Ep 149:  Making Dreams Come True with Surrogate Ashley Greene

Ep 149:  Making Dreams Come True with Surrogate Ashley Greene

Nicole: This is a really informative conversation with a gestational surrogate. Welcome to the All About Pregnancy & Birth podcast. I'm Dr. Nicole Calloway Rankins, a board certified OB GYN who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, confident, and empowered to have a beautiful pregnancy and birth. Quick note, this podcast is for educational purposes only and is not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now let's get to it.

Nicole: Hello. Hello. Welcome to another episode of the podcast. This is episode number 149. Thank you for spending some of your time with me today. So in this episode, we are talking to Ashley Greene, who is a surrogate, and I wanted to chat with Ashley because one, I know I have a lot of folks who listen who are not yet pregnant, and I thought it would be good to talk about surrogacy as an option to expand your family. Also, there may be some folks listening who are curious about being a surrogate and what it is like. So we're gonna talk about, uh, that perspective as well. And then the final reason I wanted to chat with her is because honestly, I wanted to know more about the topic too. It's not something that I necessarily know a lot about. So this is gonna be a win, win, win for all of us.

Nicole: Now, Ashley is a mom of three herself, and then she's also had three surrogate babies, twin girls for a same sex male couple from Spain and a girl for a Chinese couple from Virginia who had a long struggle with infertility. She is currently the US surrogacy case manager with NESA. NESA is the new US arm of a surrogacy agency called Nappy Endings. That was started in the U K by Rachel Westbury. Rachel herself has been a surrogate to four babies and Nappy Endings is passionate about making both intended parents and surrogates feel as comfortable and supported as possible during the process. They believe that due to sensationalized headlines, celebrity culture, and unethical practices that sometimes happen in other countries, surrogacy has not always received the positive media attention that it deserves, and they wanna change that. So again, this is a great conversation for anyone who is thinking about working with the surrogate, is curious about it.

Nicole: Or who wants to know more about being a surrogate themselves. So we talk about surrogacy from the perspective of intended parents that has often abbreviated IP. As in matter of fact, when I was looking, you know, doing research for the episode and I kept seeing IP and in my mind IP means intellectual property, but in the world of surrogacy, it means intended parents. We talk about surrogacy from the perspective of the surrogate. We talk a bit about the legal aspects, spoiler alert, it is quite complex, the relationship between the surrogate and the intended parents, and then how you could go about being a surrogate if you are interested in it. Now, one of the things that we are going to talk about is the importance of planning in this process. And you know, what else is important to plan? You know what I'm gonna say, a birth plan, yes.

Nicole: Making a birth plan. Making a birth plan can be a great way to help you have the birth experience that you want, especially if you're your giving birth in a US hospital, a system that too often takes a patriarchal approach to birth takes away power from women over what happens in their own bodies. And for some is also racist. Of course not all doctors in hospitals are like that, but too many are. And you don't know what's what, until you do some research and plan accordingly with a birth plan made the right way. And that is what I, I teach in my online class, make a birth plan the right way. Now this is way more than a template, form or checklist. Those templates and forms do not tell you whether or not your doctor in hospital actually support what's in your birth plan. And in my class, I teach you questions to ask. So you know that your doctor actually supports it. The hospital supports it. You know how to get folks to pay attention, you know what to include. And I teach you the one thing that most people miss about making a birth plan the right way. So you can sign up for that class at drnicolerankins.com/register. All right, let's get into the conversation with Ashley.

Nicole: Thank you so much, Ashley, for coming onto the podcast. I am really excited to talk about this topic of surrogacy.

Ashley: Well, thanks for having me on today. You know, I love talking about surrogacy and spreading awareness on it and any opportunity I can get to do that, I am just thrilled to have it.

Nicole: Love it, love it, love it. So why don't you tell us a bit about yourself and your work and your family, if you'd like?

Ashley: Sure. So I have been a surrogate twice, um, in the past and I have delivered three babies. So the first set was twin girls. And then my most recent one was just about over six months ago. And that was just a one girl. Um, so I'm pretty experienced when it comes to the surrogacy realm. I see. Yeah. And then I have three kiddos of my own. Um, and then I'm married, obviously we've been married for, um, 11 years. No 10 years. Okay. Shh. Don't tell anybody I said I was wrong there.

Nicole: That's like the longer you get married, the dates. I know. I was like, oh yeah, yeah, yeah. We've been at this for a while. So,

Ashley: Well, it's been dating for 10 years before we got married. So I'm just kinda like it does it even matter now

Nicole: And right now you also, um, work for a surrogacy agency and you'll mention the links and things at the end called Nappy Nappy endings. Is that correct?

Ashley: Um, that's what they go by in the UK. Okay. In the United States, they go by NESA, obviously Nappy has a very negative connotation in the United States so they try to be very aware of that. Gotcha. And they switched our agency name to NESA over here.

Nicole: Okay. Okay. All right. So how did you first come to be a surrogate?

Ashley: Um, so this journey actually, wasn't kind of something I just jumped into. It was something that my husband and I had discussed for years. Um, interesting. Yeah. The very first time it ever came onto my radar even was when I was pregnant with our second son. Well, our second kid, our first son and it was in 2012 and I had a friend who was also pregnant at the same time and she was a surrogate. Um, so we went through our pregnancies together and I got to watch her journey and I was kind of like, that's absolutely incredible. Like if I can do that, I would love to do that. Right. Uh, but it was, you know, also given to us that if you wanna be a surrogate, you really should be done with your own biological family. So that's kind of like, we put it on the back burner.

Ashley: We're like, we'll come back to this when we're done having kiddos. And so after our third kiddo was born, we were done. We were like, we got three. I don't want anymore. Right, right. Right. My husband's like, I don't want anymore. And cause our two youngest are exactly 18 months apart. Okay. So I was just like, whew, that's a lot of kills. Right, right, right. Yeah. So we tabled it and we, we would revisit it every once in a while, even after our youngest was born kind of like, okay, so when, when should we get back to this? And for me, I was like, well, I wanna wait until the youngest is, you know, pretty much self-sufficient at least out of diapers, I guess. Right. And so, because I know that being pregnant, it takes a lot away from your current kiddos anyways. So I wanted to make sure that they could, you know, do a lot of things on their own before I invested my time, energy, body emotions into another family. Um, so that's what we did.

Nicole: Gotcha. Gotcha. So what I wanna do is talk about the process, um, from the perspective of both the intended parents a little bit and then the perspective from, of being a, the surrogate a little bit. Sure. So let's start with the process from the perspective of intended parents. Uh, and I had to look up what that was. I saw IP on the, on the website and I was like, what does IP mean? It's like, oh, okay. I get it. I get it now. So what steps should someone or a family or a couple, I guess, um, who's looking who wants to be a parent through surrogacy? What does that process kind of look like for them sort of a broad overview? I know it's hard to get into all the details, but sort of an overview of that process.

Ashley: Sure. Um, gosh, when it comes to intended parents, my heart goes out to them so much. You never come to surrogacy as your first choice of building your family. Especially our traditional couples. Um, our gay, our gay dads kind of know, Hey, this is gonna be either this or adoption. Right. That's gonna be our family route. Um, but you know, our traditional couples that come to us, they've already experienced so much heartbreak on this journey of becoming parents where we are pretty much their final like this is it, right. If this doesn't happen, we're not gonna be parents. Right. Um, so their steps really look through their eyes as, you know, multiple losses, um, sometimes unexplained fertility, infertility issues, and they will, you know, oftentimes go through IVF themselves, um, still not be to either conceive or carry their pregnancy to term.

Ashley: Right. Um, but we also have some who already have children, uh, and for some reason or another something had happened after they had their last child, you know, mom had had hysterectomy or something like that, that caused fertility issues. So usually they don't come to us until they've already gone through that process. Or, and they've been to a reproductive endocrinologist, which is a doctor who specializes in fertility. Um, so they usually already have their clinic. They've already gone through that whole medical process with their doctors. Um, I always suggest, I, you know, if you're coming to an agency, like I work for an agency, um, you know, some of them come to us where they don't have embryos created, they don't even have an IVF clinic. And this is kind of like, how do I do this? And we will support you in that decision, you know, trying to find your clinics close to you or close to you wherever you wanna be.

Ashley: Um, and you know, they'll go through that process with their doctor, they'll make embryos they'll um, sometimes they have embryos tested for genetic abnormalities. Sometimes they don't, you know, and then they'll freeze those embryos. Typically you have a, um, a frozen transfer, sometimes there's fresh transfers, but it's typically frozen that I've seen in our agency. Gotcha. And you know, so by the time they come to us, they've already completed all these steps that I'm not even involved in. And I just could not even imagine, you know, some of the things that they have gone through.

Nicole: Right, right, right. So by then they, they U typically they're they're, they know that they've done all of the things, and this is the last option for them. Like, like you said. And, and then I guess, is there some sort of, um, is there like a screening process for intended parents or to make sure that they're a right fit for surrogacy? Like, I can imagine that there's some sort of psychological aspects that are involved in it as well. Do the intended parents have to go through any of those kinds of things or is it kind of like you're here, we know that based at least on like going through IVF folks have gone through some things, like, how does that process look like or work?

Ashley: So once they come to us as parents, um, I feel like all agencies, we run background checks on our parents and our surrogates we run, we do a psychological screening. I personally don't. We obviously have professional run, um, psych screenings on parents and surrogates because we wanna make sure one, um, the parents are, I shouldn't, this sounds terrible, but mentally stable enough in, in this process that the baby, when they're born are going to a loving, safe home. Yeah. Obviously, you know? Yeah. Uh, and, and surrogates too, wanna make sure, Hey, is this child going to a loving, safe home? Right. Um, so we just make sure that there's no criminal records. Um, the mental health professional provides us with the reports. Yes. At this point in time, they, the parents understand, you know, they're going through surrogacy, what all that entails they are, you know, okay. To continue. Gotcha. So we always get those clearances before we even would match them with a surrogate.

Nicole: Gotcha.Gotcha. And then how long does it typically take to match with the surrogate?

Ashley: So typical, I've seen wait lists out there between nine months to 18 months. Oh, wow. And depending on, yeah, I mean, surrogates are in pretty short supply right now. Ah-huh um, especially with COVID and now, um, different clinics requiring, you know, COVID vaccinations. Sure. Um, for our surrogates and there are still some surrogates out there who are like, absolutely will not get vaccinated. And there are clinics who state no vaccination, no medical clearance, no surrogates. So it it's, it's tough to find women one willing to be a surrogate in the first place and then two willing to jump through the hoops now, because of COVID it's, it's just a lot, um, not saying it's impossible, obviously there's still journeys going on every day. Sure. It's just more difficult in COVID as opposed to pre COVID. Gotcha.

Nicole: So at least nine to 18 months, that's good to know. Okay. So then once you are matched with a surrogate, how involved are the intended parents in the pregnancy and the birth?

Ashley: Um, so we, as, as, um, NESA, we believe parents, you get to control as much of this as you want. Um, there's so much out of their control as is, you know, you're, you're counting on somebody else to basically take care of your child for the next nine months. You have a lot of trust in that woman. And so there's so many other things that you can't control. We wanna make sure that whatever, however involved you wanna be, that everybody's on the same page. So we have seven intended parents who are like, you know, I wanna be at all the appointments I want to, which is hard again during COVID right. Cause sometimes you're only allowed, you know, sometimes no support person at appointments, sometimes one. Sure. Um, so we, we try to make accommodations, FaceTime phone calls, anything like that. And then you have other parents who are like, you know, I really only want maybe weekly contact.

Ashley: Some of 'em maybe monthly contact, you know, I, I had one intended parent who she's like, I just wanna show up at the hospital and pick up my baby, you know, I was like, well, okay, we're gonna, we're gonna, we're gonna have a hard time matching you, but you know, we'll, we'll try. You, so it just, it really just depends on what the parents are looking for out of the journey. And when we interview parents in surrogates, we ask matching type of questions, those match points, like what kind of journey are you looking for? How much contact do you want with your surrogate? How much contact do you want after the birth with your surrogate? Um, same thing with the surrogate, kind of like what kind of journey are you looking for? How much contact do you want? Do you want contact after birth? That kind of stuff. So we would only match parents and surrogates who have pretty much the same answers to those questions.

Nicole: Gotcha. Gotcha. And I'm intentionally gonna skip over the legal aspects because I know that can be quite complicated or maybe you can tell me something different, but I figured you have to check state by state. Um, cuz it can be very complex.

Ashley: It is. I, I can go into a bit, I mean I'm not a legal, I'm not a legal professional, so I can't give advice. Right. Um, not only does it vary state by state, but some states as county by county. Oh wow. Um, and it's not even where the surrogate lives, it's where the surrogate's going to give birth. Okay. So, um, for instance, me, I live in Iowa, but I live right on the border of Illinois. Um, so I've always given birth to the Sur my surrogate babies, well, the surrogate babies are not mine obviously, um, in Illinois because Illinois surrogacy laws are far more lenient than Iowa surrogacy laws. Gotcha. So, you know, it's really dependent on kind of where the babies are planning to be born at. Well where they're the parents, the surrogate have all agreed to birth the babies. Um, so and, like I said, even state to state, sometimes different states have different laws based on the county that the baby's gonna be born in.

Ashley: So it's crazy. Um, and it is complicated. Those, those contracts are 60, sometimes 70 pages long simply because they want to attempt to cover any eventuality that may come up during the pregnancy sure. And birth. And they are incredibly in depth and your lawyer, the IP lawyer, and the surrogate lawyer will go over that contract with each one of their, their clients sentence by sentence. That is one of the biggest pieces advice I always give to my surrogates. And my intended parents is make sure you understand that contract. You be comfortable with everything in that contract because that is the legally binding document in this case, everything will be deferred to that contract. If you ever have a question, anything comes up, you know, it's always going to be, let me check the contract, your attorneys. Um, and it's basically the, the outline of how to handle these situations if you aren't really sure.

Nicole: Gotcha. Gotcha. That makes a lot of sense. A lot of sense. And um, I imagine obviously your agency has a lawyer, but do you recommend that or do intended parents typically have a lawyer as well at this point?

Ashley: Sometimes they do. Sometimes they don't. Okay. We work with, um, a really great attorney who's based in LA. Uh, and we also, um, can recommend attorneys based on location of surrogates and intended parents. Uh, I say that because the, um, surrogates attorney should be licensed in whatever state she's going to give birth in. Right. Um, so when I was going through my journeys, my attorney was licensed in Illinois. Um, so just because like the, the laws are so different, you wanna make sure you have an attorney familiar with the laws of the state of you're gonna give birth in.

Nicole: Gotcha. Gotcha. Okay. And I guess it also is probably complicated because I'm sure it's theoretically possible that like you could be in Iowa and your intended parents could be anywhere in the world even, or even, even if in the US they could be in California, they could be in Texas or they can be wherever.

Ashley: Absolutely. My first set of intended parents live in Spain. Okay. So yeah, I definitely know how that goes. And then actually my second set of the intended parents that I just gave birth, um, to their daughter, they live in Virginia. And so here I am in Iowa, there they are in Virginia and then the dads from my first journey are in Spain with their daughters. So it's very, you know, it changes so much, you know, I mean, oh gosh, it's just so variable. And then there's so many different things that, um, as an intended parent, or even as a surrogate, this is why you use an agency because there are so many things that you don't know, you know, and you can't know what you don't know. That's what agencies are here to do is to kind of alleviate that burden. Like we've done this so many times. We know what to look for. We know what to expect. We know what the laws are. We know how to find you, the people and the other professionals to help you on this journey to make it as smooth as possible.

Nicole: Gotcha. Gotcha. Gotcha. So let's talk about, a little bit more about the perspective of, uh, doing it from the surrogate side. So, um, how one, how does somebody even like go about being a surrogate and what makes, um, someone a good candidate to be a surrogate?

Ashley: Um, so my first answer to this is always research, research, research, research, um, because surrogacy is an ever changing world. Um, I was part of several surrogacy groups on Facebook before I even looked into more in depth into like applying to an agency and so forth. Because again, if you've never done it, you have no idea. What, what kind of question to ask? What kind of things to look for? What are the red flags? You know, you don't know those things. So when you follow these surrogacy groups on Facebook, so many people share their experiences and you can kind of read them and say, oh, okay, I didn't know I needed to ask for that. Or, oh, I didn't know that that was something I should stay away from or anything like that. So it's always recommended as a surrogate that you do about six to 12 months of research before you even apply to agencies.

Ashley: Oh, wow. Okay. Um, you will always have surrogates who are like, shh I don't need to do that. And they'll just jump right in. Right. But this is a life changing decision. Uh, I know that as a surrogate, you're not bringing home the baby, but it's still, you're growing a baby. You are, you know, legally obligated and bound by that contract. You are for the next nine months or however, it's typically a year just simply because of medical clearance and then transfers and birth and all that kinda stuff. Um, you're, you're committing to, you know, 12 to18 months of your life to this one goal and it's, it's a lot and you wanna make sure that you are prepared for that. So always do your research. Um, and then the second thing is it, when you apply to agencies, interview agencies, you know, every agency does things just a little bit differently.

Ashley: They have, you know, different teams, they have different people. Sometimes you just click with people, sometimes you don't and you always wanna make sure for IPs and surrogates as well, your agency has your back. There's a reason why you're using an agency, you know, and you want to feel like, Hey, they're there to support me. They're there for me. If I have a concern or if I have a problem. And this goes for both IPs, surrogates, I mean, if there's anything that's going poorly in your journey, your agency is there to mediate that. And if they can't, they can refer you to those mental health professionals who can help you. And there will be, there could be some joint counseling sessions if there's any kind of issues that come up. Um, so you wanna make sure that like, when you're going interviewing agencies, they're a good fit for you and they're what you're looking for.

Nicole: Gotcha. Gotcha. Gotcha. And then, so what is the process? Someone decides that they, they wanna be a surrogate. They did their research, they get accepted by an agency. And I guess, do you, how, uh, let me back up and say, do you have, do you have a sense for how many people go through an agency versus outside of an agency and do it independently?

Ashley: I have seen, um, independent journeys. Uh it's it's I wouldn't say it's rare, but it's more rare than people using agencies. Got it. And I, I would only say that simply because most of the time independent journeys, they don't put themselves out there as much as agency journeys do. Almost like, oh gosh, cuz I was with an agency. So I was, you know, part of their surrogacy group on Facebook and a part of their agency group on Facebook. And even, you know, some of the transfer, you also have transfer groups on Facebook for your Sur the, as a surrogate, Hey, there's other surrogates transferring in the same months as you. So, you know, we make a group on Facebook so we can all connect. And most of my experience has been agencies. Um, it's kind of changed a little bit over, I would say the last six months, just kind of following along that, um, independent journeys are becoming more common. Um, because I feel like, you know, parents are kind of like, Hey, if I can do this without an agency, it's going to save me money. Right. So why don't I do that? Right. And I feel like they're kind of being more vocal about it as opposed to previously where we're just like, oh, everybody goes through an agency.

Nicole: Okay. Okay. Okay. But still, probably I can imagine that it, I don't know, it feels E easier or safer to go through an agency, but I guess it's dependent on the person. Right. Um, so then once you get selected by an agency, I presume you have to go through some sort of medical and psychological screening,

Ashley: Right. So once you, so the way our agency works is you can reach out to us. We're all on Facebook. The founders are on Facebook, I'm on Facebook. Um, you can just reach out to us on Facebook, if you wanna be a surrogate. And we will just do like kind of like a preliminary zoom call with you and be like, Hey, here we are. Let's answer any questions you have. I'll explain the process to you. Um, that's before we even make them apply, uh, and to be a surrogate, you have to fill out an application. It's a very in-depth application. I mean, it asks you for your pregnancy history, any complications, any medical concerns, you have, any, anything like pretty much your entire health history and your, you know, your family. Are you married? Who do you live with? Who lives with you?

Ashley: Um, where do you work? Do you have insurance? I mean, it's. It's very in depth. It takes almost 20 minutes probably. I mean, and that's I, 20 minutes in the grand scheme of the surrogacy journey seems small, but I mean, that's just your intake application. That's just the very first step. So we try, we have several surrogates cuz I screen our applications personally and we have several surrogates who don't even make it past my application screening. Okay. Um, simply because there's certain answers on there, cuz one of the questions on there is would you follow doctor's orders during your pregnancy? That kind of situation. And some, some surrogates are like, no, you know, I'm gonna do what I want. I'm like, well that's, you're not a good candidate. Gotcha. You know? Um, I think another one on there is like, would you undergo amniocentesis if it was medically recommended and some surrogates are like, nope.

Ashley: And I was like, well again, not a good candidate. You have to, as a surrogate, I mean you are legally bound to follow doctors recommendations for this pregnancy, right? So there are some on questions on there where it's a straight, no, from me, if they answer a specific way, there are other questions on there where if they answer no to one of those questions, I'll kind of get a clarification from them like, Hey, this is why we're asking this question. If this instance comes up, would you be willing, you know? And sometimes they change their answer sometimes they're like, no, want a holistic natural pregnancy. Don't want medications don't wanna do this, this and this. And I was like, we're not the agency for you. So, I mean, it's just, it's a very in-depth application process. And once we have the application, we will schedule another zoom call with our surrogates kind of, um, I call those the intake phone calls where, Hey, got your application, your answers look great.

Ashley: Here's the next steps. And even then those next steps are, I will send them out an email with all the releases and all the paperwork that they again need to fill out just to be in, you know, brought into the agency and that paperwork would involve like a medical release signing. So I can attempt to get their medical records from their past pregnancies and birth. A background check authorization because we run background checks on our surrogates, their spouse and anybody over the age of 18 living in their household. Sure. So we need one, uh, one of those authorizations from everybody in that household who I'll be running a background check on. Um, and we also send out, what's kind of like a fee sheet. So it's industry standard fees that surrogates can ask for. Um, and I send them out they're it's prepopulated like the fees, if they ever wanna change anything, they're more than welcome to.

Ashley: We let surrogates set all of their own compensation requests. So, and the reason why we do that is when we match that surrogate with an intended parent, nobody's shocked at what the surrogate's going to ask for. Um, it makes contracts go a lot smoother when everybody's on the same page as far as compensation. Sure, sure, sure. Um, and from there then I would, um, after they fill out all of those paper papers, send them back to me. I will request their medical records and medical records requests are ridiculous. I mean, oh my gosh, they are awful. And with COVID it's even worse and it just, it takes forever. I'm sure. I'm sure it really does. So there are times where I'm like, I I'll contact our surrogate and be like Hey, can you go to, you know, your doctor's office or the hospital and sign a release to se have them send the records to me. Um, simply because as an agency you don't wanna receive records from your surrogates personally because you never know if they're altered, so you wanna make sure you're getting those records, um, directly from, you know, the hospital or the doctor office themselves.

Nicole: Oh, wow. Wow. So this is very, very serious for sure. Oh yeah, for sure.

Ashley: Oh, for sure. Yeah. Oh yeah.

Nicole: So then what are the responsibilities of the Sur surrogate? And you talked about a bit D um, you talked about this already a bit, but during the pregnancy and birth, it sounds like they really have to do whatever is medically recommended.

Ashley: So we recognize in the contracts, even it says, these are the intentions. However, we recognize, you know, on autonomy of our surrogate. There are choices that can be made that, you know, it's because it's her body, uh, she gets to make those choices, whether it's contractually obligated to make those or not. Um, and that's why I always say, make sure, you know, what's in that contract and you're comfortable with it because again, there are legal ramifications if you don't follow your contract. Um, got it. When I say that, I I'm kind of referring to the fact where it's called a breach of contract, either way, if the parents do something that they shouldn't be doing, or if the surrogate does something that is, you know, not following their contract, it's called a breach of contract and that can open up a lawsuit.

Ashley: Um, it can also stop surrogates compensation. So, you know, it's just, it's hard because again, we recognize autonomy at the same time, you are legally, you know, obligated to follow your contract. So, um, it, it's a fine line to walk it for sure is, uh, but normally surrogates don't, don't go into surrogacy going, I'm gonna do what I want. Right, right. You know? Right. And they go into it with the ultimate goal of, I am giving this family the, a gift that nobody else can. Um, and for me, personally, as a surrogate, that that for me was like, it's my responsibility to keep this baby safe and healthy. Gotcha. Until I can turn it over. Gotcha. Uh, and I always say, it's almost like this internal pressure. Nobody puts this pressure on you, your agency doesn't, the parents don't, it's you yourself going this has to go perfectly, cuz they've already experienced so much heartbreak and so much heartache that this needs to go perfectly. Um, and it it's just this, this inside pressure where you're like, I need this to go well, right. right. Right. You know, and you always have those instances, you know, for one reason or another there's a miscarriage or a fail transfer or any other kind of, you know, abnormality of, of the, the baby. Um, and we recognize those are out of your control. You know, but it's still as a surrogate. You're like, can I cuss on this? Sure. Go for it. Okay. Cause as a surrogate, you're just like damn it. Like why, you know, you know, because you know, you come to surrogacy as a surrogate knowing you can grow babies. I mean, knowing this is what your body can do.

Ashley: It's it's done it before. And when it doesn't work out, especially when other people's hopes and dreams are, are on this pregnancy, you're just like son of a bitch, like what is going on? Yeah. Um, I actually had that with my last journey where they only had two embryos and we transferred the one and everything was going fine. And then we had our first trimester screens and the AFP came back elevated, which could be signs of spinal bifida and you know, other is issues. And, and for me, as you know, the surrogate, I was devastated. I was like, what? No, no, that's not okay. God, we need to talk about this universe because they want this baby so badly. She needs to be perfect. Right. So right. I mean, you know, I, I broke down crying and it's not my baby. Sure. But it's still this responsibility that you feel that, uh, they are counting on you to do these things. And it's, like I said, I couldn't imagine, you know, the, the journeys that the parents have walked up to this point with those kind of losses. Gotcha. Um, gotcha. Gotcha. It just, it just opens up your eyes to a whole different realm of emotions that you don't think you are, you would ever have, but you do because again, you want it to go well, you want to give these parents their dream and when it doesn't and there's bumps in the road, it's just kind of like son of a gun. Gotcha. Gotcha.

Nicole: So you, I'm guessing you do a lot in that pre-screening process, to identify people who are coming from a place of, I want to help. Um right. And, and you, and they should be compensated for it. Absolutely. But they want to help, but they're not, they're not coming from the place of, I'm just trying to make some money absolutely. Can I do this to make some money? I'm guessing you try and screen to find people who are actually committed to the, the servant piece or wanting to really be help helpful, I guess.

Ashley: Yeah, absolutely. And that's a lot of what the psych screening does as well. It kind of, it kind of weeds out those people who are like, I'm just here for the money. Um, now I'm not going to lie. The compensation is helpful. Sure. Especially with you as a surrogate, have a financial goal that you wanna meet. Sure. Um, you know, it's, it's helpful. It, anybody who's like I'm, I, I would do it for free. I, God bless you. Right. Because holy cow, it's a lot. Right. And it's, it is a lot. Right. Uh, and there are all, there are altruistic surrogates out there who are like, I don't want any compensation to pay the, the medical bills that are associated with it. And you know, and those women like hats off to you, ladies, you are angels on earth because wow. I just, just wow. It just, yeah. You know,

Nicole: I mean, it is a lot, I, I, I mean, I think there's nothing wrong with being compensated for it. It's, it's, it's, it's, it's a lot, um, emotionally and physically. So I guess what, why don't we, um, um, address that, like how much money can, what are typical rates someone could get paid for being a surrogate?

Ashley: So at our agency and most, uh, well, a fair percentage of agencies, we let surrogate set their own base compensation. Okay. Um, when I say base compensation, I am referring to just the compensation that she gets for being pregnant and carrying the baby. Okay. Um, there are other fees outside of base compensation, like medical, like, well, medication start fee, when she starts injections or transfer fees or, and, you know, I've even seen things like contract signing fees, which I'm at that point, I'm like, what are you doing? Right. Like you signed a contract, you knew going into this, you were going to sign a contract. I mean, like, I, there are some times where I look at some of the fees surrogates send to me and I'm just like, mm, no. Right, right. No, no. Gotcha. Gotcha. And then, you know, so there are those outside of the base compensation, but the base compensation, usually for a first time surrogate, I would say with non surrogate friendly insurance would be about 30, $30,000.

Ashley: Oh, wow. Um, yeah. Uh, and with, I would say a California surrogate who maybe even a first time, California surrogate with, um, surrogacy friendly insurance, it can be upwards of $50,000. Okay. And it's, it's, it's very variable. I mean, it's variable on what kind of insurance you have, what kind of job you have. Sure. Um, are you experienced, are you not experienced, where you live? Um, just because, you know, based on the laws, is it easier for the parents to gain parentage or do they have to go through more legal steps? Gotcha. Um, gotcha. Also the California surrogates are in really high demand right now because we have a lot of Chinese IPs and they want California surrogates because that's just a quick flight from China. Well, quick 16, 20 hours, from China to California. Right, right. So much quicker than say China to New York. Um, so a lot of our Chinese IPs are wanting California surrogates and the way supply and demand works, if demand goes up and your supply is down, price goes up. Sure. So,

Nicole: Sure, sure. Okay. So I mean, you can make a reasonable amount of money being a surrogate

Ashley: Absolutely.

Nicole: For sure. So then how much does it cost for intended parents then?

Ashley: Oh God. So this question's always the most difficult when parents ask me this simply because there are so many variables, right. So when I give you this range, you're gonna be like, it's $60,000 difference. Like, how is that possible? Right. So typically with an agency, um, intended parents can spend anywhere between 80,000, 240,000. It depends.

Nicole: And that doesn't surprise me. And when you take into account lawyer fees agency, exactly. All of those things, medical blah, blah, blah, blah, blah, or so. Yeah. Yeah. So what goes into that then? I guess I kind of mentioned a few things, but.

Ashley: Right. So obviously agency fee, um, then you also have lawyer fees. Your IVF clinic fees, medication fees. Because the surrogates medication isn't covered by insurance, that's paid out of pocket by the parents. When we are talking about, you know, medications for transfer, progesterone, estrogen, all of those injectable medications, um, or anything up until pregnancy is confirmed, is paid for by the parents out of pocket. It's not covered by insurance at all. Um, so it's expensive. I would have to say, gosh, I got a bill one time for one of my, my, my journey last, this last journey. And one vial of my medication was $600. Yeah. It can be expensive, very expensive. And that's why it varies so much because you know, you have agency fees, IVF, clinic fees, medication fees, lawyer fees, um, and then you have surrogate space compensation, any of her fees, um, lost wages.

Ashley: Cause if your surrogate's working, you'll be paying her lost wages. If she's married and the spouse needs to go to any appointments, you have to pay his lost wages or her lost wages. If the, their partner, the partner's lost wages. Wow. You have to pay those. If your surrogate goes on bedrest, for some reason during the pregnancy, I mean, there are, you know, you pay lost wages for her to be on bedrest. You pay a house cleaning charge. So somebody would, can come up and clean her house childcare charges. So somebody can watch her children because she's on bedrest because she's pregnant, she can't do these things. So it's, that's why it varies so much. Cuz if you have, you know, a surrogate, you transfer to embryos, one of those embryos splits into triplets, like 13 weeks that surrogate's gonna be on bedrest for the next 20 weeks, like 20 weeks. So it's a lot.

Nicole: So obviously from the perspective of an intended parent, you have to be pretty wealthy or have some sort of means in order to, to work with a surrogate I mean, and that's not, I'm not surprised by that. It's what it is, what it is. Um, and in our, you know, society, even IVF for some people oh yeah. To be, you know, cost prohibitive, but now, you know, but now we know, now we know. Absolutely. Yeah. So, and I wanted to circle back, to what happens after the child is born and like the transfer between the, the surrogate and the intended parents. And then also like how involved is the surrogate in the child's life after birth?

Ashley: Sure. Well, I would say as soon as the baby is born, as soon as soon as that baby is born, the intended parents are the guardians, the legal guardians. Um, they make all the medical decisions, all the legal decisions for that child. Um, um, for both of my births, uh, the parents were right there in the room with me. Okay. Um, and that was even with COVID this last time. Cause I just gave birth in March. Uh, so it was my husband in there and the baby's mom and dad, um, not typical during COVID right now. Um, sometimes you're only allowed one support person, sometimes none, however, our hospital, because it was a surrogacy and they knew that they do allow the parents to be in there as well, because of that reason. I mean, as soon as that baby's born, those parents are the medical power of attorneys.

Ashley: They need to be there. If there is a medical decision that needs to be made for that child. Um, so as soon as that baby's born, like it was even, they basically cut the umbilical cord, took her over to the warmer, wrapped her up, made sure she was okay. Gave her to the parents like, okay, it's nothing like this is, is not my baby. Even after, um, what they asked me a question after this, my last, the last surrogacy, uh, about the baby. And I was like, I don't know, ask her mom, like, I'm done. Right. I birthed her. I am done.

Nicole: Gotcha. Gotcha. So that's very clear and that's established ahead of time that everybody knows the hospital knows that everybody knows, like these are the intended parents. Okay. Okay. Yeah. And then what about, um, breast milk or br like do surrogates ever like pump or provide breast milk for the child after?

Ashley: So all of these situations are all covered in the contract before you even go to transfer. Sure. Including breast milk. Um, so for me, I breastfed all of my babies. Um, the last couple, listen to me the last couple, like I have seven, my last two breastfeeding was difficult for me. Um, and pumping was difficult for me. So going into these surrogacy journeys, I'm like, I'm not doing it. I will not breastfeed. I will not pump. Um, other surrogates are like, absolutely I'll breastfeed in the hospital. If you want me to I'll pump, if you want me to, uh, it's, it's a very personalized choice. Okay. Um, between surrogates and parents and you can go either way. Yes you will. No, you won't. Sometimes I will. Sometimes I won't, it's all written in that contract. Um, and if after the baby's born, you change your mind. You can always amend the contract or it even says in there kind of like the intent is to breastfeed. However, if surrogate decides not to breastfeed, kind of like, okay, you know, like it's one of those you're not obligated to do it. Um, you can, if you want, you can, if you don't want to. So it's just, it's very a personal decision.

Nicole: Gotcha. Gotcha. Okay. So really the contract is like the goal, like that's like,

Ashley: It's like the holy grail of surrogacy.

Nicole: Where everything, everything goes back to is that contract.

Ashley: Everything

Nicole: Deasl with what happens if there are problems in the pregnancy? What happens if the baby's born early? Yep. What happens? All, all of those things are covered in great detail in the contract.

Ashley: Everything that, and that's why it's so important to get a, um, lawyer who is experienced in third party reproduction. They've seen it or if they haven't seen it, they've heard of somebody who's seen it. And um, you know, they know what to put in there, how to word it because they've been there. They've seen it. They've seen these situations come up there. They're like, okay, from now on, we need to put that in there. Um, you know, and always, always, always make sure that you're attorney is very well experienced in not only surrogacy, but third party reproduction in general. Um, just, just to make sure that they are, they know what to look for. They know what to put in there. They know what situations can come up, have come up, will come up. Um, so they they're very good at what they do. And I, I love those attorneys.

Nicole: And I guess third party reproduction. Would that cover other things like egg donation or things like that or? Okay. Yep.

Ashley: Okay. Okay. And the reason why I say that is because sometimes, you know, parents need egg donors and sperm donors. Um, some parents adopt other people's embryos. So these embryos are not even biologically related to the parents. It'll be transferred into the surrogate, which causes a whole nother mess of issues because, um, in some states, the surrogate has to know either the egg donor or the sperm donor. Like they have to know them in order for the clinic to, to transfer those embryos. So it's, it's very, again, third party reproduction. You need people who are very good at their jobs.

Nicole: Gotcha. Gotcha. Now, do surrogates ever do egg donation also?

Ashley: Uh, you can, um, egg donation. There is a cutoff, um, for age typically egg donors are younger. Surrogates tend to be a little bit older because you want a surrogate financially stable. You also want her in a stable living condition. Um, and that typically comes, I'm not to knock those 22 year olds, but you know, financial stability, home stability, things like that tend to come a little bit later than 22. Yeah.

Nicole: That makes sense. Yeah. Yeah. And, and you said recommend being done with childbearing themselves?

Ashley: Right. Absolutely. But you kind of wanna be done with your own family because secondary infertility is a thing too, where your surrogates could go through, be a surrogate and sometimes the hormones and things that require that you're required to take or inject can cause infertility in the surrogate or if something were to go wrong during the pregnancy or something, as she needs to have, you know, an emergency hysterectomy. I mean, it, it happens, it really happens. So it's always recommended that you as a surrogate are done because if you're not, you might be the intended parent the next time.

Nicole: Gotcha. Gotcha. Gotcha. So then as we wrap up, what would you say is the most frustrating part of your work?

Ashley: Oh God. Um, watching people not be able to come parents, like they have been there, they've done it. They've done everything that they're supposed to do. And for some reason, transfers just don't work. Gotcha. Um, it's, it's so heartbreaking for, because I'm like you have walked this road so long and this is it like this, this, you, you know, say they could only go in for one egg retrieval on mom and you know, Sheila gets three embryos and they've transferred those three and she can't go back in, you know, that's it. Like, aside from adopting embryos or having an egg donor and husband's sperm or, um, something like that. I mean, that's, this is financially, you know, they probably can't go any further. Like it's frustrating because everybody, everybody deserves to be a parent. And when for some reason the universe just doesn't line up for those people. It's just, it's frustrating for me. So I couldn't even imagine what they would feel like.

Nicole: Yeah. I'm sure I'm sure then on the flip side, what's the most rewarding part of your work. And I can probably guess that, but what's the most rewarding part?

Ashley: Oh God making families. I mean, it's a privilege to be able to be on this journey with parents who are putting absolute trust and faith in you as you know, an agency, Hey, I know you can do this. I know you will get me the right surrogate. I know you will provide me the right resources at the end of the day. You will be a key in making sure that, you know, everything goes smoothly. I have the journey I want. And at the end of the day I have a baby. Um, it's incredible. It's oh gosh. Like, so at NESA we're new, we haven't had a birth yet. We actually have our first transfer in December, which I'm freaking excited about. Yeah. Um, uh, but like, even as a surrogate, like just knowing that you're giving these parents something, that one they didn't think they would ever have, um, I'm gonna cry talking about it just because I love, love, love, love, love it.

Ashley: I love that feeling. Right. Um, my favorite thing to say is there are not enough words in the English language to accurately describe the feeling of watching those parents see their babies for the first time. I'm sure. I'm sure. None. Sure. Uh, this last birth, like, um, my first journey was a gay couple and the second journey was a traditional couple, and just the emotional difference between going from this gay couple, who hasn't experienced loss after loss to a traditional couple who has experienced loss after loss, where they're just so reserved and they're afraid to hope. I'm sure. Like, they're like, we've been here. We don't, we know what happens and it's not good. You like, just, no, like there's a video of mom's face. My husband took this video of mom's face the very first time she's like watching her baby be born. And I love that video. I just cherish that video because like, there are tears like streaming down her face because she is just like, it's happening? Aw, this is happening. I love it. You know? And it's just, it's awesome. It's so awesome.

Nicole: I bet. I bet. So then what is your favorite piece of advice you would give about surrogacy, whether it's for intended parents or for those who may be thinking about being a surrogate, what would your favorite piece of advice be?

Ashley: Uh, my favorite piece of advice it's worth it. Mm. You know, it's worth it. I, like I said, it's frustrating when it doesn't work out, but just keep pushing if you can. Cuz there are definitely times where parents are like, I don't know if I can keep going. I've experienced so much loss and heartache. I don't know if I can keep going and then they do. And that's the one that works. That's the one that gets them, their baby. Right. Or, you know, so it is worth it. Oh, it's hard. It's grueling. It's sometimes awful and it's tearful and it's an emotional rollercoaster, but God is it worth it.

Nicole: Wow. Love that. Love that. So where can people find you and your agency?

Ashley: Um, so like I said, me and the founders, Rachel and Ursula were all on Facebook and we're pretty active in our Facebook groups. Um, but there's also our agency website, which is nesagency.com. And then we have one that's like NESA underscore USA, um, for our agency on Instagram as well. OK.

Nicole: Awesome. Well, thank you so much for agreeing to come onto the podcast. This is a really informative conversation. I know I learned a lot and I know the folks listening will have learned a lot as well.

Ashley: Awesome. Thank you again for having me on, like I said, I love talking about this. I love answering questions like making families is my passion. So ask any questions. I will answer it to the best of my ability.

Nicole: So wasn't that a great and really informative conversation. I learned a lot about surrogacy and I'm sure you, you did too now. You know, after every episode, when I have a guest on, I do something called Dr. Nicole's Notes where I talk about my top three or four or five, sometimes depends takeaways from the conversation. And here are my con I takeaways from my conversation with Ashley. Number one, again, when I was doing for this episode, I saw some stories of things like people doing sort of more like informal surrogacy arrangements. It's not common, but I just wanna say, please don't don't do that. That can be a recipe for disaster. You really wanna pay attention to the details of the pro of this process, pay attention to the legal aspects, get a lawyer involved. Yes. It's a long process. Yes. It's a very expensive process, but you wanna dot all your i's and cross all your t's.

Nicole: So there aren't any surprises. If this is the road that you decide to, to go on. Number two, I wanna say a word about surrogacy versus adoption. I know there are some folks who will say like, why do you go through all this trouble to find a surrogate when you could just adopt a child? And there are a lot of children who need to be adopted into loving homes. And to that, I would just say that it is, is really really a personal choice. And everyone has to make the decision that works best for them about how to expand their family. Those are both viable options. One is not necessarily better than another. We cannot make choices for what other people should and should not do in order to expand their family. So whether you choose surrogacy or whether you choose adoption, that is a personal choice.

Nicole: And we support people in making the choices that work best for themselves. You know, I am all about that. And then the last thing I wanna say is that to those who are surrogates, oh my goodness, what an incredible gift you are giving a family that is not a small sacrifice of what you're doing and what it takes, um, the emotional toll, um, how it affects you, how it affects your, your own family. So just thank you to all of, all of you out there who, who make that incredible gift of being a surrogate and helping people expand their family. All right. So there you have it. Do me a favor, share this podcast with a friend if you love it. And also be sure to subscribe to the podcast in Apple Podcast or wherever you're listening to me and leave me a review, in Apple Podcast. It helps the show to grow helps other women find the show, do check out my class on how to Make A Birth Plan The Right Way. I promise you. You will love it. Women love this class. Get some great, great information out of it. drnicolerankins.com/register. So that's it for this do come on back next week. And remember you deserve a beautiful pregnancy and birth.