“Every morning I get up, I drink coffee, and I get mad that women don’t have better access to health care and paid family leave,” Danielle Spradlin told Rewire.

Spradlin, on this particular Wednesday morning, was mad about a recent investigative report from In These Times magazine revealing that about one in four working women return to work two weeks or less after giving birth.

She recalled her experience with coming back to work for a local political candidate just ten days after childbirth.

“I was in the car with my candidate with my brand new baby, a first-time mom, and I was driving to a fundraising meeting to shake somebody down for some cash,” Spradlin said. “I mean, I’m still bleeding. So I’m like, well, what pants do I fit into that are black, just in case I bleed through them. And these are not reasonable ways to behave. I mean, postpartum hemorrhage is a true and real cause of death of women.”

Spradlin is now a lactation consultant, a health-care professional who helps women having trouble breastfeeding. Too often, she said, “trouble breastfeeding” is really just a symptom of a deeper problem—a system that denies too many women the chance to heal and bond with their babies because they can’t afford to take more unpaid time off of work.

Sometimes when women tell Spradlin that they’re having a problem with breastfeeding, she said, the real problem is that they’re working too hard to be able to sit down long enough in a 24-hour period to feed their baby.

“Some of these moms are waitstaff, and they don’t have time to pump their milk, they’re going to be up on their feet, they’re going back to work in two weeks, they’re still bleeding, they’re still having pain from sutures, whether those are perineal sutures or abdominal sutures or both, some of them have pelvic floor problems, they’re urinating on themselves—but they’re going to go stand on their feet for 14 hours to make money?” Spradlin said. “That’s abhorrent. That’s how women die.”

The United States is the only developed nation without some kind of national paid maternity leave, and proposals for national paid family leave aren’t going far in a Republican-dominated Congress. The Family and Medical Leave Act (FMLA) only guarantees workers the right to take up to 12 weeks of unpaid leave without losing their job.

That unpaid leave guarantee doesn’t apply to about 40 percent of working people, however. And for many Americans who are trying to start a family, it’s simply not a financial option to spend one month, let alone three, without earning income.

That financial bind can become a physical nightmare for women, as interviews conducted by Rewire revealed.

Erica Hunter wasn’t able to think about taking more than two weeks to heal from her episiotomy, or to deal with the trauma of almost losing her newborn son during an incredibly difficult delivery.

“They pretty much just split me open, and then had to pull my son out with forceps because everything had gotten so complicated,” Hunter told Rewire. “It was really pretty horrible, but I didn’t have a choice. I had to get back to work or we were going to be homeless.”

She said she was lucky to have a desk job, because it made it easier to convince her doctor to give her medical permission to come back to work.

“It was either beg my doctor for a note to go back to work in two weeks or we were going to lose everything because there was no income,” Hunter said.

The $12 an hour, plus commissions, that Hunter made doing telephone sales for a fitness equipment manufacturer was all that kept her household afloat. She and her partner, who had been out of work for months, had no savings. Her employer didn’t offer paid maternity leave, and she had no access to paid time off or disability since she had worked at the company for less than a year.

She couldn’t move in with her parents because there was no room, and she couldn’t stay with her partner’s parents because they were fundamentalists who disapproved of her having a child out of wedlock.

Hunter said her doctor was “reluctant” to sign off on letting her go back to work after just two weeks, but ultimately understood the financial pressures. Her job was happy to have her back, she said, since she was a top sales associate.

“They were, I guess, as accommodating as you could be, with me having to be in the office 40 miles away from my newborn every day,” Hunter said of her employers.

She said they let her pump breast milk, but she had to do it in a bathroom stall—not the most sanitary environment—and nursing eventually became “impossible” when she was out of the house for 12 hours a day, including the commute.

“It was exhausting,” she said.

Elle Kay (not her real name) said she didn’t get medical approval from her doctor to come back to work after three weeks, but she did it anyway.

“I could barely walk due to a third-degree tear from my clitoris to my cervix,” Kay told Rewire. “I called my boss, and she said as long as I didn’t bleed all over the chair I could come back without a note.”

She had expected to take eight weeks of maternity leave. She was technically a part-time employee but often worked more than 40 hours a week, which her bosses said would qualify her for some partially paid time off.

But the day before Kay left for maternity leave, she was informed that she would only get four hours of paid leave. Kay had saved up a few hundred dollars to supplement what she thought would be a partially paid maternity leave—but a car accident 32 weeks into her pregnancy wiped out those savings, and she had nothing to fall back on when she learned she wouldn’t get paid time off.

While she was “begging” to come back at three weeks so she could make ends meet, she said the experience took a physical toll.

Kay had trouble establishing her milk supply because she could only pump for 20 minutes a day in a filthy employee locker room full of dead bugs and with no chair, which she had to vacate if someone knocked. She had “horrible” postpartum depression from missing her baby and working 14-hour days with no sleep. 

“I struggled so much,” she said.

Alana Adams went back to work just seven days after giving birth—seven days that she had spent in the hospital recovering from a c-section and dangerously high blood pressure from postpartum pre-eclampsia.

Adams was in school and working a seasonal job as an emergency medical technician at an amusement park when she had her child. That job didn’t come with any benefits, she said, except “a slightly higher pay rate than the the local barely livable wage.”

“There was no gap between the hospital and work,” Adams told Rewire. “If I had attempted to take any time at all off of work, I would have been replaced immediately.”

She noted that since a c-section cuts through the abdominal muscles, it’s extremely painful to change positions between sitting, standing, and lying down.

“On a day that there wasn’t a lot to do, I could sit most of the day, but if I had to get up in a hurry, I was up the creek,” Adams said. “Most days I just stayed on my feet for 10 or so hours because it was safer than having to try to get up quick.”

Spradlin, the lactation consultant, said that lack of paid leave represents a national failure to care for postpartum women, and thus to care for families.

“When we talk about the cost of health care and the cost of maternity leave and the cost of unemployment insurance, people don’t take the long view of it,” Spradlin said. “Now we have this spiraling out of control of a family unit that isn’t enjoying optimal health because mom had no postpartum recovery period.”