The first time I treated a newborn with the same congenital heart defect my unborn son was expected to have, I hesitated at the doorway. I couldn’t stop picturing my own baby intubated and sedated, a fresh incision running the length of his sternum.

I thought a terrifying fetal diagnosis would be the primary stressor of my pregnancy. I was wrong. The greatest obstacle wouldn’t come as a parent navigating her child’s medical needs, but as an employee requesting postpartum mental health support. When I asked for an unpaid maternity leave extension, the options provided were stark: return or resign.

The Pregnant Workers Fairness Act (PWFA) was designed for situations like mine. Yet I encountered resistance, not collaboration. Recent Associated Press reporting similarly underscores how a health care worker can struggle to access pregnancy and postpartum accommodations despite existing federal protections. This raises a broader question about health care institutions: As employers, how effectively do they provide access to pregnancy and postpartum supports when the person in need is not a patient, but an employee?

I continued to work in the same NICU my baby would soon enter, seeing patients and families that felt like glimpses into my own future. The month before my due date, on April 1, the hospital announced that supplemental parental leave would no longer be offered to employees, abruptly reducing my planned leave from eighteen weeks to the standard twelve. A poorly conceived April Fools’ joke would have felt less tone-deaf.

My supervisor thought the PWFA might apply to my situation. When I asked human resources (HR), they were unfamiliar with the PWFA and said extending my leave past twelve weeks was no longer a company benefit. Now facing an uncertain prognosis and the loss of leave my husband and I were counting on, I was prescribed Zoloft for my growing anxiety.

Soon, badging into storage closets to compose myself became routine. As my pulse quieted, my gaze settled on an Open Forum flyer promising support and inviting employees to share concerns. Leaning against a shelf of diapers and swaddle blankets, I wondered what support the hospital might offer me. Their deepest sympathies, perhaps?

After my baby was born, the postnatal echocardiogram brought cautious hope. I laughed shakily as my husband hugged me. Our son wouldn’t need immediate surgery, though his long-term prognosis remained uncertain.

Throughout our son’s unexpectedly short NICU stay, my coworkers provided excellent care, and, perhaps most crucially, the occasional coffee. But after discharge, anxiety lurked in the shadows of my consciousness, accompanying me through every feed, contact nap, and cardiology appointment.

After I was diagnosed with postpartum anxiety, my Zoloft dosage was increased. With my return to work weeks away and still experiencing anxiety, I revisited the PWFA. In the final regulations and guidance issued in 2024, the Equal Employment Opportunity Commission (EEOC) included postpartum anxiety among the conditions covered by the PWFA and identified leave as a potential reasonable accommodation. Armed with that knowledge, I requested a temporary unpaid leave extension, citing PWFA guidelines in my email to HR.

I paced around my kitchen island, cradling my sleeping newborn as elevator music droned through my AirPods. When HR answered, I was given only two options: return when my leave ended or resign. I looked down at my baby. What was the PWFA meant for if not situations like this?

Since the law took effect in 2023, the EEOC has sued multiple health care employers for allegedly failing to provide pregnancy-related accommodations. The employees involved (who worked at a rehabilitation center, a physical therapy practice, an infusion therapy provider, and a urology practice) were fired or forced to resign following pregnancy-related accommodation requests. Three of these lawsuits were settled this year, with terms requiring improved PWFA accommodation protocols and administrative training. These cases suggest that the gap between federal protections and access to accommodations may be broader than my own experience.

For weeks, as my request escalated through hospital administration, I continued to advocate for an accommodation under the PWFA. Finally, I was granted a one-month unpaid leave extension, five days after my leave had already ended.

That month mattered. By its end, we received the news we had desperately hoped for: Our son’s heart was growing normally, with no ongoing cardiac concerns.

I looked down at my baby’s chest, smiling faintly. His sternum would never bear that scar. Only then did returning to work feel possible.

That accommodation hadn’t simply extended my maternity leave. It had kept me employed. It only took weeks of persistence, a federal law, and a generous helping of bureaucratic absurdity to make it happen: a recipe that would have benefited from treating the latter as a garnish rather than a base ingredient.

Health care institutions commonly use standards and frameworks to improve patient safety and quality of care. That same structure and consistency should apply to administrative processes when an employee, rather than a patient, needs support. The EEOC’s regulations for PWFA implementation provide that type of structure for employers. Yet situations like mine and the EEOC cases show how an employee’s access to accommodations can fail in practice.

In a 2023 study of over 400 pregnant workers, only half of those who believed they needed job-duty modifications or viewed their job as potentially harmful requested a workplace accommodation. Of those who did, just two-thirds reported receiving the requested accommodation from their employer. Health care institutions should be models for making protections like the PWFA accessible to their employees. They should be proactive in creating standardized guidelines, implementing clear protocols, training HR personnel in the accommodation process, and tracking PWFA accommodation requests. In the end, an employee’s knowledge of federal law or willingness to challenge administration shouldn’t dictate their ability to remain employed.

I badged into the NICU on my first day back, patient list in hand. Walking the length of the corridor, I passed coworkers who had provided extraordinary care to my family. Yet the institution itself couldn’t reliably give support when one of its own clinicians became vulnerable.

I exhaled, knocked on my patient’s door, and stepped inside.

Isabella Hower is a neonatal occupational therapist and Certified Neonatal Therapist practicing in a Level IV neonatal intensive care unit (NICU), where she specializes in neurodevelopmental and family-centered care for medically complex and premature infants. She earned her master’s degree in occupational therapy from the University of Florida, where she conducted graduate research as part of a faculty-led team affiliated with the university’s Institute on Aging.

Her clinical experience spans adult acute care and neonatal intensive care. She provides education on neonatal developmental care to new nursing staff and is the lead author of peer-reviewed research on circadian rhythms, exercise, and cardiovascular health published in the Journal of Circadian Rhythms. Her writing explores the experiences of frontline health care workers, the systems in which they practice, and the intersection of health care policy and clinical care.