AUSTIN, Texas -- An Austin nurse spread gel on Nicole Benham's pregnant belly and slowly moved a sonogram wand over it, describing the images on nearby monitors. This scene, in which parents get their first glimpse of baby, is played out many times a day in medical offices across America, but this plot has a twist.
Benham is carrying twins, but they are not her babies. They belong to Sheila and Kevin McWilliams, a New Jersey couple who lost their firstborn and can't have another child together. They provided the eggs and sperm, and they will bear all costs, which average $75,000 to $100,000 and include fees to the surrogate, the matchmaking surrogacy company and lawyers for both parties, experts said.
Despite such costs, U.S. surrogate births have jumped 250 percent in eight years, and experts expect them to continue rising because of advances in reproductive technology, increasing numbers of same-sex marriages and growing acceptance of surrogacy.
In the vast majority of surrogate births today, the intended parents provide the egg and sperm, minimizing the risk of custody battles. Data suggest that there are fewer multiple births, and, perhaps surprisingly, more surrogates bearing babies for others more than once.
Conservative Texas is more surrogate-friendly than many other states, especially when the intended parents are a married man and woman. Though the state's law doesn't outright forbid surrogacy for gay couples, it allows only one partner's name on the birth certificate. The unnamed partner can face a long adoption process, but that hasn't stopped some gay men from seeking surrogates here, surrogacy company representatives said.
For the McWilliamses, Texas was an easy choice over New Jersey, where the surrogacy climate is more fraught. They flew to Austin in May so they could be at Dr. Byron Darby's office for Benham's sonogram. They wanted to see how the twins are developing and learn their genders.
"It's a second and a third chance," Sheila McWilliams, 41, told the Austin American-Statesman (http://bit.ly/1nVad9R) with a nod to the twins. "I'm so blessed."
As Benham, 35, lay back occasionally glancing at a facing monitor, the couple was transfixed by the views nurse Nancy Kirks showed of the twins' anatomy. A tiny foot here, a perfectly formed hand there.
"Aw, I can see the knuckles," Sheila McWilliams said. Her eyes filled up when Kirks announced the first twin is a boy. She was thinking of Cameron, the son she lost, Sheila McWilliams said. Kirks later identified the other baby as a girl.
It's a perfect scenario for the McWilliamses, said Sheila, who had an emergency hysterectomy in 2007 after Cameron was born. He died in 2011 of a heart condition.
Called a gestational carrier or gestational surrogate because neither baby comes from her own eggs, Benham is among hundreds of American women who carry babies for family, friends and strangers each year. Although surrogacy accounts for less than 1 percent of all U.S. births, annual births by gestational surrogates climbed more than 2½-fold between 2004 and 2012, to 1,898 babies, according to the Society for Assisted Reproductive Technology.
Even so, surrogacy remains controversial. State laws vary widely, with such liberal locales as New York and the District of Columbia banning it outright. The Catholic Church also forbids it, along with in vitro fertilization, the process in which the egg and sperm are combined in a lab before being transferred to the carrier.
"It removes procreation from that intimate act of love . and puts it in the realm of science and medicine," said Marie Cehovin, director of the Office of Pro-life Activities and Chaste Living for the Catholic Diocese of Austin. "The whole idea of creating life in a petri dish is horrendous to us."
The church also opposes the destruction of embryos and terminating the fetus, which could happen, for example, if a different gender is preferred, she said.
Some critics call surrogacy "womb renting" and exploitative to women. It isn't regulated nationally, nor do many states that allow it, including Texas, oversee businesses that match surrogates to intended parents. Anyone can act as a surrogacy company, experts said.
"I think it's somewhat dangerous not to have regulation," said Gayle East, owner and director of Waco-based Surrogate Solutions.
East, 39, has been a surrogate three times since having her own two children. Two attempts failed, but, in the one that worked out, she gave birth to twins, now 5 and living in France with their parents. "That's the most amazing thing I've ever done in my life," East said.
She remains close to that family and visits them. The only problem she experienced was high blood pressure, which still requires medication, East said.
Nearly a third of the carriers with her company have been surrogates more than once, she said. One worker at Surrogate Solutions had two children of her own before carrying seven babies for five other couples.
The McWilliamses are the second couple for whom Benham is a surrogate. She sees surrogacy as giving back.
"I was adopted, and I always thought, 'I'd love to do something like that," said Benham, who lives with her husband, John, and their two children, ages 10 and 12, in Hutto.
She acted after hearing a sermon three years ago at her church, New Hope Christian, in Hutto. The preacher spoke about "finding your purpose in life," she said. Benham searched the Web that day and found The Surrogacy Experience in Red Bank, N.J. The company made a home visit, and soon Benham was matched with a couple.
The process was like a dating service in which both sides shared profiles, corresponded and ultimately met to see if they clicked, Benham said. The next steps included signing a "humongous" contract, Benham said, hiring lawyers and undergoing the embryo transfer.
Contracts, which experts called essential, are aimed at protecting both parties, including the carrier's health and the intended parents' right to take the baby home. Contracts generally state that the carrier can't drink or do illicit drugs. Some order that a specific diet be followed. Benham's contract forbids her from getting a chiropractic adjustment, she said. She also is not allowed to travel outside of Texas, mainly because she would be bound by another state's laws if anything happened, she said.
Neither Benham nor the McWilliamses, with whom she has become close, would state the precise fee Benham will receive. A surrogate's fee averages $20,000 to $30,000, and expenses can include transportation to doctors' appointments, lost wages and child care.
Some gestational carriers do it for the money, but surrogates interviewed for this article said that wasn't their motivation, and those involved with them agreed.
East said her company doesn't accept women on public assistance, who might be motivated solely by money.
Diane Hinson, a Maryland lawyer who founded and owns Creative Family Connections, said emphatically, "Our surrogates are doing this to change someone's life. They are amazing, wonderful women, and something's motivated them to give back. To them, their children are their most important thing in the world. They love being pregnant, but they're done with diapers."
Generally speaking, gestational surrogates also have completed their own families and have supportive spouses, said Judith Sperling-Newton, director of the American Academy of Assisted Reproductive Technology Attorneys. The only downside she sees is the cost, which can put surrogacy out of reach for lower-income people.
Guidelines by the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology recommend that carriers have at least one uncomplicated pregnancy before carrying for another couple. The guidelines also say that carriers should not have more than five previous deliveries or three prior cesarean sections.
As for the intended parents, the guidelines say surrogacy is indicated when a "true medical condition" would put the mother or fetus at great risk. East is seeing an increase in single women and men seeking surrogates. One intended parent working with East's company is a man in Italy, she said.
Sheila said she was comforted that Benham, who works as a medical assistant in Austin, had been a surrogate previously and is strong in her faith. Benham said her first surrogacy experience went so well that, three months later, she was ready to start the process again.
"When I was pregnant the first time and I felt her move, I thought, 'This is going to be so difficult,'" Benham said. "I was really worried about what it would be like at the hospital. (But) when the baby was born, I was so happy to see them together."
She didn't bond with the baby or experience sadness afterward, although a friend who was a surrogate became depressed, she said.
Benham's parents were worried about her health and feared her children would be confused, she said. "When I told them I was going to do it again, they said, 'OK, we'll support you no matter what you want to do,'" she said.
Each time, Benham said her husband was "super-excited." Like her, he thinks pregnant bellies are beautiful, she said.
Benham's United Healthcare policy doesn't cover surrogacy, so both sets of intended parents bought insurance to cover her care. Some United policies do cover surrogacy, spokeswoman Kim Whitaker said, adding that United doesn't ask women if they are surrogates. Nor does insure Aetna, spokeswoman Anjie Coplin said.
Several years ago, military wives were mentioned as frequent surrogates, but Hinson said she didn't see that trend. Tricare, the insurance carrier for active military members and their dependents, "has made it very clear" in the last few years that it doesn't intend to use taxpayer money for surrogate births, she said.
The McWilliamses bought coverage for Benham, and the couples are in constant contact.
"Nicole is like mother earth. She has that calmness," Sheila McWilliams said. They met when Benham went to New Jersey for the embryo transfer in February. Two were used in the hope one would work. Both did, to Sheila McWilliams' surprise.
"I am so thrilled it happened on the first try," said Sheila McWilliams, a freelance court reporter. Kevin McWilliams, 46, is a house painter and restaurant manager.
Although surrogacy is allowed in New Jersey, experts said the state's climate is daunting. New Jersey was home to the famous Baby M case in the 1980s, in which the surrogate used her egg and the intended father's sperm. At the birth, she had a change of heart, fought for custody and ended up with liberal visitation rights.
That case, along with a lack of understanding about how modern surrogacy works, is one reason it remains controversial, said Hinson, the Maryland lawyer whose firm provides surrogate matching and legal services.
A lot of people think that the carrier is using her own eggs and has a biological bond to the child. While that is true for what are called "traditional surrogates," in vitro fertilization has changed the landscape.
"Surrogacy is complex, but the fact that technology came along that allowed that separation made it all a lot simpler," Hinson said.
She is seeing "a surrogacy explosion — at least a mini-explosion," she said. "I think we'll see an exponential increase" in the future.
Hinson and other experts said more carriers are forbidding multiple embryos from being transferred at once.
Austin surrogacy lawyer Simi Denson, 36, said she broke her own rule in March 2013 to limit an embryo transfer to one, and not more than two while acting as a surrogate. Taking medical advice that three embryos were needed to ensure "any chance of a pregnancy," she was surprised when all three bore fruit.
Denson, a married mother of two who became interested in being a surrogate around the same time she began her surrogacy law practice, had told the couple that if all three embryos "took" she wouldn't terminate any; the couple agreed, she said.
Denson didn't get to have a midwife-attended birth, like she had with the first couple for whom she carried a baby at age 31. Carrying more than one baby is often more complicated, and the risk of premature birth is higher.
At 28 weeks, Denson moved in with the intended parents in Houston and had the babies by C-section at 33 weeks, about seven weeks early, she said. Her family visited on the weekends.
Her mother worried about her health, she said. In her first surrogacy, she had miscarried one of the two embryos transferred.
"It was a huge loss for both of us," Denson said, adding that she remains close to the couple. "Very difficult."
In her second surrogacy, she had a miscarriage with the couple for whom she later bore triplets.
All of Denson's surrogate pregnancies were covered by her Blue Cross Blue Shield of Texas policy, she said. It was never about her fee, Denson said. "I love being pregnant," she said. "You can't compensate people enough for something they hate doing."
Denson remains close to the parents of the triplets and visited them earlier this month. "There's no other gift you can give like that," she said.
She represents about 80 to 100 surrogate arrangements per year across the state, she said.
Hinson, the Maryland lawyer, said, "Gestational carriers bond with the parents, not the child. I have surrogates who tell me when they met with the parents, 'I'm just living for that moment when the parents hold that baby for the first time.'"
Benham said that's what fuels her. She is due Nov. 10, and the McWilliamses will be in the delivery room with her.
"We are so excited," Sheila McWilliams said. "It's such a fresh start."
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Information from: Austin American-Statesman, http://bit.ly/1h43OZN
Editor's note: This is an AP Member Exchange shared by the Austin American-Statesman.
