Taking the Time for Health

In April 2022, Kelly Ross learned she was expecting the ultimate Christmas gifts: twins, due December 25. What was supposed to be a holiday season miracle quickly turned into a nightmare when, in October, Kelly experienced a placental abruption and had to be rushed to the hospital. Days later, she gave birth to her sons Miles and Cole at just 29 weeks. Weighing just 2 pounds, 15 ounces and 4 pounds, 3 ounces, respectively, the boys required extended breathing support, and Miles developed sepsis, necessitating multiple blood transfusions, leading to a 56-day stay in the NICU.

“Those 56 days were among the most challenging of my life, filled with emotional highs and lows,” Kelly says. “We had to wait days to weeks for brief moments of holding them under supervision and didn’t hold them together until they were a month old.”

On top of the incredible stress Kelly was suffering with her babies in the NICU and recovering from birth herself, she quickly realized that her sons’ stay in the hospital would be longer than initially anticipated. She worried about how it would impact her employment.

“When my son Miles became septic in the NICU, the uncertainty of our situation hit hard, and I felt overwhelmed,” she says. “Working for a small employer, I did not qualify for FMLA, and we lacked a disability policy.”

Her husband, Ryan, ran into similar obstacles at work. As a general manager at a busy, fast-paced store, taking time off from work proved difficult. While he notes that his boss was incredibly accommodating when his sons were born much earlier than anticipated, their NICU stay presented an unforeseen challenge once he realized the four weeks of PTO he had saved would not be enough to cover the entirety of it. “For 56 days, I worked nine hours a day, visited the hospital to see my sons, and then tried to spend some time with our two-year-old daughter,” he says. “Seeing my wife struggle with postpartum challenges and having to go to the hospital alone while I worked was emotionally taxing.”

Unfortunately, the added stress of navigating and negotiating for paid leave in the midst of a medical emergency is all too common for Pennsylvania families.

Currently, two-thirds of Pennsylvania’s workers do not have access to paid family and medical leave, putting countless parents, just like Kelly and Ryan, in a nerve-wracking situation when faced with medical emergencies or difficult births. As a result, there has been a push in recent years for Pennsylvania lawmakers to pass legislation that would address what has become a pressing health crisis.

Expanding on the Problem

Calls for legislators to address paid leave have grown in recent years as post-birth mortality rates among women and babies in the United States “have gone from unacceptably stagnant to unjustly slipping, with notable racial disparities,” says Dr. Meredith Matone, an associate professor of pediatrics at Perelman School of Medicine and director of the PolicyLab at CHOP. She notes that the surgeon general issued an unprecedented advisory in August on the crisis of caregiver mental health and well-being. While this crisis impacts parents across all demographics, research has shown that certain groups are more at risk than others.

“Black birthing people experience higher risk of all complications that make up the major causes of maternal mortality … all conditions which can be mitigated with early recognition and treatment,” says Dr. Diana Montoya-Williams, a neonatologist and faculty member at CHOP PolicyLab. “Unfortunately, Black mothers are more likely to have shorter parental leaves and lower rates of attending postpartum care visits. Increasing access to paid family leave would support Black mothers’ ability to attend to their new baby and their own health.”

Impacting Health and Development

Although Kelly notes that her company had a strong maternity leave policy, she grew concerned as she began to realize her maternity leave might not cover her sons’ NICU stay.

In a moment of panic, she reached out to her boss, Ryan Boyer, who had recently attended the March of Dimes TB&C Award Luncheon and was deeply moved by the stories of families with premature babies. “Without hesitation, Ryan assured me he would make accommodations for me to work from home until the boys were discharged and allow me to take my maternity leave afterward,” she explains. “Ryan’s support was profoundly impactful for me and my family, even if he may not fully realize its significance.”

The compassion shown by Kelly’s boss made all the difference in her own recovery from the preterm birth, as well as for her children.

“Taking my leave when they came home enabled me to manage numerous specialist appointments and make up for the precious time we had lost during those 56 days apart,” Kelly says.

Paid family leave can be just as transformative for other parents, research shows.

“There is a wealth of evidence, including from our researchers at CHOP PolicyLab, that shows how paid leave supports the health and well-being of children and families,” Matone says. “The research on paid leave has shown positive outcomes like improved infant and child development, increased rates of breastfeeding, reduced infant mortality and improved maternal mental health.”

A Solution for Everyone

While Kelly and Ryan were able to eventually compromise with their employers in order to care for their children, there is still no law in Pennsylvania that requires employers to provide paid family or medical leave to their employees, leaving many workers totally stranded when unexpected emergencies arise.

Two bills waiting to be brought up for a vote in the Pennsylvania General Assembly would change that. House Bill 181 and Senate Bill 580, together known as the Family Care Act, would establish a statewide paid family and medical leave program in Pennsylvania. It would
offer up to 20 weeks of paid bonding leave after the birth or adoption of a child. It would also allow family members to provide critical care to elderly loved ones at home, help parents to care for a child recovering from a serious illness, and enable workers to care for themselves during a serious injury or illness. It is sponsored by a bipartisan group of 54 lawmakers in the House. The House bill passed out of committee in the summer of 2023 and the Senate bill passed out of committee in the summer of 2024, but both are stalled and have not been brought up for a vote.

The impact of the Family Care Act would also extend beyond maternal health. Guaranteeing paid medical leave would allow workers to take time to care for themselves or a family member while recovering from an injury or illness. This would have a large impact for more vulnerable groups, including immigrants and Black and Latine families.

“We know that COVID-19 ravaged immigrant communities in part due to inability to take sick leave or family leave without risk of losing a job, leaving immigrant workers more likely to be exposed and get sick,” says Montoya-
Williams.  “We also know that Black and Latine families have less access to paid family and medical leave from national research. Given the structural wealth gap by race in the U.S., it makes sense that paid family leave would help decrease risk of poor birth outcomes among minoritized families.” She notes that poor outcomes in these families often have to do with “increased exposure to low-quality health care, racism and discrimination.” Passing legislation that would guarantee paid family leave to all employees across the state would help address such inequities.

Allowing all parents, not just mothers, to take time off after the birth or adoption of a child is also critical for the child’s well-being. According to Matone, research on paternity leave “shows an association with fathers’ increased involvement with their children and better developmental outcomes for their children, among other positive outcomes.”

After the harrowing experience his family endured during his sons’ first months of life, Ryan sees the benefits of guaranteed parental leave now more than ever.

“While it’s understandable that mothers may need more time for recovery, not providing fathers with bonding time can hinder the family’s overall adjustment and success. Implementing a standard parental leave policy for both parents can ensure they have sufficient time to establish a healthy routine for their baby,” Ryan says. “If the Family Care Act is passed, [these] benefits could be available statewide. Quality bonding time is crucial for all parents, especially those with NICU babies, due to the stress, anxiety and trauma often involved.”

Kelly and Ryan are grateful that, with the assistance of their employers, they were able to shepherd their family through a distressing chapter and make sure their sons received the care they needed. Miles and Cole just turned two years old and are happy and healthy. The couple hopes, though, that future parents will not have to endure quite as much stress while trying to balance work with caretaking during family medical emergencies. Passing the Family Care Act will ensure that humanity prevails in these kinds of  situations.

“When an employer treats you as a human being, it’s invaluable,” Kelly says. “Supportive policies, procedures and benefits, particularly for families with premature children, are essential and make a profound difference.”