Learning from the Surrogacy Experience of McKenna West, Omar Ahmed, and Nausheen Gilkar: Early and Ongoing Cooperation is the Only Way

The surrogacy case involving gestational carrier McKenna West and parents Omar Ahmed and Nausheen Gilkar has been captivating the headlines. Although all parties willingly began this journey together, the resulting pregnancy became fraught after serious medical concerns emerged involving the baby. 

The situation is tragic, complicated, and instructive. As an informed bystander, I hope to offer perspective, through the lens of this case, about the realities of surrogacy: its extraordinary promise, its inherent complexity, and the indispensable role of cooperation. 

Surrogacy can be a remarkably successful path to parenthood. More than 90% of ConceiveAbilities’ clients bring a baby home, and both intended parents and surrogates report high levels of satisfaction with their experience. These statistics are of no comfort to Omar, Nausheen, or McKenna; however, outcomes at the extremes are exactly where the stakes are highest, the margin for error is lowest, and the need to adequately prepare is most demanding.

Cooperation, especially at times of unimaginable setbacks, is the key to improving the odds that any given surrogacy journey enjoys these successful outcomes. Sometimes that cooperation comes easily, and sometimes it is fragile and hard-won. Regardless, it is essential. 

And, in my view, it is the only viable foundation for surrogacy. 

All Parties Must Be Able to Make Difficult Decisions With Someone Else

The decision to embark on a surrogacy journey is a courageous one, for intended parents and surrogates alike. For Omar and Nausheen, their path to parenthood was already fraught with innumerable obstacles. McKenna, like all surrogates, willingly put her body at incredible risk, as is true for any pregnancy. 

While the courage to enter a surrogacy arrangement is admirable, all parties need capacity for even more resilience during a surrogacy journey. It’s not productive to contemplate every hard thing that may happen, but it is important to consider the kinds of ordinary and extraordinary issues that may surface during the several years it may take to successfully complete a surrogacy journey. Should we attempt another embryo transfer? Should we get a second opinion or an invasive test? What happens if an immediate family member becomes seriously ill? A marriage comes to an end? What kind of delivery do we envision? 

The possibility of terminating a pregnancy is one terribly fraught extraordinary issue. 

Working through intimate decisions, with another decision-making person who has their own values and beliefs, is simply what surrogacy requires.

People Change Their Minds

When difficult medical news emerged about the baby that McKenna was carrying, the decision to potentially terminate the pregnancy came to the fore. McKenna has said publicly that she changed her mind about terminating the pregnancy, despite earlier discussions and agreements with Omar and Nausheen.

That reality is difficult, but it is not surprising. It is consistent – perhaps even expected – with what many experienced professionals in this field understand. Equally, intended parents may change their minds about important matters. 

Neither side’s evolving position should be understood as bad faith. 

These crises are emotionally complex, medically complex, and lightning rods for broader disputes. A hypothetical decision that may appear clear in the abstract can feel entirely different when it becomes a real decision.

At precisely this moment, the difficult work of cooperation becomes most important.

Legal Remedies Are Crucial – But They Are Not Enough

Omar and Nausheen had a gestational carrier agreement with McKenna. Such agreements are the bedrock of surrogacy. They provide a framework to set expectations, define responsibilities, clarify financial obligations, and establish parentage. In this case, multiple states became involved and courts in Alaska, Texas, and California rendered essentially similar judgments with unanimous agreement about Omar and Nausheen’s parentage rights. 

Legal remedies fall short, however, and, in this case, in several ways. First, gestational carrier agreements do not change the ability of any individual to maintain bodily autonomy, and they do not change the obligation of informed consent for any medical procedure, such as a medical procedure to end a pregnancy. The parties must seek cooperative solutions about the gestational carrier’s medical care, and certain of those decisions are hers and hers alone. 

Second, McKenna has said publicly that she felt coerced by the agreement with Omar and Nausheen.  That perception may have made it harder for the parties to find a constructive solution when the conflict began. Whether or not McKenna’s feeling is accurate based on the letter of the agreement, a cooperative process must address either party’s feeling of imbalance in order to be effective. While some may believe that a one-sided contract is to their benefit, this case illustrates that a contract with even a perceived feeling of imbalance can be quite harmful. 

Further, an agreement, such as Medical Authority Clauses in gestational carrier agreements that advance the appealing idea of clarity for all parties, is particularly dangerous in that it overpromises certainty, an outcome far worse than an agreement that is clear about its limits.

Third, McKenna leveraged the press to tell her story and was able to solicit political involvement such as Ken Paxton’s interest, the attorney general for Texas. In fact, a number of special-interest groups became involved with both sides of the conflict. As the conflict deepened, each side sought power from wherever it could be found, likely further frustrating the ability of the parties to cooperate with one another.

Legal remedies can establish certain rights and obligations but they cannot substitute for communication, empathy and cooperation between the people most directly affected. When the conflict hardens, the underlying dispute may persist and further escalate for years to come.

How Effective Cooperation Is Built

I’ll share a word about what we do at ConceiveAbilities, fully acknowledging that I’m an observer in this case. Our view is resolute that there are effective ways to build even-handed cooperation in these delicate and fragile scenarios and we work tirelessly to find the best ways to do so.

Our program includes a commitment to a shared decision-making process by the participants. This is not a matter of good intention; it is a structured, credentialed, expert-led process to work through the ordinary and extraordinary conflicts that can be part of a surrogacy experience, from the start of the journey. Our team consists of licensed mental health professionals, registered nurses, attorneys, and experienced match managers. Collectively, we have supported thousands of matches and bring more than three decades of experience to this work. 

Through this process (one that we continuously strive to improve), we prompt difficult conversations because we know that challenging decisions are part of every surrogacy journey. Our role is to remain a neutral, informed guide that helps intended parents and surrogates alike:

• Build and sustain a respectful relationship

• Clarify which potential decisions are shared and which are not shared

• Address conflicts promptly, before they become entrenched

• Ensure the most important and sometimes changing information relevant to a potential conflict is shared with all parties as quickly as possible

• Help the parties concentrate their energies on one another, rather than the well-meaning but sometimes cacophonous perspectives of family and friends

• Work toward outcomes that honor the humanity and dignity of every person involved

Through shared decision-making, we have a multitude of first-hand experiences with intended parents and surrogates who work through the unimaginable and still find a path to success.

My heart breaks for all the parties involved in this particular case – and especially for the critically-ill baby at the center of the conflict.

Surrogacy is a vital pathway that has built countless families and can have profoundly positive, life-changing impact on people’s lives, across generations. Cooperation is the only way.