Sunday, March 30, 2014

More on the realities of surrogacy in India

Part of this post is prompted by the the commenter in the previous post; her first comment was rather judgmental, but allowable. The second one was fairly rabid in tone, and talking about how a blood pressure value of 150/90 is not preeclampsia (no, of course it is not), and how the situation could have been managed while not uprooting J from her home environment, and finally ending with a rant on the utter uselessness of vitamin D, and how I was inflicting this utterly pointless thing on her.

Now, since I am slowly starting to attract the trolls, here are some ground rules for this blog: comments of that tone, with such a content will just be deleted, and you will never be allowed to comment again. You can say whatever you want anywhere else on the internet, and if you can find somebody to listen to you, good for you, but here, you get no talktime. You are, of course, welcome to spend a long, long time composing a new vitriolic comment. I will then delete it as soon as I spot it, and you would have wasted all that time. If the situation ever gets truly annoying, I will turn on comment moderation to save myself a headache, and then nobody can ever see your words of wisdom  for even a short while.

But overall, this annoying episode, and Katrina's very thoughtful comment highlighted that it would be useful to talk a little bit more about this situation.

I can't even begin to sum up what a minefield surrogacy in India is. All the doctors involved have expressed upon me a 1000 times that these surrogates are not like surrogates in the west, and how they should be handled differently. How they should be handled is the billion dollar question, and trying to come up with the most optimal way to do it is a very complex topic. I think I'll spend a good part of my book trying to thrash it all out, and atleast outline how some of the current practices should change, and how that change is sometimes stifled by various issues.

First, about medication compliance: from the start, her bloodwork has not tallied with the doses she said she was taking. I didn't want to not believe her, but if two sachets of 60,000 IU have not increased your blood levels at all, then something is off. She could be absorbing it very poorly, or she could be lying, or she could have been throwing up what she took. None of these possibilities could be dismissed, and to this day, I do not know what to believe. After I kicked up a fuss after the first few months, the Vitamin D she was taking started to be reflected in her blood levels. I have not checked in several months, and this drop has shocked the crap out of me. Again, cannot tell what the issue is, whether it is lying, poor absorption, vomiting after the dose, or very much increased needs.

Also, surrogates in India would have a very different take on say, prenatal vitamins and nutrition than a surrogate in the west. Such a person would be self-informed, and would understand what was going on. Because surrogates in India are mostly uneducated, they may not also take these things seriously. Also, nobody bothers explaining anything to them. They just say "here, take this pill or this injection." I've spent a lot of time just talking to J explaining what each thing does, and it is my duty to convey that information, even if she pays me no attention or does not understand. I've also tried to give her similar health advice about her own kids. Completely goes over her head, and if she ever takes my advice, I'd be shocked. Still, I cannot help myself. 

Here is some background on the housing situation. J lives in a sort of housing called a chawl. Her bathroom is outside her apartment, which means she has to get up in the middle of night and leave her house to go use the facilities, which is insanely difficult when your pregnancy progresses to this point. It is also getting hot here, and sometimes, without air conditioning in the noonday sun, you feel like you would get heatstroke. Imagine dealing with this when you are nearly 9 months along. Keeping all this in mind and how exhausted she is, I offered her the only comfortable option I could offer: hospitalization. She wanted to get admitted to the hospital after April 2nd, because she was also feeling run down/exhausted. When she showed up with a steadily increasing BP on March 26th, it was the OB's decision to hospitalize her, and I was definitely on board with that because I am really afraid about the medical facilities she has access to right next to her house (an extremely poor neighborhood), where her care would be coordinated by the handler. 

If you went with other agencies, you could have more options. Many surrogate agencies/doctors offer housing/more hands-on care. People can move in in the start, or in the last few weeks in case of a special situation (such as this one). My RE offers nothing other than the handler to manage the whole shebang. Dr Patel at the Akansha Clinic in Gujarat offers a home of sorts, where surrogates live for 9 months. The Mumbai-based agency Surrogacy India (SI)  has a few apartments where surrogates can be housed, and there is a nursing home in the same building, with an ambulance on the premises. While these options offer many benefits, what I do not like about these situations is that the surrogate is separated from her family. While there many be some advantages in separating her from her husband in some (e.g., if the husband becomes positive for an STD, or is deadbeat spouse (very much common in this socio-economic group), I would definitely feel a great deal of guilt if I separated her from her children for this really long period.  If I ever do this again, I'd want a situation where the surrogate could move in with her kids, and I'd be more than willing to spend the extra money to make this happen.

An alternate, viable option is to have your surrogate live at home with the family  (close to the agency's housing), and, if there is any sort of emergency that requires separation from her husband (SI told me the story of a husband who became positive for syphilis during the pregnancy) or for greater medical supervision, move into the agency's housing for maybe the last few weeks.In that way, she would be much closer to her family and see them on a daily basis, etc.  However, in my unique situation, I have no options other than the hospital.

Anyway, I just spoke to J. Apparently, she received IV antibiotics for an infection last night. I have no idea what is going on; going to go to the hospital to try to figure things out.


  1. Good luck, hope the antibiotics are not for anything serious.

    Good for you deleting her second comment. I also am very interested in reading your book!

  2. I think you have been wonderful and supportive to J in all this. The commenter must not have read much of this blog to think otherwise. I hope everything is ok with J and that these last few weeks fly by. :-)

  3. I haven't followed the Vitamin D issue but I know in my case, I was prescribed 50k iu per week and they told me they wouldn't even think about rechecking my levels until at least a year. Apparently it's very difficult to raise those levels.

  4. Very interesting read...I would also read your book.

    Hope all is ok with J & your babe & the infection isn't serious.