Weekend Call Presents Unique Challenges with Surrogate Birth

Amy Wasdin, RN, CPHRM, Patient Safety Risk Manager, Department of Patient Safety and Risk Management.

Communication among healthcare providers, patients, and adoptive parents is critical.

Weekend call is a responsibility that is common to most obstetricians who have hospital privileges. With that responsibility there are often unique challenges that may require risk management interventions.

A patient at 35 weeks' gestation with twins presented to the local hospital’s maternity emergency department and requested to be examined. She was concerned because she was having contractions that were increasing in frequency and duration. Her obstetrician was out of town. Another obstetrician, who was unfamiliar with the patient, was covering call for the weekend.

After examining the patient, the physician learned that the patient was a surrogate. The doctor also learned that a birth plan had not been established, and the patient and adopting parents had differing views about expectations for the birth process. The physician on call was able to contact the patient’s primary obstetrician who provided information regarding the case but was unable to come to the hospital to manage the patient's care.

The patient was offered a trial of labor as her condition warranted, but the adoptive parents were adamantly opposed to it. The dynamics of the situation declined as discussions focused on visitors to the patient’s hospital room. The patient was permitted to have visitors, but she did not want the adoptive parents’ family members in the room.

The patient elected to have a vaginal birth and delivered Baby A without incident. Immediately after the birth of Baby A, Baby B exhibited fetal distress with a sustained drop in heart rate that was unresponsive to maternal interventions, including repositioning, oxygen, and intravenous fluid boluses. A decision was made to deliver Baby B by stat C-section.

Baby B was delivered successfully by C-section and required supplemental oxygen for several hours. Subsequently, the health of both babies was stable and they were discharged from the hospital to the care of the adoptive parents.

This challenging experience provided valuable insight for the obstetrician who was on call. Communication between a patient and her care provider is a key factor in ensuring that treatment goals are met and the patient has a positive experience. In the case of surrogate pregnancy, communication between care providers, patient, and adoptive parents is particularly essential. If critical information, including a contingency plan, is not established prior to a birth event, hospital staff members can be faced with a difficult situation.

In addition, it is important to understand the relevant informed consent laws in your state. Remember, that unless the law has determined otherwise, the patient can make care decisions for herself and the unborn child. The adoptive parents do not have any decision-making rights until the child is born.


  • Ensure proper handoffs are provided to transition the care of your unique patient situations and birthing plans have been well documented.
  • Familiarize yourself with the policies and protocols at your hospital or birthing center regarding surrogate birth.
  • Understand applicable HIPAA restrictions regarding photography and visitation and communicate them to the patient and adoptive parents.
  • Discuss anticipated patient issues with maternity staff to prepare them for unique patient situations.
  • Clearly communicate with surrogate patients and discuss possible scenarios that may occur if unexpected situations arise. Provide specific scenarios in advance. The discussions may alleviate stress during the pregnancy and also eliminate potential conflicts between the patient and adoptive parents.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

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