May 2004

For parents working outside the home, the importance of good and reliable childcare cannot be overstated. Without stable childcare arrangements, you cannot go to work. If you ever had to stay home unexpectedly due to a sick child or a sick nanny, then you know how disruptive this can be. Turnover in childcare arrangements, whether planned or not, can also cause turmoil, resulting in frantic rearrangements of schedules and anxious phone calls to friends and neighbors. The psychological and emotional peace of mind that comes from knowing that your child is safe and thriving enables you to focus on work and be more efficient.

This article is not about whether it is right or wrong for mothers to work outside of the home. First of all, let me say that I strongly believe the phrase "working mother" is redundant. Every parent works, whether at home or outside. Every parent needs to find what works for their family according to their own beliefs and needs. I had my first child the year I moved to San Diego to start my first independent faculty position. There was never an issue of whether I was going back to work. In addition to wife-physician-scientist, I would simply add "mother." To be honest, I vastly underestimated how difficult it would be to find consistent and reliable childcare. Although we had no family living in town, there seemed to be so many options both live-in and live-out. I just had to find Mary Poppins, that's all. It would just take a little research and determination.

For the first seven years of her life, my daughter has known and been cared for by three nannies, a few babysitters, my mom and my mother-in-law. I wish I could say that all our nannies were clones of Mary Poppins, but while they were all nice and genuinely cared for my children, they varied in their quality of care. For instance, there was a six-month stint in a family daycare center that was highly recommended by a neighbor. The caregiver was bubbly and caring. The facility was clean and filled with toys. We thought that this would be a good opportunity for our child, who was 18 months at the time, to be with other children. She cried everyday when we dropped her off. We initially believed that she just needed to get used to the place. Although she always appeared to be happily playing when we picked her up in the evening, she was never enthusiastic about going. To make a long story short, in hindsight, I think that she was just bored. Although we intended that she have playmates, we didn't stop to think about whether she would actually get along with the other children there. As it turns out, there was an infant girl and three very active boys also being cared for at this home. Our daughter just didn't bond with any of them.

I also did not realize how difficult it was going to be to leave my child in order to go to work. No amount of preparation or rationalization can prepare you for the overwhelming guilt of leaving your child with a caregiver. In addition to the mother instinct, there are the cultural, emotional and biological expectations of being a mother. No father is ever thought to be a bad father because he works outside the home, but there is always the lingering sense of guilt of not being a "good" mother when you leave your baby in the care of another. In my case, I didn't have to work because of financial considerations. So was I being selfish in wanting to go back to work?

To make matters worse, I soon realized that we were not just looking for a babysitter. We were looking for someone who was going to be helping us raise our daughter. And that is what makes finding good childcare such a special issue. An employee who is not reliable or frequently late may wreak havoc on your schedule, but hiring a bad childcare worker raises the additional prospect of traumatic emotional and physical consequences for your child. And having never raised a child before, what exactly was I going to be looking for? Someone "nice?" Fun? Young and physically more active? Or older, but more sedentary? What about discipline issues? Who was going to be able to love my child but not compete with me?

Over the years, I have learned to incorporate this new role of mine into my identity, to trust my instincts and find my own balance between my various jobs in life. I am as much Madeleine and Emma's mother as I am a staff physician and research scientist at the VA. While this article cannot define parenthood for you, I hope that it makes the process of finding good childcare a bit easier.

Be sure to come back next month for Part II.