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- Choose the right first contact
- Other changes need their own responsible plan
- The clinical team leads medical decisions
- Use a written contingency map
- Autonomy continues when the plan becomes difficult
- Prepare with the right people
- A contingency plan should feel like support, not expectation
- Build a real Tbilisi care map before it is needed
Good preparation does not predict every outcome. It gives the surrogate, intended parents and professional teams a safe way to respond when plans change.
Put health first, contact the appropriate clinician for medical concerns, and use the written communication and contingency plan. The surrogate remains the patient and gives consent for her own care. Intended parents receive the agreed information, support reasonable needs and make parenting, travel and document decisions with their own qualified advisers.
Choose the right first contact
When something changes, the safest first contact depends on the problem. Urgent symptoms belong with the clinical team, document questions with the responsible authority and adviser, and practical disruption with the coordinator who can connect the wider plan.
| Situation | First response | Guide |
|---|---|---|
| Transfer result is negative or unclear | Follow the fertility clinic’s testing and medication instructions | After an unsuccessful transfer |
| Bleeding, pain or possible pregnancy loss | Contact the maternity or fertility team; use emergency care for severe symptoms | If a miscarriage is suspected |
| Headache, vision change, swelling or breathing difficulty | Seek urgent maternity assessment | If preeclampsia is suspected |
| Contractions, fluid loss or pain before 37 weeks | Contact the maternity unit urgently | Premature labour and birth |
| A newborn needs special care | Let the neonatal team lead care and create an update plan | Neonatal and NICU care |
Other changes need their own responsible plan
Not every difficult event is a medical emergency, but every one deserves a defined response. The people involved should know how changes in travel, communication, finances, embryos or relationships are discussed and who has authority to decide the next step.
| Situation | First response | Guide |
|---|---|---|
| A prenatal result is concerning | Confirm whether it is screening or diagnostic and arrange specialist explanation | Prenatal findings |
| Gestational diabetes is diagnosed | Follow the obstetric glucose and monitoring plan | Gestational diabetes |
| Cesarean birth is recommended | Ask the obstetric team to explain urgency, consent and recovery | C-section planning |
| Intended parents may miss the birth | Activate the hospital, newborn and representative backup plan | Parents cannot arrive |
| Newborn travel documents are delayed | Identify the exact authority step and extend lawful local care | Document delay |
| Embryos remain in storage | Review the clinic inventory, consent and disposition instructions | Unused embryos |
The clinical team leads medical decisions
A coordinator can make calls, arrange interpretation, align transport and document next steps. A coordinator cannot diagnose a symptom, change medication, choose a procedure or ask the patient to delay urgent care while commercial participants are consulted.
Use a written contingency map
A short contingency map reduces panic because it names the first call, the decision-maker, the communication route and the available practical support. It should be reviewed before treatment and updated as the pregnancy and travel plan develop.
- Clinical contact and emergency route
- Consent and information-sharing boundaries
- Interpreter and transport arrangements
- Practical support during extra appointments or admission
- How intended parents receive verified updates
- Budget and payment administration for changed care
- Travel, birth and newborn-document backup plans
- Emotional support for the surrogate and intended parents
Autonomy continues when the plan becomes difficult
The gestational carrier is the source of consent for care involving her body. Intended parents may need to make decisions about their embryos, prepare to parent a child with additional needs or manage travel and documentation, but an agreement should not turn their preferences into control of another patient’s treatment.
Prepare with the right people
Ask the clinic, obstetric team, independent legal advisers and coordinator to explain their roles before treatment. Read our ethical surrogacy safeguards and intended-parent responsibilities guides for a practical pre-treatment checklist.
A contingency plan should feel like support, not expectation
Discussing pregnancy loss, urgent symptoms, early birth, delayed travel or unused embryos does not mean the team expects something to go wrong. It means the people involved know whom to call, who makes the clinical decision, how information is shared and how practical needs will be funded if the original timetable changes. That preparation is especially important in a cross-border journey where intended parents may not be physically present when a question first appears.
The first response should always fit the situation: urgent symptoms go to the maternity team, embryo questions to the fertility clinic, document problems to the responsible authority and legal adviser, and emotional or relationship strain to the agreed support route. A coordinator helps those responses connect. Keeping the roles clear prevents a family emergency from becoming a medical opinion given by the wrong person or a clinical problem delayed by administrative discussion.
Build a real Tbilisi care map before it is needed
Tbilisi has fertility clinics, maternity hospitals, high-risk pregnancy services, operating theatres, laboratory and ultrasound services and neonatal intensive care. The important question is not whether a service exists somewhere in the city, but which facility has accepted the patient, which doctor holds the pregnancy record and which hospital can receive her after hours. Gagua Clinic publicly lists high-risk pregnancy, obstetric and NICU services; Gudushauri Clinic lists maternity, perinatal and neonatal care; and Chachava Clinic lists pregnancy, birth, cesarean and anaesthesia services. These are examples of local capability, not automatic referrals or guarantees of admission.
| Before treatment, record | Why it matters in Tbilisi |
|---|---|
| Fertility clinic and direct number | For transfer medication, testing and early-pregnancy questions |
| Named obstetrician and maternity hospital | For routine pregnancy care and urgent maternity assessment |
| High-risk or NICU backup | For complications, early delivery or newborn intensive care |
| Interpreter and transport plan | So care is not delayed by language or a late-night journey |
| 112 | Georgia’s 24/7 emergency number when immediate ambulance help is vital |
Questions people ask about What If? guides
Clear answers for real decisions: what to prepare, who is responsible and what can change the plan.
No. It can record discussions, values and responsibilities, but real-time clinical care still requires current information, professional advice and the patient’s informed consent.
The communication plan should name a coordinator or clinical contact and define what may be shared. Urgent treatment should never be delayed simply to organise a group update.
Keep the fertility clinic’s direct and after-hours numbers, the named obstetrician, the intended maternity hospital, a high-risk or neonatal backup, the coordinator, interpreter and driver in one short care map. Record which facility has actually accepted the patient rather than merely listing nearby hospitals. The map should also show 112 as Georgia’s 24-hour emergency number when immediate ambulance, police or rescue assistance is vital.
Yes. Tbilisi providers publicly list high-risk obstetric, perinatal and NICU services, including Gagua Clinic and Gudushauri Clinic; other maternity providers offer pregnancy, birth, cesarean and anaesthesia care. Service listings are not guarantees of admission, a specific doctor or an available bed. The treating obstetrician should identify the appropriate receiving hospital for the actual pregnancy and explain the transfer route before an emergency.
Have the surrogate’s name, gestational age, current symptoms, exact location, treating doctor, pregnancy or embryo-transfer summary, medicines, allergies and any recent results that the clinician requested. In an emergency, do not delay care to collect every document. Give the clinic or 112 operator clear facts and follow instructions; the coordinator can send the remaining record and arrange interpretation once the urgent response is underway.
Related guidance
Ethical Surrogacy and Transparency
Practical safeguards for voluntary consent, independent advice, transparent compensation, privacy and clinically responsible surrogacy coordination.
Read guide
Intended Parent Responsibilities in Surrogacy
A practical guide to intended parents’ financial, communication, legal, travel and ethical responsibilities throughout surrogacy.
Read guide
Surrogate Pregnancy and Birth in Georgia
A stage-by-stage guide to pregnancy communication, clinical care, contingency planning and delivery coordination in Georgia.
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