Navigating the Emotional Complexities of Surrogacy and Loss with Mental Health Professional Kristy Miller, MSW, LSW, PMH-C

Today, we’re addressing a topic that holds profound significance for many in our ConceiveAbilities community, especially for intended parents and surrogates.

While many journeys to parenthood are filled with joy, some paths include moments of unexpected heartbreak, and navigating perinatal loss is one of the most challenging aspects. Navigating perinatal loss is undoubtedly one of the toughest challenges, but it’s also a time when compassion and connection can bring great strength.

Here to help us explore this sensitive and vital topic is Kristy Miller, MSW, LSW, PMH-C, a certified perinatal mental health professional and a dedicated member of our ConceiveAbilities Match Experience team.

As a member of the Pregnancy Loss and Infant Death Alliance and Postpartum Support International, Kristy’s unique blend of expertise and heartfelt commitment is a true gift to those she supports through the complexities of surrogacy.

Kristy joins All Things Conceiveable: A Surrogacy Podcast with Nazca Fontes to share insights from the International Perinatal Bereavement Conference and discuss how her training empowers her to support surrogates and intended parents through their most difficult moments, from failed embryo transfers to pregnancy loss. Her approach is all about honoring grief and helping individuals find resilience to continue their journey. In this episode, we’ll look at the importance of open communication, emotional support, and the personal nature of navigating loss in surrogacy.

🎧 Don’t miss Kristy Miller’s in-depth insights on our podcast! → Listen Here.

Understanding Perinatal Loss in Surrogacy

NF: Kristy, you’ve been an essential part of this team, and we’re incredibly grateful for the empathy and strength you bring. Tell us about yourself and your role in surrogacy as a mental health professional.

KM: My professional background spans over ten years. I have recently become certified in perinatal mental health, which is particularly applicable to so many experiences that our surrogates and intended parents have as they’re coming into these journeys. On the mental health team, I work alongside other staff to help support that emotional side of surrogacy that our intended parents and surrogates are going through. It’s very meaningful work that I truly enjoy. I am so excited to talk a little bit more about some of the tougher aspects of that too, because I think it’s important for everyone to know coming into this process that we’re prepared to help them through anything that may come up and that they’re never alone.

NF: You’re certified in perinatal mental health. What exactly is that?

KM: The Perinatal Mental health certification is through an amazing organization called Postpartum Support International, which does offer resources across the globe to pregnant women and to people trying to conceive. The term perinatal means anything covering the spectrum of trying to conceive through pregnancy and up through a year postpartum. That encompasses so much of what we are seeing with our intended parents and our surrogates and how the emotions that come up, the losses that may happen during that time span can really impact them. The certification is focused on making sure mental health professionals are equipped to help those people going through the perinatal period through unexpected losses, through mental health challenges, and to make sure that they can support their wellbeing through that process.

NF: How does your certification and training in pregnancy loss and grief apply uniquely to surrogacy, where both intended parents and surrogates are navigating this deeply personal experience?

KM: Pregnancy loss, even outside of surrogacy, can often feel like an invisible loss, making the accompanying grief seem misunderstood or overlooked. What makes loss in a surrogacy journey uniquely complex is that it affects multiple people. A surrogacy match is a true partnership between the surrogate and the intended parents, and they navigate these losses, along with the highs and lows of the journey, side by side.

NF: Loss can be defined in so many ways and can be felt very differently by each individual.

KM: Loss can mean a lot of different things. It can mean a failed embryo transfer, a chemical pregnancy, a miscarriage, or still birth. It can mean a termination for medical reasons. Dr. Julie Bindeman, who’s an expert in reproductive trauma and grief and loss, will often say that a loss is a loss, meaning there is no hierarchy of loss and no one can bring judgment toward how someone is experiencing a loss. That’s important because if you do say something like, “it’s just a failed transfer, we can try again” or “at least you weren’t further along when you had this miscarriage,” that really deeply minimizes that experience for those intended parents and for that surrogate who have gone through this and who know how much effort, energy and hope there was in that transfer and in that early pregnancy. Loss can be experienced in many different ways, and every emotion that comes with it is valid. Acknowledging these feelings is essential to providing the support people need to heal. That’s where we come in — offering compassionate support to surrogates and intended parents, no matter when in the process the loss occurs.

Why Pregnancy Loss Can Be Especially Complex in Surrogacy

NF: What should both surrogates and intended parents know about each other’s intentions and experiences prior to embarking on a surrogacy journey?

KM: It’s really important to know intended parents and surrogates come into the surrogacy journey from different paths. Many intended parents have experienced a lot of loss on their own prior to getting here, which can sometimes mean that they are feeling more cautious early on in a journey, even if they feel great about their surrogate and their match. They would not be pursuing surrogacy if there wasn’t hope, but sometimes that hope can be a little bit buried under some fear of the shoe dropping, and again experiencing another loss. That can manifest in a way that may impact how they’re relating to their surrogate early on in the process.It’s important for surrogates to recognize that they are protecting their hearts in a way and not take that personally.

For intended parents, it’s crucial to understand that their surrogate is deeply committed to helping them and genuinely shares in their hopes and dreams. She will likely share in some of their emotions throughout the process. If a loss occurs, it’s something they will all grieve together. Open and honest communication can be incredibly helpful in navigating these challenges and supporting one another through any unexpected circumstances or losses.

Supporting Intended Parents Through Fear, Grief and Loss

NF: How do you help intended parents become more emotionally available to the process?

KM: It’s common for intended parents to feel nervous or guarded, and knowing they’re not alone can be reassuring. Acknowledging that fear and hope can coexist is a powerful step. Open communication helps both surrogates and intended parents build trust and navigate the journey together.

In the event of a failed embryo transfer, the experience can be deeply emotional for both the surrogate and intended parents. Open communication is key to navigating this together and strengthening their relationship to move forward. Sometimes it’s hard to know what to say. People may want to help someone feel better and they may want to help someone fix it. But, grief around a loss is not a problem to be solved. It’s not something that has an easy solution. It can’t be fixed. The best way through it is by acknowledging it.

Intended parents may need time and space to process their loss. Surrogates can offer support by expressing their shared sorrow and understanding, saying something like, “I’m so sorry. I’m heartbroken for you. I’m thinking of you and understand if you need some space.” This acknowledgment helps intended parents feel seen while showing that the surrogate is grieving too.

Likewise, intended parents should feel comfortable sharing their needs, such as, “We’re so sad and need some time to grieve. We don’t blame you and know this isn’t your fault. We remain hopeful and want to move forward when we’re ready.” Mutual understanding and communication foster trust and healing, allowing everyone to navigate the journey together.

Finding Control When So Much Feels Out of Control

NF: How do you address topics that come up that come from a very real place of fear?

KM: Every intended parent’s journey is unique, shaped by their individual perspective as they begin this process. We work closely with them to consider the support they already have in place and how it can play a role throughout the experience. One of the most common challenges we hear about is the difficulty of feeling a lack of control over many aspects of the journey — a feeling that’s completely understandable.

We guide intended parents in identifying areas where they do have control, such as taking care of their physical and mental well-being. Prioritizing self-care, maintaining healthy habits, and strengthening relationships in their lives can make a significant difference. When they focus on what they can manage — like using relaxation techniques, engaging their support system, and staying grounded — they often feel more balanced and prepared.

We also encourage them to nurture their relationship with their surrogate. Open communication and building a connection during the smoother parts of the process create a sense of partnership and help make the pregnancy feel real. These moments allow intended parents to embrace the journey more fully. With these tools and strategies, intended parents are better equipped to navigate both the emotional highs and any difficult moments that may come their way.

Building a Support System Before Challenges Arise

NF: Do you have anything that you might work on in terms of getting ahead of an issue if a journey is not going as planned?

KM: One of the best things to do in tougher circumstances is to help our surrogates and intended parents have other outlets for support, especially when things could potentially become more challenging and sometimes having a safe space, someone they can talk to. That could be a member of our mental health team. It could be a therapist, and we might help make a referral for them to have that safe outlet outside of ConceiveAbilities. It could be a support group with people who have had similar experiences and who know what this is like that can feel like safe spaces to express the emotions and fears they are having and for those to be validated.

It’s so helpful to know that you’re not alone in this process. One of the biggest goals that we have at ConceiveAbilities is no matter what is happening in a match and what surrogates and intended parents are experiencing, we never want them to feel isolated in that and to feel alone in that. We wrap our arms around them, figuratively and literally with the support we can offer from our mental health team, from support groups that we have in place, referring them to external supports that are out there. And even our match managers, our other staff, are helping sift through all the logistics and the information that’s coming with perhaps every appointment and every milestone to make sure that they are not alone in that.

NF: Could you share more how our team collaborates in these moments to provide comprehensive support?

KM: Surrogacy is not a one man show. We have such a multidisciplinary team and everyone plays a critical role in the surrogacy process. Different surrogate experts are involved at different times and in different areas with all of our matches. It really is an all hands on deck attitude. When there is the potential for something difficult coming up in a match, our surrogates and intended parents can rest assured that they will have support they need. We’re going to support them emotionally. Logistically, we’re going to help them navigate the appointments that may be coming, the financial aspects of things, and we have a team of legal experts to help guide them. All of our staff members work so well together to make sure that our clients are supported in every way.

Helping Surrogates Navigate Grief and Self-Blame

NF: Most surrogates have not experienced loss when it comes to obstetrics. So for many, if they do experience a loss in the surrogacy journey, this may be the first time that they’re experiencing something at this level related to pregnancy. How do we help them?

KM: For surrogates, thoughts and feelings about a loss in a surrogacy pregnancy are ultimately fairly similar to what someone might experience with their own pregnancy loss. The vast majority of surrogates have not had that experience personally. They may have thoughts around how their body failed them. They may think “what did I do wrong?” or “could I have done something differently that would’ve led to a different outcome?” Even if they know that it’s not logical, there is a worry sometimes that they may be blamed, that maybe their intended parents feel like the surrogate has let them down.

Sometimes, we don’t have a clear reason these losses happen. That can be helpful to hear, but it can also be really hard because people want a reason. They want to know why, so that they can for the next try do something differently that’s going to lead to a different outcome. One of the most reassuring things that we hear across the board from clinics to doctors, is that it’s not the surrogate’s fault and that there was nothing that could have been done to prevent what happened.

Going through that loss experience really highlights the lack of control that everyone feels through this process. It’s a blessing and a curse to know that there’s so much out of our control because that does mean that the things we can control, we can do our best. The surrogate can take all of her medications exactly as prescribed and she can take the best care of herself.

Surrogates often share that the impact of loss is more profound than they anticipated. It wasn’t their baby or their personal hope for a child, but they carried immense hope for their intended parents. As a result, they often find themselves grieving both for and alongside those parents. By normalizing these feelings and reassuring surrogates that they’re not alone, we strive to provide unwavering support. It’s about surrounding them with care and compassion as they find the strength to move forward.

Coming together through an experience of loss is a vital step in reassuring everyone involved. Recognizing that this was unexpected, it wasn’t what anyone wanted, and it’s deeply heartbreaking is paramount. Most importantly, acknowledging there’s no blame. For surrogates, hearing this can be incredibly comforting. If it’s a surrogate’s first experience of loss, we provide the support she needs to navigate those emotions and remind her that she’s not alone. Other surrogates have faced similar situations, felt the same emotions, and found a way through. It’s not an easy journey, and it’s essential to make space for grieving. The pain can be intense, but with support, healing is possible.

Ways to Honor and Process Pregnancy Loss

NF: Moving through grief is universal, whether it’s surrogacy or otherwise. How can normalizing grief help people move forward in surrogacy?

KM: When we think about grieving a death in our society, certain rituals often come to mind: funerals, memorial services, sending flowers, and cards. These moments are usually centered around reflecting on the life of the person who has passed. However, pregnancy loss is different — it involves grieving what could have been. It’s the loss of a hoped-for child, cherished dreams, and anticipated milestones, such as a due date, which can become particularly poignant and painful.

There are many meaningful ways to honor a pregnancy loss, helping individuals navigate their grief. Lighting a candle on special dates, displaying artwork that holds significance, or planting a tree can serve as touching tributes to a loss that might otherwise feel invisible. Some may name the embryo or baby or keep a special item, like a blanket, as a tangible memory. Surrogates, too, often find comfort in memorializing the experience, perhaps through a necklace, bracelet, or other keepsakes. These gestures acknowledge the loss as an integral part of their story, honoring it instead of pushing it aside.

How the Surrogate–Intended Parent Relationship Can Support Healing

NF: How does the relationship between the surrogate and intended parents play a role in helping both sides cope with grief and loss during the journey?

KM: I often view the relationship between the surrogate and intended parents as that connecting point that helps the intended parents feel connected to this pregnancy that they are not physically carrying. Their relationship with their surrogate is their line to that pregnancy. She is often sharing updates and helping them feel involved at appointments. Sometimes intended parents and surrogates will utilize things later on in their journeys like belly buds where the intended parents can have their voices be heard by the baby in utero or bond touch bracelets where the surrogate can tap it and intended parents will feel their own bracelet vibrate when the baby is moving. These are ways that can help that connection grow and flourish as the pregnancy continues. So if a loss does happen, which is so heartbreaking, intended, parents may have those memories of the pregnancy to reflect back on as they’re grieving. If the match does move forward together to try again, these methods of connecting can be reassuring and emotionally so valuable as everyone keeps moving forward.

Maintaining Communication After a Loss

NF: Even the best relationships under the best of circumstances, communication can become strained. Difficult moments — such as a loss or a tragic event — can add extra strain. For relationships that are already less stable, these situations can be even more complex. How do you guide and support intended parents and surrogates to maintain open, effective communication, no matter the circumstances, to help them navigate these challenging experiences together?

KM: If communication is feeling strained, we encourage a set time each week that they can reach out and check in on one another or share updates usually at doctor’s appointments. Those are times when we are encouraging involvement and communication around what’s happening at the appointments, what updates need to be shared with all parties. Our staff can also help with this to help make sure that it’s going smoothly, that it’s comfortable for everyone, and it’s okay for there to be boundaries in place. Knowing that this is such an emotional experience, especially for intended parents and also often for surrogates, it’s really important to remember that the intended parents are not responsible for managing their surrogate’s emotions, and the surrogate is not responsible for managing her intended parents’ emotions.

There will be lots of things that they’re sharing with each other, but it’s just as in any relationship, it’s important to have those safe and supportive outlets outside of the relationship that help everyone bring their best selves to the relationship. That may be each party’s respective support systems. It may be staff at our agency that can help with that so that they can communicate respectfully with each other and that the needed information is shared even if things are strained in the meantime. These steps will help continue to build trust and hopefully help repair and mend that relationship moving forward.

Finding Hope and Moving Forward After Loss

NF: Are there any key factors that help surrogates and intended parents continue working together after experiencing a loss and maybe even sharing an example of a match that moved forward after such a loss?

KM: Yes. Open communication is a key factor in moving forward through experiences of loss. I recall two matches where both experienced a failed transfer followed by a miscarriage before finally achieving a successful third transfer that led to a full-term pregnancy and a healthy delivery. As you can imagine, enduring a failed transfer and then a miscarriage made it incredibly challenging to maintain hope and sustain their relationship through such profound loss. However, the strong bond they built before and during these experiences — rooted in open communication, shared hope, and aligned priorities — was instrumental in helping them persevere together through the surrogacy journey.

A crucial factor in moving forward was their commitment to keeping communication open, even in the immediate aftermath of loss. Despite the grief and hard work each had to navigate, knowing that both parties remained dedicated to the journey alleviated fears that one might step away or be unwilling to continue. This mutual commitment allowed them to grieve while moving forward together, ultimately leading to a shared success.

Kristy’s Perspective as Both a Surrogate and Mental Health Professional

NF: As an experienced surrogate yourself, you have gone through more than one surrogacy journey and you’ve had a great relationship with your intended parent. No doubt there were moments where you experienced your own setbacks or various forms of loss along the way. So how do you bring your personal experience and perspective to your work?

KM: It’s really important to me to share with our surrogates that I have been in your shoes and I’ve been through this process. I understand how unique these relationships are between intended parents and surrogates, and I can speak to how helpful that open communication can be. Proactively discussing scenarios with intended parents, such as how they prefer to receive communication if something unexpected happens, can make a significant difference. Asking questions like, “Would you like to receive bump pictures?” or “Are there specific milestones that might be more challenging for you?” fosters understanding and helps create a supportive environment. Being upfront about each other’s needs throughout the process can be both comforting and empowering.

As a surrogate, I bring these insights to others by drawing from my experiences with my own intended parents and those I’ve supported. Each intended parent’s journey is unique, as are the emotions they experience along the way, and I aim to share what I’ve learned to help them feel less alone. Many intended parents find comfort in knowing that I can also offer a surrogate’s perspective, which they value — even as I’m transparent about not having walked in their shoes. Ultimately, my goal is to ensure that everyone involved feels supported throughout the journey.

Grief and Hope Can Coexist

NF: What do you find most rewarding about helping build families?

KM: I absolutely love what I do, and building relationships is at the heart of it. Strong connections allow me to help them navigate unexpected circumstances with care and understanding. One quote that has deeply resonated with me is, “The best gift we can give someone who is grieving is our presence.”

We have the privilege of supporting families through the highs and lows, the heartbreaks and triumphs, of their journeys. That presence and support mean so much. I often remind others — and myself — that grief and joy, grief and hope, can coexist. This journey can be incredibly hard, but it can also be profoundly beautiful. Both realities can exist at once, and I firmly believe that every step of the journey is worth it.

Interested in learning more about surrogacy? Learn more about building your family through surrogacy or about becoming a surrogate.