Labor of Love

Heather Jacobson

• Publisher: Rutgers University Press
• Year: 2016
• ISBN:
  9780813584386
• Topic: Social Sciences
• Subtopic: Marriage & Family Sociology
• Index: Social Sciences

While the practice of surrogacy has existed for millennia, new fertility technologies have allowed women to act as gestational surrogates, carrying children that are not genetically their own. While some women volunteer to act as gestational surrogates for friends or family members, others get paid for performing this service. The first ethnographic study of gestational surrogacy in the United States, Labor of Love examines the conflicted attitudes that emerge when the ostensibly priceless act of bringing a child into the world becomes a paid occupation.     Heather Jacobson interviews not only surrogate mothers, but also their family members, the intended parents who employ surrogates, and the various professionals who work to facilitate the process. Seeking to understand how gestational surrogates perceive their vocation, she discovers that many regard surrogacy as a calling, but are reluctant to describe it as a job. In the process, Jacobson dissects the complex set of social attitudes underlying this resistance toward conceiving of pregnancy as a form of employment.    Through her extensive field research, Jacobson gives readers a firsthand look at the many challenges faced by gestational surrogates, who deal with complicated medical procedures, delicate work-family balances, and tricky social dynamics. Yet Labor of Love also demonstrates the extent to which advances in reproductive technology are affecting all Americans, changing how we think about maternity, family, and the labor involved in giving birth.  For more, visit  http://www.heatherjacobsononline.com/  

Chapter 1

Conceptions

Molly Hughes¹ never imagined it would be so hard to get pregnant. She was a healthy twenty-nine-year-old and had already had two children. With her daughter, Nina, and son, George, she conceived quickly and had enjoyable, uneventful pregnancies and births. When I first met Molly in 2009, she had been trying for three years to get pregnant using advanced reproductive technologies. She had completed four in vitro fertilization (IVF) procedures, none of which had resulted in the birth of a child. Molly was shocked. It had been so easy with her first two pregnancies, and she felt like a failure. In one of the four procedures, the embryo failed to implant. Two other cycles ended in what is known as a “chemical pregnancy,” a very early miscarriage in which the embryo does not properly adhere to the uterine wall. Most devastating for Molly, however, was the second trimester miscarriage she suffered. During a routine obstetric exam in her fourteenth week of pregnancy, the technician at Molly’s doctor’s office could not find a heartbeat. The doctor contemplated having Molly labor and birth the deceased fetus, but instead performed a dilation and evacuation procedure (D&E). Molly was distraught and left to try again with another round of IVF.

As we sat on the couch in her small, tidy East Texas home, Molly let me know that three years of attempting pregnancy was taking a toll on her and on her family. Her husband, Dustin, accompanied her to almost all of her appointments, which were numerous—and many of which were several hours away from their home. Molly was nervous about driving in the big city, and Dustin was there for her—not only as a chauffeur, but also for support. For these visits, Dustin had to take time off work. That was fine, Molly told me, as Dustin was a salaried employee; but still, she said, it “wore on him.” Molly, the primary caregiver to their two school-age children, had previously worked in child care and was now looking for part-time work. Sometimes Molly and Dustin would bring Nina and George with them to appointments, but other times, especially when they had to go to the infertility specialist’s office (a good four-hour drive away), Molly had to find someone to care for the children. Luckily, she had a good support system in her mother and her best friend. During the previous three years, Molly had been gone from home a lot more than usual due to all of the doctor’s appointments. She had to miss some important events in her children’s lives—a baseball tournament, a mother and son dance—occasions she would never be able to make up, and she felt bad about that.

Molly’s children, Nina and George, had initially been excited by the thought of a baby. But after three years, they had become blasé about the idea that their mom would ever get pregnant. Molly and her doctors, after all, had tried almost everything. Everything, that is, except using Molly’s eggs or Dustin’s sperm, or creating a child the “old-fashioned way.” Molly, you see, had no interest in adding another child to her family; with Nina and George, her family was complete. She was trying to add a child to someone else’s family—a family of strangers. For three years, Molly had been trying desperately to succeed as a gestational surrogate.

GESTATIONAL SURROGACY

Gestational surrogacy is a relatively new medical procedure, social arrangement, and form of compensated labor in the United States. Gestational surrogates, like Molly, are implanted with embryos via IVF and paid to gestate and bear the resulting children. The people they are helping—the intended parents (IPs)—are unable or in some cases unwilling to get pregnant or carry a pregnancy to term themselves due to infertility, social or medical issues, or because they are men. Though some surrogates undertake altruistic surrogacy and receive no monetary compensation, today most are thought to engage in commercial surrogacy and are paid for their services. At the time I met Molly, however, she had received little compensation for her three years of work. It is only after a successful “journey”—one that ends in the birth of a live baby—that most surrogates receive full compensation.

Though Molly had yet to bring a pregnancy to term, she was not out of pocket; her IPs had paid for all of the medical tests and procedures, office visit copayments, and travel expenses. Her first set of IPs (there had been two sets so far) had compensated her for her three months of pregnancy, according to their contract. Nonetheless, she had invested three years of her life trying to get pregnant for others, people she had not known before meeting them through a surrogacy agency. Why was Molly so intent on being a surrogate? And why did she rearrange her life—and the lives of her family—to do so?

Popular discourse, including the 2008 Tina Fey movie Baby Mama, would have us believe that Molly was doing surrogacy solely for the money, that she was “renting her womb” to the highest bidder. Gestational surrogates usually make between $20,000 and $35,000 for successfully completing a journey. But when Molly first started surrogacy, she did not even know that she would get paid. Some surrogates I spoke with even thought at first that they would be responsible for the medical expenses associated with carrying and birthing someone else’s child. Not all surrogates, of course, are naive about payment, but the story of surrogacy—including the motivations of women like Molly—is more complicated than a simple cash transaction.

Molly had been working at surrogacy for three years when I first met her. Her life, she told me, had been “consumed by surrogacy.” The IVF medical protocol alone was intense. Molly had to take a series of medications—to first regulate her menstrual cycle and then shut it down, to thicken the uterine lining, all to trick her body into thinking it was pregnant so that it would accept a foreign embryo and sustain it. Her husband had to learn how to give her the daily injections, and sometimes they had to forgo outings that coincided with medication timing. She and Dustin had to abstain from sexual intercourse when she was cycling on the medications, especially in the period immediately before and after embryo transfers. Molly wanted to be extremely careful, so she and Dustin had not had intercourse regularly since she began attempting to have a surrogate pregnancy.

For three years, Molly had been on this medical regimen, cycling with nothing to show for it except a deepening understanding of both infertility and the medical reproductive procedures meant to combat it, as well as a lot of heartbreak and frustration. For Molly and her family, those three years had been like a roller-coaster ride. Molly was dedicated, though. She continued to try, and over the course of the next three years she did get pregnant, bearing a singleton for one couple and twins for another. She loved it. She might try again. After six years in the world of surrogacy and seeing the joy on the faces of her IPs, it was hard, Molly told me, to imagine “retiring.”

This book examines the experiences of women like Molly who are paid to gestate and bear children for others. The data on which this book is based come from three years spent in the world of surrogacy as a researcher. From the summer of 2009 through the fall of 2012, I interviewed thirty-one surrogates like Molly about their surrogacy journeys and their lives. I also interviewed others intimately involved with surrogacy—IPs, surrogacy agency directors and employees, attorneys, counselors, and psychologists, an infertility doctor, and surrogates’ family members and close friends. In all I spoke with sixty-three people about their surrogacy experiences, following many on their journeys through follow-up interviews, e-mail messages, phone calls, and blog updates. I also frequented surrogacy websites, popular online surrogacy forums, and a wide range of surrogacy blogs from 2009 through 2015.

As I spent time in the world of surrogacy, I became more interested in examining surrogacy not from the perspective of IPs and the lens of family formation but, rather, from the perspective of surrogates and the lens of work. I was initially curious, as many are, about the motivations of women who bear children for others. However, I became increasingly fascinated by what I came to realize was quite a complex and laborious process that is largely enacted and often managed by surrogates. This book is the result of that interest, focusing on the work surrogates engage in and how they, and others, understand that labor in a society in which these arrangements have a contentious history.

Surrogacy itself is not a new practice. Those familiar with the biblical story of Abraham, Sarah, and Hagar or the cultural rules of the system of concubines in traditional China know that these arrangements have a long history. In both of those traditions men with infertile wives impregnated women (most often concubines or slaves) to bring children into a marriage. While those traditions are quite old, surrogacy today—particularly its volume, medical options, commercialization, and apparent similarity to paid employment—is rather different.

Contemporary surrogacy was first introduced to many in the United States with the Baby M case of the late 1980s. In that arrangement, the surrogate, Mary Beth Whitehead, contracted with William Stern to conceive via artificial insemination (with Stern’s sperm), gestate, and bear the resulting child. The contract stated that Whitehead would relinquish all parental rights and custody, allowing for the child to be adopted by Stern’s wife, Elizabeth. Whitehead was to be paid $10,000 and have all of her medical care covered. After the birth of the child, however, Whitehead decided she wanted to parent the baby. There ensued a custody battle and a protracted legal case—all played out before a captivated nation.

Whitehead was what is known as a “traditional surrogate”—that is, one who conceives for others a child who is genetically related to her. In much earlier times, traditional surrogates were the only kind possible, with insemination occurring via sexual intercourse between intended father and surrogate. Today and in Whitehead’s case, traditional surrogates conceive via artificial insemination (AI). Beginning in the mid-1970s, AI or traditional surrogacy began to become commercialized, with lawyers and physicians practicing in the field and being compensated for their work, and with some surrogates receiving fees for their time and labor—though not, ostensibly, for their children (Field 1990, 5). It was not until Baby M, however, that many people in the United States became aware that surrogacy was occurring and that a market had developed around these arrangements.

With the exposure that came with the Baby M case, surrogacy and the incorporation of third parties, contracts, and money into birth and parental rights became a political issue and topic of national discussion (Markens 2007). Conservative opponents of surrogacy argue that what they call the natural relationship between husbands and wives, parents and children, and marriage and pregnancy is disrupted with the use of surrogate wombs (E. Roberts 1998). The Roman Catholic Church, for example, opposes the use of all artificial reproductive technologies and finds the use of surrogates in the creation of children immoral. A 1987 Vatican document presented Catholic objections to surrogacy directly:

Surrogate motherhood represents an objective failure to meet the obligations of maternal love, of conjugal fidelity and of responsible motherhood; it offends the dignity and the right of the child to be conceived, carried in the womb, brought into the world, and brought up by his own parents; it sets up, to the detriment of families, a division between the physical, psychological, and moral elements which constitute those families. (Congregation for the Doctrine of the Faith 1987)

It is this division between conception, gestation, and parenthood that the Catholic Church and many people find so problematic. Popular cultural conceptions of motherhood in the contemporary United States honor and privilege the unity of biological, gestational, and social mothering. Despite historical and cultural variations in what it means to be a mother, the unity of motherhood today is framed as part of nature itself, with the belief that natural bonding occurs between mother and infant—thanks to their female instinct, women naturally love, understand, and have empathy for and a connection to the children they beget and birth (Glenn 1994; M. Nelson 1990). Surrogacy disrupts that unity by dividing motherhood into distinct activities (donating an egg, gestating and birthing a baby, and parenting that child) and is therefore often seen as an affront to nature (E. Roberts 1998; Teman 2010). In this framework, surrogacy is unnatural because the unity of motherhood and the natural relationship that develops between mother and infant should preclude women from purposefully gestating and bearing children they do not intend to parent, and if they do have such children, it should make it impossible for them to hand those children over to other people.

The introduction of money into these arrangements represented a sea change to some people, who saw it as potentially coercing women, especially poor women, into behaving unnaturally. Commercialized surrogacy is understood to be an extreme example of “the heightened commodification of intimacy that pervades social life” (Boris and Parrenas 2010, 1). As Viviana Zelizer has observed, there is an intense resistance to the overlapping of what are understood as the separate spheres of intimacy and economics; when this does happen, “inevitable contamination and disorder” are thought to result (2005, 20–21; see also 1985). In surrogacy, the argument goes, compensation is understood to push women—especially poor women—to use their bodies unnaturally, as reproductive machines, out of economic desperation (Corea 1985; Oliver 1989). In doing so, women are objectified “by selling their capacity to bear children for a price” (D. Roberts 1997, 277). In an interesting twist that others have noted, on this point of assumed coercion and exploitation Catholic conservatives were in line with a vocal contingent of feminists (Andrews 1989; Macklin 1990; Markens 2007).

Feminist opposition to surrogacy, especially from the 1970s through the early 1990s, focused primarily on the potential commodification of children and the market control of women’s bodies that surrogacy allows (see, for example, Corea 1985; Oliver 1989; Rothman 1989). There were also concerns that surrogacy “encourages the point of view that women’s primary function is as child-bearers, which reduces women to being ‘gestational vessels’ with little worth outside reproduction” (Weiss 1992, 16). Unlike conservative opponents, feminists did not (and do not) object to surrogacy on the basis that it threatened the “traditional family”; rather, the issue was the exploitation of women, especially poor women, for their reproductive abilities (D. Roberts 1997; Rothman 1989; Teman 2008).

Though many feminists opposed surrogacy as inherently oppressive to women and stood behind Whitehead, not all felt that surrogacy should be banned. Reproductive autonomy, an important cornerstone of feminist thinking and activism, was a divisive issue when it came to surrogacy. There were some who argued that reproductive autonomy included the right to participate in surrogacy and that women should have control over their bodies, including the choice to conceive and bear children for others (Andrews 1990; Oliver 1989). Some argued that this right should be exercised but tempered by a ban on paid surrogacy to discourage exploitation (Charo 1990). Others upheld women’s rights to engage in contracts and framed as paternalistic conservatives’ argument that surrogates cannot fully understand what they are agreeing to: “It questions women’s ability to know their own interests and to enter into a contractual arrangement knowingly and competently” (Macklin 1990, 141). This position is visible in the arguments of Lori Andrews, for example, when she imagines possible ramifications of the banning of surrogacy: “Once women are held incompetent to make surrogacy contracts, they may be denied the right to make other contracts. Once policymakers deny women the reproductive choice of surrogacy in order to protect potential children against putative harm, they may deny women other prenatal choices—to undergo amniocentesis or not, to rule out Cesareans, to abort—on those same grounds” (1989, 253). These rights—to make the choice to be a surrogate and to enter into surrogacy contracts—were supported, of course, by surrogacy professionals: surrogacy agency directors and the attorneys and physicians who worked in the field.

Professionals also framed surrogacy in terms of the rights of infertile couples—especially biological fathers (at that time, the surrogates were the biological mothers)—to have children via these traditional surrogacy arrangements (Oliver 1989). This pronatalist right-to-parent discourse has traction in the United States, a country in which parenthood has long been viewed as natural (and “barrenness” as a curse), in which people are pressured to procreate, and in which investment in our children is very high and seen as not only personally fulfilling but good for the nation (Lovett 2007; Zelizer 1985). It was in 1942, in Skinner v. Oklahoma, that the U.S. Supreme Court framed “marriage and procreation [as] fundamental to the very existence of the survival of the race” and “one of the basic civil rights of man.”² The Skinner case was challenging the compulsory sterilization of criminals (Cahn 2009; D. Roberts 1997), and with the development of advanced reproductive technologies, this “basic civil right” to procreate became complicated in ways that the Supreme Court might not have imagined in 1942.

Notions of the right to a family in the contemporary United States and what constitutes family, especially the child-parent relationship, rely heavily on the connections that are thought to derive from genetic linkages between people (Jacobson 2008). This shapes who are seen as family members and supports the notion that one’s “real children” are only those who arrived through the biological route to parenthood (Wegar 1997). Of course, this notion is not held by all and is challenged by many people, including those in adoptive families, stepfamilies, blended families, foster families, and families that have used egg or sperm donation and surrogacy. As others have argued, however, in addition to the ways assisted reproductive technologies challenge notions of the “traditional family,” they also reinforce them and privilege biological parenthood. This can be seen in the way that surrogate professionals justify their practices by presenting the need for biological children and the right to have what they call “real children” of “one’s own,” to “pass on one’s genes,” as a natural desire of all people, one the professionals do not create or shape but are only attempting to help people fulfill. This “right” is also articulated by the consumers of reproductive technologies, who come to see reproduction as a basic human right (Becker 2000).

Feminists have long critiqued pronatalism and the pressure women—especially white, middle-class women—historically have experienced to procreate (Lovett 2007; D. Roberts 1997). Under pronatalism, being a “good woman” in the United States is equated with motherhood, establishing a “motherhood mandate” that coerces or forces women to mother and to think about themselves primarily as mothers (Glenn 1994; Russo 1976). However, the motherhood mandate has social class and racial dimensions, with working-class or poor women and women of color more challenged in fulfilling the middle-class ideal of proper mothering (that is, intensive and full time) (Hays 1996; McCormack 2005). Scholars have shown important ways in which the reproductive capacity of women of color and poor women is, and historically has been, policed, while reproduction is encouraged among the white middle class (Cahn 2009; Lovett 2007; D. Roberts 1997). For example, the eugenics movement, which began in the United States at the beginning of the twentieth century, promoted “reproductive strategies that would ensure higher rates of reproduction among the fit [read: middle-class whites] and lower rates among the unfit [read: poor women and women of color]” (Solinger 2005, 89). Some argue that this schism between encouraging and policing reproduction has intensified with the development of new reproductive technologies, denying poor women of color alternative reproductive possibilities while encouraging middle-class women to devote more time, energy, and money in attempting biological motherhood (Becker 2000; Bell 2014). Opponents of assisted reproductive technologies also “object to the naive technological optimism inherent in the mainstream view [that these technologies are inherently good] and raise questions about who will control the new technologies”—and for what purpose (Purdy 1996, 75). They are concerned about the ways in which the existence of the technologies and how they are used “reinforce harmful biologically determinist stereotypes of women” (ibid., 76).

Surrogacy is seen by some as coercive pronatalism that encourages surrogates to find their worth in their reproductive capabilities while at the same time stripping them of their maternal rights. For example, Barbara Katz Rothman, a leading feminist opponent of surrogacy, writes that she is “horrified” by surrogacy because it “reinvents motherhood.” “If any pregnant woman,” she continues, “is not necessarily, inherently,...