What Should Intended Parents and Surrogates Expect During Labor, Delivery, and Postpartum?
Preparing for the birth of a baby through surrogacy involves more than choosing a hospital and estimating a delivery date. Intended parents and surrogates must also discuss medical autonomy, hospital access, delivery-room preferences, newborn care, feeding, postpartum recovery, and what should happen if circumstances change unexpectedly.
In a three-part ACRC Surrogacy webinar, Elizabeth from ACRC spoke with Jennifer Cataldo and Jaimee Peck, registered nurses and co-founders of Childbirth Allies LLC, about how intended parents and surrogates can prepare for labor, delivery, and the postpartum period.
The central message was simple: a thoughtful and flexible surrogacy birth plan can reduce uncertainty, prevent misunderstandings, and help everyone feel supported—but it must leave room for medical needs, hospital policies, and personal preferences to change.
If you are considering surrogacy in the United States, book a complimentary consultation with ACRC Surrogacy to learn more about the process and the coordination available throughout your journey.
Watch the Complete Surrogacy Birth and Postpartum Webinar
The webinar is available in three videos:
Quick Answer: How Should Intended Parents and Surrogates Prepare for Delivery?
Intended parents and their surrogate should begin detailed delivery planning around the beginning of the third trimester. Their discussions should cover hospital procedures, who may be present during labor, the surrogate’s privacy and medical preferences, newborn care, feeding, legal documents, travel, emergency scenarios, postpartum communication, and support after discharge.
The birth plan should be treated as a flexible communication tool not a guarantee or substitute for medical or legal instructions. Hospital policies, the surrogate’s clinical needs, the baby’s health, and the circumstances at delivery may require the plan to change.
Why Is Surrogacy Birth Preparation Different?
Every birth requires preparation, but surrogacy introduces additional people, responsibilities, legal considerations, and emotional dynamics.
The surrogate may have given birth before, but this may be her first experience delivering with intended parents present. The intended parents may have never experienced labor, entered a labor and delivery unit, or provided hands-on care for a newborn.
The webinar speakers identified one of the biggest challenges as the limited availability of birth education specifically designed for surrogacy. General childbirth and newborn-care classes can be valuable, but they may not address questions such as:
When should the intended parents arrive at the hospital?
Who may be present during labor or a C-section?
Will the intended parents receive a separate hospital room?
Who communicates with the medical team?
What happens if the intended parents do not arrive before the birth?
When do the intended parents begin making decisions for the baby?
What are the surrogate’s preferences immediately after delivery?
Will the surrogate provide colostrum or pump breast milk?
How will the surrogate and intended parents communicate postpartum?
Discussing these questions before labor begins helps establish realistic expectations and reduces the likelihood of conflict or confusion at the hospital.
Who Makes Medical Decisions During a Surrogacy Delivery?
During labor and delivery, the surrogate is the hospital’s patient and maintains authority over decisions involving her body and medical care. Her consent, privacy, comfort, and immediate preferences must be respected.
For example, a surrogate may originally plan to have an intended parent accompany her if a C-section becomes necessary. If she becomes frightened during an emergency and instead asks for her spouse, family member, or another support person, the medical team must respond to her current wishes and clinical circumstances.
After the baby is born, decisions concerning the newborn generally transition to the intended parents in accordance with applicable law, completed parentage documents, and the hospital’s verification procedures.
Because parentage procedures and hospital protocols vary, intended parents should confirm the applicable process with their independent surrogacy attorney, agency team, and hospital before delivery.
What Should a Surrogacy Birth Plan Include?
A surrogacy birth plan should document the group’s current preferences and give the hospital team a clear point of reference. It is not a legal contract, and it should remain flexible enough to accommodate changes during labor.
A comprehensive plan may address the following areas.
Labor and Delivery Preferences
Discuss:
When the intended parents should be notified
When they should travel to or arrive at the hospital
Who the surrogate wants in the labor room
Whether she wants periods of privacy or rest
Where the intended parents should stand during delivery
Whether photographs or videos are permitted
Who may cut the umbilical cord
Preferences regarding skin-to-skin contact
How updates will be shared during labor
Who should communicate with family members
The surrogate’s comfort should remain central to decisions about who is present while she is receiving medical care.
C-Section and Operating-Room Planning
Operating-room access is often more restricted than access to a standard delivery room. Some hospitals may permit only one support person during a planned C-section, while emergency circumstances may result in additional restrictions.
The group should ask the hospital:
How many support people are usually permitted?
Who determines whether an exception can be made?
Can an intended parent accompany the surrogate?
What happens if general anesthesia is required?
Where will the intended parents wait if they cannot enter?
Who will accompany the baby if NICU care becomes necessary?
Even when a preference has been documented, safety requirements and decisions made by the clinical team may override the original plan.
Privacy and Personal Boundaries
The birth plan should explain what would help the surrogate feel safe, respected, and supported.
Questions may include:
Does the surrogate want the intended parents present throughout labor?
Would she like them to leave during examinations or procedures?
Does she want physical encouragement, conversation, or quiet?
Who may receive updates about her medical condition?
How soon after delivery would she prefer private recovery time?
Does she want to hold or spend time with the baby?
There is no single correct answer. Some surrogates value witnessing the intended parents’ first moments with their baby, while others prefer that the baby go directly to the parents. Both preferences can be valid and should be discussed without pressure.
A Backup Plan
Birth timing is unpredictable. An induction date or scheduled C-section can help with planning, but it cannot guarantee when the baby will arrive.
The birth plan should address what happens if:
Labor begins before the intended parents arrive
The intended parents are traveling internationally
The surrogate needs an emergency C-section
The baby is born prematurely
The baby requires NICU care
The planned support person is unavailable
A separate room for the intended parents is not immediately available
The surrogate or baby remains hospitalized longer than expected
International intended parents should work with their agency, attorney, medical team, and other qualified professionals to plan their travel and newborn-documentation timeline.
How Can Intended Parents Support Their Surrogate During Labor?
The most helpful approach is to ask the surrogate directly what support feels right to her.
Some surrogates may welcome conversation, encouragement, or practical help. Others may need quiet, privacy, pain management, or time alone with their chosen support person.
Intended parents can prepare by asking:
What usually helps you feel calm?
Would you like us in the room throughout labor?
How will you let us know if you need space?
Is physical touch comforting or distracting?
Would you like us to help with water, ice, or other small tasks?
Who should be your primary labor support person?
How should we communicate if the room becomes stressful?
Intended parents may understandably feel anxious or powerless while watching labor unfold. Taking breaks, asking appropriate questions, and remaining aware of the emotional atmosphere can help them support the surrogate without adding pressure.
How Should Everyone Prepare for an Induction, C-Section, Premature Birth, or NICU Stay?
No birth plan can predict every event. Preparation should therefore include both practical contingency plans and emotional flexibility.
If an unexpected intervention is recommended, the surrogate can ask her clinical team about her medical options. Intended parents can ask the appropriate clinician for an explanation of what is happening with the baby.
When possible, questions about the baby can be discussed outside the surrogate’s room if she is resting, coping with contractions, or undergoing urgent treatment. This can help intended parents obtain information without increasing stress in the labor room.
If the baby is transferred to the NICU, intended parents should ask whether they may accompany the baby, how they will receive updates, and what identification or parentage documents the hospital needs. NICU access and decision-making procedures can vary by facility and circumstance.
What Should Intended Parents Bring to the Hospital?
Intended parents should confirm requirements with the delivery hospital, but a practical hospital checklist may include:
Government-issued identification
Insurance information for the baby, when applicable
Copies of the parentage order or other attorney-provided documents
Copies of the surrogacy birth plan
Contact information for the surrogacy attorney and agency team
Contact information for the newborn’s pediatrician
A properly installed infant car seat
A going-home outfit
A swaddle or blanket for transportation
Formula or preferred feeding supplies, if requested by the hospital
Phone chargers and basic personal items
Accommodation and transportation information
Emergency contact details
Hospitals generally provide basic newborn supplies while the baby is admitted, including diapers, wipes, blankets, and feeding supplies. Exact provisions vary, so parents should verify what their delivery hospital supplies.
If the intended parents live outside the delivery area, they should also prepare their hotel, apartment, or other temporary accommodation for safe newborn care before the baby is discharged.
What Happens During the First 24 to 48 Hours After Birth?
Immediately after delivery, the medical team will monitor the surrogate’s bleeding, pain, vital signs, and overall recovery. If medically appropriate, the intended parents may begin holding, feeding, or having skin-to-skin contact with their baby.
The first recovery period commonly lasts approximately one to two hours, although the timing and location depend on the delivery and the health of both the surrogate and baby.
After this initial period:
The surrogate may move to a postpartum room.
The intended parents and baby may move to a separate room if the hospital can provide one.
Nurses will perform routine checks on the baby.
A pediatric clinician will examine the baby.
Newborn screening and other required testing will be completed.
Parents will begin learning the baby’s feeding, sleeping, and diapering patterns.
The surrogate will continue receiving postpartum monitoring and care.
Discharge timing depends on the type of delivery, medical recovery, the newborn’s health, hospital policy, and the treating clinicians’ recommendations. Intended parents and surrogates should avoid treating any estimated length of stay as a guarantee.
What Newborn-Care Skills Should Intended Parents Learn?
Before delivery, intended parents should become familiar with:
Holding and supporting a newborn
Preparing and offering feeds
Burping
Changing diapers
Swaddling safely
Soothing techniques
Umbilical-cord care
Recognizing hunger and fullness cues
Tracking feeding and diaper output
Using an infant car seat correctly
Safe sleep practices
Knowing when and whom to call with a medical concern
Parents do not have to know everything before meeting their baby. The goal is to understand basic care and know where to seek qualified help.
Newborns also have individual preferences. A technique that works well for one baby may not work for another. Parents gradually learn what is normal for their baby by observing patterns in feeding, sleep, behavior, and diaper output.
For sleep, the CDC recommends placing babies on their backs on a firm, flat sleep surface and keeping pillows, loose blankets, bumper pads, and soft toys out of the sleep area. Parents should review the complete CDC safe-sleep recommendations and follow their pediatrician’s advice.
Before discharge, intended parents should know:
Which pediatrician will care for the baby
When the first appointment should occur
Whether a 24-hour advice line is available
Which symptoms require an urgent call
When emergency care is necessary
How Should Colostrum and Breast-Milk Arrangements Be Handled?
Colostrum and breast-milk plans should be discussed well before delivery, while recognizing that the surrogate’s health, comfort, and preferences may change.
Questions to address include:
Does the surrogate want to provide colostrum?
Does she want to pump after leaving the hospital?
How long does she currently expect to pump?
What compensation or reimbursement applies?
Who will provide pumping equipment and supplies?
How will milk be stored?
Who will arrange local pickup?
Will refrigerated or frozen milk need to be shipped?
What is the backup feeding plan?
Does the hospital offer donor milk, and who qualifies to receive it?
Providing colostrum does not necessarily mean that enough milk will be available for every feeding. Intended parents should discuss supplementation options with the baby’s pediatrician and hospital team.
Pumping can also become physically demanding. The surrogate should feel comfortable communicating if she wants to change or stop the arrangement. Likewise, intended parents may need to adjust the duration because of logistics, cost, supply, or the baby’s medical needs.
All collection, storage, transportation, thawing, and feeding practices should follow current medical guidance.
What Should Surrogates Expect During Postpartum Recovery?
A surrogate experiences the same physical recovery and hormonal changes associated with childbirth, even though she is not caring for the newborn at home.
Recovery may involve:
Bleeding and uterine cramping
Pain or soreness
Incision care after a C-section
Breast changes or milk suppression
Fatigue
Hormonal changes
Mood changes
Adjusting to the conclusion of the journey
Some emotional changes may be temporary, but persistent or intense sadness, anxiety, hopelessness, withdrawal, or difficulty functioning should be discussed promptly with a qualified healthcare professional.
The CDC explains that postpartum depression is more intense and longer-lasting than temporary “baby blues” and encourages anyone experiencing possible symptoms to seek care as soon as possible. More information is available through the CDC’s postpartum depression guidance.
In a crisis, call 911 or the 988 Suicide & Crisis Lifeline. The U.S. National Maternal Mental Health Hotline also offers free, confidential support at 1-833-TLC-MAMA (1-833-852-6262).
How Can Intended Parents Support the Surrogate After Delivery?
Support should not end when the baby is born.
Intended parents and their surrogate should discuss their postpartum expectations before delivery, including:
How often they would like to communicate
Whether the surrogate wants updates or photographs
Whether future visits are desired
How intended parents can check on her recovery
Whether she needs practical help
Who will coordinate breast-milk arrangements
What support is available through the agency
Who to contact if emotional or medical concerns arise
Misunderstandings can occur even when everyone has good intentions. Intended parents may avoid contacting the surrogate because they want to give her space, while the surrogate may interpret the silence as a sudden loss of connection.
A simple conversation about preferred communication can help both sides feel respected and supported during the transition.
Intended parents should also pay attention to their own emotional well-being. Becoming responsible for a newborn after a long and demanding fertility journey can bring joy, exhaustion, anxiety, and unexpected emotional changes. Parents should identify their support network and ask for help when needed.
When Should Surrogacy Birth Planning Begin?
Detailed birth preparation should generally begin near the start of the third trimester and continue as the pregnancy progresses.
This allows time to:
Contact the hospital and ask about its surrogacy procedures.
Confirm that the hospital has received required legal documents.
Create or update the birth plan.
Review the surrogate’s privacy and support preferences.
Discuss vaginal delivery and C-section scenarios.
Establish a backup plan if the intended parents are delayed.
Confirm newborn feeding preferences.
Choose a pediatrician.
Prepare accommodation and transportation.
Review postpartum communication and support.
Revisit the plan if medical circumstances change.
Preferences discussed during the initial match may no longer reflect the relationship or circumstances later in the pregnancy. Revisiting them in the third trimester gives everyone an opportunity to communicate more clearly.
How Does ACRC Support Delivery and Postpartum Coordination?
ACRC Surrogacy helps intended parents and surrogates prepare for the practical milestones surrounding delivery by coordinating communication among the professionals involved in the journey.
Depending on the journey and individual needs, this may include:
Supporting birth-plan discussions
Helping intended parents prepare for delivery travel
Coordinating communication with the surrogate and case-management team
Helping organize hospital documentation with the appropriate professionals
Supporting newborn-care preparations
Coordinating breast-milk logistics when applicable
Providing continued support during the postpartum period
Connecting families with independent legal, medical, insurance, and other qualified professionals
Medical decisions remain with the patient and the treating healthcare professionals. Legal advice should come from independently licensed counsel, and hospital policies remain under the control of the individual facility.
If you are exploring surrogacy and would like to understand the process, timeline, matching options, and support available, schedule a complimentary consultation with ACRC Surrogacy.
Frequently Asked Questions About Surrogacy Birth and Hospital Planning
Can intended parents be present when their surrogate gives birth?
Often, yes, but the surrogate’s preferences, hospital policies, room capacity, medical circumstances, and the type of delivery will determine who may be present.
Can both intended parents enter the operating room for a C-section?
Possibly, but it should not be assumed. Many operating rooms restrict the number of support people, and emergency procedures may allow no support person. Ask the hospital in advance while preparing for the possibility that access will change.
Does an induction date guarantee the baby’s birth date?
No. Labor may begin before the induction, and the induction process itself may take an unpredictable amount of time.
Who makes decisions for the surrogate during labor?
The surrogate retains medical autonomy and makes decisions involving her own body and care.
Who makes decisions for the baby after birth?
The intended parents generally assume responsibility for newborn decisions after birth, subject to applicable law, parentage documentation, hospital verification, and the baby’s immediate medical needs.
Will intended parents receive a separate hospital room?
Some hospitals provide a separate room after the baby is born, while others cannot guarantee one. Intended parents should ask the hospital how it handles surrogacy deliveries.
What if the intended parents do not arrive before the baby is born?
The birth plan should identify emergency contacts, communication procedures, temporary newborn-care arrangements, and the legal documents the hospital may need. International and long-distance intended parents should prepare this backup plan early.
Does a surrogate have to hold the baby after delivery?
No. Her preferences regarding contact with the baby should be discussed respectfully and communicated to the hospital team.
Does a surrogate have to provide colostrum or pump breast milk?
No. Colostrum and pumping should be based on a voluntary, clearly discussed arrangement that accounts for her recovery, preferences, and any applicable agreement.
How long will the surrogate and baby remain in the hospital?
There is no universal timeline. Discharge depends on the delivery, recovery, the baby’s health, hospital procedures, and the medical team’s recommendations.
When should intended parents begin preparing for the hospital?
Detailed planning should generally begin at the start of the third trimester, with updates as the delivery approaches.
Prepare for Delivery With Confidence
A successful surrogacy birth plan does not attempt to control every moment. Instead, it helps the intended parents, surrogate, hospital, agency, and professional team understand one another’s roles, preferences, and backup plans.
Early preparation, respectful communication, and flexibility can make labor, delivery, and postpartum transitions feel more manageable for everyone involved.
To learn how ACRC supports intended parents throughout a U.S. surrogacy journey, book your free consultation with ACRC Surrogacy.
This article is for general educational purposes only and does not provide medical, legal, mental-health, or insurance advice. Procedures vary by hospital, jurisdiction, and individual circumstances. Always consult the appropriate licensed professionals and treating healthcare providers.
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