More Than Help: Dr. Alexandra Stockwell on Building Childcare Relationships That Feel Like Home

Hey Doc,

In this bonus episode of Stethoscopes and Strollers, Dr. Alexandra Stockwell returns to talk about one of the most vulnerable and underdiscussed parts of motherhood for physicians: inviting someone else into your home to care for your child.

She shares:

• What it was like to welcome a 17-year-old “au pair before its time” into their small apartment
• How she mentored both of her early nannies with warmth, patience, and real expectations
• Why daily appreciation not just correction is a non-negotiable part of how she led at home
• And how those early childcare setups shaped her values around trust, communication, and shared growth

If you’ve ever felt guilty about needing help at home or questioned whether your childcare setup was “good enough”, this conversation will meet you right where you are.

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Transcript

Okay, so take me to the transition back into medical school as now a  fourth year. How did that go?  

Okay, well, the main thing of relevance that I remember about fourth year of medical school  is that we spent sometimes three hours Sunday evenings going through our schedules We, we had, um, actually a really good friend of mine came and was Josephine's nanny during that year. Although 

I was about to ask, yeah, 

 She was a good friend.

She was between things. She moved right near us and, but she started in August. So we had a gap in July and, my mother actually knew someone whose daughter was a, I think she was a senior in high school, a rising senior. And so she came and lived with us for a month. and so she was Josephine's first nanny for that first month.

And that was a little complicated because we had a small two bedroom apartment. And Josephine was in one bedroom, we were in the other. And so we basically hung a sheet in our living room. And that was her bedroom. and she was young. And, you know, so. I think it was sort of like having an au pair without any of the typical restrictions and requirements of their own space and all that sort of thing.

We had one bathroom that the three of us shared and, um, basically folded her into our family and  she was like an older sister who was super responsible. Although, I remember the first few days Josephine cried when she was alone with her and it scared her. And so I needed to say, you know, you'll get used to it, like, there's no shortcut, there's no way to avoid that., I'm sure we did not pay her very much, I don't remember what it was, but it was very low. But, she ate all of her meals with, she just was part of our family, which  completely worked, because it made for, just an easier transition for Josephine. it didn't feel like shift work in, which was a much easier transition for me also.

And the main thing that I remember is that, so when we, when Rod and I did our fourth year schedules, we had to go to quite some lengths to coordinate so that, um, we  weren't both doing Q3 overnights or whatever. And so Sundays we would get our calendars out. And  go  through every single day of the week.

Okay, what time do you need to leave on Monday? What time do I need to leave? Okay, so then the nanny needs to be here at this time. Okay, what time do you expect to be getting home? Oh, not till the next day? Okay, I'll be home  by this time probably.  So that I could send the nanny the schedule for the week.

But also, every single  day,  Rod and I needed to be coordinating, if Josephine was sick, which one of us was going to walk off of our rotation? And so like when he was in the CCU and I was doing outpatient family medicine, then obviously that was me. But it wasn't always so obvious,  especially I did an ophthalmology rotation and I had to drive a distance.

So even though it would have been good for me to be that, I was an hour away and it It was incredibly intricate. And in the end, she was never sick, so we never needed to activate this, but we had it  in Right, we planned. Every single day. And  while this sounds sort of like a logistical nightmare, I completely don't think about it that way.

Because having to do the logistics that way, because we were both fourth year medical school students, I knew his experiences and responsibilities were really important. Mm hmm.  And I knew mine were, and he knew mine were, and his were, and both of us  in those days totally tended towards being people pleasers. 

And if we weren't both medical students, I think  there would have been a lot more accommodation and compromise and prioritizing the other person and discomfort saying what I needed, discomfort from him saying what he needed. And so. While I've described this in logistical terms, I think this was something so, so beautiful for our marriage because it was a playground in which  we had to grow comfortable,  each of us respectively, identifying our own needs and being able to say them and feeling on the same team about getting them met.

, it wouldn't have done me any good any personal or professional favors to undermine his CCU rotation because I was in the ICU. We had to figure it out. And I consider that something that, um,  is a really significant skill. And over the years we learned to do that in other areas besides logistics, but it gave us a really strong foundation of knowing how successful it can feel to identify my needs and state them.

And have them met as a team, and for him to state his needs, and have them met as a team.  

Yeah, I think that's significant. There's a certain level of understanding when you and your partner are on the same path that, like, for me example, we had a lot of issues when I was on call in the beginning because he just did not understand it.

And he still talks about the first time he came over when I was on call and he was so pissed. It's just like, what do you mean you're gone? It's like, I'm on call. What did you think was going to happen anyway? So  there are complications that come with it or intricacies, as you put it, but, um, they're definitely benefits.

I wanted to go back to the living nanny and then the other nanny, because something you said about Josephine, getting used to her and crying. I very recently had a conversation with a client where she was talking about the pain of hearing her daughter cry. Now, I know you were comforting.

The nanny, the first one, but what was going on inside of you? Like, was that very difficult for you? 

Of course it was, but there was only one way forward. 

Right. 

And while I've had that with other children once I started working from home, you know, much later, I wasn't actually there for it. 

So, but I would hear from the nanny that,  It was just kind of scary for her. She was, she was a child, I mean, she was 17 and, um, and she didn't know if she was doing something wrong and  the thing, and I knew she wasn't experienced, but that  Josephine cried with me too. 

Yeah. 

And she 

literally sounds like an au pair, but without the agency.

Yes, yes, exactly. Yeah. And, and,  You know, so I gave her some guidelines and one of the main things I needed to do was tell her it wasn't because she was doing something 

wrong. Right. 

That they were still getting to know one another without the verbal introductions and she was a 10 month old.  

Right, right. . So I wanna ask about the nanny, both of them actually, because you had a unusual setup and you know, au pair before its time.

How did you go about finding these people? You mentioned your mother knew somebody, but was it.  Just out of this is necessity. I'm going to ask and find somebody What were your feelings about even bringing the nanny into the home? And how did you go about getting these people for a very unique situation to help you out?

Okay, so my mother knew someone and she knew the children, too And so when we were visiting my mother in December We we met this girl  who was a junior in high school You And  I knew it was just for one month  to bridge this gap. And so she was a lovely person. She was punctual. She was clean. She was comfortable to communicate with.+

and I just thought this is completely workable for a month.  She likes babies. And, like she's willing to learn. The relationship was right. She was willing to learn and I would be comfortable teaching her and I was clear it would be fine to have her in our home for a month. And it really was. And you know, because she was in high school, there were some complicated things happening in her family.

So she was very glad to be with us. I think it was sort of healing to see. Two parents being really respectful to one another and  so it was sort of an oasis 

Yeah, it 

was not sustainable long term But right and and she didn't drive like there was no getting a break from her she was in our living room literally and we didn't you know, the only other room we have was a small galley kitchen but it was, it was really like just having another person in the family, if we went anywhere, she came with us, there were, there were no, there were no professional boundaries.

I thought of it much more as like, you know, the way it might have happened  70 years ago or in, in a country where there aren't professional childcare people, but an auntie comes and helps out and this just was an auntie who hadn't raised her own children,  she needed all of the guidance. And so it was much more of a family experience than a professional experience.

And I did not hold her to the standards one might have. I held her, like her clear purpose was  a warm heart and keeping Josephine safe. I didn't have any expectations that she would teach her anything or  guide her into potty training. No, no, no, no, no. It was just like  a loving presence.

Yeah, who would keep her safe 

I think that is very important. I know this was not an au pair, but for people who are considering one, because even though we talk about what it means, and you know what it's supposed to be, I think there is still a feeling for many physician moms that, you know, These are professional childcare providers, and I think the way that you expressed your expectations of her was really perfect for a very, very similar situation.

Um, so I think that was very valuable to hear and thank you for sharing that. . I 

just want to add one more thing that I did a lot of babysitting when I was in high school. And so. I felt like  this was just a babysitter with many longer hours. This was not  a early childhood educator or any of that. 

Okay. Right. So then the other nanny that needed to be  a little bit, I don't know that I would say specifically professional cause our interactions didn't feel like that cause she was a friend of mine, but I needed to depend on her more. She needed to have more responsibility, but.

One of the key things was that we met every week and one of my high priorities, and it has been with any nanny I've had,  is to make it really comfortable for her to ask questions. 

Mm hmm. 

Because you can very easily get into a situation where  the nanny feels like she ought to know. Yeah. And I never want a nanny to be restricted in asking questions, and maybe I know the answer, Mm hmm.

Maybe I don't, but I'm definitely going to have an opinion about, like, which way we go with whatever the question is. And so, in a lot of ways, I feel like,  she was responsible, she had experience being a teacher, not of She didn't have experience with a 10 month old, but she had experience with children, um  Um, and I also mentored her, which, to be very frank, was way easier because I had been home with Josephine for nine months myself.

I have, I don't think I could have been so good overseeing my child care if I had only been home for two weeks because there really wasn't anything that either of these nannies with their different skills went through that I hadn't also had to navigate myself. And I had no illusion that. Children follow the rule book or that they're not going to cry or that,  you know, I fully expected my longer term nanny to have days that were frustrating and days when, when we got home, she just wanted to leave and days when she had to connect with another adult, like I related to all of that and I was grateful for her humanity.

I wasn't looking for a robotic expert. I was looking for a human being. Devoted to learning and growing  and tending my child in a way that was aligned with our values. And there were things that she did that I didn't like, but it didn't occur to me to say not to do them until she'd done them. So that wasn't her fault.

That was, it wasn't anybody's fault, but if it was anybody's, it was mine for not anticipating. Like, it is a learning curve, and as my husband likes to say,  One of the things about children is that as soon as you become comfortable with where they are at one stage, they develop into another stage, and that is also true with nannies caring for children, and so I think understanding that we're all developing, I definitely  sometimes gently, sometimes silently, sometimes very overtly, 

 aim to guide 

my nanny's development in a way that would be good for her and my daughter. 

Gotcha. Okay. Thank you for sharing that. I think that's going to be very valuable for many people because childcare is, you know, one of my biggest, platforms, but also people have a lot of issues with having somebody come into their home and take care of one of the most precious things in their lives.

So actually, I want to say one more 

thing about it, which is,  um, childcare. Just by its nature is a thankless job. The kids don't say thank you. They either don't talk or what they have to say is certainly not, I really appreciate what you're doing for me. It is just fundamentally a thankless job. And so one of the things I really aspired to with any of my child care providers is that  the majority of their feedback was not ways they should change or weren't being successful.

So I every single day Thank you so much for being with her. I mean, I don't know that it was exactly that line, but like I wanted her to feel  that I was grateful every day, which made it much easier to bring up things that were complicated because that wasn't going to be like the entire real estate of my feedback.

It was, it was all in proper proportion if every day I said,  you know, thank you.  

Yeah, I think that's very important because I can see you come home from clinic, you're tired, whatever, and you're like, you did this, this and this wrong, fix it. Or say nothing. Or say nothing.