They arrive anxious for an answer. Or maybe, finally, a sense of peace. They arrive because they haven't been able to resolve the biggest question of their lives: Do I want to be a parent? And so they come to the California therapy practice of Ann Davidman - by plane, by car, by phone - in the hope that the self-titled "motherhood clarity mentor" might deliver an epiphany.

Next comes a simple instruction: Write down every fear, every loaded question, every disapproving comment and every panic-inducing headline that has coalesced into a stranglehold of indecision.

Will my mum be disappointed if I don't give her a grandchild?

What kind of world will my kid grow up in?

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Will I regret it if I don't have a baby?

Will I regret it if I do have a baby?

Then: "You put them all away in an envelope," Davidman says. "These are really important issues, but we just don't want to talk about them right now. When you're considering all those external factors prematurely without knowing what you want and why you want it, they just get in the way."

Parental indecision has been Davidman's area of expertise since 1991, when she and fellow therapist Denise L. Carlini created a group for those who sought help deciding whether to have a child. The pair co-authored a book, "Motherhood - Is It for Me? Your Step-By-Step Guide to Clarity" in 2016. And in the years since then, Davidman says she's found herself busier than she's ever been, as waves of 30- and 40-somethings - members of the so-called "xennial" micro generation, made up of the youngest members of Gen X and the oldest millennials - have realised that if they are going to make a choice about building a family, they should probably make it soon.

READ MORE: • Woman gives birth to six babies in 9 minutes

For members of this cohort, the decision might feel especially daunting. Studies and stereotypes have frequently branded them as burned out, beset by decision fatigue, prone to scrupulous self-examination. They struggle with analysis paralysis in their careers, and with FOBO (fear of better options) in their personal lives. They're waiting longer to get married, and so are more likely to confront a narrowing fertility window. Throw in subpar parental leave, exorbitant child-care costs, the looming spectre of climate change and a culture that has slowly grown more accepting of women who don't want kids, and there are plenty of reasons for deliberation. Which can sometimes spiral into anxiety and confusion.

Ann Davidman is a licensed marriage and family therapist. Photo / Ann Davidman
Ann Davidman is a licensed marriage and family therapist. Photo / Ann Davidman

By the time the angst-ridden turn to Davidman, they have typically exhausted other potential sources of insight. They've late-night-panic-Googled their way to every parenting blog and advice column and TED talk; they've read feminist essays by women who are proudly child-free. They've fielded nosey questions from relatives, sought advice from friends, made lists of pros and cons. Finally, they decide it is worth the time and cost (ranging from about $400 for an online group course to upward of $2,500 for one-on-one counselling) to have an expert help solve the problem.

But a motherhood clarity mentor is nothing like the well-intentioned auntie who coos, "Oh, honey, of course you should have a baby," or the sleep-starved mum friend who sternly warns, "If you're not totally sure, you better not." A parental indecision therapist isn't interested in adding one more voice to the cacophony. She wants you to learn to listen to your own.

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"My husband and I had a really good life, but the question just kept coming up," says Teri Vaziri, a 42-year-old human resources professional from California who had a son two years ago after working with Davidman. "I always bounced back and forth. We were reaching the end of what we assumed were childbearing years, and it just started to close in on us."

Until fairly recently, the question at hand - do you want to become a parent? - wasn't really a question so much as a pervasive social expectation. When Merle Bombardieri, a clinical social worker who specialises in parenting decision-making and wrote "The Baby Decision: How To Make the Most Important Choice of Your Life," held her first therapy workshop on parental indecision in Nashville in 1978, the attendees were deeply uneasy discussing their doubts.

"Nobody, in those first few years of workshops, actually knew anybody who had chosen to be child-free," Bombardieri says.

Like Davidman, Bombardieri has noticed more interest in her practice in recent years; there are often waiting lists for her course at the Cambridge Center for Adult Education. "Now, I think more people are willing to admit that they're not certain about whether they want to have children," she says.

But that doesn't mean they're willing to admit it publicly. When Annie Vought, a 41-year-old artist in Oakland, California, felt torn about whether to start a family, she searched for solidarity online. She found that voices like her own - wavering, ambivalent - seemed to be missing from the conversation.

Katie Wilson sought the help of a parental-indecision therapist several years ago and is now proudly child-free and at peace with her decision. Photo / Washington Post photo by Katherine Frey
Katie Wilson sought the help of a parental-indecision therapist several years ago and is now proudly child-free and at peace with her decision. Photo / Washington Post photo by Katherine Frey

"There is sort of a go-to expectation for women that is very old, that we are all going to get married and have kids and live happily ever after. And then there is a vocal group of women who are speaking out against that and saying, 'That's not my path, I'm going to do my own thing,'" Vought says. "But the middle ground area is somehow -" she sighs. "It does feel particularly embarrassing, because it feels sort of wishy-washy and almost sort of weak, which is ridiculous."

Davidman wants a future where this issue might simply be part of any conversation about women's health. Imagine, she says, if there were a line on the patient history forms you fill out at your doctor's office: Do you know whether you want to have children? Here are some resources to help you decide.

"Even when people call me today, they often say, 'I can't believe you exist,' and 'No one knows I'm calling you,' " she says. "The culture is changing - but very, very slowly."

The more abrupt change she's noticed, she says, is the psychological state of the clients who seek her out: "Anxiety is huge now," she says. "That's increased tremendously in just the last couple of years."

Family dynamics, relationship fears and fertility have long factored into the equation for Davidman and Bombardieri's clientele (a majority of whom are women, but the therapists also counsel clients across the gender spectrum, as well as couples). But these days, Davidman sometimes hears people bring up concerns about the current political climate and the prevalence of gun violence. Bombardieri's clients have voiced worries about climate change. Both therapists have heard would-be parents bemoan the tremendous cost of raising a child, especially for millennials whose financial stability was dealt a lasting blow in the 2008 recession.

Danielle Maihofer, 33, a philanthropic fundraiser in Chicago who is considering signing up for Bombardieri's course, was laid off twice after graduating from college, which she says affected both her career and her outlook in general: "Life planning in any way, shape or form was completely out of the question. It makes everything feel so shaky," she says. "I still feel that feeling of 'I could lose my job any day.' "

For Vought, who now has a 3-year-old son, "the state of the world just couldn't be overlooked," she says. She notes that her family lives in California, on the front lines of climate change: "It's scary to have a kid right now, especially where we live."

Even at a time with so many complicating factors, in an era when more people speak openly about seeking professional help in defining moments - marriage counsellors, career advisers, life coaches, grief support groups - Davidman and Bombardieri's work remains relatively obscure.

"There are only a handful of people in the world who take this issue seriously and who even know this is a real issue," Davidman says. When she tells people what she does for a living, they sometimes laugh.

"Whether or not to have a kid is perhaps the biggest and toughest choice of your life, because it's the only irreversible choice," says Stephanie Reyes, 42, who had a son after working with Davidman. "You can change jobs. You can move cities. You can get a divorce. But with something as big as whether or not to have a child, seeking professional help is completely appropriate."

There is one particular exercise from Davidman's class that Vaziri still uses whenever she struggles to make a decision.

"She had us live in the 'yes' for a week, and then live in the 'no' for a week, and write about everything that came up," Vaziri says. "I was so used to going back and forth in my head a million times a day, and never just sat with one answer. And it was so powerful."

For Katie Wilson, 40, a health-care management professional in the District of Columbia, who worked with Bombardieri several years ago, keeping a journal was especially illuminating.

"Merle said, when you have a feeling of excitement about being a parent, write that down in one colour. And when you're leaning toward, 'This is a reason I don't want to have kids,' write that down in another colour," she says. "After a while I realised that I was, about 75 percent of the time, using the color of the pen that symbolised not wanting to have a kid." She ultimately chose to be child-free.

And for Valerie, 37, who asked that her last name be withheld to protect her family's privacy, the revelations continued even after she finished her course with Davidman, having concluded that she didn't want to have a biological child. Her husband had always wanted to be a father, she says, and the sorrow of realising that their desires didn't align led them to conversations about other parenting possibilities. What if they could love and support a child without having a baby?

In November, the couple welcomed a foster child, a 15-year-old refugee, to their family. "The depth of love that I feel for this child has kind of bowled me over," Valerie says. "He's my son."

The most important thing, Davidman says, is for a couple to understand what they want before they decide what they're going to do. "It's more about having clarity than choosing one path over another," she says. "This process is not for the faint of heart, and it's not simple. It requires people to possibly face some very uncomfortable feelings."

Because the nature of the work is both temporary and profound, Davidman says her clients often feel compelled to stay in touch, to let her know what their lives look like as they make their choices and carry on.

"Sometimes, a year later, I'll get a picture of their dog," she laughs. "Or I'll get a picture of their baby."