For the 10 to 20% of pregnancies that end in miscarriage, the loss is compounded when there are more people involved in the journey toward becoming parents. And when assisted reproductive technology is part of that journey, there may be an increased risk of early miscarriage. When a gestational carrier experiences pregnancy loss, it’s a devastating period of time for both the surrogate and the intended parents. This can make the web of grief and coping with the loss even more complex for all parties.
Lynetta Cuomo, a surrogate with the agency SurrogateFirst, had three of her own pregnancies that resulted in live births, including one with twins, and nothing went wrong. It wasn’t until she became a surrogate that she experienced a pregnancy loss. Her original desire to become a gestational carrier came out of a desire to support a person she knew who was dealing with infertility; she wanted to be able to do something to help people like that achieve their dream of having their own family.
After signing up with the surrogacy agency and going through the process to get medically cleared, Cuomo got matched with a pair of intended parents, a heterosexual couple who had been together for 20 years and had been trying to have children for 10 of those years. Cuomo underwent a successful embryo transfer and found out she was pregnant. But once the six-week mark rolled around, she began bleeding and had a bad feeling about the outcome of the pregnancy. She let the parents know that she was going to see her doctor, who confirmed that the pregnancy was lost.
“It is hard to explain how it feels because I know it’s not my baby, and I never thought of it as my own, but it was still something my body went through. Mentally, I felt like I had failed them,” Cuomo says. She had to process the loss herself and in a different way than the intended parents, who still graciously sent her flowers and noted that they wanted to try again for another pregnancy with her.
Soon after, the family decided to initiate another embryo transfer with the last embryo they had frozen. It was successful, and Cuomo was pregnant again. However, right around six weeks gestation, she had a healthy ultrasound at her local doctor and then started bleeding again within days. The intended parents met Cuomo at their local fertility clinic, and by then, there was no longer a heartbeat.
By this second loss, the intended parents were beside themselves. This was their last banked embryo, and they needed even more space and time to process what they would do next to build their family. Even though she knew it wasn’t the truth, Cuomo felt “a hundred percent at fault,” she shares. The next step for both parties was moving forward: The couple ended up splitting off from Cuomo so they could figure out their fertility plans.
Just a few months later, Cuomo got matched with a second family, a queer couple who was living outside the U.S. It was difficult to shake off the fear and the intense will to see the finish line of this surrogacy journey. This pregnancy was not without its scares: Around 12 weeks, Cuomo found out she had a subchorionic hematoma, a blood clot that forms in between the outer layer of the amniotic sac and the uterine wall and can be common with IVF pregnancies. She experienced heavy bleeding, but went to the doctor’s office and still heard a heartbeat. A huge bleed-out happened again about a month later, a message she had to relay to the intended parents (who were across an ocean and often used online translators to communicate with her). They were scared but supportive from afar, and Cuomo shared with them that there was still a heartbeat, fluttering away.
She ended up with other pregnancy complications, including placenta previa that put her on bed rest for eight weeks, and then gestational diabetes. After her two surrogate pregnancy losses and two near-losses in the second surrogate journey, Cuomo delivered a healthy eight-pound baby boy in June 2023, a month before her due date. “I’ve had my own kids, and I love them, but watching you give that to someone else is a different high. It’s a different family’s happiness that wouldn’t have happened if it wasn’t for you—it’s all love, but a different kind of love,” she says.
How to cope with miscarriage during a surrogacy journey
1. Recognize that every pregnancy is different.
Surrogacy pregnancies, especially if the conception is via IVF, can be completely different than giving birth to your own children. “Even though your prior pregnancies went amazing, your surrogacy pregnancy could have issues—for example, I never had an issue with my own pregnancies, but was almost in my trimester and had diabetes with the surrogate pregnancy,” Cuomo says. This was a new experience for her, but she had no choice but to monitor her nutrition to keep her blood sugar numbers low for the sake of the pregnancy.
It’s also important to remember that even when a complication happens during a pregnancy or a pregnancy loss occurs, it is not the gestational carrier’s fault. “With surrogacy there is so much testing that goes into the process that sometimes we have to remember that loss happens for more reasons than someone’s body is unable to carry a pregnancy,” explains Arden Cartrette, a certified birth and bereavement doula and founder of The Miscarriage Doula. So much is out of your control in the process, so it is understandable to have heightened anxiety, whether you’ve experienced pregnancy loss or not.
2. Hold space for all experiences of loss.
Pregnancy loss involving surrogacy is not something that we talk about enough. If you are going through this grieving process or know someone who is in this situation, understand the multifactorial grief experience. “For the surrogate, they feel a lot of the emotions that any pregnant person would feel with the added trauma of the physical element of loss, too. There is often an additional blame or feeling of shame,” says Cartrette.
Biological parents might experience a physical disconnect but a major emotional loss of their child. “With surrogacy, there's also added elements of doctors appointments, money spent, time, so the loss is more than the physical loss for the parents,” Cartrette adds. Seeking support from a bereavement doula is always an option for all people involved in the pregnancy—a doula can give the same level of care to a gestational carrier any other pregnant parent would receive, according to Cartrette.
3. Lean on your support system.
Besides working with a doula whether or not you experience loss, any assisted reproductive journey requires a strong personal support system. Cuomo was lucky to have the support of her partner during her surrogacy journeys, and shares that her case worker and advocate at the surrogacy agency was amazing throughout the process of her pregnancies and pregnancy losses. “They genuinely check in on you and give you advice. I called her so many times, and she was a huge help,” says Cuomo.
4. Communicate how you’d each like to be supported.
Everyone experiences pregnancy loss differently, so each partner or individual involved might have different feelings, trauma, triggers, and different needs, Cartrette says. There are additional layers when it comes to a surrogate. “It's important for the carrier to identify what this loss means to them and how they feel about it as the person who was pregnant but also process the emotions that they may feel for the person(s) that they were carrying the pregnancy for,” says Cartrette.
To work through surrogacy pregnancy loss with both the surrogate and intended parent or parents, each person should ask the other a simple question of what they can do to help, advises Cartrette. Sometimes the intended parents might have questions and might invite the gestational carrier to share what they’re going through physically, and vice versa with the parents sharing more about their emotional loss. This can help both parties stay connected and supportive of one another during this difficult period. Other times, people might need more space to grieve privately, and that’s okay too.
Mara Santilli is a journalist reporting on health and wellness and how social and political systems influence the well-being of certain groups, including but not limited to Black and brown communities, women, and the LGBTQ+ community. Her editorial work has appeared in publications such as Shape, Marie Claire, Cosmopolitan, Women’s Health, InStyle, Glamour, and more. Outside of reading and writing, she enjoys traveling (especially to Italy), singing, dancing, musical theatre, and playing guitar and piano.