A few weeks ago, Gabrielle Union and Dwayne Wade were able to welcome their first child together through the miracle of surrogacy after suffering through the trauma of infertility for 3 years. Gabrielle Union has publicly and courageously shared her struggles with infertility many times, most recently in her book, “We’re Going To Need More Wine.” [1].
During her first post-baby interview with Oprah Winfrey, Union admitted that while she’s ecstatic her daughter is finally here, it’s “still hard to let go” of the fact that she couldn’t experience pregnancy herself after spending years trying to make it happen.
“For three years, my body has been a prisoner of trying to get pregnant — I’ve either been about to go into an IVF cycle, in the middle of an IVF cycle or coming out of an IVF cycle,” she explained.
Her candid share has opened a very needed conversation around the very common issue of infertility as well as parenting after surrogacy.
Infertility is defined as the inability to become pregnant or the inability to maintain a viable pregnancy, after one year of trying to become pregnant. For women over the age of 35, infertility is defined as an inability to become pregnant after 6 months of trying. Approximately 10% of women in the United States or 6 million women in the United States ages 15 to age 44 are affected by infertility. [2]
There are many reasons for infertility. [3] This may include problems with the number of eggs or quality of eggs in women, as well as a number of sperm and quality of sperm in men. In women problems related to infertility leading to decreased egg production or decreased number of viable eggs may be related to several issues, including advanced age, history of cancer, problems with uterine lining, problems with blockage of the fallopian tubes or history of abdominal surgery.
In male infertility may additionally be related to several reasons, including, decreased sperm production which may be related to environmental reasons including temperature and medication exposure, history of cancer treatment, as well as problems related to delivery such as premature ejaculation. In both men and women environmental factors such as smoking, and obesity can affect fertility. An evaluation for fertility requires an extensive workup by a fertility specialist.
For couples that may find themselves affected by infertility that are unable to successfully conceive and carry a pregnancy to term, despite the application of significant interventions, surrogacy can be a viable option. There are two general approaches to surrogacy. During traditional surrogacy, the father provides sperm which can then be used to artificially inseminate a biologic carrier who will be the infant’s biological mother.
The infant would then be raised by the expectant couple following delivery. Now through the miracle of in vitro fertilization gestational surrogates can carry the embryo that is the product of eggs from the biological mother and the biological father. The AAP Committee has provided standard guidelines for Assisted Reproductive Technology that assist with the navigation of issues both medical and ethical that surround surrogate pregnancies. [4]
But creating the baby and monitoring the journey to a successful pregnancy is only half of the battle. The American Bar Association defines parentage n three ways (Biologically, Gestationally and Socially). [5] Thus, motherhood is often viewed through the same lens…though we know that the concept of the experience of motherhood begins before pregnancy and is expounded after delivery.
Once the pregnancy ends and hopefully provides a healthy baby, the intended mother will need to navigate the journey of bonding with baby. One way to navigate and maximize this bond is through the touch.
It is standard of care in non-complicated pregnancies to provide skin-to-skin care between mother and infant as soon as possible after delivery. This is sometimes referred to as “kangaroo care” Kangaroo care has many benefits including promoting temperature regulation for the infant, promoting regulation of glucose control by providing an opportunity for early breastfeeding with colostrum, regulation of heart rate and respiration rate of the baby just by being naked on the mother’s chest, hormonal benefits of attachment for mother and baby as a part of the natural bond and later studies which show the benefits on brain development which are associated with skin to skin care in preterm infant. [6] https://my.clevelandclinic.org/health/treatments/12578-kangaroo-care .
As a pediatrician and a neonatologist, this is one of my favorite parts of the job…taking a newborn and placing them on their mother’s chest. It is in many ways perhaps the most important part of our assessment and resuscitation.
This would explain why Gabrielle Union was indeed in a hospital gown and providing skin to skin infant for her newborn shortly after delivery. This is standard of care for all healthy newborns and perhaps even more crucial for bonding and attachment for newborn delivered through surrogacy. It is wonderful that the Wades were able to have this experience as a standard of care after delivery. Additionally, the American Academy of Pediatrics strongly recommends the promotion and support of mothers who desire to breastfeed following the delivery of an infant traditionally as well as through surrogacy. [7]
There are several documented cases of successful breastfeeding of infants delivered through surrogacy and infants breastfed successfully following adoption. The first successful case of induced lactation in a nonlactating female for an unrelated newborn infant was documented in 2014. [8]
It is not clear if Gabrielle Union has decided to breastfeed or not but skin to skin care immediately after delivery would support the success of this process. In order to breastfeed following surrogacy, there needs to be stimulation of the breast/nipples for milk production as well as promotion of milk production through medications known as Galactagogues. Some of which include Reglan, Domperidone, Fenugreek, and Thistle. There are a variety of protocols for induction which can be reviewed at a variety of sites.[9]
Typically, if there is time to prepare for the infant a mother will receive a combination progesterone and estrogen using oral contraceptives to maximize structural changes in breast tissue which are gradually weaned prior to the delivery of the infant to maximize nursing. Following delivery, mothers are encouraged to begin nursing and pumping every 2 to 3 hours with supplementation.
Many women are able to achieve success by using a supplemental nursing system during breastfeeding. In this scenario, the baby will have a feeding tube in their mouth connected to a bottle that may contain formula, donated breast milk or mothers’ milk while the baby practices suckling at the breast. [10]
In addition to promoting skin to skin care immediately as well as encouraging a desire if interested to breastfeed, additional suggestions for establishing bonding and breastfeeding for the intended mother during and after surrogacy include: Being involved as much as possible during the pregnancy, talking to the baby during the pregnancy, having a transitional item for the baby that the surrogate mother sleeps with such as a blanket or teddy bear or cloth that can be given to the baby after delivery which maximizes the babies sense of sight, touch and smell with their intended mother [11] https://www.simplesurrogacy.com/bond-with-your-newborn/
[1] https://www.npr.org/2017/10/20/558838759/gabrielle-union-gets-real-in-were-going-to-need-more-wine.
[2] https://www.cdc.gov/reproductivehealth/infertility/index.htm
[3] https://www.mayoclinic.org/diseases-conditions/infertility/symptoms-causes/syc-20354317
.[4] https://www.fertstert.org/article/S0015-0282(14)02309-7/fulltext
[5]https://www.americanbar.org/content/dam/aba/events/family_law/2014/05/section_of_familylawspringcleconference/4_thur_parentage.pdf
[6] https://my.clevelandclinic.org/health/treatments/12578-kangaroo-care
[7] http://pediatrics.aappublications.org/content/129/1/e214
[8] https://www.ncbi.nlm.nih.gov/pubmed/28631931
[9] https://breastfeedingusa.org/content/article/breastfeeding-your-adopted-baby-0
[10] http://www.jabfm.org/content/19/4/374.full
[11] https://www.simplesurrogacy.com/bond-with-your-newborn/
Prepared by Terri Major-Kincade MD MPH
CEO/Founder DrTerriMD www.drterrimd.com; Physician, Speaker, Author, Advocate
Attending Neonatologist, Chair Steering Committee for African American Outreach, Texas Chapter of March of Dimes, Board Member PLIDA: Pregnancy Loss and Infant Death Alliance
Two Time Amazon Best Selling Author: Early Arrival: 9 Things Parents Need to Know about Life int the ICU Nursery and Thinking About Quitting Medicine
Contact: DrTerriMD@Gmail.com