Surrogacy used to be morally incorrect and socially strange. Now it’s a standard method of making individuals reproduce in most countries. Couples and individuals get an actual chance at parenting with the help of surrogacy, especially couples who deal with issues like infertility, same-sex parenting or genetic flaws. Regardless of the increasing acceptance, no one talks or understands the emotional and psychological challenges that a surrogate mother faces.
There are many conversations around the legality of the process, contracts, and medical specificity, but very little emphasis on the psychological experience of the surrogate mother, especially how she deals with the formation and management of attachment with the developing baby.
This paper fills that gap by applying John Bowlby’s attachment theory (1969, 1973, 1980), that early caregiver relationships create internal working models that influence emotional control and relational behaviours across the lifespan. For surrogate mothers, this allows examining how they navigate the conflicting demands of close physical caregiving during pregnancy, with emotionally rehearsing relinquishing the child at birth.
The article employs Object Relations Theory (Klein, 1952; Winnicott, 1960), which states that the internal psychological images of the caregivers are the substratum for adult relational patterns. With surrogacy, these theories describe how early relational patterns of a surrogate mother can influence the capacity to form emotional boundaries, manage attachment to the foetus, and have relational clarity with the intended parents.
In a long-term study, Imrie and Jadva (2014) established that the majority of surrogate mothers reported low-to-moderate prenatal attachment and felt psychologically ready to transfer the baby, especially if they had received proper information and support. Nonetheless, a minority also reported unforeseen sorrow or loss after delivery, particularly in situations where there was confusion over or a failure to meet post-birth contact expectations. These outcomes indicate that surrogate attachment styles are heterogeneous and can vary according to the quality of relational communication with intended parents and the availability of psychological support systems.
To transcend the above theory, the paper incorporates a venture of a relational ethics model based on feminist bioethics (Keller, 2020; van Zyl & Walker, 2016), which takes into consideration moral, legal, and social frameworks affecting surrogacy. These involve aspects of informed consent, emotional labour, contractual power inequality, and post-birth contact. Furthermore, there is recent evidence from neurobiology that pregnancy activates powerful hormonal and neural attachment mechanisms, like oxytocin-mediated maternal-foetal attachment, which may influence a surrogate’s emotional state regardless of her motivation (Swain et al., 2017).
Along with psychological models, ethical reasoning has come to acknowledge the relational burden on surrogates within commercial and altruistic arrangements equally. Surrogacy tests conceptions of autonomy, the necessity for a wider ethical focus on emotional labour, care ethics, and power imbalances among surrogates and commissioning parents. These are important in resolving the moral and relational conflicts arising when the surrogate mothers are being asked to develop physical caregiving relationships while soon to relinquish the child at birth.
As a perspective paper, this report does not present new empirical findings. The particular paper is a combination of recent research, combining which it proposes a new theoretical framework, connecting psychology, ethics and neuroscience.
Read More: Exploring Human Connection: A Look at Attachment Theory
Theoretical Framework: An Integrative Attachment–Relational Ethics Model
Bowlby (1969) suggested that people who are securely attached tend to form stable relationships. On the other hand, those with insecure, avoidant, or disorganised attachment may struggle with managing emotions and keeping stable relationships. A surrogate mother’s attachment patterns can affect her feelings about pregnancy, how she interacts with intended parents, and her decision to relinquish the child after delivery.
Object Relations Theory expands on this idea by introducing internalised object representations. These are the mental images of others, especially caregivers, that shape how people behave in relationships (Klein, 1952). Surrogacy can trigger these object relations, particularly if unresolved attachment wounds from the past are still present. For some, the surrogate experience can have a reparative quality; for others, it can rekindle unresolved mourning or dependency needs (Jadva et al., 2015).
The relational ethics model broadens these intrapsychic approaches by focusing on the moral and social circumstances under which surrogacy occurs. It emphasises respect, mutuality, and power awareness in caregiving relations (Keller, 2020). This model of ethics demands that the psychological and emotional interests of surrogate mothers be respected, beyond those of intended parents and children.
Attachment, Empathy, and Maternal-Foetal Bonding
Studies indicate that surrogate mothers typically rate lower maternal-foetal attachment than biological mothers, but this must not be confused with emotional detachment (Lamba et al., 2023). Instead, surrogates deliberately use strategies to maintain emotional boundaries to prevent themselves from forming intense bonds, which is a mechanism depicting high cognitive empathy– referring to understanding others’ emotional needs without getting them overpowered (Pizitz et al., 2023).
A concept called mentalization is used, which refers to the ability to notice and observe the mental states of others and oneself, and is important to this process. Surrogates with stronger mentalization skills can better separate their temporary caregiving role from that of a mother. However, some surrogates report unintended emotional bonding during pregnancy, especially in the later stages as foetal movement and hormonal changes increase (Tehran et al., 2014). This contradiction highlights the need to screen and prepare surrogates for various possible emotional responses.
Neurobiological Correlates of Surrogate Bonding
Pregnancy triggers complex neuroendocrine responses that promote bonding, even if the mother does not intend to raise the child. Swain et al. (2017) found that higher oxytocin (a hormone associated with bonding, trust, and caregiving) levels are related to increased brain activity in areas linked to maternal behaviour, such as the amygdala and prefrontal cortex.
Such findings indicate that surrogates can develop involuntary emotional attachments to the foetus despite wishing to remain emotionally detached. When there is an imbalance between emotional intention and the biological link, it can lead to the creation of postpartum emotional turmoil. Thus, surrogates should not only be mentally prepared but also assisted with coping with the hormonal and somatic consequences of pregnancy.
Sociocultural and Ethical Dimensions
Surrogacy does not take place in a vacuum. Attitudes in culture about motherhood, family roles, and third-party reproduction heavily influence surrogate mothers’ experiences. In collectivist cultures, where motherhood is closely aligned with identity and family honour, surrogates can be stigmatised, hidden, or condemned morally (Tehran et al., 2014).
Western cultures often see surrogacy as a contract, leading to emotional disconnect and making the surrogate’s role feel less personal. Legal and ethical issues are also important. Topics like post-birth contact, emotional exchanges, and informed consent often do not receive enough attention in surrogacy agreements. Söderström-Anttila et al. (2015) found that there was more grief and emotional confusion in surrogate mothers who had lost contact with the intended parents after childbirth. Ethical surrogacy needs not only clear laws but also emotional honesty.
A Three-Phase Psychological Support Model
This paper suggests a three-phase model of psychological support:
- Pre-conception phase: Counselling should involve education in mentalization, boundary setting, and communication expectation following birth, questionnaires of attachment style, emotional stability, etc.
- Gestational phase: Routine consultations with mental health experts to track emotional control, bonding response, and relationship dynamics with prospective parents.
- Post-birth phase: Debriefing and psycho educative sessions wherein the surrogate is able to work through emotions of loss, identity shift, and relationship closure. Ongoing therapy and support groups must be available, especially when there is a withdrawal of contact by intended parents.
Conclusion
Surrogacy raises an important psychological question: How does a person build a strong physical and emotional bond during pregnancy and then relinquish the baby at birth? Surrogate mothers have their own attachment histories, relationship patterns, and emotional needs. The following paper is a presentation of 3 models – attachment theory, object relations, neurobiology, and ethics to improve our understanding of this phenomenon.
Future researches should focus on long-term studies to understand and compare the experiences of surrogate mothers across cultures, their emotional outcomes and conduct clinical trials to evaluate effective psychological support interventions. By applying this multidisciplinary approach, surrogacy will become not only a legally or medically safe procedure but also an emotionally stable and ethically fair procedure.
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