Families have options to protect their job and wellbeing while caring for a baby in a neonatal intensive care unit (NICU). This guide explains your rights to time off work and to changes at work that make it possible to care for your baby and yourself.
This document covers federal law, which applies nationwide. Your state may give you more rights and options — see our state law map or our California NICU guide for more information.
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You should know:
- You may have a right to take 12 weeks off, with continued health benefits, under the FMLA. Time off during pregnancy, to recover from childbirth, to care for your baby in the NICU, and to bond with your baby when they go home all come out of the same 12 weeks. Other laws may provide additional time off, but your employer may not have to pay for your health insurance during any additional time. Plan carefully and contact our free helpline for support.
- Both parents may have a right to take time off work under the FMLA.
- Not all workers are eligible for the FMLA. Read on to learn the requirements. Even if you are not covered by the federal FMLA, you may have rights under other laws. This may include the right to take time off for your own health needs, such as childbirth recovery, nursing/breastfeeding, anxiety, post-traumatic stress, and depression.
- You may have a right to changes at work that you need for your own health needs. These are called reasonable accommodations.
- You have a right to lactation breaks and a private space to pump milk while at work. You may be entitled to other workplace changes for pumping or for directly nursing your baby.
- Pay during your leave may be available through state laws or your employer. There is no federal paid leave.
- WorkLife Law’s free legal helpline can help you understand your rights and come up with a plan. Contact us at PregnantAtWork.org/GetHelp.
Time off work
Many parents are entitled to time off work when welcoming a new child, or when unable to work for their own health. The sections below explain the different rights you may have.
The FMLA: 12 weeks of job-protected time off
The Family and Medical Leave Act (FMLA) gives eligible workers up to 12 weeks of unpaid, job-protected time off in a 12-month period. During FMLA leave, your employer must keep paying its share of your health insurance benefits. After your time off, your employer must give you your same job back, or one that is nearly identical.
You are eligible if: (1) your employer has at least 50 employees within 75 miles of your worksite; (2) you have worked for that employer for at least 12 months, which do not have to be in a row; and (3) you have worked at least 1,250 hours in the 12 months before your leave starts (roughly 24 hours a week).
You can use FMLA leave for your own serious health condition, including pregnancy and recovery from childbirth; to care for your baby or another family member with a serious health condition; or to bond with your baby during the first year of your baby’s life. If you take leave for any of these reasons, your employer may be able to count it as a part of your 12 weeks of FMLA.
Yes, and that includes time off during pregnancy, time to recover from childbirth, time at the hospital caring for your baby, and time to bond after your baby comes home. Keep close track of how much time you use.
Employers can measure the 12-month period in different ways, so the answer depends on where you work. Ask your HR department how your employer measures it, or contact our free helpline.
If possible, ask your supervisor or HR for time off at least 30 days in advance. If the need is unexpected — which is common with a premature birth or complications — tell your employer as soon as you are able. Your employer can require you to provide a medical form when you take FMLA leave. Be sure to get the form completed and returned on time. Contact our free helpline if your employer says you can’t get time off because you missed a deadline.
You may have a right to split up your FMLA leave so you don’t have to use it up quickly. Whether your employer is required to allow you to split it up depends on why you are taking it:
If you are taking time off to care for a baby in the NICU or who has a serious health condition: You can take FMLA for short periods of time, such as one day a week or a few hours at a time. For example, a father who has FMLA leave available can choose to take just three hours off a day for two weeks while his newborn is in the NICU. This is called “intermittent leave.”
If you are taking time off to bond with your healthy baby at home: You have to take this time off all at once, unless your employer agrees to let you split it up.
Your 12 weeks of leave should be reduced proportionately based on the days or hours you take. Taking time off in smaller portions of time is a great way to stretch your leave.
Example: Monica’s baby was born prematurely and is expected to be in the NICU for around 10 weeks. Monica takes the first 4 weeks off work while she is physically recovering from childbirth. If Monica took off the rest of the time her baby is in the NICU, she would only have two weeks of FMLA leave left when her baby is sent home from the hospital. Instead, Monica uses FMLA to work half-time for the remaining 6 weeks that her baby is in the hospital. Because Monica is working half time, she uses up only 3 weeks of her FMLA leave. Monica has 5 full weeks to bond with her baby at home.
You may have a right to time off even if you are not eligible for the FMLA or have used up your entire 12 weeks.
Even if you don’t have FMLA leave available, you may still be able to take protected time off work.
Many people qualify for time off under other laws.
First, check out our state law map to find out if you have time off available under the laws of the state where you work.
Second, if your employer has at least 15 employees, the Pregnant Workers Fairness Act (PWFA) applies nationwide and can give you time off (or reduced hours) as a “reasonable accommodation” for pregnancy, childbirth, or a related medical condition. That includes the time you need for recovery from delivery, childbirth complications, and pregnancy-related mental health conditions like postpartum depression, anxiety, or PTSD.
This time can be used after your FMLA leave runs out, and it may be available even if you were never eligible for FMLA. But there are two important differences from FMLA leave: 1) your employer does not have to keep paying for your health insurance, and 2) your employer does not have to provide the time off if doing so would be very difficult or expensive. If you aren’t sure whether it would be too difficult or expensive to take this leave, ask your employer or contact our free helpline for support.
Your employer may ask you to provide a note from your healthcare provider to confirm you need time off. There are limits to the medical documentation your employer may request. Learn more here. Make sure your healthcare provider states an end date for your time off, even if it has to be changed later. Give this guide to your healthcare provider to help them share information in a way that protects your rights.
This section is for all caregivers, including fathers and non-birth parents.
Up to half of parents experience mental health challenges, such as PTSD, depression, or anxiety while their newborn is in a NICU. If you have a health condition of your own and need time off work for your own health needs, you may have a right to take it as a “reasonable accommodation” for a mental health condition under disability law. This time can be used after your FMLA leave runs out, and it may be available even if you were never eligible for FMLA.
How do I know if I’m eligible for time off as a reasonable accommodation?
- If your employer has at least 15 employees, the Americans with Disabilities Act (ADA) requires it to provide reasonable accommodations for your own disability. (Some states have rights that apply to people working for smaller employers.) The legal definition of disability is broader than many people expect. Mental health conditions that came from or were made worse by a traumatic birth experience or lengthy NICU stay may count as disabilities that employers must accommodate. If you have a health need and would benefit from time off work or reduced hours, you may be able to get those as reasonable accommodations for a disability.
- Be ready to provide a medical note to support your request. Your healthcare provider should provide an end date for your time off, even if it has to be changed later.
- Even if you have a disability and your doctor says you need time off, your employer does not have to provide this time off if it would be very difficult or expensive. If your employer says no, contact our free helpline.
Must my employer continue my health insurance benefits?
- Your employer does not have to continue your health insurance when you are taking time off as a disability accommodation. On the other hand, your employer must cover its portion of your health insurance benefits if you are taking FMLA leave (see above).
Getting paid while you are off
There is no national paid leave law. However, if you have a baby in the NICU, you may be able to be paid from one of these:
- State paid leave program. Check our state law map to see whether the state where you work has NICU leave, paid family and medical leave, or a temporary or short-term disability insurance program.
- Paid sick days. Many states and cities require employers to provide paid sick time. Learn more at the National Partnership for Women & Families website.
- Your employer’s own policy. Check with your HR department, union representative, or your employee handbook to find out if your employer offers short-term disability insurance, paid parental leave, or paid medical leave.
Other family members may be able to take time off too.
Some state laws may provide a right for grandparents, siblings, or other family members to take time off too. Contact our free helpline to learn more.
Changes at work
Changes to when, where, or how you do your job — called “reasonable accommodations” — can make it possible to be at the hospital, manage appointments, and keep working. The information below explains how to ask for reasonable accommodations, based on the reason why you need them:
If you need the change because of…
Who this can apply to: Birthing parents
What you can ask for: Schedule changes, remote work, extra breaks, time off, pumping breaks and space, time to nurse your baby, and more. The Pregnant Workers Fairness Act requires employers with 15 or more employees to make these changes.
What to say:
Because of the Pregnant Workers Fairness Act, parents who gave birth have strong rights and the simplest path to getting the changes they need. To access those rights, your employer needs to know the need is related to your pregnancy or childbirth recovery. For example, you could say:
“I am requesting a reasonable accommodation under the Pregnant Workers Fairness Act for a condition related to my [pregnancy, childbirth, or lactation].“
Tips when asking for a reasonable accommodation:
- Think about what you need to make work manageable while meeting your or your child’s health needs.
- Tell your supervisor or human resources that you are requesting a reasonable accommodation; use the language above. It is a good idea to request the changes in writing, if possible.
- Keep in mind that your employer will probably ask for a note from a healthcare provider. There are limits to what your employer can ask for (learn more here). Contact WorkLife Law’s free helpline if you need help understanding what kind of medical documentation you are required to provide.
People with pregnancy-related conditions should use the section above, as your rights are different.
Who this can apply to: Any parent or family member
What you can ask for: Schedule changes, remote work, breaks for therapy appointments, time off, and more. The Americans with Disabilities Act (ADA) requires employers with 15 or more employees to make these changes.
What to say: “I am requesting a reasonable accommodation for my [post-traumatic stress disorder/anxiety/depression/etc.]”
Tips when asking for a reasonable accommodation:
- Think about what you need to make work manageable while meeting your health needs.
- Tell your supervisor or human resources that you are requesting a reasonable accommodation; use the language above. It is a good idea to request the changes in writing, if possible.
- Keep in mind that your employer will probably ask for a note from a healthcare provider. There are limits to what your employer can ask for. Contact WorkLife Law’s free helpline if you need help understanding what kind of medical documentation you are required to provide.
Because rights for your own health are stronger, this is a last resort option if the situations above do not apply to you.
Who this can apply to: Any parent or family member
What you can ask for: Federal law does not require your employer to change your job so that you can care for your baby. But the law does require it to not treat you worse than your co-workers because you are caring for a child with a disability. This means you can ask for the same flexibility your employer gives other workers, such as remote work or schedule changes that coworkers are allowed to take for their own reasons.
What to say: “Other employees are allowed to [work remotely / adjust their schedules / take this time]. I am asking for the same to care for my child with a disability.” “It would be discrimination to deny me because I need this for my child who has a disability.”
Tips when asking for a reasonable accommodation:
- Think about what you need to make work manageable while meeting your health needs.
- Tell your supervisor or human resources that you are requesting a reasonable accommodation; use the language above. It is a good idea to request the changes in writing, if possible.
- Keep in mind that your employer will probably ask for a note from a healthcare provider or your baby’s healthcare provider. There are limits to what your employer can ask for.
- Many employers don’t understand the complex law on accommodations for a loved one’s disability. Contact WorkLife Law’s free helpline if you need help.
Accommodations for breastfeeding and pumping
You have a right to lactation breaks and space and may also be entitled to other changes at work if you need them to protect your milk supply and your breastfeeding/nursing relationship.
Under the federal PUMP Act, you have the right to break time to pump as often as you need it. You also have a right to a private lactation space that is:
- available when you need it,
- not a bathroom,
- functional as a lactation space (safe and free of hazards with a place to sit), and
- private — meaning people can’t see in or walk in when you’re using it.
Some employers with fewer than 50 employees believe they don’t have to provide these breaks, but that is rarely true. Contact our free helpline if you are told no.
The PUMP Act applies until your baby’s first birthday, but many people have a right to pumping space for longer under the Pregnant Workers Fairness Act (PWFA) or state laws. Check our state law map to learn more.
Nursing your baby directly is part of building and keeping a breastfeeding/nursing relationship and can support your ability to produce milk. When your baby is in the NICU, nursing must happen at the hospital, often on the hospital’s schedule. If your employer has at least 15 employees, you may have a right under the Pregnant Workers Fairness Act (PWFA) to get changes that make it possible to nurse at the hospital. Here are examples of some of the accommodations you can ask for under the PWFA:
- A shifted start or end time that lines up with your baby’s feeding times
- Working remotely, from home or from the hospital, so that it is easier to get to the hospital to feed your baby
- A longer break, or a break at a different time, so you can get to the NICU and back
- Other changes that support your milk supply, such as extra water, extra breaks, or a different uniform
Discrimination and harassment are illegal
If your employer has 15 or more employees, federal law makes it illegal to treat you worse because of pregnancy, childbirth, lactation, your own mental health condition, or your relationship with a person with a disability — including your baby. In addition, the laws of the state where you work may apply to smaller employers.
For example, your employer cannot cut your hours, give you worse shifts or assignments, make harassing comments, penalize you, or fire you because you are caring for your baby in the NICU. It is also illegal for your employer to punish you for asking about or requesting leave or accommodations. If you think this is happening, get help immediately. You can contact WorkLife Law’s free helpline.
Your state may give you more
Some states offer stronger protections than national law. Depending on where you work, your state may:
- Pay you while you are off work, through a NICU leave, paid family and medical leave, or short-term or temporary disability insurance program;
- Require employers who have fewer than 15 employees to make changes to when or where you work;
- Give you more job-protected time off than the FMLA (12 weeks), or make it easier to qualify;
- Let grandparents, siblings, and other family members take leave to care for your baby; or
- Require your employer to accommodate you so that you can care for your baby.
Check out our state law map to learn about the laws in the state where you work.
Questions? We can help.
Every family’s situation is different, and these laws overlap in complicated ways. WorkLife Law attorneys are here to help. Our legal helpline is free and confidential.
Get started online: PregnantAtWork.org/GetHelp
Or you can leave a message at 415-703-8276 or email [email protected].
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