At week 20, your surrogate calls after the anatomy scan: the doctor saw a small finding and recommends follow-up. She asks what you'd like to do. And you, at 10 p.m. Israel time, suddenly grasp a question you never thought through: in a pregnancy of your child, in someone else's body, in a foreign medical system – how do decisions even get made?
Let's establish the basic principle, worth knowing before signing: over her body – she decides. No contract in the world can (or should) force a medical procedure on a woman. What the contract does do – and does well when written properly – is align expectations in advance at every foreseeable junction: which screening tests will be done, the approach to invasive tests like amniocentesis, both sides' positions in difficult medical scenarios. This is exactly why the matching process checks alignment of views – so that at moments of truth you discover you're on the same side, not on opposite ends of an impossible decision.
And in routine times? The American healthcare system is actually very friendly to long-distance parents. Most practices let you join appointments by video – we were "present" at quite a few ultrasounds from our living room in Israel, including the moment we first heard a heartbeat (tip: check the time difference twice; daylight saving almost cost us that moment). It's also worth signing HIPAA release forms in advance, allowing the medical team to talk to you directly and send you results – don't leave your surrogate as the sole conduit for medical information; it burdens her and stresses you.
Another thing worth arranging: a "translator" doctor in Israel. Not because American doctors aren't good – they're excellent – but because when a result arrives full of unfamiliar terms, a ten-minute call with an Israeli OB who knows you is worth gold. Protocols also differ somewhat between the countries (Israeli anatomy scans are more detailed, for example), and it's good to have someone explaining the gaps so you don't panic at every difference.
Most importantly: through most of the pregnancy, remember to live. We followed, asked, stayed involved – but we also learned to trust: the surrogate who knows her body, the team that does this every day, and the framework we built in advance. Involvement is not remote-managing every blood test.
My tip: ask the clinic for the pregnancy's full appointment schedule in advance, and put it all in your calendar including time differences. That way you know when to expect an update, when to be free for a video call – and when silence is simply silence.
