Labor of Love: CU Nursing Celebrates Nurse Midwifery Week

“I love being pregnant. When I say that to most women, they look at me as if I’m crazy,” said expectant mother Abby Zamora. For Zamora who is on her fifth pregnancy, having babies is the “most wonderful experience.” And that’s why she decided to become a surrogate. “I wanted to do this for another family,” said Zamora. When she broached the subject with her husband, he asked her why. She said, “When we’re done with having our family, I want to make sure that another couple is as exhausted, overwhelmed, underappreciated, irritable, but yet wonderfully overjoyed, excited, rewarded, loved and complete as parenthood makes us.” It was a big decision. “In the beginning, my husband was not as on board with it as I was. A lot of that was because of a lack of information and misinformation. He needed to know how it works.” Zamora and her husband selected a surrogacy agency that walked them through the process and provided answers to their questions.

Questions to Ask Yourself

“You must ask yourself many heavy questions – the number one being are you finished having a family?” Because the process can leave the surrogate infertile and unable to have children in the future, “You really need to know that you are done growing your family,” said Zamora. Surrogacy is not impregnation and adoption. It is something very different. It requires In Vitro Fertilization (IVF) and in Zamora’s case embryo transplantation – risky procedures that carry a higher probability of hysterectomy, infertility, and the embryo splitting. A traditional surrogate uses her own embryos. As a gestational surrogate, embryos were donated, retrieved and implanted, and IVF was used to inseminate them. “People are under the impression that as a gestational surrogate it’s the mother’s embryos and her baby. In actuality, you’re a vessel and you are giving over your body for 10 months to grow someone else’s child,” said Zamora.

Questions and answers surrogates must come to terms with are – if the embryo splits are you prepared to carry multiple fetuses to term or to reduce the number to improve survival for the baby and carrier? Other questions: Can you separate yourself from the fetus you are carrying – knowing that it is not your child, but someone else’s? Will you be able to give the baby up once born? Will you terminate the pregnancy if the baby has a congenital defect and the family wants to terminate? How will you explain the pregnancy to your children? One question stood out for Zamora – “How am I going to feel when the baby doesn’t come home with me?” She needed to know that answer before proceeding.

Zamora said, “I knew I could do it knowing the baby was not genetically mine. The father used an embryo donor, so I was literally the oven – that helps.”

Matching with a Family is Like Online Dating

Zamora described the initial process to match her with potential parents as, “Kind of like online dating.” With a lot of sharing of surrogate and parent profiles and Zoom chats to get to know each other, “You have to be on the same page as the parents.” According to Zamora, the agency was amazing. You have to agree to everything upfront or be willing to walk away. Setting expectations is essential. Lawyers get involved, which gets tricky. “They are there to protect both sides,” she said. Sometimes there are things that the family or lawyer requires that make the situation potentially untenable. For Zamora, the one contentious requirement that needed to be ironed out before moving forward was the use of a traditional obstetrician over midwives for her care. “I put my foot down. If I can’t see my midwives I’m done,” she said. The lawyer was unwavering. It had to be an OB. “I’ve had four babies with these midwives. I asked them, ‘You’re going to make me go to a doctor I’ve never been to before?’” In order to overcome the family’s lawyer’s reticence, Zamora suggested one of the UC Health OBs attend a prenatal appointment. “That did the trick and seemed to satisfy the lawyer,” said Zamora. In the end, it came down to the family trusting her and her choice of midwife for care, labor, and delivery.

Surrogacy and Midwifery Share Similar Stigmas

Like surrogacy, the choice of midwifery is very personal. It is also something that is shrouded in a bit of mystery, which means becoming educated about the experience. “I’ve seen it before. My husband wasn’t very supportive of midwifery at first. But then we experienced it with our first, and we’ve had great births ever since,” recalled Zamora. People tend to think it is all-natural, with no doctors, no hospitals, and no drugs. “I think he thought I was going to give birth on the living room floor. His perception was that if it wasn’t a doctor, then it was some sort of medieval practice. He ended up trusting me and my decision,” she said. After they went through it with their first child, he agreed that it was the best experience for the family.

“The midwives are there to help you however you need, which can include epidurals and pain meds. And an OB is on call if necessary,” said Associate Professor Jessica Anderson, DNP, CNM, the director of Midwifery Services at the University of Colorado College of Nursing and one of the midwives Zamora sees. With the UCHealth Center for Midwifery, who are part of the UCHealth University of Colorado Hospital and the University of Colorado College of Nursing, patients give birth at the Hospital on the Anschutz Medical Campus. “All of my children have been born there. I wouldn’t use anyone else,” said Zamora. Studies show the benefits of midwifery care include fewer instances of complications, reduced use of anesthesia, and higher rates of breastfeeding.

For Zamora, her surrogate family trusted her and her instincts. “You are on a journey with the family. After all, you’re carrying their child,” said Zamora. So weekly belly bump pictures and Zoom ultrasounds as they happen are part of the process. It’s a lot of communicating.

Her fourth delivery was without complications and delivered with the assistance of a water birth. “I labored in the tub with my other births, but I found it too difficult to get traction, or I got too hot. So I would get out of the tub before the births. This time, it worked like a charm,” she recalled.

Each Birth is Different

All of Zamora’s births have been unique. Her first was a breeze, and she had little to no pain. Because her first was so easy, she wanted to feel some pain for the second one because she wanted to know where the baby was in the process of labor and delivery. “Be careful what you wish for. The pain was very intense. After 46 hours of labor, I ended up having an epidural as the pain just got the best of me and I was exhausted,” said Zamora. Then the third was better again. And the fourth, another great experience.

Could She Let Go?

With the birth of her first surrogate son (and her fourth pregnancy), Zamora was able to answer the question she had posed at the beginning of the journey – would she be able to let him go? And yes, she could. “I never felt like I had lost him. He was never mine to lose,” she said.

Because the first surrogacy went so smoothly, her husband and family were okay with her doing it again. So, Zamora decided on a fifth. The two “surrobabies” (as Zamora calls the surrogate children) will be 25 months apart. Her fifth required that she travel to California in June for the embryo transfer. “That was a bit unsettling given that I was traveling during the pandemic,” said Zamora. Once she returned, she gave herself daily intramuscular injections with the support and help of her children.

“My kids were amazing with both surrogacies. I explained that we were doing this for another family and that the baby was not their brother or sister,” said Zamora. “They took it in stride.” Others did not. Zamora and her family lost friends after announcing their first surrogacy. “They couldn’t comprehend why I was doing it and what I was doing to my body,” she said. There is stigma involved in being a surrogate. “The second most asked question after they find out I’m a surrogate is ‘how much are you getting paid?’” said Zamora. “I think I get an average of $3 an hour. Believe me, you don’t do it for the money,” she said. “You do it for the love.” Because there are strict financial requirements to be a surrogate, it can’t be your main source of income, and you can’t be on government assistance.

Now the Zamoras know what to expect for this second surrogacy. And all are on board for another amazing journey.