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You have definitely got everyone’s bullshit ‘what-I-did-over-the-weekend’ story beat. Oh, Really Carol? Skydiving, that’s interesting. I dropped a baby from my innards, and I was forced to leave it right there in the hospital for financial reasons, but go ahead, tell me what you had for brunch the next day. You had waffles? You’re incredible Carol, that’s a great fucking story.

In this clip on the week before last’s Last Week Tonight with John Oliver, profiled mom Selena Allen describes how she had to return to work just days after the birth of her premature infant in order to delay using her maternity leave until he came home from the hospital.


I’ve been wanting to write about how ugly maternity leave can be when it comes to prematurity–because it’s a total disaster. And it’s hard to explain exactly why it’s so terrible without getting too technical, too boring, or too personal. But at the risk of never writing about it at all…

Adjusted Age and a Handful of Weeks

Not very many people understand this, so let me be clear: when an infant is born prematurely, their time in the NICU is essentially spent gestating ex utero. Although their organs are still developing, their bodies are tasked with breathing, digesting, and pumping blood. They might be able to grasp your finger, but they may still be weeks away from developing the suck/swallow/breathing reflex that is necessary for liquid consumption.

Because the infant is now physically separated from its mother, it no longer has all that mommy time it would have had otherwise. Which is why little things like holding the baby and chatting about the weather are actually humongously significant in terms of growth and development, which can shave whole days off a NICU stay.

A good rule of thumb for determining how long the hospital stay might be, is to go by whatever the original due day was. Sometimes it’s earlier, sometimes it’s later (it varies by individual of course)–but for us, it was spot-on. 11 weeks early, 11 weeks in the hospital.

When the infant is finally discharged from the hospital, he or she is for all intents and purposes a newborn with a newborn’s needs. Their actual age may be three months, but their adjusted age is more like three days.

In addition to all those late-night feedings every parent complains about, the first month home will be jam-packed with weigh-ins and follow-up visits with specialists (when we brought our daughter home, we had two different appointments each week for five weeks). There’s also the complicated feeding schedule some parents will be tasked with following–a schedule that is hard to trust with a stranger at daycare.

And speaking of daycare…

Most daycares do not accept infants who are younger than three months old; those that do tend to charge a premium for their care. The infant may be three months old, but, again, developmentally, they are very much a newborn.

Also, germs. No matter how clean a daycare is, remember that a mother’s passive immunity against infectious diseases is largely transferred to the developing fetus through the placenta in the last few weeks of pregnancy, which means preterm infants are at higher risk for medical complications and rehospitalization owing to, for example, RSV.

Okay, so, with all that said, if a working mother is eligible for any sort of paid maternity leave, it will only be a handful of weeks (usually five, sometimes six)–nothing close to what she’d actually need. Some mothers, like Selena Allen, get to choose when to take their leave–a demoralizing choice, to be sure, since mothers must work out when their time will have the greatest impact on their infant’s care. However, many mothers have very little choice at all.

Maternity Leave or “Leave”

Paid maternity leave is something of a unicorn; even partially paid maternity leave is rare. Companies that do offer this benefit tend to only do so for full-time workers after a year of employment (never mind that the average full-time worker changes their job every four years).

But the bright side is, if the working mother’s health fails and she needs hospitalized bed-rest, that time will be covered by paid-time-off and short-term disability. Then, she can put off her maternity leave until after the baby comes home. What’s more, if she still has paid time off, she can tack it on to the end of her maternity leave.

Short Term Disability (STD)

If a working mother does not qualify for maternity leave, her “leave” can be partially covered by the short-term disability offered by her company (note, the coverage varies by company, policy, and state) (also note, you get a bonus week or two for having a c-section).

STD is fine in most cases–namely, a healthy, term pregnancy–but for preterm deliveries, it’s not so ideal. Because STD applies specifically to the “medical event,” it begins immediately upon the delivery of the child. It cannot be broken up or delayed until the child comes home. It is pretty much a use-it-or-lose-it kind of offer. (As for me, my STD ran out six weeks before my daughter came home).

But the issues with STD don’t end there. Some policies require employees to cash in all their personal time BEFORE they can be eligible for STD, which translates to no paid time off for doctors appointments and daycare emergencies.

And then there’s hospitalized bedrest. In theses cases, STD will begin even before the infant is born….

Unpaid Leave

Unpaid leave is the bitter reality of many preterm parents. FMLA protects this time for up to twelve weeks (sort of), but it typically lasts as long as a family’s finances can hold out without the additional income. Maybe even longer if the family does not have a support network to lean on for help, in order to delay daycare enrollment for as long as possible. Oftentimes, unpaid leave is subsidized by credit cards.

At which point, all the medical bills start rolling in.

I should also mention it runs concurrently with short-term disability, and employers are not legally required to break up this time into chunks.

Not Ideal, But…

So like I said earlier, maternity leave is less than ideal for most working mothers, but for the mothers of premature infants, it is a total disaster, emotionally and financially.

It doesn’t have to be so bad, though. And I’m not talking European-style social welfare programs, I’m thinking more along the lines of little tweaks to our already existing system, at least as a place to start. Like paid paternity leave. Or amending STD so that it can be extended or even delayed under special circumstances. Even allowing mothers to break up their maternity leave (a week on, a week off, for example) would have a tremendous impact on family care.

Because prematurity effects 1 out of every 9 births, this conversation about maternity leave needs to be had. Until then, if you are the new parent of a preterm infant, know what your options are, and don’t feel shy about raising a little hell.