Karen Wixom

What happens when a surrogate mother cannot overcome postpartum depression and can't afford therapy?


Three years ago, with our four young children to care for, money was tight for my husband and me. Although I had worked in the past as a substitute schoolteacher and a ride operator at Disneyland, and for an employee background check company, and my husband was employed at a local car dealership, we felt that additional income would be very helpful for our family. But we also found that good part-time jobs were hard to come by, and good childcare was difficult to afford.  Surrogacy seemed a good way for me to be able to supplement our family income while also allowing me to take care of our kids. With compensation of about $50,000 being offered by surrogacy agencies at that time— more than most of us could hope to make in a year working outside the home full-time—surrogacy seemed like a very attractive option. Besides, all of my pregnancies with my own kids had been easy, with no complications, and so I felt being pregnant was something I was good at. And I liked that I would be helping others to have a family, while at the same time helping my own family.

I was especially drawn to a surrogacy agency called Center for Surrogate Parenting,  headquartered in California, which boasted having more than four decades’ experience, and claimed to take special pride in its care and treatment of all parties to surrogate transactions, including surrogates themselves. 

My first experience as a surrogate went quite well. The commissioning parents were a gay couple living in Texas, and both they and I were thrilled when I was able to deliver to them a healthy almost-ten-pound baby boy. The pregnancy itself went reasonably well, although it was nothing like my prior pregnancies with my own kids. I hadn’t suffered from morning sickness before, but in this pregnancy my morning sickness was so severe that I had to be hydrated intravenously at the hospital several times. I also had to deliver by caesarean-section—something I’d never had to do before—which extended the time I needed for recovery after the pregnancy. 

Although two embryos had been transferred to me in that first surrogacy experience, only one survived. The same gay couple still wanted a second child, however, and so, one year after giving birth to their son, I agreed to serve as a surrogate for them a second time. This time, however, after going through all of the IVF procedures and taking all of the hormones needed for successful transfer of the embryo, and then becoming pregnant, I miscarried after six weeks. This was a huge disappointment to both the commissioning parents and me. But while the dads were eager to try again right away—they wanted that second child as soon as possible--I felt that both my body and my psyche needed time to recover. The D & C I had to undergo as a result of the miscarriage was especially rough for me. Truthfully, I really didn’t even want to go through another surrogacy pregnancy again. But I also felt that I had no choice. If I didn’t agree to follow through a second time and try to provide them with a second baby—and quickly!--then my husband and I would be expected to pay them back for all of the expenses they had incurred in getting me pregnant up until the miscarriage---$5,000 or $6,000 at least. My husband and I couldn’t begin to come up with that kind of money, and so within three months of miscarrying, I was pregnant for the dads again. 

And I delivered to them a second healthy 10+ pound son, following a pregnancy that was quite like the one before—including severe morning sickness requiring hospital care, and another c-section delivery.  (In hindsight, had I known what c-sections are like and that they would be real possibilities in my surrogacy pregnancies, I would never have signed on to be a surrogate.)

What happened to me after this second delivery, however, was altogether different than any before. Just shy of two months after giving birth, I developed an umbilical hernia directly related to the pregnancy, which required expensive medical treatment, including surgery. Although the surrogacy agreement required that the dads provide me with health insurance for up to two months following delivery, there were complications—and a lot of paper work and red tape-- involved in securing the needed insurance coverage. Neither the agency nor the dads were very helpful with this, and neither of them offered any sympathy either. 

It was while recovering from the hernia surgery that I was hit with another far more dangerous and debilitating condition. My husband noticed that I was acting out of character and became quite worried, and asked me to see a doctor. When I did, I was diagnosed with postpartum depression. An antidepressant was immediately prescribed, but it had little or no effect. And the Zoloft I was prescribed thereafter made me almost suicidal.

As has been said by others, the reproductive labor of pregnancy and birth is difficult to commodify. How do you monetize a bladder injury, a tear stretching from vagina to anus or a hemorrhage leading to hysterectomy? I and other surrogates may have been informed that some of these serious complications could occur, but they are rare, and most times they don’t happen. Yet the most common complication of pregnancy was never discussed with me when I was being examined and advised as a candidate for surrogacy. Postpartum mental illness was never mentioned, either before or during the months of my pregnancy, or at any time in the surrogacy agency’s support groups or in any therapy sessions that were offered by the agency. 

I have since learned that postpartum depression is a major contributor to maternal death in the U.S. Estimates of postpartum depression vary from fifteen to twenty percent of all new mothers, and can be triggered at any time within the first postpartum year. Because I had never experienced depression of any kind before in my life, nor had any member of my family ever been afflicted, it was very weird and even terrifying to experience it for the first time. I wasn’t sad about having been separated from my surrogate children. What tormented me was the feeling of having been used and then discarded by the dads and the surrogacy agency, and feeling exploited by them both.

I had picked Center for Surrogate Parenting as my agency because it had the best reputation for treating surrogates well. And I was treated pretty great when I was pregnant. I felt taken care of. But now, I lost the health care insurance that had been provided by the surrogacy contract when I needed it more than ever, and for a condition directly related to my surrogacy pregnancy. I did reach out to both the agency and the dads, telling them that I needed help.  But the dads explained that they had honored the terms of the surrogacy contract and didn’t feel obliged to provide any further assistance, and the agency chastised me for not having saved more of the money I earned from surrogacy, that could have gone towards my health care at this point, and accused me of being greedy for wanting anything more than what was called for in the contract. They both made me feel horrible for even asking for help.


My condition is very very hard on my family. For my children and husband, postpartum depression has literally stolen their mother and wife. Most days, getting out of bed--if I can manage it at all--is a herculean struggle. I use what little energy I can muster to tend to the most basic needs of my kids, but I have no energy left for things like trips to the playground or other activities, and no energy left to care for myself. Plenty of days I can’t even manage to take a shower, or eat a meal. I feel incredibly guilty, not being able to be the mother my children need, or a good wife to my husband. My youngest child, a daughter aged six, talks about how “the baby broke Mommy.” My oldest child, a son aged sixteen, is very sad and worries deeply about me—not what a sixteen year old should have to be dealing with. My husband has to pick up the slack and manage the household, on top of his full-time job (he was re-hired), as I can no longer manage any of it myself. Anti-depressants help some, but I am far from being well, and still need therapy that I can’t afford.

I don’t think surrogacy should be legal, when even the most common of serious and debilitating health risks isn’t required to be disclosed, making informed consent impossible. I don’t think surrogacy should be legal, when much-needed health care for longer-term pregnancy-related harms is not required or made available. The lives of too many perfectly healthy and fit young mothers and wives are forever compromised or irreparably harmed, not only to their own detriment, but to the detriment of their families who need them.

I suffer deeply, every single day, as do my children and my husband. No amount of money was worth this cost to us all.


Sources for this story


Telephonic interview conducted with Karen Wixham


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