The gestational carrier does. She is the patient in the pregnancy, and she controls consent to her own medical care from transfer through prenatal care, labor, delivery and recovery. Not the intended parents, not the agency, not the clinic, not the attorneys. This is the settled position in professional ethics guidance, and it should be visible in how a program talks to you during matching — not buried in a disclaimer.
What the contract can and cannot do
A gestational carrier agreement is a real and necessary document. It can record shared values, expectations, financial responsibilities, insurance arrangements and the consequences if someone does not do what they agreed to do. What it cannot do is transfer authority over another adult's body. If a program describes the contract as giving you control of medical decisions, it is describing a document that does not exist.
That is not a loophole to work around. It is the reason the matching conversation matters so much. Alignment reached before medication starts is worth more than any clause written afterward.
Talk about the hard topics before you match
These belong in the mutual match conversation, not in contract boilerplate:
- how many embryos are transferred, and why single embryo transfer is strongly favored in carrier cycles
- prenatal testing and what each of you would do with results
- termination and selective reduction
- miscarriage, loss and what support looks like afterward
- pregnancy complications, bed rest and travel restrictions
- vaccination and other medical recommendations
- hospital and delivery preferences
- privacy and social media
- contact after birth
Finding a values mismatch here is not a failed match. It is a successful screening conversation, and it is far cheaper before transfer than after.
Information sharing is consent, not access
You will receive the information she has authorized you to receive. Clinic and HIPAA releases are specific and revocable; they are not a permanent window into her chart. Build a written communication plan before transfer covering how results are shared, appointment attendance, video calls when you cannot be there, routine update cadence, what counts as urgent, and expectations at nights and weekends. Revisit it after pregnancy is confirmed and again in the third trimester, because preferences change.
Support should never slide into surveillance. Medication reminders, appointment coordination, secure records and clear escalation are useful. Continuous monitoring, sharing her medical information beyond consent, or treating a missed message as a contract problem are not.
When you disagree
Disagreement is not automatically a crisis. A well-run program routes it to counseling, the clinical team and, where needed, independent legal advice for both sides. It does not route it to a coordinator applying pressure. Ask any agency to describe its escalation path and its grievance channel before you sign, and ask whether her support is independent of the people managing your case.
The birth plan is a coordination plan
Separate the layers. Medical decisions belong to the carrier and her clinical team. Relationship preferences are agreed together. Hospital administrative steps are coordinated with counsel and the hospital. Newborn decisions become yours once applicable law and hospital policy recognize you as parents — which depends on your delivery state and on the parentage work your attorney has done. Rules and procedures vary by state and by court practice; see surrogacy laws and policies and legal parentage for same-sex couples for how that planning fits together.
Nothing here is a guarantee about how a pregnancy will go. It is how responsible programs keep respect and coordination in the same room.