Andy Bludworth-McNeill, scrubbed in and wearing hospital blues, entered the delivery room of a Panamanian hospital. It was just before 11:30 p.m. November 8, and he took a seat next to the pregnant woman he had met only briefly before.
The pristine room was a sprawling ocean of sterile hospital fabric. Waves of turquoise sheets covered the woman's petite body. Four doctors with sea-foam surgery aprons, pale-blue scrubs, and matching surgical caps hovered over her. A parting in the sheets revealed a wide slit across her belly, ripe with Andy's children. He held her hand tightly as doctors prodded at the incision with shiny tools and suction tubes. The what if thoughts that expectant parents try to keep at bay rushed through Andy's mind as he watched the doctors nimbly maneuver clinking instruments. The doctors pushed on her belly with the confidence and intuition of talented improv theater performers who have worked together for years.
Less than five minutes after Andy entered the blue room, the doctor to the woman's right pressed his forearm on the upper part of her stomach, leaning over her torso and pushing down with his body weight as the doctor on her left reached within, coaxing out a tiny head, then shoulders, then a body. The woman on the table closed her eyes, breathing through pursed lips. The newborn boy's mouth opened to cries, and a pair of doctors carried him to a table also covered in turquoise sheets. Another push by the doctor on the right gave way to another tiny head, then shoulders, then body, wailing and squirming like the first. Doctors whisked the baby girl to another sheeted working table.
The children's cries synced, resulting in a harmony of wah-ing, pleasing only to the ears of a new parent, and Andy's anxiety gave way to excitement. Doctors gave each of the newborns a dose of oxygen from baby-sized masks that instantly turned their complexions from gray to pink; they checked the babies' vitals, took footprints, and wheeled them out of the delivery room and into the nursery.
Andy left the room to tell his partner, Todd Bludworth-McNeill, the news that their family had healthfully doubled in size. The couple, who own a Fort Lauderdale-based event and meeting planning company, anticipated this day since deciding they wanted a family almost three years ago.
Since only one of them had been allowed in the delivery room, Todd had waited down the hall and wrote in their journal: "It's kind of weird in the waiting room. I think I am in here with the surrogate's family. They keep staring at me. I think I might recognize her cousin, but not sure."
As Andy told Todd about their children, doctors stitched the surrogate's womb. With the money from her pregnancy, she would buy plumbing for her home to provide a better life for her own four children. The newborns were a couple of weeks premature and both over five pounds. They had to stay in the nursery to receive oxygen since they were born early and light therapy as treatment for jaundice. The surrogate recovered in the hospital for three days after the C-section, but she was kept separate from the babies to avoid attachment as hormones and emotions ran high.
Andy and Todd bore no scars, needed no physical recovery, and, with nowhere else to go, walked from the hospital to their temporary home, a nearby rented condo. They couldn't see Samuel Robert and Annabelle Rose until visiting hours the next morning, when one of them could enter the nursery. With the birth behind them, more challenges were ahead, including proving their paternity to immigration officials and bringing their babies home safely.
Having children this way was an unconventional process in the formation of a new kind of family. When Andy and Todd, who were legally married in Vermont, started the surrogacy process, it was illegal for gay couples to adopt children in Florida. Last September, a federal appeals court overturned Florida's law banning gay couples from adopting, but state law still requires legal marriage for surrogacy and does not recognize gay marriage. Andy and Todd found that one of the surest paths to starting a family involved traveling more than 1,000 miles to a Third World country and putting their faith and money in a process as uncertain as it is scientific.
Andy and Todd used an American egg donor, and both contributed sperm, meaning they could have each biologically fathered a child or one could be the biological father of both. The surrogate who gave birth shared no DNA with the twins, but in Panama, she was still considered the mother as indicated on the tags posted on the nursery baby beds, even though she signed paperwork outlining Andy and Todd's parental rights. A surrogate could, conceivably, demand that the children belong to her, but it is not clear whether that would stand up in Panamanian court.
"It's not an easy process," Todd said. "Straight folks don't know how good they have it... there's always an extra layer of paperwork for us that other people don't have to deal with."
The night before leaving for Panama, both men relaxed in the living room of their quaint two-bedroom Fort Lauderdale home as they recounted the years of leadup to the next morning's flight. Buddy, their mini-Dalmatian, rested on the couch, blissfully unaware that his canine antics would no longer be the center of their lives.
"It's really cerebral still. I don't think emotionally it's hit me yet," Andy said that night. "We're just really anxious at this point."
The expectant fathers had two binders heavier than newborns full of the paperwork and research they had prepared. Instead of spending the gestational period feeling the baby kick, Andy and Todd mulled over egg donor and surrogacy contracts with lawyers and spoke to another gay couple in Miami who had undergone the same process months earlier.
"I was sick the whole nine months — no, even before that," Todd said. He experienced his own nausea that was not limited to mornings.
"Todd's a worrywart. It's pretty much a miracle that I got him to do this," Andy said. If Todd is the worrier, Andy is the researcher, but both have the enviable quality of appearing well-rested even after a long day's work. Andy listens pensively and speaks in a manner both engaging and self-aware, while Todd draws people in with a wide smile and big hugs. "Put it this way: I'm the brains of the relationship. Todd's the heart of the relationship," Andy said. "That's just how we are."
Two large rolling suitcases sat by the front door, the way an expectant mother keeps a prepared overnight bag. Both pieces of luggage brimmed with bottles, diapers, clothes, and supplies.
The nursery in the next room gave way to their almost palpable anticipation. Two matching yellow-ducky robes hung in the corner. Above the crib, two colorful wooden cutouts with animals arranged around them read "Samuel Robert" and "Annabelle Rose." A plush rocking chair sat in the corner, waiting, and a soft carpet with zoo animals warmed the tile floor.
Throughout the process, they had a lot of firsts: decorating the nursery, buying bottles, seeing a 3-D sonogram. They admitted neither of them had ever even changed a diaper. "Ne-ver," Todd said, laughing. Their first baby shower, their own, with about 120 people, was shortly before Halloween with the theme "It Takes a Village People." Andy estimates that having twins required the direct help of about 45 others, not quite an intimate experience.
Less than a three-hour flight from South Florida, Panama is poised to increase in popularity as a destination for reproductive tourism. Surrogacy in India has already become so popular that a Today Show segment referred to it as a "commercial industry often described as 'wombs for rent,'" but it's a smaller, more understated industry in Panama.
Exact numbers are not recorded, but a State Department official noted an increase in Americans traveling abroad for what is called Assisted reproductive technology. The State Department must verify that children born from surrogates are biologically related to an American citizen in order to issue an American passport. The department's website has a page dedicated to international surrogacy that details risks, including that a disreputable clinic substitutes genetic material and the children bear no relationship to the prospective parents. This scenario, while extremely unlikely, could render the child stateless, neither an American citizen nor a citizen of the birth country.
Websites warn that in Panama, largely a Catholic country, same-sex couples may be turned down, but like the couple from Miami, Andy and Todd were never questioned or treated differently.
Laws governing surrogacy in the United States vary from state to state, but Florida law explicitly favors the couple who commissioned the process and excludes gay couples by not recognizing same-sex marriage. Even so, certain in-state in vitro fertilization clinics have a loose "don't ask, don't tell" policy, but others do not. Still, Panama is a significantly less expensive option and provides a degree of separation throughout the process.
As many couples do, Andy and Todd began their search for an egg donor online. They interviewed several women by phone, but one stood out to both of them, an American living and studying in Canada. The young woman, who is now 24 and asked that her name not be used for this article, reached out to them through a blog they had created to document the process of starting their family. After corresponding online and talking on the phone, Andy and Todd traveled to Montreal to meet her at an Ethiopian restaurant that she suggested.
"Loved her, absolutely loved her," Todd said, impressed with her confidence and lighthearted personality. The day after meeting her, they called and said they would love for her to be the biological mother.
Months later, after she had taken daily hormone pills to stimulate egg production, Andy and Todd flew her to Panama for the egg retrieval, a process by which a long instrument is inserted into the cervix and an attachment removes the eggs. Andy and Todd rented her a condo in the same building as their own and grew close to her over the ten-day trip. They admired her free spirit as she went through the process without hesitation, and they appreciated that she would answer questions quickly and easily.
The donor said she was exposed to the egg donation process when she was 16 and her mother's best friend could not get pregnant. "At the time, I really wanted to do that for her... but I was not old enough to do it," she said. Years later, she still felt strongly about helping couples have children. "I'm not using these eggs right now. The fact that I have that capacity — I feel really blessed and honored to do that," she said. She called "helping people" the ultimate reason for her choice but said that she would have waited until after college if it weren't for the money, which helped finance her education. Andy and Todd paid her $20,000.
Doctors at Punta Pacifica Reproduction Center in Panama City successfully implanted an egg in the surrogate. Andy and Todd told family and friends that the Panamanian surrogate was pregnant. Then in July 2009, less than two weeks later, Andy and Todd were in Vermont, where they were taking cooking classes for Todd's birthday. As they walked Buddy outside, the phone rang. It was their doctor calling from Panama. The pregnancy had ended in a miscarriage. They were stunned.
"It was enough to pique you with excitement and enough to completely disappoint you when it didn't take," Todd said. Once they regrouped, Andy and Todd flew the egg donor to Panama for another donation and used different surrogates for three more attempts, hoping for better odds. None of the implantations resulted in pregnancy. "We were really surprised how emotional it was for two guys who weren't physically having to carry a baby," Andy said. "That was really intense."
The thought of starting over devastated them, but Andy and Todd began the process once more, interviewing six egg donors, flying two to Florida to meet them. The next donor they found was a student at a university in the Midwest. "I really liked this intelligence and independence that she had. She was very confident. She had this great poise about her," Andy said. Though she declined an interview for this article, she agreed to meet the twins when they are older — something Andy and Todd required of their donor.
The first fertilization attempt with the new donor resulted in a pregnancy. "Our current donor — boom! — right away," Andy said. This time, Andy and Todd waited to tell their family and friends. A few weeks went by, and they told their parents, and then they spread the word gradually as weeks turned into months. Andy and Todd went to Panama at the end of the first trimester, when they met the surrogate for her sonogram. She was quiet and in good spirits, but Andy and Todd don't speak Spanish, and she didn't speak English, so they mostly communicated through facial expressions. Her 4-year-old daughter stayed by her side as Andy and Todd watched a 3-D image of their two children — a boy and a girl — floating in the woman's womb.
The doctor turned up the sound on the machine, and the unborn babies' heartbeats reverberated through the room. Then, that quickly, it was time to leave. Todd remembered feeling as though he were abandoning his children. "You feel just horrible that you have to get back on a plane," he said. Doctors called regularly to tell them that the pregnancy was moving along well, and Andy and Todd made another visit at the end of the second trimester, but they still felt disconnected, going about their lives while their children were developing so far away.
In the first trimester, doctors also conducted a prenatal blood analysis, testing for birth defects and abnormalities. The children were healthy and were developing normally, allowing the couple to exhale momentarily. But they knew that after the babies were born, they would face the challenge of getting them out of Panama and back to Florida. A laboratory would determine whose sperm fertilized which egg in order for them to prove their children's citizenship before they could bring them home.
The morning after the babies were born, Andy and Todd returned to the hospital. Since Andy sat in the delivery room, it was Todd's turn to see his children in the nursery. He expected to walk in and hold them immediately, but both Samuel and Annabelle were in incubators. "When I first walked in, it kind of takes your breath away a little bit," Todd said. "It was a little overwhelming to see them enclosed." The oxygen tubes, IVs, Band-Aids, and medical equipment struck him. It was not the ethereal scene he had anticipated.
Dressed in hospital scrubs to maintain the facility's impeccable cleanliness, he pulled up a chair between the two incubators where his children rested, monitored by machines and nurses and dwarfed by their Winnie the Pooh diapers.
Again, he had to cede control to the Spanish-speaking nurses, whom he had come to like but could barely understand. At the end of the day, he still could not hold either child and surely could not take them home.
Despite the uncertainties, surrogacy is becoming exponentially more popular, especially among gay couples, according to a Fort Lauderdale pediatrician, Dr. Amy Relkin, who said she has seen the number of same-sex couples with children in her practice triple in the past two years. Relkin, who cares for Annabelle and Samuel, said she has also seen an increase in the number of twins as a result of surrogacy, which yields a higher percentage of multiple births than traditional pregnancy.
The surrogacy process is reliable enough that it is gaining popularity but risky enough that the "what ifs" are still plausible. The couple from Miami who had already gone through surrogacy in Panama helped Andy and Todd through the uncertainty, passing along advice about everything from paperwork to the laid-back approach of South American medical professionals.
One of the men, Jack, a doctor, asked that his name be changed because he had adopted a child as a single father before the ban was lifted on gay couples. He explained that at first, he and his partner were uneasy about using a surrogate in Panama. "Even when we flew down there the first time... we weren't a hundred percent sure it wasn't all a hoax," he said. They had to pay more than $10,000 before the procedure began. "You have to take a leap... It wasn't until the first ultrasound that I really believed it wasn't some big, elaborate scam."
Surrogacy in Panama has one major advantage: It costs about $50,000 less than surrogacy in the United States, both couples estimated. Jack said that the whole process cost $85,000 but that he didn't choose Panama simply for the lower cost — the distance between the couple and the surrogate makes everything "a little more transactional," he said. He also knew that the money would vastly improve the surrogate's life. As it worked out, their surrogate was the same woman who would later give birth to Annabelle and Samuel. Doctors told Jack that she used the money from the procedure to buy a home — the same home for which Andy and Todd's surrogacy check furnished plumbing. Jack was also comforted by seeing that Punta Pacifica Reproduction Center is a top-of-the-line facility similar to the best American hospitals, with a well-educated staff and new medical equipment such as the 3-D sonogram.
He and his partner simultaneously pursued surrogacy in Panama and adoption in Florida. When Jack filled out adoption paperwork as a single man, it was hardly a lie, since Florida does not recognize the couple's marriage performed in California. Forty-five days before their surrogate gave birth in Panama in the summer of 2009, a Florida adoption came through, and they became fathers to a baby girl.
Soon afterward, they went to Panama to bring home her sister. When it came time for them to work with the U.S. Embassy to obtain a passport for their newborn, the process was more cumbersome than they had anticipated. Embassy officials told them they were the first couple to reenter the country with a child born this way, and they got the feeling that the State Department was developing the rules as it moved forward. Without warning, they were told they needed a paternity test. "You feel like a little demeaned by it," Jack said. "Like it's not good enough to say, 'This is my child.' Let's say some crazy mishap happened; she's still our child, so what was the point of the test?" Jack and his partner were clearing a path for couples like Andy and Todd.
Two days after the birth of Annabelle and Samuel, Andy and Todd returned to the hospital, and, finally, Todd held Annabelle in the nursery. He brought her up to the window for Andy. She was almost ready to come home. Samuel still needed oxygen in the incubator. He was improving day by day, but the fluid in his lungs at birth developmentally set him two days behind his sister.
Three days after the birth, Annabelle was discharged from the hospital. A nurse entered with a wheelchair to push Todd outside with the baby. "I was like, 'Do I sit? Do I stand?'" Todd said, recalling being treated like a new mother. He stayed awake most of the night with Annabelle, and Andy took over next. During their first morning as a family, Andy, who rarely cries, broke down. All of the buildup and worry seemed distant for a moment.
But with Annabelle in the condo in Panama, Andy and Todd became anxious about Samuel, still in the hospital but breathing better and becoming stronger every day. Andy still had not held his son. Finally, two days after Annabelle, Samuel joined his new family in their temporary home. Andy documented the babies' personalities in their journal. "Sam, quiet confidence, very sweety, snuggler... Belle, energetic, lovable, would sleep through a concert... "
The family, now complete, lived in limbo as they applied for certificates of birth abroad, social security cards, and passports and had to prove their paternity with DNA tests. The surrogate signed a form relinquishing her rights and allowing the children to obtain an American passport. If Panamanian authorities were to ask Todd if the children belonged to the surrogate before the paperwork was complete, he said, "I didn't know how to answer that."
Next up was the DNA test to prove that they fathered the twins. A week after the birth, Andy and Todd, with the babies in carriers, entered a space in the U.S. Embassy as small and stark as an interrogation room. A Panamanian lab technician swabbed their cheeks while an embassy official watched from behind a window. The tech passed the DNA samples to the official, who packaged them accordingly and sent them to an American laboratory to determine paternity.
A paperwork misstep could set them back days or even weeks, and they hoped to make it home for Thanksgiving. They were down to less than a week.
They tracked the FedEx package of their DNA on its route to the laboratory, followed up to make sure the lab received it, asked for the results to be expedited, and tracked the package of paternity paperwork back to the embassy. It was the day before Thanksgiving when the package arrived.
Andy went to the embassy to find that the gates were closed early. Knowing that the DNA results were there, he would not accept that they must wait four more days until after the holiday weekend. A few employees were still in the building, so Andy dialed the emergency number and explained his situation.
His persistence paid off, and an embassy official reviewed the test results. The twins were granted American passports. They were cleared for their trip home.
They booked a direct flight to Miami for the next day, Thanksgiving. Cautious not to get too excited, Todd worried that their documentation would be questioned at the airport. Every step of the surrogacy process had unexpected blips; surely the flight home would too.
They boarded the plane without issue, and the babies slept throughout most of the flight. As they exited, an American customs official told them, "Welcome home."
Todd's parents and Andy's father and his girlfriend greeted them at the airport. "You just want to cry," Todd said, his voice wavering. "You're done. You're emotionally just exhausted, tired, excited."
It had been Andy and Todd's eighth trip to Panama. "Panama and the whole process went into the back of my head — at that point, you're just dad," Todd said. When they finally arrived at their home, the same neighbors who hosted their sendoff breakfast brought over a turkey dinner.
After Thanksgiving, Andy and Todd were immediately engulfed by fatherhood, preparing for the babies' first Christmas with everything from silver pine cones hanging from the beams of the living room to a tall tree covered with colored lights. A week after Thanksgiving, they took the newborns for photos with Santa.
"Oh my God, we couldn't get to Santa," Andy said as he sat on their patio one Saturday in early December as Annabelle slept on his stomach in one of their matching Baby Bjorn carriers a friend bought them. "We probably had six or seven individuals or couples stop us, ask us about the kids, congratulate us, and we're a same-sex couple, so it's definitely — they know it, but they don't want to ask."
Todd continued, "This one Italian lady, she goes, 'How's the mama? Is she sleeping?' [Andy] goes, 'No mama. This is the other dad right here.'"
"This light went off in her head; she's like, 'Ohhhh, mazel tov!' She was funny," Andy said.
"They must know how much more work it is for two guys to have babies than it is the traditional way," Todd added, laughing.
"Pregnancy is certainly cheaper. There's no question about that," Andy said. The entire process cost them about $100,000, compared with the $150,000 he estimates it would have cost in America.
"Anybody who could have a baby should realize just how lucky they are," Todd said. "It's amazing."
The next day, Andy and Todd took Samuel and Annabelle to a holiday party for gay couples and their children at the Pride Center at Equality Park in Wilton Manors. On the drive there, Todd sat in the back seat of their jeep between the two car seats in his crisp, light-pink, buttoned-down shirt with a wide smile across his face. They were one of the first families to arrive at the crowded event, juggling baby carriers, a diaper bag, and a turkey Todd prepared for the potluck.
While Todd and Andy sat anchored at their table by the two newborns who slept through most of the party, a parade of parents approached them to peek at the 1-month-old babies. "Can I touch her? I promise I'll be very gentle," one woman asked Todd, fussing over Annabelle. "Of course," he told her.
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A more popular question that afternoon was, "Adoption or surrogacy?" The families traded tales of adoption as single parents, adoptions that worked out last-minute without warning, and long-term foster care as the children danced, played, and ate dessert, most of them too young to possess an awareness of what their parents went through to have them.
On the drive home from the party, Andy and Todd went a few blocks out of their way to pass a four-bedroom home in Wilton Manors that they were interested in buying. It was on a very pleasant block with a small park nearby and quiet streets so suburban that they looked perfectly fit for strollers and training wheels. The Bludworth-McNeills had outgrown their quaint downtown Fort Lauderdale home and would close on the home in Wilton Manors two weeks later.
When Andy and Todd pulled into their driveway after the party, the same neighbor who had hosted the breakfast when they left for Panama walked over to visit the babies. She stood in front of the two carriers guessing which newborn looked more like which father. Todd and Andy looked at each other and smiled as they laughed off the implied question. They knew the answer but couldn't care less.