Toxemia, pre-eclampsia, eclampsia, & HELLP syndrome are all very serious diagnoses that can happen to a woman in pregnancy. In general, these conditions are all varying degrees of the same problem, centered around high blood pressure in pregnancy. While we hope that you’ll never be faced with any of these complications of pregnancy during your surrogacy journey, it is helpful to understand the differences of toxemia vs. preeclampsia and similar complications.

TOXEMIA

Toxemia is a condition that can occur both during and after pregnancy. In the most general of terms, toxemia means pregnancy-induced hypertension or high blood pressure. Occurring in roughly 7% of pregnant women, this condition can vary in severity. The condition can begin as early as when the placenta begins to form, affecting people who are pregnant for the first time more frequently than those who have previously experienced pregnancy. Symptoms include protein in the urine and bloating in the face, hands, or feet. With proper detection and an increase in rest, this condition can generally be controlled with little risk to the carrier or fetus. However, if left untreated, it can develop into pre-eclampsia. 

PRE-ECLAMPSIA

This is a condition that exists only during pregnancy and is generally linked to gestational hypertension, protein in the urine, and increased swelling. The only cure is delivery of the fetus. The severity of the condition can be wide ranging. 

Treatment will vary based on the gestational age of the fetus and severity of the pre-eclampsia. In some cases, all that may be needed is bed rest and an increase in fluid intake. In other cases, an immediate delivery may be required. 

If not treated, pre-eclampsia can lead to eclampsia, renal failure, or death to the carrier. Risks to the fetus included diminished oxygen and food supply from the placenta, often resulting in low birth weight. While this condition can happen to any pregnant woman, it tends to affect women who are under 20, over 40, have a body mass index (BMI) of 30 or higher, or who are carrying multiples more frequently. This condition is expected to appear in roughly 5% to 8% of all pregnancies. 

ECLAMPSIA

Eclampsia has many of the same markers as pre-eclampsia and is generally recognized as the same disorder. However, eclampsia is the more serious of the two conditions. While many of the risks to the person who is pregnant and baby remain the same, eclampsia also carries the risk of seizures. When someone is diagnosed with eclampsia, it is best to deliver all babies as soon as possible, regardless of gestational age. Generally the baby will be delivered via Cesarean section once the surrogate’s medical condition has been stabilized.

HELLP SYNDROME

HELLP syndrome is a life-threatening condition believed by many to be a complication of pre-eclampsia/eclampsia. It can pop up before and after childbirth. The condition gets its name from the common indications of its presentation: 

• Hemolysis (red blood cell destruction)

• Elevated liver enzymes

• Low platelet count

While some patients are already being monitored for an eclamptic condition, many others will not appear to be in distress, exhibiting only minor symptoms including increased heartburn, headache, and nausea/vomiting. 

HELLP Syndrome is more rare than pre-eclampsia, estimated to occur in less than 1% of pregnancies. However, according to the American Pregnancy Association, 4% to 12% of women with pre-eclampsia will go on to develop HELLP. 

Because this syndrome is rare and often mimics pre-eclampsia, it is often misdiagnosed. Blood tests are necessary to confirm the diagnosis. Treatment includes bed rest, blood pressure medication, magnesium medication to prevent seizures, and potential blood transfusions. Following a diagnosis of HELLP Syndrome, a swift delivery is often recommended. 

Growing Generations is a premier surrogacy agency providing attentive, concierge-level services to intended parents, surrogates, and egg donors. If you are interested in becoming a surrogate, contact us online or complete our surrogate application.

Intended parents and surrogates often have questions about the types of insurance coverages used during the surrogacy process. Growing Generations (GG) is here to help intended parents understand how they can limit financial exposure and to help surrogates understand how insurance is used to provide them with safety and security. GG will be with you to provide guidance and connect you with top insurance providers as needed.

Here are the different types of insurance that will be discussed.

HEALTH INSURANCE FOR PREGNANCY AND DELIVERY

What is it?

This insurance is designed to cover routine pregnancy and delivery care as well as any complications that may arise.

How Does it Work?

Pregnancy and delivery are covered in the following ways:

• A surrogate’s existing health insurance policy

• The Affordable Care Act (ACA)

• A specialty surrogate maternity product underwritten by Lloyd’s of London.

During a surrogate’s admissions process, GG will review her personal insurance to determine whether it is acceptable to use. If it is not, we may ask the surrogate to apply for an ACA insurance policy. ACA insurance policies are only available during an “open enrollment” period that most commonly occurs in December of each year. If we cannot use a surrogate’s existing insurance or an ACA policy, Lloyd’s of London’s specialty surrogate insurance will be used.

Once we’ve determined the method of coverage, we will create an insurance coverage plan outlining the type of insurance which will be used for maternity care along with cost information for intended parents.

Why it’s Important?

Medical care in the United States is known for being top notch but very costly. Health insurance is designed to offer financial security no matter the level of care a surrogate may need during pregnancy and delivery.

HEALTH INSURANCE FOR NEWBORN BABY CARE

What is it?

This insurance is designed to cover medical care for baby once born.

How Does it Work?

For intended parents living withing the United States, they will simply add their child as a legal dependent to their own insurance policy within 30 days of birth. For intended parents living outside of the United States, policies are offered through Allianz and Lloyd’ s of London.

Why it’s Important?

Again, medical care in the United States is known for top notch but very costly. Health insurance for the newborn is designed to offer financial security in the event the baby needs care beyond what is considered “well baby care.”  Babies that are born prematurely or born with other health conditions will often result in medical bills in the hundreds of thousands to millions of dollars and health insurance  helps to mitigate this financial risk for the intended parents.

Cycle Insurance

What is it?

Cycle insurance is designed to cover complications arising from IVF protocols and procedures.

How does it Work?

Your case specialist will request cycle insurance as soon as an IVF calendar is received.

Why it’s Important?

While complications are rare, we want to ensure that should a complication arise, there is no delay in obtaining medical care, and there are no surprise costs for intended parents.

LIFE INSURANCE, TOTAL DISABILITY, AND LOSS OF REPRODUCTIVE ORGANS

What is it?

This policy pays a benefit to the surrogate or the surrogate’s named beneficiary should she lose a reproductive organ, experience complete disability, or lose her life because of pregnancy or childbirth.

How Does it Work?

Upon confirmation of pregnancy, your case specialist will request that the policy be placed.

Why it’s Important?

As unpleasant as it is to think of an extreme outcome, like most things in life, pregnancy is not without risk. The health and safety of our surrogates is a top priority, and as a result, surrogates are specifically screened to make sure they are ideal candidates for pregnancy. Despite best efforts, no one can completely remove risk, so we require that all surrogates be provided this policy.

We know insurance can be complex but remember that we are here to help guide you along the way.  Our insurance specialist will work with and connect you with respected insurance professionals as needed.

There have been multiple studies in recent years highlighting the importance of immediate and continued skin-to-skin contact in newborns. Skin-to-skin contact is your first opportunity to embrace your new child, and doctors say these first cuddles are as enjoyable as they are beneficial. Doctors note both physical and emotional benefits from the contact.

WHAT IS SKIN-T0-SKIN CONTACT?

Skin to skin contact is defined as placing a naked baby, not one wrapped in a blanket, to your bared chest.

Most researchers recommend that this be done as soon as possibly following delivery. Many hospitals will now even clean the newborn and cut the cord while skin-to-skin contact is happening.

Physically, the contact often allows the newborn to transition from fetal phase to newborn with less observed stress. The contact can equalize their temperature more quickly and with less effort as well as help the newborn manage respiratory transitions and glucose stability. Also, if you and your surrogte comfortable allowing her some skin-to-skin time, research shows that the newborn will be able to colonize the same bacteria as the surrogate. If a newborn is placed into an incubator, colonization will still occur, but it will differ from the bacteria present in the surrogate. Bacteria colonization is one of the key elements shown to reduce instances of allergic diseases forming.

EMOTIONAL BENEFITS OF SKIN-TO-SKIN CONTACT

There are noted emotional benefits to skin-to-skin interaction as well. Often these newborns display less violent crying, suggesting that they are under less stress and anxiety during their first moments of life. As the days and weeks move forward, your newborn will learn to mirror your steady breathing during skin-to-skin contact, promoting calm and content behavior. Additionally, prolonged skin-to-skin interaction has been shown to lead to babies and toddlers with less separation anxiety and better self-regulation over time.

Research shows most benefits come from skin-to-skin contact during the first hour and continue for the first 24 hours. Unless medical restrictions cause you to need to be separated, this is a great time to begin bonding with and cuddling your newborn.

SKIN-TO-SKIN CONTACT FOR SURROGATES

Having a surrogate birth does not need to complicate your desires to engage in immediate and prolonged skin-to-skin contact following birth. However, it does mean you need to be more deliberate with your planning. If you plan to do skin-to-skin, make sure you wear clothing that enables ease of contact. Plan to wear (or pack) button up shirts, and intended mothers can also bring additional blankets or sweaters to provide any desired modesty.

It is a good idea to share your plan with your nurse well in advance of the birth so they can make arrangements to encourage skin-to-skin interaction during the first moments of life. Things like not automatically swaddling the newborn after initial weighing & measuring and doing initial cleaning and cord cutting on the surrogate’s chest may be contrary to the hospital’s typical routine, but should not be considered impossible.

Contact us if you want more information about becoming a surrogate.

During surrogate pregnancy, some women are advised to receive an Rh-immune globulin injection. This medication, more commonly known as Rhogam, is often given to women who carry a “negative” blood type.

All people have two elements to their blood type. There is first the actual type, represented by a letter (A, B, AB, or O), and then a positive or a negative designation. This designation refers to the presence or absence of Rhesus in the blood.

Rhesus is an antigen that rests on the surface of red blood cells and occurs in most people. An Rh+ designation denotes that your blood carries this antigen.

For women whose blood type is Rh-, issues can arise in pregnancy if there is any chance that the fetus you are carrying may inherit an Rh+ status. In the case of surrogacy, if either the egg donor or sperm contributor is Rh+, there will be a chance of the baby inheriting this antigen.

It may be entirely possible that, through the use of an egg donor, the child will have a blood type that differs from you or the intended parents.

This presents a problem if the Rh- carrier’s blood were to mix with the Rh+ fetus’ blood. In that situation, the Rh- carrier would begin to develop antibodies to the Rh+ blood. These antibodies could cause problems in the current pregnancy, and would be very likely to attack and kill the red blood cells of a future Rh+ fetus.

For this reason, many surrogates may be asked to accept the Rhogam injection. The injection is very common and considered standard care. It is administered in office by your OBGYN typically in during the twenty-eighth week of pregnancy. A second booster shot is often given immediately following the birth. In some cases, specifically if you experience bleeding early in your pregnancy, the Rhogam injection may be given earlier in the pregnancy.

You should note that previous administration of a Rhogam injection does not safeguard you for a future pregnancy. In that way, even if you’ve had the injection several times before, you’ll still need to be immunized again for each new pregnancy.

Throughout your surrogacy medical cycle, you will be asked to keep multiple appointments at a clinic near your home. During these visits, you will typically have blood taken and have a transvaginal ultrasound. The purpose of the blood sample is to monitor and evaluate hormone levels in your blood. The ultrasound's purpose is a bit more involved. Typically, the ultrasound will check for just two things: the thickness of your endometrial lining and the presence of the “triple stripe” or pattern of your uterus. Sometimes, however, the ultrasound will highlight the presence of fluid in the uterus or other potential abnormalities. 

WHAT CAUSES BLOOD IN THE UTERUS?

Everything from leftover menstrual blood to normal bodily secretions can cause fluid to appear on an ultrasound. Many women will have some amount of fluid in the uterus, and this is not always a cause for concern.

WHEN IS FLUID IN THE UTERUS A CONCERN?

Fluid in the uterus is a concern when it remains there or when the amount increases as it can be a complication in IVF procedures. Excess fluid in the uterus can interfere with the implantation of a transferred embryo in the uterine lining. Additional fluids in the uterus generally lead to the current cycle's cancellation.

WHAT IS 'FREE FLUID' IN THE UTERUS?

Free fluid that shows in the uterus early in the pregnancy refers to any fluid that is not enclosed within a structure.

The clinical significance of free fluid depends on its volume, appearance, and the patient's symptoms. It is often a critical clue in diagnosing conditions such as ectopic pregnancy, pelvic inflammatory disease (PID), or ruptured ovarian cysts.

HOW TO REDUCE FLUID IN THE UTERUS SO IVF CAN CONTINUE

In some cases, the IVF doctor can drain fluid from the uterus in an effort to salvage the cycle. Your IVF doctor will work to determine the cause of the additional fluid in your uterus and take corrective measures to avoid having it occur in a future medical cycle. Sometimes a slight adjustment of your fertility or hormone medications can resolve the fluid retention in a subsequent cycle. There is nothing that you can, or should, attempt to do on your own to correct the fluid retention within your uterus. 

Rarely, doctors may be unable to determine the cause of the fluid, or unable to stop it from recurring. If this is the case, it may be recommended that you not proceed as a surrogate. Your nurse and IVF doctor can also speak with you about any medical questions you may have. 

Growing Generations is honored to support surrogates every step of the way. Contact Growing Generations to learn more about the surrogacy journey.

Packing your bag for the hospital can be just as stressful for intended parents as it can be for surrogates. In many cases, this is the intended parent’s first trip to the hospital for childbirth. It is important to feel comfortable and prepared on your big day, but packing your hospital bag can leave you feeling a bit perplexed over what items are most important to take.

It may make things easier if you break your packing down into two subgroups: labor & delivery, and recovery.

Labor & Delivery:

• Paperwork: While it is generally the surrogate’s responsibility to bring all of her medical and legal paperwork with her to the hospital, she may be incredibly distracted during labor and forget to grab it. For this reason, it is often a good idea to have copies of your birth plan, parentage order, and surrogacy agreement (contract) packed in your bag. While most hospitals will not ask to see these documents, knowing that you have them at your fingertips can provide you a great deal of peace.

• Entertainment: This part of the process can be very quick, or incredibly slow. It is impossible to predict how much time you will spend waiting for delivery. For this reason, you may want to pack items that will help you pass the time. Many intended parents pack a book, a laptop for movie viewing or work, a small craft project, or crossword puzzle. Also, if your surrogate is OK with being photographed or filmed, make sure to pack a camera as well.

• Snacks: Because the labor & delivery timeframe is so uncertain, it might be a good idea to pack snacks in your bag so that you don’t have to step away. However, if you’re in the laboring room with your surrogate, do consider asking her permission before enjoying a snack. Laboring women can be extremely sensitive to smells, and they are not permitted to eat during the labor process. Asking permission is a courtesy that will be very appreciated.

• Attire: Skin-to-skin contact is becoming a more regularly encouraged practice in the moments to hours following delivery of your child. Science shows that it can help the child regulate both temperature and breathing patterns while also allowing you some immediate bonding. For this reason, we encourage you to wear, or pack, a front-buttoning shirt and perhaps a blanket for modesty. This allows you to expose your chest for those first cuddles as quickly as possible.

Recovery:

• Most hospitals require at least a 24-hour stay for your child following the birth. Do note that, because this is a surrogacy arrangement, your surrogate may be discharged before or after your child. This is completely normal and is no cause for concern.

• Comfort Items: Growing Generations will work with your delivering hospital as closely as possible to try and secure separate recovery rooms for your surrogate and yourself. This not only allows you the ability to bond with the baby more closely, it allows her peace and quiet so she can rest. However, in the event that the hospital is crowded or this is not possible, you should plan on bringing items with you that could make you more comfortable with sharing a recovery room with your surrogate. Slippers, pillows, socks, and comfortable clothing will help.

• Toiletries: In most cases, you will need to stay at least one additional night in the hospital. For this reason, it is important to pack your overnight toiletries. Items such as a toothbrush, toothpaste, contact lens solution, and glasses will help make your stay a comfortable one.

• Camera: Finally, don’t forget to pack your camera! You’ve waited a long time for this moment, and it’s one you’re going to want to remember! Enjoy your first few days with your new baby and don’t forget to take a lot of pictures!