Earlier this month, newspapers reported that a 53-year-old woman had "given birth to her own grandchild." Cindy Reutzel is not the first post-menopausal woman to act as gestational carrier for her daughter's child, and surrogates well into their sixties have successfully given birth. Still, each new report prompts readers who have not considered or experienced surrogacy to ask: How far would I go to have a child? How far would I go to help someone have a child?
Laws governing surrogacy vary from country to country, and within the US, from state to state. Places like Australia, Washington state, and most of Canada, for example, permit only "altruistic" surrogacy in which the surrogate is not paid for her services. In contrast, Oregon, Texas, and, most famously, India, recognize commercial contracts that compensate a surrogate financially. Some jurisdictions also distinguish "traditional" from "gestational" surrogacy, permitting one but not the other. A traditional surrogate is artificially inseminated but uses her own eggs to create the embryo; a gestational surrogate carries a baby created through in vitro fertilization (IVF) and is not the genetic mother of the child.
The diversity of legal opinion on surrogacy reflects perhaps a wider range of public opinion. Traditional surrogacy, according to several sources, dates back thousands of years. In the past few decades, however, IVF has made gestational surrogacy possible, and the business of commercial surrogacy -- known by critics as "rent-a-womb" -- has exploded in developing countries.
In this new scope of possibilities, women considering surrogacy may find themselves on the defense. How, or should, they justify their choices to friends, family, employers, faith groups -- or indeed, in their own mind? Three new memoirs offer three different surrogacy stories, yet each tackles this essential question head on.
In The Sacred Thread, Adrienne Arieff chooses gestational surrogacy in India. At age 36, after three miscarriages and upon receiving news that uterine fibroids would likely preclude a full-term pregnancy, Arieff explores surrogacy as an alternate route to motherhood. She and her husband Alex research options, consider surrogacy at home in the US, but opt for the Akanksha Infertility Clinic in Anand, India, where their surrogate, a woman from a remote village, will be paid:
To me this was not exploitation. This was a win-win, allowing the surrogate to have a brighter future and the couple to have a child. If my money was going to benefit an Indian woman financially for a service she willingly provided, I preferred that it be a poor woman who really needed help because the money that a surrogate earns in India is, to be blunt, life-changing.
Arieff thus lays out the ethical debate around commercial surrogacy in developing countries. Has Vaina, Arieff's surrogate, entered this agreement by choice? What does choice really mean when disparity is so vast, when a couple can offer "life-changing" amounts of money for a pregnancy and in Vaina's case, the surgical birth of twins? These questions are difficult to answer, in part because we are not privy to Vaina's point of view except through Arieff and a translator, nor do we learn much of Vaina's family or culture.
To her credit, Arieff tries to know and portray Vaina. While Dr. Patel, the clinic's director, and her staff encourage genetic parents to maintain a brief and business-like relationship with their surrogate, to pay agreed-upon fees, bring gifts, "and then leave her alone, patiently waiting for the birth," Arieff does not take this approach. She returns to the US after Vaina is implanted with embryos, but upon learning that Vaina is expecting twin girls, feels compelled to bridge the geographic and emotional divide. Arieff spends the remainder of the pregnancy in Anand and visits Vaina every day. She asks Vaina direct questions about her life and her decision: "'Are you comfortable being a surrogate? Are you afraid of what might happen if people in your village found out?' Vaina pauses and then shakes her head no. She smiles, and I believe her."
Through such conversations, and time spent together browsing American magazines, even playing a toy drum she buys for Vaina, Arieff comes to accept and cherish her relationship with Vaina: "I'm at peace with Alex's and my decision ethically, spiritually, physically, and emotionally. I know in my gut...that we're doing the right thing." She evens visits Vaina in her home village a year after the twins are born.
Arieff may be satisfied, but I wanted more: Vaina's voice, her thoughts, motivation, and feelings. Although Vaina is one surrogate of many and her experience singular, and although Arieff takes care to transcribe her words and understand her life, I did not feel at peace when closing the book. I felt a vital part of this story missing.
We may never read Vaina's memoir, but in Someone Else's Child, Sue Phillips details her own experience as a gestational surrogate in Australia. India and Australia are oceans apart, literally as well as economically. Australia ranks among the world's most equal countries, and Australian law prohibits commercial surrogacy. While Arieff finds comfort in the win-win of a compensated arrangement, Phillips is reassured that her motivation must be altruistic; she cannot gain financially from the surrogacy. Readers may well ask of Phillips: Then why? Why become pregnant with another couple's child? Why experience the joy and pain of pregnancy, only to give away the baby at birth?
Phillips devotes much of her book to these questions. Lily and Ben, the genetic parents of the baby she carries, are not close friends -- they are friends-of-friends -- but Phillips knows them well enough to witness their yearning for a child they cannot conceive. Due to illness, Lily had a hysterectomy at age 27 but retained her ovaries. Phillips has three children of her own, and does not plan to have a fourth although she admits "the feeling of a baby moving inside me is something I wouldn't mind experiencing again." Through reflection and writing (and a well-timed church sermon), Phillips decides she simply needs to help:
How could I watch [Lily] in pain when I had three kids and there was no physical reason I couldn't have a fourth? How could I sleep soundly knowing that no treatment would help her, while I had hardly needed to think about conceiving and I could hug my kids anytime I wanted?
The surrogacy is not easy. In Australia, surrogacy must be approved through an ethics committee. Phillips undergoes psychological and medical tests; her two older children (aged five and seven) are interviewed; lawyers counsel that Phillips and her husband are the baby's legal parents until they formally relinquish that right through the Supreme Court. These trials precede IVF, a miscarriage, another round of IVF, threats of dismissal from the Catholic school where Phillips works, and a draining pregnancy. Phillips' surrogacy makes little rational sense, and yet Someone Else's Child reads true. I sense honesty in her teetering emotions and straight-up writing. She wants to help, yes, but veers through patches of utter selfishness and resentment. Who wouldn't? After delivery, she holds baby Sophie just a moment longer than planned -- then gives her to Lily.
In her final chapter, Phillips writes that today she and Sophie, Lily, and Ben "don't see each other a lot but we never wanted to live in each other's pockets." Like Arieff and Vaina, Phillips knows she will always be connected to Sophie and her family even if geography, culture, or preference keeps them physically apart. Phillips also knows Sophie is with her true parents, "exactly where she is supposed to be."
In Bringing in Finn by Sara Connell, however, ties among parents, surrogate, and baby remain close, eternal. They are, after all, family: Connell's mother is her gestational surrogate. Like Cindy Reutzel in this month's news, Kristine Casey gives birth to her own grandchild. Reactions to this scenario most likely range from horror to amazement to aspiration, and indeed Connell experiences a full gambit of feeling. Thankfully for readers, Connell's writing is up to the task; her prose swells with emotion and imagery.
Bringing in Finn opens with devastation and a glimmer of hope. Connell had lost a baby at six weeks into pregnancy; she then loses twins boys at twenty-one weeks. Months later, at home and shattered, Connell accepts comfort from her mother:
There had been a time, even two or three years before, when she would not have come, or when I would not have let her near me....She encircled me in her arms, squeezing my body as if she was trying to suck the pain out of me, as one does for snakebites....I heaved and wept. When I'd exhausted myself, she held me a foot or so from her and lifted my chin, forcing me to meet her eyes. "You will know joy again," she said.
In this short passage, we learn of Connell's distance from her mother, and their reconnection; we feel her bone-wrenching grief at the loss of her twins; and we sense the strength and prescience of Kristine Casey.
A professional life-coach, writer, and speaker, Connell also dedicates time to yoga and meditation. Her book glows with faith and spirituality, not religious belief, but an underlying wisdom of the universe or, as Connell writes, the Great Mother. Even at the nadir, after the death of her twins, she meditates and seeks advice: "For ten days I wept... and beseeched the Great Mother to offer me some comfort and support." In response, she hears words; among them, "You have been initiated."
Connell realizes that despite her loss, despite the fact that she may never carry a baby to term, she is nonetheless a mother. In a beautiful scene, she attends a friend's church concert, unaware that it is also Mother's Day. When mothers in the audience are asked to stand, she hesitates, then stands: "Why not? I thought. The minister hadn't said, 'Stand if your children are living.'" The woman next to Connell asks how many children she has and Connell says three, and in explanation offers simply, "Didn't stay."
Casey, though skeptical of life-coaching and counseling, attends one of her daughter's sessions and creates a vision board with images of healthy food, a young woman with a child, the words "women after menopause have a choice," and a picture of a baby ostrich. Casey can't explain these images but comes to understand that she is meant to carry and give birth to her grandchild. She feels this is her calling, her purpose. At 61 years old, after two rounds of IVF and a cesarean, she gives birth to Finn, and the circle closes. Connell writes:
I'd felt cracked open by our fertility challenges and the loss of the twins. But as I felt the baby move in my arms and saw my mother's body opened and laid out in sacrifice for the deepest dream of both our hearts, I was cracked open again.
Bringing in Finn provides a compelling read. As in The Sacred Thread and Someone Else's Child, we want to know what happens: Will the surrogate become pregnant? Will the pregnancy and birth go well? How will the genetic parents feel when holding their child for the first time? How will the surrogate feel? All three books, debuts for each author, deftly move the story forward, and provide enough detail to satisfy the curious or advise those considering a similar path. And these three writers accomplish, in the end, what all parents must: weigh our convictions, doubts, limitations, and gifts; examine our choices in light of the many forces -- spiritual, cultural, and personal -- around us; and then learn to let go and trust the Great Mother within.