‘Making it up as we go’: Midwives’ perceptions of preparedness and role clarity in surrogacy birth care

BACKGROUND: Surrogacy poses unique clinical, psychosocial, and organisational challenges. Midwives, often with limited experience, education, and guidance, may feel uncertain about providing appropriate care, potentially affecting the quality of care and experiences of surrogates, intended parents, and newborns. OBJECTIVE: This study explored how midwives navigate surrogacy birth care, with a focus on role clarity, involvement of intended parents, and preparedness across the intrapartum and postnatal continuum. METHOD: An interpretative phenomenological design was adopted. Five midwives with experience in surrogacy births were recruited through professional networks and the Australian College of Midwives newsletter. In-depth interviews were conducted and analysed using reflexive thematic analysis. FINDINGS: Four interrelated themes were identified. Navigating uncertainty without guidance described midwives' reliance on personal judgement in the absence of surrogacy-specific policies. Balancing multiple parents in the birthing space highlighted tensions when surrogates, their partners, and intended parents all sought presence and recognition during labour and birth. Carrying the emotional labour of ethical tensions captured the moral strain midwives experienced when negotiating competing rights and expectations. Finally, gaps in education and professional development reflected participants' limited preparation for surrogacy care, compounded by the rarity of such cases. CONCLUSION: This study highlights how midwives navigate surrogacy birth care without clear guidance, relying on personal judgement while balancing expectations of surrogates and intended parents. Their experiences reveal uncertainty, ethical strain, and limited preparedness, underscoring the need for surrogacy-specific education and organisational guidance to support equitable, inclusive, and women-centred care.