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This paper advances our understanding of how Black women who have a child with autism negotiate paid labor in relation to the range of work they must also do to help their child meet their developmental needs. Although women are entering the paid workforce in higher numbers every year, the kinds of unpaid and/or reproductive labor conducted by women remains unequal. In the realm of taking care of a child with special healthcare needs, women are at the forefront of negotiating many kinds of labor. To better understand the nuances of negotiating paid labor while managing the social, medical, and therapeutic life of a child diagnosed with autism, this paper draws on fifty-seven qualitative interviews conducted with Black female caregivers who have a child with autism, a life-long developmental disability. Based on a grounded theory analysis, this data reveals how women must negotiate their work life to fulfill other types of parenting work that is expected to meet the needs of their children. I identify two patterns of work negotiations based on in vivo coding, including: “home moms” and “working every day”, as well as the consequences this has for their children, which I conceptualize as therapeutic loss. These narratives of negotiations and consequences reflect the nuance and complexity of working and adjusting to multiple shifts of paid and unpaid labor that are associated with taking care of a child with autism but also situated at the intersections of race, class and gender. By analyzing these different employment compromises and their consequences, this paper highlights compounding factors that stand as barriers to successfully negotiate work-life balance and the effects this ultimately has for the children who need autism services, as well as the women who are their primary caregivers.