While most surrogacy journeys involve carrying a single baby, there are times when surrogates may become pregnant with twins or more—either intentionally through the transfer of multiple embryos or spontaneously if an embryo splits. Carrying multiples is an incredible experience, but it does come with unique considerations and responsibilities.
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Understanding How Multiples Happen in Surrogacy
Multiples can occur in surrogacy for two main reasons:
Multiple Embryos Transferred: In some cases, fertility clinics may transfer more than one embryo to increase the chances of pregnancy—though this is becoming less common as single embryo transfer becomes the standard for safety of both the surrogate and the baby.
Embryo Splitting: Even when only one embryo is transferred, it’s possible (though rare) for it to split naturally and result in identical twins or more.
The decision to transfer multiple embryos is made carefully and should always involve conversations between the fertility clinic, the intended parents, and the surrogate. Your health and safety are top priorities in this decision.
Medical Considerations for Carrying Multiples
A twin (or higher-order) pregnancy is considered higher risk than a singleton pregnancy. That doesn’t mean something will go wrong, but it does mean closer monitoring and additional precautions will be necessary.
What to Expect:
More Frequent Appointments: You’ll likely have additional ultrasounds and prenatal visits to monitor the health of the babies and yourself.
Increased Physical Symptoms: Carrying more than one baby may lead to more intense pregnancy symptoms—like fatigue, nausea, back pain, and swelling.
Greater Risk of Complications: There’s a higher chance of conditions like gestational diabetes, preeclampsia, and preterm labor in multiple pregnancies.
Possibility of Early Delivery: Multiples are often born earlier than singletons, so your medical team will monitor for signs of preterm labor.
As a surrogate, it’s important to stay in close communication with your healthcare provider and follow all medical recommendations to ensure the best outcome for you and the babies.
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Emotional and Physical Preparation
Carrying multiples can be a more demanding experience both emotionally and physically. Preparing yourself mentally for the additional challenges can make a big difference.
Tips to Prepare:
Prioritize Rest: Listen to your body and rest when needed, especially as the pregnancy progresses.
Stay Hydrated and Nourished: Eat balanced meals and stay hydrated to support your health and the babies’ growth.
Lean on Support: Don’t hesitate to ask for help with household tasks, childcare, or errands. A strong support system is especially important in a multiples pregnancy.
Communicate Openly: Talk regularly with your surrogacy coordinator and the intended parents. They’ll want to know how you’re feeling and support you however they can.
Compensation for Carrying Multiples
Surrogacy compensation typically includes a multiples bonus—an additional payment if you are carrying twins or more. This bonus recognizes the increased demands and risks associated with a multiples pregnancy.
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What You Should Know:
The multiples fee is usually outlined in your surrogacy contract before the embryo transfer.
It is often added to your base compensation once a multiples pregnancy is confirmed via ultrasound.
Additional expenses, such as increased time off work, childcare, or medical needs, may also be covered depending on your agreement.
Delivery and Postpartum Recovery
Delivery for multiples often requires a more carefully planned birth. Many multiples are delivered via C-section, though vaginal births may be possible depending on the babies' positioning and gestational age.
Things to Keep in Mind:
You’ll work with your medical team and the intended parents to create a birth plan that prioritizes safety for all.
Postpartum recovery may be more physically demanding after carrying multiples—especially if a C-section is required—so plan for extra rest and support at home.
Emotionally, the experience of delivering two (or more!) babies for a family can be incredibly powerful and rewarding. Give yourself time and space to reflect and recover.
Final Thoughts: A Unique and Rewarding Journey
Carrying multiples as a surrogate is a remarkable experience that comes with both challenges and rewards. With the right preparation, support, and medical care, many surrogates have positive, healthy twin pregnancies and are proud to have helped their intended parents welcome not just one, but two beautiful babies into the world.
Check out our podcast with Surrogate Caitlin as she discusses her experience carrying twins!
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