From Negotiation to Uncertainty: Surrogates' and Intended Parents' Experiences of Antenatal Care in Australia.

BACKGROUND

Surrogacy represents an increasingly common pathway to parenthood, yet maternity care services remain largely designed around conventional models of care centred on the pregnant woman and her partner. This study explored how surrogates and intended parents experienced antenatal care in Australia, where national surrogacy-specific guidance is absent.

METHODS

A qualitative design was used, incorporating semi-structured interviews with 17 participants (nine surrogates and eight intended parents) across different states. Interviews lasted 60-90 min, were conducted online, de-identified, and analyzed thematically following Braun and Clarke's six-phase framework. The antenatal phase was defined as care from confirmed pregnancy to hospital admission for birth.

RESULTS

Three themes captured participants' experiences: (1) Recognition and system inconsistencies in antenatal care reflected variable institutional awareness and conflicting documentation processes that left families repeatedly clarifying their roles; (2) Negotiating inclusion in antenatal care highlighted the inconsistent inclusion of intended parents in scans and appointments, often shaped by hospital rules, geography, and surrogate discretion; and (3) Navigating emotional preparation and uncertainty described how both groups balanced excitement with anxiety about recognition, expectations, and the impending handover. Together, these themes reveal that care quality depended on individual clinicians rather than system-level guidance.

CONCLUSIONS

Antenatal surrogacy care in Australia remains inconsistent and emotionally demanding for families. Establishing national, adaptable guidance that promotes recognition, inclusion, and coordinated communication between surrogates, intended parents, and healthcare teams could enhance equity, clinician confidence, and the person-centred foundations of surrogacy birth care.