A surrogacy journey has a lot of big, emotional milestones.
The match call.
Medical clearance.
Legal contracts.
Embryo transfer.
The first positive test.
The heartbeat ultrasound.
Delivery day.
But between those moments, there are hundreds of details happening behind the scenes. Travel has to be booked. Monitoring appointments have to be scheduled. Medications have to arrive on time. Escrow has to be set up correctly. Intended parents need updates. Surrogates need answers. Hospitals need paperwork. Birth plans need to be discussed before anyone is in labor.
That is where surrogacy case management matters.
In this episode of Carrying the Conversation, Kayla sits down with Liz, one of Reproductive Options’ case managers, to talk about what real support looks like after a surrogate is matched. Liz brings a unique perspective because she has been both a surrogate and a case manager. She completed four surrogacy journeys, carried five babies total, and has been working in surrogacy case management since 2015.
Her approach is shaped by experience, but also by something more personal: she knows what it feels like when support is missing.
From Surrogate to Case Manager
Before Liz ever became a case manager, she was a surrogate herself.
The seed was planted years earlier when she had a friend in college who was born without a uterus. As they learned more about alternative ways to build a family, including adoption and surrogacy, the idea stayed with Liz. At that time, she was not ready. She had become a mom young, was still in school, and was in a different season of life.
Later, when things felt more established, she knew it was time.
She became a surrogate, fell in love with the experience, and went on to complete three more journeys. In total, Liz carried five babies, including a set of twins. Looking back, she is honest about that too: she does not recommend twins, and she believes one embryo is the best idea.
That kind of honesty is part of what makes Liz such a strong voice in this field.
She is not speaking from theory. She has lived the medications, appointments, transfers, pregnancy, delivery, postpartum, relationships with intended parents, and the emotional pull that brings many surrogates back for another journey.
After her first surrogacy experience, Liz eventually stepped into surrogacy case management. She had originally worked as a teacher, but after moving and facing the process of relicensing, a professional connection encouraged her to apply for a coordinator role.
That opportunity led her into the field professionally.
Now, more than a decade later, Liz helps guide other surrogates and intended parents through the process.
Why Her First Surrogacy Journey Shaped Her Support Style
Liz’s first surrogacy journey was successful in the sense that it worked. She became pregnant, had a good clinic experience, and helped intended parents grow their family.
But the surrogacy agency support was not what it should have been.
She had to find her own monitoring clinic as a first-time surrogate, even though she did not really know what she was supposed to be asking for. She was asked to call the hospital about the intended parent bills. She was being handed tasks that should have been managed for her.
That experience stuck with her.
Instead of walking away from the field, Liz thought: I can help make this better for someone else.
That is one of the recurring themes in Reproductive Options’ team: many people come into this work because they either had an incredible experience they want to recreate for others, or they had a difficult experience they know could have been handled better.
For Liz, surrogacy case management became a way to make sure other surrogates did not feel alone, confused, or responsible for things that should have been handled by their agency.
What a Surrogacy Case Manager Actually Does
Liz describes her role as handling everything from the time a surrogate is matched until about a month postpartum.
That includes a lot.
Once a surrogate is matched, Liz helps make sure the details are moving. She works with escrow, fertility clinics, psychological evaluations, medical screening, partner screening when needed, travel arrangements, local monitoring appointments, transfer coordination, medication orders, pregnancy communication, delivery planning, and postpartum support.
In other words, her hand is in almost every part of the surrogacy journey.
The goal is not for the surrogate to wonder what she is supposed to do next. The goal is for someone to already be thinking ahead.
A surrogate should not have to spend her day calling around trying to figure out which monitoring clinic can do the right type of ultrasound. Intended parents should not have to wonder whether they are missing an update. Everyone should know where things stand, what comes next, and who to contact when something changes.
Surrogacy already comes with enough emotional weight.
Good surrogacy case management should reduce stress, not add to it.
Proactive Support Matters for Surrogates
One of the most important messages from this episode is that support should be proactive.
There is a big difference between a surrogate case manager who reacts only when something goes wrong and a case manager who is looking ahead to prevent confusion before it happens.
Surrogates are encouraged to research and understand the general process before they begin. That education matters. But they should not feel like they have to know every next step on their own.
As Kayla explains in the surrogacy podcast episode, a surrogate can understand the process overall without carrying anxiety about what comes tomorrow or next week. The case manager is there to guide the journey step by step.
That kind of support also matters for intended parents.
Unless intended parents need to review legal contracts with their attorney or speak directly with their doctor, many of the logistical pieces should be managed for them. The surrogacy agency should be helping everyone stay on track, keeping communication open, and making sure details do not fall through the cracks.
That is the difference between being technically “managed” and being truly supported.
Why Caseload Size Affects Surrogacy Care
Kayla and Liz also talk about something that does not always get discussed openly: surrogate case manager caseloads.
When a surrogate case manager is responsible for too many journeys at once, it becomes much harder to build real relationships, anticipate needs, and stay proactive. A person may be able to respond to emails or check boxes, but that is not the same as deeply knowing each case.
At Reproductive Options, the goal is to keep surrogacy caseloads at a level where case managers can actually support people well.
That matters because surrogacy is not a standard transaction. Every journey has its own personalities, preferences, challenges, medical updates, relationship dynamics, and emotional moments.
A strong case manager knows the surrogate.
She knows the intended parents.
She knows the clinic.
She knows the history.
She knows where things may need extra care.
That kind of support is difficult to provide when someone is overloaded.
One Point of Contact for Both Sides During Surrogacy
Another important part of Liz’s role is that she supports both the surrogate and the intended parents.
Some surrogacy agencies separate case management into two roles: one case manager for the surrogate and one for the intended parents. That structure may work for some business models, but Liz and Kayla both explain why they prefer one shared case manager.
When communication has to pass through multiple people, things can get delayed or lost.
For example, if a surrogate’s appointment time changes, a shared case manager can quickly tell the intended parents. But if there are separate coordinators, the surrogate tells her case manager, that case manager tells the intended parent case manager, and then that person tells the parents. If anyone is busy, unavailable, or delayed, the parents may miss an appointment update or feel left out.
One point of contact helps create consistency.
It also allows the surrogacy case manager to understand both sides of the relationship. If something goes wrong or a sensitive conversation needs to happen, the case manager knows how each person may respond and can approach the situation with care.
That relationship-building is a huge part of the work.
Birth Planning Should Not Be an Afterthought in Surrogacy
One of the strongest parts of Liz’s episode is the conversation about birth planning.
A lot of surrogacy agencies provide heavy support at the beginning of the journey. They help with matching, medical screening, travel, monitoring, transfer, and early pregnancy. But once the surrogate is pregnant, support may fade.
That can leave surrogates and intended parents feeling unprepared when delivery approaches.
Birth planning is not just about having a legal pre-birth order in place, although that is incredibly important. It is also about making sure everyone has talked through the real-life details of delivery before emotions are high and labor is happening.
Who does the surrogate want in the room?
When do the intended parents want to come in?
Does the surrogate want rest and privacy before pushing?
Do the parents want photos taken?
Who will cut the cord?
How will the baby be fed?
Will there be cord blood banking?
What happens if the parents are not there when the baby arrives?
Does the hospital have a nursery?
Can the intended parents have their own room?
Who makes decisions about the baby’s first bath, pacifier, or vaccines?
These may seem like small details until delivery day arrives.
Then they matter a lot.
Creating a Birth Plan That Honors Everyone
Liz explains that Reproductive Options sends questionnaires to both the surrogate and the intended parents. Each side shares their wishes, preferences, and concerns. Then Liz brings that information together into one cohesive plan.
The purpose is not to control the delivery. Birth is unpredictable, and everyone knows the plan may need to change.
The purpose is to make sure people are aligned.
If a surrogate is nervous and wants the intended parents present only at certain points, that should be discussed before labor. If intended parents are private and do not want photos taken during delivery, that should be understood before someone pulls out a camera. If parents strongly prefer to make decisions about feeding or newborn care, the hospital needs that information.
The birth plan helps protect the surrogate’s comfort, the baby’s safety, and the intended parents’ wishes.
At the end of the day, delivery is deeply vulnerable for everyone involved.
The surrogate is physically exposed, working through labor, and recovering from birth. The intended parents are waiting to meet their baby and may feel anxious, emotional, or unsure how to navigate a hospital system where they are the parents but not the patient.
A strong birth plan helps everyone walk in with more confidence.
Working Directly With the Hospital in Surrogacy
Birth planning also includes direct communication with the hospital.
Liz contacts the hospital to find out who handles surrogacy deliveries. She asks who needs the pre-birth order, whether they want a digital copy, whether intended parents should bring physical copies, whether there is a social worker involved, and what the hospital’s process looks like for surrogate deliveries.
She also asks practical questions.
Does the hospital have a well-baby nursery?
What happens if the baby needs additional care?
Can the intended parents have their own room?
Does the hospital need guardianship paperwork if the baby will be with the surrogate temporarily before the parents arrive?
These are the kinds of questions that can create major anxiety if no one asks them ahead of time.
No surrogate should show up at the hospital wondering where the intended parents will stay. No intended parent should arrive unsure whether they will be treated as the baby’s parents. No one should be trying to figure out paperwork while labor is unfolding.
Even when hospitals are supportive and familiar with surrogacy, having a plan matters.
Reducing Anxiety So Everyone Can Be Excited
Birth planning does more than organize logistics. It helps reduce anxiety.
Kayla points out that once these conversations happen, people often feel like they can finally be excited. Instead of worrying about the what-ifs, the surrogate and intended parents can look toward delivery with more peace.
The conversations may feel a little awkward at first.
Not everyone knows how to say, “I want you in the room, but not holding my leg.”
Not every intended parent knows how to ask, “Can we be present when the baby is born?”
Not every surrogate knows how to explain that she wants rest, privacy, or certain boundaries during labor.
A surrogate case manager can help bridge that gap.
The goal is not for every journey to look the same. Some surrogates and intended parents want a very close, intimate delivery experience. Others prefer more space. Some intended parents want to be involved in every moment. Others may feel nervous or overwhelmed and want to stay near the surrogate’s head or enter when it is time.
All of those preferences can be valid.
They just need to be discussed before delivery.
Surrogacy Support Should Continue After Pregnancy
One of the biggest frustrations discussed in the surrogacy podcast episode is when surrogacy agency support drops off after pregnancy is achieved or after delivery.
Liz knows what that feels like firsthand. After one of her own journeys, she did not hear from her surrogacy agency until weeks after delivery, and the reason they contacted her was to ask whether she could call the hospital about a bill.
That is not postpartum support.
Surrogates deserve to be checked on after delivery. They deserve to know the agency still cares about them, not only the pregnancy outcome. They may be recovering from vaginal delivery or a C-section. They may be pumping. They may be emotional. They may be physically exhausted. They may be processing the sudden shift after months of being actively needed.
Support should not end when the baby is born.
At Reproductive Options, surrogacy case management continues postpartum. That includes checking in, helping with pumping-related support when applicable, staying connected with the intended parents, and making sure the surrogate is not left feeling like the journey ended abruptly.
Surrogacy is not only about getting to delivery.
It is about caring for the people who made delivery possible.
Availability and Backup Support for Surrogates
Surrogacy does not always happen between 9 and 5.
Flights get canceled. Pharmacies call late. Medications need last-minute attention. A surrogate may have an urgent concern. A delivery may happen overnight. Something unexpected may come up when the primary case manager is unavailable.
That is why backup systems matter.
In the surrogacy podcast episode, Kayla explains Reproductive Options’ phone tree. The surrogate or intended parent starts with their case manager. If the surrogate case manager is not available, the concern escalates to the program supervisor. If needed, it escalates to Kayla.
There is even an old-school pager involved for overnight emergencies.
The point is simple: someone is reachable.
Liz also talks about seeing surrogates in online groups who say they emailed, called, or texted their coordinator days ago and still have not heard back. To her, that is hard to imagine. A surrogate should not be waiting five days for a response to something important.
Availability builds trust.
A surrogate should not feel abandoned. Intended parents should not feel like they are chasing answers. Everyone should know there is a system in place.
Surrogacy Case Management Is Emotional Work
Liz and Kayla also talk honestly about the emotional weight of this field.
This work is rewarding, but it can also be heavy. Surrogacy case managers are not just booking appointments and checking boxes. They are walking with people through infertility, hope, anxiety, pregnancy, loss, medical complications, relationship dynamics, delivery, postpartum, and sometimes hard endings.
That kind of work requires heart.
It also requires balance.
Liz shares that even as a retired surrogate, case management gives her a way to keep helping families grow. She may not be carrying babies herself anymore, but she is still helping carry the journey.
That perspective is powerful.
Good surrogacy case management is not detached. It is personal, invested, and thoughtful. But it also requires boundaries, support, and a team that understands the emotional load.
When the heart is in the work, people feel it.
Surrogates Still Need to Advocate for Themselves
Toward the end of the surrogacy podcast episode, Liz gives advice to surrogates who are just getting started.
Her message is clear: even with a strong surrogacy agency and a supportive surrogate case manager, surrogates should still advocate for themselves.
A surrogate case manager can predict a lot. She may understand the flow of the journey, know what emotions commonly come up, and anticipate many logistical needs. But she cannot read minds.
If a surrogate feels afraid of medications, she should say that.
If the clinic is causing stress, she should share that.
If the intended parents feel too intense or communication feels off, she should speak up.
If the case manager is texting too early because of a time zone difference, she can say that too.
Advocacy does not mean being difficult.
It means communicating honestly so the team can help.
Liz tells surrogates that they will not hurt her feelings by speaking up. A good surrogacy agency should want the surrogate to have a positive experience, and if something is not working, they should want to fix it.
Every Surrogacy Journey Is Different
Kayla adds an important reminder: this is the surrogate’s journey too.
Of course, surrogacy is the intended parents’ journey. They are the ones waiting for their baby, trusting another person with something deeply personal and life-changing.
But the surrogate is also living the experience in her body, her household, her schedule, her emotions, and her family.
That matters.
Repeat surrogates may also discover that what they wanted in one journey is not what they want in the next. Maybe they wanted a close relationship the first time and more space the second time. Maybe they want more communication now than they did before. Maybe their family life has changed. Maybe their boundaries have changed.
That is okay.
Every surrogacy journey is different, and communication helps make each one feel aligned.
Surrogacy Support That Carries the Whole Journey
Liz’s episode is a reminder that case management is not just administrative support.
It is relationship support.
It is emotional support.
It is logistical support.
It is birth planning support.
It is postpartum support.
It is the steady presence that helps everyone move through a process that can be beautiful, complicated, emotional, and unpredictable.
Surrogacy should never feel like a surrogate is handed a checklist and left to figure it out alone. Intended parents should not feel like they are chasing updates or wondering where they fit. Delivery should not be approached with unanswered questions that could have been discussed weeks earlier.
The right support changes the experience.
For Liz, that support is personal. She knows what it feels like to carry for another family. She knows what it feels like to love the process. She knows what it feels like when a surrogacy agency falls short. And now, as a surrogate case manager, she uses that experience to help surrogates and intended parents feel seen, prepared, and cared for.
Because in surrogacy, the details matter.
The relationship matters.
And support should last from match through postpartum.
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