? Some IP's are even in the Exam room when the embryos are transferred!)
Let's toss the possibility of postpartum depression into this already unusual situation and you can easily imagine how a surrogate can end up feeling lost and confused after the birth. The message has been sent that feeling detached at birth is a good thing which, by human nature, is not a normal emotion when a baby is brought into this world. We want moms and babies to bond...but in this case it isn't what the Intended Parents want to have happen unless it's them doing the bonding! Add on top of this the fact that the Surrogate has become very attached to her Intended Parents. Because communication usually ramps up near the end of the pregnancy, with more phone calls, appointments and plans, IPs and their surrogate can be closer emotionally then ever before. Although the Surrogate is preparing her family for the eventful day and the Intended Parents are checking their list to make sure all is in order on their end, the possibility of some sort of depression or even regret sneaking in can take everyone involved by surprise.
Let's take a look at some of the signs of postpartum depression some of which are listed on eMedicine Health:
-Postpartum Depression occurs in about 10-20% of women, usually within a few months of delivery.
-Risk factors include previous major depression, psychosocial stress, inadequate social support, and previous premenstrual dysphoric disorder (If the surrogate has had previous bouts with depression she may not make a good candidate in the first place)
-Symptoms include depressed mood, tearfulness, inability to enjoy pleasurable activities, trouble sleeping, fatigue, appetite problems, suicidal thoughts, feelings of inadequacy as a parent, feelings of rejection, and impaired concentration.
-Postpartum depression interferes with a woman's ability to care for her baby. (Or in a surrogate's case, her own family).
The causes of Postpartum Depression are the same in everyone who has just given birth...it can happen in a surrogate situation, to a birth mother who has given her child up for adoption or a mother who has planned her pregnancy. As hormones play a huge role in Postpartum Depression with levels of cortisol, estrogen, and progesterone decreasing significantly within 48 hours after delivery, some women can be very sensitive to these changes. Other risk factors might include, but are not limited to, poor support system at home, conflict in relationships including a surrogacy relationship, feeling of loss of identity (she is now a past surrogate and no longer in the lime-light), feeling less attractive physically, pain and recovery of pregnancy with no baby in hand to distract her, and feeling overwhelmed with enormity of the birth "handing over of the baby" to the Intended Parents.
Although Intended Parents can be sensitive to the needs of their now past surrogate by making an effort to call, e-mail and check up on her in general, there are things that she can do to help herself. She should be setting realistic expectations for herself and her recovery, try to avoid isolation, surround herself with supportive friends and family, make time for herself and talk to other surrogates. If the depression lasts for longer than 2 weeks, she should talk with her OB or midwife for recommendations. There are tests and medications available for severe postpartum depression.
Remember that Postpartum Depression in a surrogacy situation does not indicate that the match or relationship between the parties was flawed or that the surrogate wanted to "keep the baby"...every Intended Parents nightmare. Instead it is a medical side effect that can happen in any birth situation. Being concerned and aware of this possibility is not only wise but shows caring and respect for someone who has offered the greatest gift to her Intended Parents, the gift of life.