Welcome to the age of the either/or economy. For some, meaning a slim slice of the social pie, that trade-off is either Botox treatments or a full-time nanny, as The Wall Street Journal recently reported about Suzanne Sirof, a stay-at-home mother of two. As it turned out, the nanny was the “or not.”

While that conundrum has the trappings of an urban legend about the era of overconsumption, millions of parents are faced with desperate decisions when it comes to nannies. According to 2006 data from Breedlove & Associates, a payroll tax company that deals mostly with employers of household workers, 1.2 milliannon households in the U.S. employed a nanny, the umbrella term for in-house child care.

Interviews with families and domestic placement agencies reveal that the kind of service the right caregiver represents–safe, nurturing and stimulating child care right in your own home–ranks extremely high on the Maslow hierarchy of family needs. But the high-end help economy is going through its own recalibration, as hours are re-jiggered or downsized, and job descriptions tinkered with to justify the cost.

Here’s a Map of the Current Nannyscape:

Annie Davis, founder and CEO of Annie’s Nannies Household Staffing in Seattle and president of the Association of Premier Nanny Agencies, says her business is down about 7% from last year in this quarter.

While Davis says that when the economy goes bad, household help is a luxury that’s the first to go, she sees a hierarchy that puts the nanny at the top.

“The nanny would be the last person to go,” says Davis.

Wendy Semonian Eppich, the mother of a 6-month-old son and publisher of The Improper Bostonian magazine, says even though the cost of child care sent her into sticker shock, it would be the absolute last thing she would cut. “I would rather not eat out as much,” says Semonian Eppich.