Responsible Surrogacy

Information regarding the ethical aspects of the process

As with any pregnancy, surrogacy requires medical decision making, such as whether to use anesthetics, choosing between natural birth and a caesarean section and deciding who should be allowed in the delivery room. In extremely rare cases, medical decisions are made without the consent for the surrogate, often even without her knowledge (see, for example, the evidence presented in Hebrew in this article on page 66). More commonly, decisions are taken by the surrogate formally, but sometimes they might be influenced by the interests of doctors and sometimes even of the intended parents.


For example, doctors and parents often prefer the birth to be by C-section, because it allows for planning in advance regarding the date of birth and is considered healthier for the baby. However, C-sections involve more risks to the surrogate. On the other hand, there are surrogates who prefer giving birth by C-sections for various reasons. In India, many surrogates prefer to perform a C-section because babies with western genes tend to be larger than the Indian babies, and surrogates are afraid of the pain involved in natural birth of a large baby. Another consideration in favor of C-sections, which is relevant not only for India, is that it will reduce the surrogate’s interaction with the baby relative to natural childbirth, thus preventing any possible attachment of the surrogate with him/her.


We recommend making sure the surrogate receives all necessary medical information regarding any decision concerning her body in a clear and transparent manner. We also recommend that intended parents clarify to the medical staff that the well being of the surrogate is their top priority and clarify that any decision she makes is acceptable and legitimate. We recommend confirming that the surrogate receives clear and relevant medical information that will be easily accessible for her independent decision-making in all contexts related to the experience of pregnancy and childbirth.

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