Bleeding during Pregnancy with a Gestational Carrier
Bleeding in pregnancy with a gestational carrier is common! In 22 of the recent (and some are still ongoing) pregnancies with gestational carriers through Forward Fertility, we’ve had 8 matches experience bleeding during the pregnancy (36% or 1 in 3). Of those eight matches with bleeding, 25% (two matches), unfortunately, lost the pregnancy.
This is a stressful and unwanted outcome of such a planned and wanted pregnancy. The complexities of bleeding in pregnancy with a gestational carrier can add layers of emotional, logistical, and financial stress. Talking about this up front among the surrogate, parents, IVF clinic, agency, and ob/gyn is a critical step in being prepared, should this happen to you.
What causes Bleeding during Pregnancy?
Blood Clotting & Pregnancy: The body is more readily able to form blood clots during pregnancy. The embryo, as it implants into the uterine lining, begins work to build the placenta. The placenta is an organ entirely made up of blood vessels and is the communication organ between the fetus and the gestational carrier. Given the blood, building of vessels to transport the blood, and the pregnant body’s tendency towards clotting, this can set up a situation for bleeding & clotting to occur — hence the SCH (subchorionic hematoma).
Auto-Immune Theories: This is not specific to surrogates, so I won’t spend much time here, but in women who have auto-immune disorders, they may create antibodies that create a difficult environment for a pregnancy to develop. In part, the auto-immune role in pregnancy is not well understood for women going through IVF, so bringing it into the world of surrogacy has not yet happened. As we learn more about auto-immune factors and how they impact pregnancy, it’s possible auto-immune screening could become a standard part of the gestational carrier work up.
IVF Pregnancies: Theories about poor embryo quality, procedures done to the uterine cavity prior to embryo transfer, and even the hormone levels created to achieve the pregnancy are thought to possible contribute to the higher rates of SCH in IVF pregnancies.
Learn more about bleeding in pregnancy from experts at ACOG here.
Logistics: What should we expect?
Symptoms. Most commonly, the surrogate will notice some brown, pink, red blood. They may notice clots and also have cramping. When an ultrasound is done, there will often be a Subchorionic Hematoma (SCH). This is a pocket of blood that has accumulated between the chorionic sac (where the fetus is growing) and the uterine wall. Occasionally, a SCH can be found on ultrasound and the pregnant person will not have any bleeding at all. The pocket of bleeding is either 1) resorbed into the body or 2) the blood, and possibly clots, will pass.
Timing. Most commonly, this bleeding will happen between 6-11 weeks (from the last period). Rarely, bleeding continues into the second trimester. Once bleeding starts, it will typically resolve after a few weeks, but could go on for the remainder of the pregnancy.
Extra Monitoring. Some IVF clinics or ob/gyns may suggest doing some serial ultrasounds to confirm the fetus is growing and to monitor the size of the SCH. Many surrogates/parents may not agree on plans surrounding extra monitoring. Since the monitoring will not change the outcome of the SCH and the pregnancy, the added appointments can actually add stress to the pregnancy, in addition to the time away from work/family to attend the appointments.
There is no treatment. If someone is bleeding during pregnancy, there is no treatment available. Advice not to lift heavy items, to reduce physical activity, or avoid sex may be suggested. Doing things that keep your emotional state strong during this time are important. Surrogates and parents who (understandably) perseverate on the bleeding will endure mental anguish that is, most likely, not making the situation better.
Emotions: Many! And, they may morph along the way. Learn more here….
Fear – am I ever going to be a parent? Will I be ok – how much bleeding is too much?
Worry – Did I walk too much yesterday? Is this because we had sex last night? Am I going to disappoint the parents? Did I do something wrong, if so, what was it and how will I know?
Doubt – Maybe my body can’t do this. Maybe I’m not meant to be a parent. Why should I try again?
Anger – Why do these things happen to me? Did we make the wrong choice (in being a surrogate or choosing surrogacy)?
Sadness – I wish the parents I’m matched with didn’t have to go through this. I’ve spent so much time getting to this point, and now we might be back to square one.
Anxiety – Will I be ok? Will this pregnancy continue? Will the IVF clinic suggest we need a new gestational carrier? If I have a miscarriage, will the parents choose to work with me again? How will I get my kids to practice and what about my work meeting?
Envy – Why is this happening to me? I hate reading about other surrogate journeys that go smoothly.
Shame – I don’t want to let the parents know. Maybe this will go away if I ignore it. I deserve this. Others can do this, but I can’t. This always happens to me.
These feelings are normal! Your feelings give you clues about what you need to pay attention to — listen to your feelings and be curious about them. Try not to push them away — but let them have space and time – learning more about your feelings will help you come out of this experience better.
Navigating the Process: Be as prepared as you can be.
Have a plan before you’re in the situation. At Forward Fertility, we discuss at every match meeting that bleeding is likely to occur during the surrogate pregnancy.
Once we have a positive pregnancy test, we have a conversation among the group to discuss what the group wants to do if there’s spotting or bleeding. Do the parents want to know right away? Or, do they prefer the surrogate reach to the OB provider get a plan, and THEN contact the parents?
Know who you’re going to contact: Support person, agency, OB provider, IVF clinic, Parents to be?
Have supplies handy: Make sure you have some pads and tampons with you. There is something about being prepared for something means it’s less likely to happen.
“Step 1” to any situation is never to FREAK OUT. If you go to the bathroom and notice blood when you wipe or maybe you wake up with a lot of bleeding, try to remind yourself that this is common. This does not mean the pregnancy is lost. You have a team of people here to support you. Enact your plan!
Communication is the most important piece — ask questions, share information, share how you’re feeling. Bleeding during a pregnancy is difficult and when it happens with a gestational carrier, there are a lot of moving parts. Stay in touch with each other — the work you put in up front building a good team at the beginning of the match will help you navigate this tough situation.