How mental health can complicate the decision to have children

Many were certain that they did not want to take the risks. Others were wavering, undecided. And some explained why, in the end, parenthood felt like the right decision.

Some researchers are beginning to study how adults with challenging health conditions weigh parenthood. Their work suggests that physical and mental health concerns are crucial in shaping fertility plans: in one 2025 study, participants who rated their mental health as poor were more likely to report a lower likelihood of becoming parents one day.

We spoke with four couples, and a woman who is considering becoming a single mother, about what it’s like to have mental illness while navigating one of life’s biggest decisions: whether to become a parent.

Courtney Kramer and Charlie Enders of St. Paul, Minnesota, are weighing their desire for children against the challenges posed by anxiety and depression.

Courtney Kramer, 34, and her husband, Charlie Enders, 34, both enjoy spending time with their niece and nephews. When the kids are being especially sweet, Kramer said, she gets a “warm, fuzzy feeling”.

It happens when they’re having quiet time, reading books together or snuggling up to watch their favourite movies, like the Godzilla franchise from the ’50s and ’60s.

In those moments, Kramer can imagine having children of her own. But then she thinks about her anxiety and depression, and the decision to have kids seems less appealing.

It’s a similarly difficult decision for Enders, who has been in treatment for depression since he was 18.

Although they both benefit from medication, they said, they still have rough days.

“It’s hard to take care of yourself,” Enders said. “Adding another person that’s entirely dependent on you can be scary.”

For Kramer, depressive episodes can happen out of the blue. And during one, doing the bare minimum feels like a chore. If she’s suddenly “sitting on the couch catatonic,” she added, how would she care for a child?

Studies suggest that both anxiety and depression run in families. Other members of Kramer’s family are also on antidepressants – and the couple worry a future child might develop their disorders.

So, for now, they remain undecided.

Enders said he would let his wife take the lead. If she decides she wants to try, they’ll go for it. He believes he would be a good dad. But if she decides against it, he’ll be okay with that, too.

“I’m happy with just me and her,” he said.

Aimee and Tommy Bui of Los Angeles decided to have children. Her anxiety and depression flared in the first year.

For Aimee Bui, 39, the decision to have children didn’t come easily. Bui, who was diagnosed with anxiety and depression in childhood, feared that her future children would experience the same suffering she did, and that she would blame herself.

But her husband was more optimistic. With the right supports in place, he was sure they could manage.

So they decided to try, and quickly became pregnant.

The pair were at the gynaecologist’s office last year for a routine early pregnancy check-up when the doctor paused, looked at the screen and grew quiet.

They weren’t having one baby, the doctor explained. They were having two. It was shocking news, but also exciting.

“We took every precaution we could and tried to get in front of the travails of the pregnancy,” Tommy Bui, 40, said. “We arranged perinatal counselling and prepared ourselves for the emotional slings and arrows.”

During pregnancy Aimee Bui continued taking her antidepressants, but in the second trimester, she began feeling increasingly depressed. By the third trimester she was experiencing debilitating sciatica, high blood pressure and pre-eclampsia.

Then, in the weeks after the twins’ arrival, she found herself racked with fear. She barely slept. Sometimes she found it difficult to breathe.

“It was like a sense of doom. Like it was the end of the world,” she said, adding that it felt like “chronic panic”.

Her parents offered to help pay for a nanny, and she joined a support group for new mothers. Her psychiatrist also increased her antidepressant dosage.

Today, the twins are 11 months old, and Bui said she was starting to feel like her old self again. Her husband said he had seen the change, too.

Liz Robinson of Seattle has always wanted children – but it feels difficult to choose that path while also managing her mental health.

Liz Robinson, 42, likes to joke that she runs her life on a different clock called “Liz time”.

Robinson, who has both attention deficit hyperactivity disorder and a history of severe depression and anxiety, is often late to appointments and gatherings. And there are rites of passage that she assumed she would experience earlier, but hasn’t yet.

One of those is having children.

“The thing that I wanted more than anything was to be a mum,” she said. “I could not even begin to conceive of a future in which I didn’t have kids.”

But the right partner never materialised. As time passed, she decided at age 39 to freeze her eggs. Now at 42, she is still single and feeling as if time is running out.

She considered the possibility of getting pregnant with the help of a sperm donor but isn’t sure that she should choose to raise a child by herself. For Robinson, the decision to move forward isn’t a simple one.

“There’s this divide between my heart and my brain,” she said.

She wonders how her mental health will change during the pregnancy. And if she’s more anxious or depressed, could it affect the development of the baby?

She worries about whether it’s safe to take her medications while pregnant and whether she will develop post-partum depression.

She also ruminates on the possibility of passing on her mental health struggles.

“Do I want to force this on someone else?” she said. “I didn’t ask for all of these things that I inherited.”

And she questions whether she could handle the fierce love and vulnerability that accompanies parenting.

“I am such a sensitive, emotional person that I can’t even imagine having that,” she said.

Mental health concerns helped Jess and Courtney Faust of Macungie, Pennsylvania, decide which of them would be their child’s biological mother.

Mental illness has been a constant for Jess Faust, 35, ever since she started having panic attacks at 6 years old.

Her brain felt chaotic. As a child she would peel the skin on the bottom of her feet, pull out her hair and pinch her stomach to distract herself from her psychological pain.

At 21, after she voluntarily admitted herself to an inpatient mental health clinic, her psychiatrist diagnosed her with bipolar disorder as well as generalised anxiety disorder, which she had also been diagnosed with in her youth. None of this stopped her from wanting a child, however.

“I assumed I would marry a man,” she said. “I assumed I would have a biological child. And I absolutely assumed that as a result, that child would develop some kind of mental illness.”

Then she met Courtney.

Jess was 24 when they started dating. “She was the best person I’d ever met,” she said. “It was a no-brainer.”

They married and started talking about the possibility of having children. While Courtney, 37, has experienced anxiety, too, her symptoms were less severe.

In the end, given Jess’ mental health issues and some of her physical health problems – she has lupus and the BRCA2 mutation, which raises breast cancer risk – they decided it made more sense for Courtney to be the biological mother of their child, and to carry the pregnancy.

At times Jess felt jealous, “watching Courtney go through this beautiful life experience,” she said.

But those feelings didn’t linger. Once their child was born, Jess said, “I felt nothing but pride, exhilaration and liberation at the fact that my daughter was now officially mine, and free of my genetics”.

For Jim and Patricia Gatewood of Walnut Creek, California, mental health was the top concern.

Jim Gatewood and his wife, Patricia, married in midlife: he was 41, and she was 39.

Patricia Gatewood sometimes felt pressured by other people’s expectations. Friends and co-workers would ask whether she and her husband wanted children. Jim Gatewood’s mother, unprompted, knitted a baby blanket.

They considered trying to conceive. But their top concern, Patricia Gatewood said, was her husband’s history of obsessive-compulsive disorder, or OCD, a diagnosis shared by his mother and another family member.

While his family had found relief with medication, Jim Gatewood, now 53, struggled with his condition. He couldn’t seem to escape his obsessive thoughts. He often catastrophised. When he had stomach pain, a frequent problem, he wondered whether it was pancreatic cancer.

“I’ve thought so much about my own death,” he said.

Even with therapy, a support group and medication, it could be hard to stop ruminating.

A month ago he had a flare-up. Gatewood, a nurse practitioner, was juggling final exams – he is training to become a psychiatric nurse practitioner – and teaching graduate students.

Patricia Gatewood, now 52, could quickly tell something was wrong.

“He was physically here, but mentally in a separate space that I couldn’t reach,” she said.

Ultimately, having a child didn’t feel right for the couple. Instead, they each decided to invest in their careers. Patricia Gatewood transitioned into nursing from the tech industry.

They have no regrets.

OCD is difficult to live with, Jim Gatewood said, and he didn’t want to pass down such a painful disorder to a child.

And while children can be a blessing, he said, they already feel that they live a full, rich life.

This article originally appeared in The New York Times.

Written by: Christina Caron

Photographs by: Ben Brewer and Sasha Phyars-Burgess

©2026 THE NEW YORK TIMES