A legal contract in surrogacy is essential. But as a case that is now making headlines reminds us, it cannot protect you in every situation. In this case, a surrogate, carrying for a California couple, traveled to Texas in a dispute over her desire to treat the fetus’s heart condition. She reported that the intended parents wanted to terminate the pregnancy.

Before a match is made, the intended parents and surrogate need to explore whether they are truly aligned on the issues that matter most and need to develop a trusting relationship. After seeing many difficult cases, I was the only therapist asked to testify before the State Judiciary Committee when they were considering legalizing compensated surrogacy in New York. I do not have a magic wand, but I have developed frameworks that I believe help intended parents and surrogates have the best chance of success.

We don’t know everything that happened in this particular situation, and it is devastating for everyone involved. But it is an important reminder that a contract cannot replace shared values and a strong relationship.

Zooming Out to Consider Long-Term Needs

It is completely understandable for intended parents to want to find a match and move forward quickly. Surrogacy is stressful, long, and expensive, and it is not easy to get matched with a surrogate, so when the match finally happens, everyone is eager for it to work out. In my decades of practice, I have learned that this is an area where my Zoom Out theory can be truly useful. The Zoom Out theory asks us to pause before each family-building decision and consider what our future family needs long term, rather than what feels most comfortable in the moment.

If we focus only on what we want right now, it is clear to see why everyone is viewing the match through the lens of “How can this work?” When the legal agreement is presented, many intended parents and surrogates feel overwhelmed. The contract offers a list of what-ifs that are often frightening. For example, considering whether a surrogate’s partner would keep the surrogate’s body alive if she fell into a coma, for the sake of the baby, is an overwhelming thought. Some professionals will look for a way to simplify the contract and calm everyone’s nerves and may suggest reframing the contract as a simple guideline that no one would choose termination for a cosmetic reason or that everyone will follow the doctor’s guidance. This simply does not work. The doctor will never tell a patient that they must do something. They will present the situation, share the risks and odds if available, and then a decision needs to be made.

It is also not feasible to address every possible scenario in a few pages of a contract. Last, there is so much grey area. What if the doctor says there is a 10- or 90-percent chance of something going wrong? As we can see in this recent case, it is very complicated. Intended parents may seek second and third opinions and perhaps disagree with the gestational carrier’s position on the issue. All the while, the pregnancy is progressing, making an already difficult decision even harder.

A 2-Category Framework for Decision-Making

Working with these difficulties led me to construct a framework, which I presented at the American Society for Reproductive Medicine’s annual conference. This framework funnels all medical testing and termination issues into two categories. First, if something goes wrong and it will affect the surrogate’s health, she needs to be in charge of that decision. She needs to protect her health for herself and her family at all costs. Second, if an issue arises that does not affect her health but pertains to the fetus or embryo, the intended parents should make that decision. They need to decide if they can parent that child, and that answer will be different for every couple.

While this may seem simple, I find that this framework helps clarify where people truly stand more effectively than the frameworks often used when everyone is trying to make the match work.

Sometimes these matches do not work, and that is actually a good thing. If the parties cannot agree on this basic concept, they are entering into a risky agreement. Although the idea of breaking the match may be painful, it would be better to find a match that is genuinely aligned with everyone’s value system.

Once it is clear that the match is a good one, it is important to develop a strong bond. I have created a framework for that as well, as I believe it is easier to have heartfelt discussions when you feel truly close.

None of this is easy, and my system is not a guarantee, but neither is a legal agreement. So why not put some additional, and sometimes uncomfortable, work into the initial group calls? It may save everyone from significant problems in the future. The families who navigate the surrogacy experience best are not always the intended parents who have the fewest difficulties, but the ones who were able to take the steps needed to ensure that their match is aligned and their relationship is close.