The Complex Choice of Parenthood

Choosing to become a parent is, without a doubt, one of the most significant decisions someone will face. It’s really a leap into the unknown—no one can truly predict what being a parent will entail.

Many hopeful parents express concerns about issues like financial instability, global issues, and the challenge of balancing work and family life. This is especially true for those dealing with mental health struggles, as the decision can feel even more complicated.

In April, The New York Times reached out to readers to explore how mental health has shaped their views on parenthood, and nearly 700 responses poured in. Quite a few shared worries about potentially passing on mental illness to their children or managing their mental well-being while raising a family.

One reader noted, “I feel utterly ill-equipped to raise a child when I often struggle to take care of myself.”

Some were decisive about not wanting to take those risks, while others were unsure. A few shared how, despite their apprehensions, they ultimately felt ready for parenthood.

Some researchers are investigating how adults with various health challenges consider becoming parents. Their findings indicate that both physical and mental health factors significantly influence reproductive choices. For instance, one 2025 study found that participants who perceived their mental health as poor were less likely to envision themselves as parents.

We connected with four couples and one woman contemplating single motherhood to explore their experiences of managing mental health while facing the life-changing decision of having children.

Still Trying to Decide

Courtney Kramer and Charlie Enders from St. Paul, Minnesota, find themselves grappling with their desire for kids against the backdrop of anxiety and depression.

Both aged 34, they enjoy time spent with their niece and nephews. When the kids are especially sweet, Kramer describes feeling a “warm, fuzzy feeling.” This often occurs during quiet moments—like reading together or cuddling up for their favorite movies, including classics from the “Godzilla” series.

In those moments, Kramer can envision having her own children. But then, thoughts of her anxiety and depression creep in, making the prospect of becoming parents seem daunting.

Enders has been receiving treatment for depression since he was 18, and he shares similar concerns.

Even though both find some relief through medication, they face tough days, as Enders points out: “It’s hard to take care of yourself. Adding another person depending on you can be frightening.”

Kramer’s depressive episodes can strike unexpectedly. During those time frames, even basic tasks feel overwhelming. She wonders, “If I’m sitting on the couch feeling out of it, how could I care for a child?”

Research shows that anxiety and depression can run in families. Some of Kramer’s relatives also take antidepressants, which adds to their fears about a future child potentially facing similar issues.

Currently, they remain undecided about parenthood. Enders is willing to let Kramer take the lead; if she decides to try for children, he’s on board. However, if she opts out, he’s fine with that too. “I’m happy with just us,” he mentions.

A Difficult Transition to Parenthood

Aimee Bui and Tommy Bui from Los Angeles chose to have children, but shortly after, Aimee’s anxiety and depression intensified during the first year of parenting.

Aimee, 39, struggled with the decision. Having been diagnosed with anxiety and depression as a child, she worried her children might endure similar pain and that she might hold herself responsible.

In contrast, Tommy, 40, remained optimistic. He felt that with proper support, they could navigate the challenges ahead.

They decided to move forward and soon became pregnant. The couple was at a routine check-up when they received surprising news: they were expecting twins—shocking, yet thrilling.

“We prepared as best as we could for the ups and downs of pregnancy,” Tommy explained. They sought perinatal counseling to help them adjust.

However, Aimee continued her antidepressants. By the second trimester, she felt increasingly down, and by the third, physical issues like sciatica and high blood pressure set in.

In the weeks following the twins’ birth, Aimee experienced overwhelming fear and sleepless nights, often feeling a sense of impending doom. “It felt like chronic panic,” she admitted.

With her parents offering financial support for a nanny and joining a new mothers’ support group, Aimee’s psychiatrist increased her medication dosage.

Today, the twins are 11 months old, and Aimee feels a sense of returning to her former self. Tommy has noticed the positive change as well.

He described their journey as an “emotional roller coaster,” noting, “But we’re in this together, and that’s what matters most.”

Feeling as if Time Is Running Out

Liz Robinson from Seattle always envisioned herself as a mother, but managing her mental health makes that path feel complicated.

At 42, Liz jokes that she operates on her own timeline, often being late to events and missing milestones she thought she would reach sooner—like motherhood.

“Being a mom was my biggest aspiration,” she said. “I couldn’t fathom a future without kids.”

However, the right partner never came along. At 39, she opted to freeze her eggs, yet now at 42, she feels time slipping away.

She has explored the idea of using a sperm donor but is hesitant about raising a child solo. For Liz, deciding to move forward feels like a particularly tough choice.

“There’s a conflict between my heart and my mind,” she observed.

She worries about how her mental health would be impacted during pregnancy. Could heightened anxiety or depression affect her baby’s development?

Questions about medication safety during pregnancy and the potential for postpartum depression plague her thoughts. The idea of passing on her mental health challenges weighs heavily on her.

“Do I want to impose this on someone else?” she pondered. “I didn’t choose these inheritances.”

Ultimately, she worries whether she could handle the intensity of love and vulnerability required in parenting. “I’m such a sensitive person—I can’t even imagine it,” she shared.

An Unexpected Path to Parenthood

Mental health issues influenced Jess and Courtney Faust from Macungie, Pennsylvania, in deciding who would be their child’s biological mother.

For Jess, 35, mental illness has been a constant part of her life, starting with panic attacks at age six. She turned to self-harm to cope.

Diagnosed with bipolar disorder and generalized anxiety disorder, Jess still dreamed of having a child. “I thought I’d marry a man and have my biological child, and that child would probably inherit some mental illness,” she reflected.

Then she met Courtney.

“I was 24 when we started dating, and she was the most wonderful person I’d ever met,” Jess recalled. “It was an easy choice.”

They married and began discussing children. While Courtney, 37, has her own anxiety issues, they were less severe than Jess’s.

Considering Jess’s mental and some physical health hurdles — such as lupus and a genetic mutation linked to increased breast cancer risk — they concluded it made more sense for Courtney to carry the pregnancy.

Although Jess occasionally felt a pang of envy watching Courtney experience pregnancy, such feelings quickly faded. Upon their child’s birth, she felt nothing but pride, exhilaration, and relief knowing her child would not share her genetic predispositions.

Deciding Parenthood Wasn’t Right

For Jim and Patricia Gatewood of Walnut Creek, California, mental health was the primary concern in their decision not to have children.

Jim, 53, and Patricia, 52, married later in life—he was 41 and she was 39. Often, Patricia felt the pressure from others. Friends and co-workers frequently inquired about their plans for children, while Jim’s mother even knitted a baby blanket without being asked.

They briefly considered conceiving but quickly realized that Jim’s history of obsessive-compulsive disorder (O.C.D.) was a significant concern. His family had found relief through medication, yet Jim continued to struggle.

Their fears centered around Jim’s incessant obsessive thoughts. During anxiety-driven moments, he could spiral into catastrophic thinking. “I often think about my own mortality,” Jim revealed.

Even with therapy, supportive groups, and medication, he still found it difficult to quiet his mind. Recently, amidst various stresses, he hit a breaking point while studying for exams as a psychiatric nurse practitioner.

Patricia recognized the signs immediately: “He was physically present, but mentally unreachable,” she explained.

Ultimately, they decided against having children, instead choosing to focus on their careers. Patricia transitioned into nursing from technology.

Neither has any regrets. Jim reflects on O.C.D. as a difficult condition to manage, and he didn’t want to pass that burden to a child. They’ve come to feel that, while children can bring fulfillment, their lives are already complete.