Who Makes Medical Decisions During a Surrogate Pregnancy?

Short answer: The gestational surrogate makes the medical decisions about her own body, pregnancy, labor and delivery. Intended parents may have preferences that are discussed before the journey and reflected in the surrogacy agreement, but they do not replace the surrogate’s right to give or refuse medical consent.

The surrogate remains the patient

The American Society for Reproductive Medicine states that gestational carriers are the sole source of consent regarding their medical care from embryo transfer through prenatal care, labor, delivery and aftercare. See ASRM’s 2023 Ethics Committee opinion.

The American College of Obstetricians and Gynecologists (ACOG) likewise emphasizes the gestational carrier’s autonomy and states that the obstetrician should not look to intended parents for consent when medical decisions are being made during pregnancy, labor or delivery. See ACOG guidance on gestational surrogacy.

Then what is the surrogacy contract for?

A gestational-carrier agreement is still extremely important. It allows the parties, with independent legal counsel, to discuss expectations before treatment begins. Topics often include prenatal testing, communication, travel, embryo-transfer decisions, pregnancy complications, selective reduction, termination, delivery preferences and financial responsibilities.

These discussions can reveal whether intended parents and a potential surrogate have fundamentally different values before they commit to one another. A written agreement can document their shared intentions and responsibilities, but it does not turn intended parents into the surrogate’s medical decision-makers.

What happens if the parties disagree?

Serious disagreements are one reason matching and independent legal counseling matter. ACOG recommends separate legal representation for the gestational carrier and intended parents because surrogacy law and parentage procedures vary by state and conflicts of interest must be avoided.

If a disagreement concerns an actual medical decision, the surrogate’s medical team owes its duties to the surrogate as its patient. Legal questions about the contract or parentage should be handled by attorneys licensed in the relevant jurisdiction.

Can intended parents be involved in prenatal care?

Often, yes—when the surrogate consents. Many surrogates and intended parents agree on a communication plan that may include updates, video calls, ultrasound attendance or participation in certain appointments. The level of involvement is something the parties should discuss during matching and contracting.

However, access to medical information is not automatic. Privacy rules and the surrogate’s authorization control what information can be shared.

What about decisions involving the baby after birth?

Once the baby is born, medical decision-making for the newborn depends on the legal parentage arrangements in the applicable state and the hospital’s documentation. Because parentage procedures differ across jurisdictions, intended parents should work with a reproductive-law attorney well before delivery.

Key takeaway

Surrogacy is collaborative, but medical autonomy is not transferred by contract. The gestational surrogate remains the patient and controls decisions about her medical care. The best protection for everyone is thoughtful matching, independent legal advice, clear preconception discussions and a care team experienced in third-party reproduction.

This article provides general educational information and is not legal or medical advice.