It’s never been easy to be a working mother — before COVID-19, during COVID-19 or now, in the post-COVID-19 economy.

At the height of the pandemic, while mothers around the country juggled full-time work while essentially homeschooling their homebound children, the stress was off the charts and unsustainable. The struggle was heavily covered in the media, often by female reporters trying to file stories while helping their toddler make a Magna-Tile castle and signing their first grader into the sixth Zoom class of the day. 

But now, as we come into a new era of post-COVID-19 life, the shifting ground is creating a new and enormous stress for mothers, one that has been barely covered by the media who have moved on.

It’s what’s happened to the availability and cost of child care.

In the early spring, we heard about child care shortages, with stories emerging about the labor shortage and how the Biden administration hoped to alleviate the strain. NPR reported at the time, “So while overall in the economy we’ve recovered to within 2% or 3% of our pre-pandemic employment levels, the child care industry is still 11% or 12% below its pre-pandemic employment levels.

“And when you don’t have enough workers in child care programs, what happens, because of those legally mandated adult-to-child ratios, which are really important for safety and quality, is programs have to shut entire classrooms. In some cases, they have to shut entire programs. And so you’re seeing the capacity be reduced even more.”

Promises of federal help, however, failed to materialize, and soon the news cycle moved on. The child care problem remains with us, and it is especially acute for women who work in health care.

Even as our focus on our health care system has sharpened over the course of the pandemic, there has been little, if any, conversation about how the pandemic and post-pandemic child care crisis has affected health care providers, especially female doctors.

When problems with child care are discussed publicly, we often hear chiding from social conservatives who implore women to simply stay home and raise their own children. But do we really want to see every female doctor suddenly drop out of the workforce? What would that do to our health care system and standards of care in this country? The child care crisis is one that truly impacts everyone, whether we like it or not. 

In early September, the New York Post reported, “More mothers are self-employed today than before the pandemic — and a dire shortage of child care workers is largely to blame, a pair of studies show.” Unfortunately, medicine isn’t one of those fields where one can simply scale back hours or go into business for yourself. There’s no workaround for those in the health care industry.

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According to Patrick Brown, a fellow at the Ethics & Public Policy Center, these woes aren’t driving women from the workforce in higher numbers yet. He told me, “On the national level, I’m not seeing evidence that (child care issues are) systematically keeping parents out of the workforce. One big caveat is that these numbers work a little bit on a lag so it’s possible that stuff that’s happening now won’t show up in the data for a month or two.”

Brown went on: “The Federal Reserve estimated (in August 2021) that ‘the share of the population reporting as not participating in the labor market due to caregiving reasons has increased by 0.4 percentage point from February 2020 to August 2021.’ That’s not nothing, but it’s not a huge groundswell either.”

The numbers, however, don’t show the mental health strain and the difficult choices that mothers are making as they try to decide between their careers and a different path forward. There is little discussion or research into how all of these issues are impacting patient care and our health care system. Mothers working in health care are bearing this extreme burden quietly, buckling under the pressure. 

For example, a woman I’ll call Alexandra is a physician working in hospitals in the Washington, D.C., area. She is in desperate need of reliable child care for her 3-year-old daughter and 1-year-old son. Because of her long shifts and erratic schedule, she finds it necessary to have a nanny, instead of using a day care center. The problem is: She hasn’t been able to find anyone reliable or safe in the past year.

Her most recent nanny came from an agency that was supposed to check credentials and conduct a background check. When Alexandra’s husband tried to add the new nanny to their car insurance (she drives the kids to and from preschool and other activities) they discovered that their nanny had been driving with a license that was suspended thanks to multiple egregious moving violations.

The nanny before her was fired after a house camera showed neglect to such a degree that Alexandra didn’t feel safe leaving her children alone with her anymore.

Alexandra told me her husband is begging her to just quit working. “He just can’t deal with this crazy child care stuff. I’m seriously considering it.” After looking at their finances, Alexandra realized that the costs are often higher than her take-home pay, both in expected hourly costs and in the costs of having to line up alternate and emergency care, nanny agency fees and more.

But the choice to leave a career that she spent a decade studying and sacrificing for isn’t an easy one; Alexandra delayed her childbearing years in order to complete her training, which she told me “cost us tremendously in infertility, which is something about a quarter of physician women suffer from.” And it’s not easy to pause a medical career, between the loss of skills and medical licensing requirements. 

Alexandra put me in touch with another physician mother in Texas who counted at least 12 different nannies her family has employed over the course of the past year, who all left despite generous pay and benefits, often for retail work or other families willing and able to pay more than her family was offering. Because of the mom’s long hours, the family has to hire an au pair (who contractually is limited in how many hours she can work) in addition to their nanny. She told me they’re planning to bring in a second au pair “because the nanny care coverage for the other days (was unreliable); people keep not showing up or they were lying about their qualifications.”

The horror stories that I’ve been told include requests for $800 to $1,500 deposits at child care centers and yearlong wait lists, things affect all families, whatever field the parents work in.

Elizabeth, a neuropsychologist in Maryland, told me she goes back and forth about if staying at her job is worth it, both in the cost and the sacrifice it entails. Recently she was forced to pull her children, ages 2 and 4, out of their child care center because of significant concerns about their safety and well-being. She told me that the only places that had openings were ones that were simply “keeping my kids alive, and that’s it.”

“I had so many concerns even just about that. I questioned, ‘Are these really the people I want my children around?’” 

Alexandra, the doctor in the D.C. area, recently warned her boss that if she is unable to shift to more part-time work, she’ll be forced to quit altogether. For now, she said, “At the end of the day, I may have to give it all up. I love my children more than anything, and when push comes to shove, I am going to do what’s best for them.

“We’re kind of limping along right now, hoping that things get better, but if they don’t, what’s going to happen is the world will lose one more highly qualified female physician.” 

Bethany Mandel is a contributing writer for Deseret News. She is a home-schooling mother of five and a widely published writer on politics, culture and Judaism. She is an editor for the children’s book series “Heroes of Liberty.”