The first months of a child’s life are a critical time for bonding, care, and recovery, but for many American women, those weeks are overshadowed by work and financial stress. And when a baby is born early or with special needs, that stress is intensified.

Most mothers plan meticulously for their baby’s arrival but for an unlucky few, a premature delivery can derail every expectation. For Rebecca Meredith, a first time mom with an uncomplicated pregnancy, delivering at 33 weeks was a shock.

parent co is seeking writers to pay for original submissions

“I had my regular check up with my doctor at four pm and there were no problems. [That night] I went to the local hospital to check if I was leaking amniotic fluid with nothing but my purse and didn’t come home for three weeks after I was life-flighted to a hospital two and a half hours away,” says Meredith.

A few months earlier, Meredith’s husband had gotten a job in a different state and the couple had moved cross-country. Meredith had taken a new job at a Montesorri preschool and daycare while going through the process of transferring her teaching certification.

Ineligible for paid leave, she had initially planned to return to her job when her son was eight weeks old; he would attend the same daycare where she worked. But when eight weeks had passed, her son was the developmental equivalent of a one-week-old baby. The Neonatal Intensive Care Unit (NICU) staff had advised the couple to keep him out of daycare for a year if possible because his increased risk of infection was too great. Having left her family on the other side of the country, Meredith had no choice but to quit her job.

Meredith’s story isn’t uncommon. In the United States, only 12 percent of private sector employees have access to paid leave. For many women, this results in returning to work well before what is considered ideal. A shocking one quarter of women in the United States are back at work within two weeks of giving birth. Many of these women are mothers of premature infants who decide to keep what little maternity leave they have for when their baby comes home from the hospital.

Even the federal Family and Medical Leave Act (FMLA) provides little coverage for mothers. FMLA only covers employees at workplaces with more than 50 employees who have worked there for at least 12 months.

Meredith, like roughly 40 percent of Americans, did not qualify for FMLA. Even if workers are covered by the law, FMLA is only a guarantee of job security after 12 weeks. It does not require an employer to pay an employee who is on leave. Many parents, especially those faced with unexpected medical bills from a NICU stay, cannot afford to take unpaid leave.

Christiana Stafford, another first time mother, also faced the unexpected after giving birth to her daughter. After one week in the NICU, her daughter was diagnosed with Down syndrome and a heart defect that is common in babies with the syndrome. Stafford and her husband soon learned their daughter would need heart surgery before her first birthday, forcing Stafford to re-work her maternity leave plans.

Stafford went back to work when her daughter was 10 weeks old, saving the last two weeks of her paid leave and FMLA leave for when the baby would need surgery. “It was heartbreaking to have to decide to take her to daycare earlier than we expected,” says Stafford.

The weeks leading up to the surgery were filled with stress. “It was just a whirlwind of emotions and information all jam-packed into a few days and months,” says Stafford. “Having a baby with unexpected Down syndrome, having a baby with an unexpected congenital heart defect. And, hoping and praying she didn’t get sick in the weeks leading up to her surgery, which would have pushed it out even farther. When your kid’s in daycare, that’s nearly impossible.”

After her daughter underwent heart surgery at five months old, her supervisor ended up letting her take an additional third week of leave despite having exhausted her FMLA. Having a child with special needs also means extra doctors, specialists, and appointments. Stafford says she has to be careful now how she budgets her time, alternating with her husband for appointments and keeping an eye on how much available leave she has every time she gets her paycheck.

Paid maternity leave has numerous benefits, from increasing women’s labor force participation to decreased employee turnover to better health outcomes for parents and children. But with few American women qualifying, millions are left scrambling to even keep their jobs after a premature or special needs baby is born.

Back in the fall, paid parental leave received plenty of attention from both presidential candidates. In his campaign, President Trump floated the idea of a six week paid maternity leave for mothers who give birth. In the spring, he appeared to endorse paid leave for both mothers and fathers, but has yet to offer any details on the plan.

Critics worry his plan might not be enough to meet the needs of families facing unexpected circumstances. For parents caring for high needs infants, six weeks might not be enough time to even be discharged from the hospital.

“Parental leave is not this one-size-fits-all thing,” says Stafford. “So many variables can come into play.”