'It's all settled on the right page' surrogates' feelings and reflections of surrogacy two decades on.

study questionHow do surrogates think, feel, and reflect on their experiences of being a surrogate over time? SUMMARY ANSWER: Despite continuing to require physical, emotional, and interpersonal labour, surrogates in this study reflected positively on their experiences of being a surrogate decades later. WHAT IS KNOWN ALREADY: Research on families created through surrogacy shows that it can be a positive experience for both the intended parents and the surrogate. No existing research has examined the experiences of surrogacy for surrogates beyond 10 years post-birth. STUDY DESIGN, SIZE, DURATION: Semi-structured, qualitative interviews were conducted with 21 women who had completed a total of 71 surrogacy arrangements. Participants had given birth to their first surrogate child on average 20 years previously. PARTICIPANTS/MATERIALS, SETTINGS

methodsData were collected about (i) surrogates' relationships with the families they had helped, (ii) how important being a surrogate was to their own identity, and (iii) how they felt surrogacy was perceived by the public. Data were analysed according to the principles of reflexive thematic analysis. MAIN RESULTS AND THE ROLE OF CHANCE: Surrogates' reflections on their experiences were constructed into two themes: (i) hard work but worth it and (ii) part of who I am. Surrogacy had taken a physical toll on some participants, and for most, being a surrogate continued to involve emotional labour and effort to maintain relationships with the families. Making friends through the process and feeling proud of what they had done to help someone meant that overall, surrogates reflected positively on surrogacy and had incorporated their experiences as surrogates into a stable aspect of their identity. LIMITATIONS, REASONS FOR CAUTION: There is a risk of selection bias, with surrogates who had a more positive experience being more likely to continue to participate in the research. All surrogacies occurred within the UK. While the sample is relatively diverse in terms of surrogates' ages, current employment status, and relationship status, the sample lacks ethnic diversity. Most participants had been surrogates for heterosexual couples, and thus long-term relationships involving gay couples or single men may differ. WIDER IMPLICATIONS OF THE

findingsThe findings from this study show the importance of understanding surrogacy as a 'relational' process and suggest to prospective surrogates and intended parents what they may expect from their relationship over time. Given the findings that even as the children grow up, being a surrogate continues to require emotional labour, support should be made available to surrogates over the longer term if required. STUDY FUNDING/COMPETING INTEREST(S): This project was funded by the Wellcome Trust [grant number 208013/Z/17/Z] and the University of Cambridge Returning Carers Scheme. The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER: N/A.