When my daughter was born at 24 weeks gestation, everything was terrifying.

Her survival, her ability to ever breathe or eat on her own, and my health complications from the pregnancy and c-section were all concerns, but I also had other children at home who needed to be fed, hugged, and cleaned up after. That meant that instead of staying with her in the NICU, I was steadily driving back and forth from hospital to home, a drive that could take around an hour and a half depending on traffic.

Then comes the decision about how much of that time and energy can be or must be devoted to employment.

Premature Births Often Lead To Lost Employment

I was lucky. Only a short time after my micropreemie was born, I was offered a job working from home, with flexible hours. It meant a lot of decisions about how to divert my energies to yet one more responsibility, but it also meant paychecks that helped cover gas, baby clothes, and other necessities, or to grab fast food on my way home from the hospital so that I wouldn’t have to cook for my older kids after the drive.

It doesn’t always work out that way.

A new study shows that about 30% of parents to a low-birth-weight preemie have to make serious decisions about their employment after the baby’s birth, according to US News. Around 20% of these babies have one parent give up their employment altogether.

Health Concerns, Time Budgeting, And Medical Care

In my case, my daughter spent about 5 months in the NICU before coming home with a feeding tube and supplemental oxygen. This was in the middle of COVID-19, so we had additional health concerns for her already struggling lungs as well.

Other preemies come home with other complications, disabilities, and medical devices. These mean extra care needs that might make daycare and babysitters a nonstarter, and extra doctor visits.

For us, for instance, it meant that in addition to the regular well checks every child receives, we were making regular trips to the pediatric gastroenterologist to check her feeding tube, extra visits to check her lungs, a few visits to the hospital where she sat under an x-ray while being fed to test whether she was still aspirating, and visits to check her eyes, since retinopathy of prematurity (ROP) can leave many preemies with long-term vision disabilities.

All of that makes working a regular job, outside the home with set hours, pretty complicated.

How Much Impact Does This Have On Families?

This study examined the impacts only for the first three years of the preemie’s life and found significant impacts from ongoing health issues and employment struggles. The authors wrote:

“Caring for children with medical complexity requires substantial time and financial resources for families, particularly during the first 3 years…Understanding the association of prematurity with caregiver employment is important because household finances can affect child health outcomes and household well-being.”

Some health impacts and developmental delays may resolve by this point and others will not (my daughter, for example, was able to eat and breathe on her own by age 3, and had her feeding tube and supplemental oxygen removed).

Returning To The Workforce After A Premature Delivery

A 2017 study found that about 2/3 of extremely premature babies (those born at 23-24 weeks) are ready for kindergarten on time, though on average they lagged behind their full-term peers on standardized testing, according to Reuters.

That could mean that it’s easier for the parent of a preemie to return to work at this point, with their child in school full-time, but if there are ongoing health complications, there still may be increased school absences and medical appointments, which means more missed work days for one or both parents.

Even in the best-case scenarios, returning to the workforce after a prolonged absence can be complicated for a parent. They’ve lost years of training and experience, and some employers are reluctant to hire someone who has gaps in their experience.

Long-Term Effects Of Premature Birth For Baby

Premature birth even seems to have long-term effects on the baby, outside of health struggles.

A separate study released earlier this year in the Journal of the American Medical Association (JAMA) examined the effects of pre-term birth on income and socioeconomic mobility. The study followed 1.6 million births in Canada between 1990 and 1996, and measured outcomes through 2018. The authors reported:

“[Pre-term birth] was associated with lower annual income (mean difference, CAD −$687 [95% CI, −$788 to −$586]; 3% lower per year), and the differences were greater among those belonging to families in the lowest family SES quintile (mean difference, CAD −$807 [95% CI, −$998 to −$617]; 5% lower per year). Preterm birth was also associated with lower upward mobility and higher downward mobility, particularly for those born earlier than 31 weeks’ gestational age.”

How Do We Fix This Disparity In Outcomes?

Pre-term labor isn’t something that anyone would choose willingly, and it’s not something that one typically has much control over in a pregnancy. There are risk factors, and those of us with complications are often shifted to a medical practice that’s more prepared to care for high-risk pregnancies, we may receive extra medical instructions, like bed rest, but even so, preterm labor isn’t fully preventable.

Instead, as a society, we can focus on some of the risk factors and try to mitigate them. For instance, the disparity in access to medical care can be a significant factor, and women with lower incomes are at higher risk, as are those in marginalized demographics, those suffering from high stress levels during pregnancy, and women under 18 or over 35, according to the CDC.

That means that addressing social factors and increasing access to healthcare could help reduce the overall number of preterm births, and social safety nets may need to be expanded to address the needs of families after a premature birth.