One day in March 2010, Katie Welsh returned to work after yet another disappointing doctor’s appointment. The 30-year-old dental assistant from Richmond, B.C., had been told, again, that it wasn’t safe for her to get pregnant. Barb Nimchuk, a long-time friend and colleague, found Katie crying in the hall. Barb had shared in her friend’s distress over the years and impulsively decided there was something she could do to help. “Listen,” she told her. “It doesn’t have to be this much heartache. I have a body that’s healthy and I’m more than willing to do this for you.” Katie was overwhelmed — Barb was offering to have her baby.
Katie’s health problems began when she was seven and nearly died. She had dilated cardiomyopathy and became Canada’s first child heart-transplant recipient. Twenty-plus years of anti-rejection medication has been tough on her kidneys — so tough, in fact, that her doctors feared she wouldn’t survive a pregnancy. Then there was the problem of the drugs themselves. If she stopped taking them, her body might reject her heart, but if she stayed on the drugs and did get pregnant, they could affect her baby’s development. No matter how many doctors she went to, the story was always the same — Katie simply couldn’t risk getting pregnant.
It got even harder when all her friends began having children. “I wanted so badly to be part of that,” she says. “It was really depressing.” Katie checked out adoption websites, but it just didn’t feel like the right fit for her and her husband, Matt. “We desperately wanted to have our own baby,” she says. “We looked into adoption, but still clung to the possibility that something would change, and maybe someday we could have a child of our own.”
At first, Katie didn’t take Barb’s surrogacy offer seriously, dismissing it as a characteristically kind offer from her friend. But when she mentioned the conversation to Matt later that night, the idea that Barb could actually become their surrogate began to sink in.
A week later, over coffee at a sunny picnic table by the Fraser River, Barb met with Katie and Matt and told them that she was serious about the offer. The divorced mother of three says she was blessed with easy pregnancies and deliveries, and acting as Katie’s surrogate simply felt right.
“It really seemed worth it to me, just to see the joy that somebody else could have for something that I already have and that had been very easy for me to achieve,” says Barb, who was 41 at the time. “Katie’s had so many doors close on her that I felt I could make a difference by making it possible for her to have a child.”
They talked for hours about how things would play out, from who would be in the delivery room (Barb, Katie and Matt) to how much contact there would be with the child over the years (they decided Barb would become the “special aunt” who would visit regularly), and what would happen if the Welshes moved away (Barb asked that they send Christmas cards and progress reports).
Making it official
The next step was meeting Paula Anderson, then nurse co-ordinator of the gestational surrogacy program at Vancouver’s Genesis Fertility Centre, to see whether both women met the clinic’s strict surrogacy requirements.
Barb was physically and emotionally the perfect match, says Anderson. She easily qualified as a surrogate under the clinic’s standards: She was between 21 and 45 years old and had an unremarkable pregnancy history, at least one healthy delivery and a stable home environment.
Surrogacy in Canada is still relatively rare, in large part because it’s illegal to pay a surrogate, unlike in the U.S. That means the options for a carrier are narrowed to a friend, a family member or the truly altruistic. Out of the approximately 800 Genesis clients who underwent IVF cycles in 2012, about 12 were for surrogacies, says Anderson.
And even if a couple manages to find a willing surrogate, everyone must pass stringent physical and psychological screening processes. Anderson has also turned away people because money was part of the surrogacy deal: “We’re looking out for both intended parents, as well as the gestational carrier. We don’t want anyone being exploited.”
Everyone underwent counselling: the Welshes to explore their level of comfort with someone else carrying their baby and their commitment to raising the child, and Barb to ensure she wouldn’t have second thoughts about giving the baby up after delivery.
“All the stars lined up,” Anderson says. “We had a surrogate who was known to the couple, she’d had her family, she was healthy and fit and really entering into this for all the right reasons.”
Still, some of Barb’s friends thought she was crazy. “A lot of people were a little taken aback,” she says. “When you make a decision to help somebody like that, it’s not the norm. Although it still seems normal to me. My friends and family often say, ‘Oh, that’s so Barb.’ ”
Barb also had to make sure her own children were fine with her decision. “For them, it was just one of those things that Mom does,” she says. “I want the children to grow to understand that there’s more to life than just themselves and they can make a difference in somebody’s life, whether it’s a community or even just one individual.”
Baby on board
In the summer of 2011, Katie and Barb began taking medications in preparation for the pregnancy. Barb was prescribed birth control pills and a hormone-inhibitor nasal spray to “quiet” her ovaries and prevent egg development, as well as another hormone pill to thicken the lining of her uterus.
Meanwhile, Katie injected hormones into her abdomen twice a day for almost two weeks to stimulate the growth of her eggs. She took it so seriously that she stayed home from work to focus on the task. There can be physical side effects, including bloating, fatigue and mild nausea, but it’s also emotionally arduous. “You have to be mentally strong to do it,” she says. “The injections themselves weren’t painful. It’s just that you feel so much pressure. You can’t help but think, ‘I hope this works, I hope this works.’ ”
Once Katie’s eggs developed enough, they were retrieved with a needle and left to fertilize with Matt’s sperm in the Genesis labs. Embryologists then watched any resulting embryos carefully, selecting the healthiest-looking ones to transfer after three or five days. “They count the number of cells to make sure they’re round and well defined,” says Anderson. “Kind of like a diamond, where you look at colour, cut and clarity.”
Day-5 embryos tend to bring higher pregnancy rates, but waiting that long also means there are fewer of them. The centre decided to transfer two day-3 embryos to Barb in a painless five-minute procedure. Each embryo was drawn into a fine catheter, inserted through her cervix and deposited in the upper uterus. It was then up to Mother Nature to decide if they would implant in Barb’s uterine wall.
Two weeks later, a nurse from the clinic phoned Katie to tell her Barb was pregnant. “It was the best day ever,” she says. “I started crying, and it was difficult to even call Barb and my husband because I felt like I couldn’t speak.” She and Matt celebrated with a sushi dinner and a bottle of champagne they had received as a wedding gift. “We were on top of the world that night!” she says.
A matter of trust
People had to look hard for the bump under Barb’s white dental coat even in her third trimester. The marathon runner continued to exercise, volunteer, chauffeur her three kids around and scold staff about their unhealthy snacking habits. As she had predicted, this pregnancy unfolded like her previous ones with no morning sickness, fatigue or complications.
She did, however, treat the pregnancy differently from her own: “I was more cautious. I didn’t run as fast or as far. And I went to Mexico when I was five months pregnant, but where I would have gone parasailing if I’d been pregnant with my own child, I didn’t with Katie’s.”
Barb tried to keep expenses down by wearing borrowed maternity clothes, while the Welshes paid for her medication and gas costs. They also pampered her with spa and dinner gift certificates. That kind of compensation is common practice and allowable under Canadian law, says Anderson.
“As much as we were friends and co-workers prior to the pregnancy, we had to instill an immense amount of trust in each other,” Katie says. “Trust that I was going to support her, and trust that she was going to make all the best decisions for the baby every day. There were zero conflicts between us. We all did what was best for the baby.”
Katie went to every prenatal appointment and talked to the baby bump every day, pushing aside her own maternal disappointment. “One hundred percent, I felt like I was missing out. Barb would say, ‘Oh, the baby is kicking’ or ‘The baby has hiccups,’ and I’d put my hand on her belly. ‘Do you feel it? Do you feel it?’ And I didn’t. So I missed that. And I was sad knowing I’d never feel the baby inside of me.” Instead, Katie focused her attention on furnishing a nursery, enjoying her baby showers and guessing the baby’s gender. “It’s likely that this is going to be my only baby, my only child. So I wanted to go through all that excitement of planning and celebrating.”
A dramatic delivery
Barb had laboured for five hours to deliver her first child, two hours with her second and 30 minutes for her third. But her prediction that this fourth delivery would be a piece of cake proved wrong.
Barb’s water broke on May 29, 2012, at 1 a.m. She paced the hospital halls for hours, then took oxytocin to speed things up, but her labour was still not progressing. The baby’s heart rate dropped, and doctors discovered the umbilical cord was wrapped around the baby’s head.
With the Welshes at her side, Barb pushed while the obstetrician used a vacuum extractor to pull on the baby’s head. The doctor then swiftly unwrapped the umbilical cord. The baby came out blue, but after 30 seconds, a cry filled the room.
Katie was in tears and so relieved that Barb’s 17 hours of labour was safely over that she forgot to check the baby’s gender until her husband whispered it in her ear. They had a boy.
Katie may not have carried or given birth to Charlie Ethan Welsh, but she was finally overcome with the feeling she’d been yearning for all those years.
“I feel so blessed to have been given not one but two amazing, selfless gifts of life,” she says. “First my heart and now my son — it’s more than I could have ever imagined.”
Katie and Charlie, who’s turning two next month, get together with Barb about once a month, usually for lunch. Barb’s children dote on Charlie, and both families were in Maui at the same time for vacation, so the kids all played together.
Katie and Barb no longer work at the same dental clinic but they have the same comfortable relationship they had before. “We will forever have this unspoken bond,” says Katie. Barb, now 45, says she never second-guessed her decision to be a surrogate: “No regrets at all. I would probably do it again if I was younger.” Katie says the whole experience was magical. “Finally, our family feels complete.”
Parents and surrogates should have an exhaustive legal agreement prepared by a lawyer to outline the obligations of all parties. It should cover health requirements, such as regular medical appointments the surrogate must attend, as well as serious custody scenarios, including the death of the intended parents before the birth. Most fertility clinics in Canada won’t proceed without such a contract.
Legal roadblocks: how hazy laws make surrogacy tougher in Canada
In Canada, it’s illegal to pay a surrogate, to accept a fee for arranging a surrogacy or to buy eggs, sperm or embryos. Penalties range from a maximum fine of $500,000 to 10 years in jail or both.
It’s legal to reimburse surrogates in Canada for their expenses, such as maternity clothes and the cost of medications, yet the guidelines as to what qualifies as a legitimate expense are not clearly defined.
Who actually enforces the rules around surrogacy is currently in limbo. In 2010, the Supreme Court of Canada ruled that surrogacy guidelines should fall under provincial jurisdiction, but provinces have yet to step in. Then, in March 2012, Ottawa closed the agency that was supposed to enforce the law and regulate the fertility industry. This means doctors have been left to regulate themselves.
Average costs for surrogacy
In vitro fertilization cycle: $10,000 to $20,000
Medical evaluations: $800 to $2,000
Psychological exams: $500 to $1,000
Legal fees: $3,000+