Parents have a lot to juggle even in good times, throw in a pandemic and it takes a toll.
"Just the idea of how am I going to adjust to this new world, but also adjust to taking care of a baby," said Tiffany Murray, therapist at Nature's Playhouse in Ferndale.
It's a concern Tiffany often hears, she leads free parent support groups and offers one-on-one counseling.
Throughout the pandemic, demand for her services skyrocketed.
"Much of what we talk about in this space, too, is a sense of safety and if we’re not feeling safe to become pregnant or safe to birth or safe to raise our children," she said.
For much of 2020, many didn’t feel safe.
While the birth rate in the U.S. has been on a steady decline, in 2020, that rate dropped significantly with 4 percent fewer births than 2019, a record low for the U.S.
Despite talk of a possible COVID-19 “baby boom," when you compare December 2019 to December 2020, 9 months after the pandemic began, births declined by about 8 percent.
It makes sense to Dr. Danny Benjamin at Huron Valley Sinai based upon state restrictions at the time.
"Virtually for 8 weeks, we were only seeing people who were already pregnant ... most patients were putting off everything," said Dr. Benjamin.
Towards the end of 2020, they felt the impact.
"We deliver like 80 to 90 deliveries a month and we have a couple months where we were down to 60, 65 which was a 20 percent reduction," he said.
The big question now: will birth rates bounce back?
"We are seeing a 20 to 30 percent increase in our births over the next two to three months. I mean we are getting ready for a big big boom," said Dr. Brian Torok at Troy Beaumont.
He said he doesn’t expect the baby boom to last long.
"If you look at the data, there’s been a 60 percent decrease in the birth rate in teens since 2007 and about a 40 percent decrease in the birth rate in women in their early 20s," said Dr. Torok.
Dr. Benjamin says, "I see plenty of the patients in the office and they have no intention of having children."
For some, school debt feels overwhelming.
"They’re just trying to figure out, 'how am I going to afford to raise a kid when I’m still trying to control the costs that I have already incurred,'" said Dr. Benjamin.
There’s also been an increase in infertility issues that started long before the pandemic.
A 2017 Harvard study of 325 women in fertility treatment found that men and women who ate fruits or vegetables with high pesticide content were 26% less likely to have a live birth and 18 percent less likely to get pregnant, for example.
So the birth rate decline is a multi-layered issue with big potential economic impact.
"If you have fewer people having fewer children, your labor market starts to shrink," said Matthew Roling, an economist at Wayne State University. "That places a huge obligation today to support the retirement, pension and health care of the people who are trying to retire tomorrow."
To forecast our future, he points to Japan, a country with a birth rate declining faster than the United States. As a result, Japan’s population declined 1 percent in a 5 year span.
"That might not seem like a big number, but if the United States lost 1 percent of its population, that would be almost 4 million people, the would be the equivalent of Philadelphia and Phoenix going away," said Roling.
So what will it take to see the birth rate in the U.S. rise again?
Perhaps more support groups like those at Nature's Playground and more parent friendly workplace policies so women don’t have to choose between working and being a parent.
"Women want to have careers, but we also want to have families and the expectation of what does that look like and how do we balance that," said Tiffany.