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?
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" microgeneration, 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.
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.
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 nosy 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.
"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."
Family dynamics, relationship fears and fertility have long factored into the equation for Davidman'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.
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 colour of the pen that symbolised not wanting to have a kid." She ultimately chose to be child-free.
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."
This is an edited version of a story which first appeared on The Washington Post.