I get a lot of questions on TikTok, but one of the most common over the last year has been some version of: “How did you have a baby?”‍

‍For a long time, I wondered if my indecision around parenthood was unnecessary — if I was overthinking something that so many people seem to do without much deliberation at all. It’s been surprisingly validating to realize how many others living with chronic illness are sitting with the same questions, weighing the same concerns, and wanting to approach this decision with care.

‍I’ve written before about how chronic illness and parenthood mirror each other, and how recognizing those similarities helped me see that I was more equipped than I initially thought. This post is more practical.

‍The reality is that many people don’t think very hard about having children. They decide (or life decides for them), they do it, and life works itself out. I can respect that approach, but chronic illness has a way of fogging your lens.

The idea of being a parent feels heavier when there are days you struggle to hold a toothbrush.

‍I want to honor the journey my husband and I went on, and the journey so many others are on now, by reflecting on how we made this decision and the steps we took to make it happen. The following is a step-by-step framework of how we made it happen. I hope it can serve as a guide as you think through what parenthood might look like for you.

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1. Decide What You Want Your Daily Life to Look Like

Most people describe a “good life” by pointing to achievements and milestones. But life is actually lived in the ordinary rhythm of each day. What matters most is your daily reality — the things that actually determine your capacity for happiness: how much sleep you get, whether your job gives you anxiety, if you’ve talked to friends lately, if you have it in you to cook one. more. meal. This is the stuff that fills 99% of life.

Chronic illness doesn’t necessarily steal your happiness, but goddamn it makes it a lot harder to come by. I’ve come to think of myself as a Gardener of Happiness — I plant little seeds, tend the soil, and pull the weeds that crowd out the good stuff. In some seasons I work sun up to sun down, in others I sit back and reap the harvest.

In the same way, I don’t think parenthood has to steal happiness either. We just have to define what happiness could look like when life is filled with illness and children and the other constants.

Before having a child, it’s important to get clear on what you want an ordinary day to look like for you:

• How much rest does your body need?
• What pace of life feels sustainable?
• What helps a day feel calm rather than overwhelming?
• How much alone time do you need with your partner?

Your daily life is the container everything else lives inside. When that container is shaped intentionally, it becomes much easier to build something that actually feels livable.

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2. Be Honest About Reality

A lot of people equate honesty with pessimism, but I truly believe that honesty is freedom. Honesty helps you define boundaries and set expectations. So much of parenthood is defined by an expectation — the expectation that you’ll have help, the expectation that your child will sleep, etc. When you see your life for what it is, rather than what you wish it were, you can plan for a future that won’t completely knock you on your ass.

That honesty needs to include:

• the current state of your body
• your mental health
• how your partnership actually functions
• whether your support system is reliable or just hopeful

I have a TikTok about the beauty of an unknowable future. Sometimes we can be so sure that our future will 100% suck or will be 100% perfect. The truth is that our future is a weird mix of both, and the beauty of not knowing what tomorrow holds is that it makes our present all the more manageable. Take stock of what’s in your hands now.

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3. Take That Reality Seriously

Once you’re honest, the next step is allowing that honesty to shape your decisions. For my husband and I, it meant waiting years into marriage before starting a family. I want you to see exactly how reality shapes decisions, so I’m going to give some very specific examples:

• I have a chronic illness and some days I can barely care for myself + We live 8 hours away from family = We need to live closer to family.

• Flares come on quickly and are unpredictable + My partner commutes 3 hours one way to work = He needs a job closer to home with flexible hours.

• Clutter makes us both anxious + Caring for a dog and baby at the same time would be easier if we didn’t live in an apartment = We need to find a larger, single-family home to rent.

We knew we needed to be near family, have more flexible jobs, and work with a rheumatologist who truly cared about my wellbeing before entering parenthood. For you it could mean:‍

• waiting until work is more flexible or you have better benefits
• having explicit conversations with your partner about labor and responsibility
• confirming what support will truly be available
• thinking carefully about postpartum recovery, not just pregnancy or birth
• finding a care team that truly has your back

We could have had a child without completely changing our lives, but I can now attest that every single decision has paid off already.

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4. Make a Plan With Your Partner

Quite a few people made comments about how much my partner and I planned for parenthood, remarking that life was life and our plans won’t work out the way we think. But for us planning is more micro than that. Planning meant getting down to the hour-by-hour, play-by-play of how we wanted our days to flow.

Our plan included:

• How responsibilities would be shared — everything from cooking meals to caring for the baby during the night.

• What support looks like during flares — how severe a flare needs to be before we call for help, and how much PTO my husband should reserve.

• Coordination between doctors and specialists — am I clearly communicating to my rheumatologist what my OB says I need, and vice-versa? Do they both know my goals and desires for future care?

• Mental health — we know I have a pre-disposition for depression and anxiety, how can we anticipate needs for medication and professional help? What signs will my partner look for in postpartum that I could miss?

• Postpartum recovery that extends beyond the first few weeks — how will we share responsibilities once my partner goes back to work? How will we deal with sleep regressions?

‍This planning should be collaborative. Chronic illness requires partnership and parenting certainly isn’t something to carry alone. Shared understanding lightens the mental load in ways that matter deeply over time.

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5. Share the Plan

Support works best when expectations are clear. There’s a saying that people can’t perform in a play they didn’t audition for, as in, you can’t expect family and friends to help in a certain way if you never communicated your needs to them and they didn’t agree to it. It’s imperative you ask people about the roles you’re expecting them to fill.

‍Sharing your plan with:

• family and friends
• doctors and care providers
• anyone who may be part of your support system

…helps people show up in ways that are actually helpful. Sometimes, the people that love us are dying for a chance to help but they’re unsure how. Close all the loops by having these conversations.

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A Final Thought

Having a chronic illness doesn’t make parenthood impossible — or even inherently harder. In many ways, it prepares you for it. Living with limits teaches you how to slow down, how to plan ahead, how to ask for support, and how to prioritize what truly matters. Those skills translate beautifully into parenting. And remember, parenthood isn’t a requirement to living a beautiful life. You may discover through all of this planning that having children just isn’t right for you, and what a gift it would be to learn that now instead of later.

P.S. I have always loved and used the em dash — and will continue to do so even though it’s now synonymous with ChatGPT. ✌️

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