Does Paid Time Off After Having a Baby Help Mothers and Newborns?

What three recent studies by Lee, Ahrens and Hergenrother and their colleagues found about paid family leave, pregnancy, birth and breathing infections in young babies

New research from the United States suggests that when states give parents paid time off around the birth of a baby, fewer mothers develop high blood pressure in pregnancy and fewer very young babies need emergency care for breathing infections. One large study also found very small increases in early and smaller births, which researchers think may partly reflect more pregnancies continuing to birth. Overall, paid leave looks helpful for families, especially those with fewer resources.

Many parents remember the first weeks with a newborn as a blur of feeding, sleeping in short bursts and worrying whether the baby is well. For some families, those weeks are also shaped by money and work: whether a parent can afford to stay home, and how soon the baby must start childcare. Researchers have been asking a simple question with a complicated answer. Does giving parents paid time off make mothers and babies healthier?

Why this question matters, and how families managed before

In many wealthy countries, new parents receive paid leave from the government. The United States is the only high-income country without a national paid family leave programme. Federal law allows 12 weeks of leave without pay, and California became the first state to offer paid leave, in 2004 [1]. Before that, the main help some pregnant workers had came from state disability insurance. When those payments were extended to pregnant women in 1978, slightly fewer babies were born with low birthweight, especially to unmarried and Black mothers [2]. Still, a review of the evidence found that only 16% of US workers had paid parental leave through their jobs, and up to 23% of working mothers went back to work within 10 days of giving birth [3].

After California's programme began, researchers compared it with states that did not have one. They found fewer babies dying after the first month of life [4], fewer hospital admissions for abusive head trauma, a serious injury caused by shaking or hitting a baby [5], fewer hospital stays for babies overall [6], and parents reporting healthier children with less asthma [7]. Mothers' emotional health also tended to improve [8]. New York started its own programme on 1 January 2018, offering eight weeks of paid leave with a guarantee that parents' jobs would be kept for them; in the first year, leave was claimed for about one in three babies born in the state [9]. Afterwards, more New York mothers used paid leave [10], with bigger increases among Black and Hispanic mothers, and more Black mothers breastfed [11]. Two important questions were still open: what paid leave does during pregnancy itself, and whether every family benefits equally.

The three studies and how they fit together

Three research teams looked at these questions in different ways. Because a state law cannot be given to some families and not others at random, all three used "natural experiments": they compared places with paid leave to similar places without it, before and after the law began.

Dr Lee and colleagues studied birth certificates for 11,452,411 babies born between 2016 and 2022 [1]. They compared five places that started paid leave during that time (New York, Washington State, Washington DC, Massachusetts and Connecticut) with states that had none. New York made up most of the babies in the paid-leave group.

Dr Ahrens and colleagues focused on babies aged eight weeks or younger in New York and four nearby states that did not yet have paid leave at the time (Maine, Massachusetts, New Hampshire and Vermont) [9]. They counted 52,943 emergency visits and hospital stays for breathing infections such as colds, chest infections, ear infections, whooping cough, cough and fever, between late 2015 and early 2020.

Hergenrother and colleagues reviewed earlier research and found 10 suitable studies, most of them about California [12]. Their search was done in March 2024, before the other two studies were published, so the review describes the earlier evidence and the two new studies add to it. The review's authors concluded that paid leave was linked with better physical and emotional health for birthing parents, and with either benefits or no change for partners and babies, while noting that different groups of families benefited by different amounts.

What the researchers found for mothers and at birth

The clearest benefit for mothers was less high blood pressure during pregnancy, a group of conditions that includes pre-eclampsia. Before paid leave, about 6.4 in every 100 mothers in these places had one of these conditions. After paid leave, the risk fell by about 13% [1]. That works out to roughly 8 fewer mothers with high blood pressure for every 1,000 births. The researchers think that knowing paid time off is coming may reduce money and job worries during pregnancy, and long-term stress is known to affect the body's hormones and inflammation [13].

The findings for babies at birth were more surprising. Babies were very slightly more likely to be born early (before 37 weeks), to be small for their stage of pregnancy, or to weigh less than 2,500 grams, and average birthweight was about 5 grams lower, a tiny amount for babies who on average weighed about 3,300 grams [1]. For early birth, the increase was about 6 extra babies in every 1,000. The researchers described these changes as modest and of uncertain importance. Breastfeeding at the start was not affected.

Why might a helpful policy be linked to slightly earlier births? One explanation is that when mothers are less stressed, some fragile pregnancies that might otherwise have ended in miscarriage or stillbirth continue to a live birth, and those babies are more likely to be born early or small [14]. A New York study found more live births and fewer pregnancy losses after paid leave began [15], which fits this idea, but it has not been proven. Earlier California studies found no overall change in early birth or low birthweight [4].

What the researchers found for young babies and infections

The infection findings were reassuring. In New York, emergency visits and hospital stays for breathing infections in babies aged eight weeks or younger fell from about 31 to about 26 for every 1,000 babies during the October-to-March virus season, a drop of between 5 and 6 for every 1,000 babies [9]. An earlier report from the same team found a similar drop, including fewer visits for respiratory syncytial virus (RSV), a common virus that can make young babies very ill, and only a very small drop in one-year-olds, who would not be expected to benefit as directly from the leave [16]. The researchers think the reason is that parents on leave can keep babies out of group childcare a little longer, where they would meet more germs [16], although they could not measure this directly.

The benefit was bigger in some families. Hispanic babies and babies whose care was paid for by Medicaid, the public health insurance for families with lower incomes, saw larger drops than non-Hispanic White babies and babies with private insurance [9]. These were also the groups who had the most visits to begin with, so paid leave may help narrow the gap.

What this means for families

If you are expecting a baby or have a newborn, these studies suggest that paid time at home in the early weeks may help protect your baby from serious breathing infections and may be good for your own health. They do not mean that returning to work or using childcare is harmful; many families have no choice. Talking with your baby's care team about your work and childcare plans can help them suggest ways to lower infection risk, including the newer RSV protection now offered to babies and pregnant women (see In[Neo]Sight's article on the RSV vaccine in pregnancy and nirsevimab).

It is also worth knowing that not everyone can use paid leave equally. Black, Hispanic and Asian workers have been less likely than White workers to have access to it [17].

Keeping the findings in perspective

These studies looked at whole populations, not individual families, and they measured whether paid leave was available, not whether each parent actually took it. The review found that all of the studies it included had at least some risk of bias [12]. The infection study ended in early 2020, before new RSV protection for babies became available; one such preventive antibody injection, called nirsevimab, cut doctor visits for RSV chest infections by about 80% in clinical trials [18], so paid leave might make a smaller difference today. And the changes in birth size depended largely on New York, although the small rise in early births remained even without New York [1]; earlier California studies found no overall change in these outcomes [4].

What researchers are working on next

Researchers want to learn which features of paid leave matter most, such as how many weeks are offered, how much pay is replaced and whether jobs are protected. They also want to follow individual families who did or did not take leave, to check whether the slightly earlier births reflect more pregnancies continuing rather than harm, and to see how leave affects mothers' emotional health [19], which is closely tied to babies' wellbeing.

The bottom line

Across these three studies, paid family leave was linked with healthier pregnancies for mothers and fewer serious breathing infections for very young babies, with the biggest gains for families with fewer resources. The very small changes seen in birth size and timing are still being worked out and may not mean harm. For families, the message is a hopeful one: time together in the first weeks appears to matter.

References

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