(CNN) - Emily James, a high school teacher in Brooklyn, New York, tries to never miss a day of work. She's taught with two infected wisdom teeth. She's taught with strep throat. One time, she had no voice and just wrote things down and used signs to communicate with her students.
"The kids said to me so many times, 'Miss, why don't you just go home?' And I had to explain to them, 'I can't,' " James said.
She couldn't because, like many other teachers across America, James hoarded more than a dozen sick days so she could take time off after she gave birth to her two girls. So, when she was actually sick, she had to go to work.
The United States is one of just a handful of countries that don't have a national parental paid leave policy. When a woman in the United States gets pregnant, she's entitled to 12 weeks of unpaid leave within 12 months after birth, thanks to a Clinton-era law known as the Family and Medical Leave Act. But American women are not automatically entitled to 12 paid weeks off like women in Mexico or 46 paid weeks off like women in Bulgaria. Other countries without a national parental paid leave policy include Swaziland, Lesotho and Papua New Guinea.
This lack of policy isn't just inconvenient for American women. In some cases, it determines how women make crucial choices about their health, their finances and their families.
In the United States, teachers are hit particularly hard by this lack because roughly 76% of public school teachers are women, and they're underpaid. In 2015, their weekly wages were roughly 17% lower than those of comparable workers, according to the Economic Policy Institute.
So, teachers have found work-arounds. They rack up sick days for years on end and then use them all up after they give birth. They combine these days with vacation days. On occasion, they ask other teachers to donate days to them. In New York, a teacher can donate two sick days so a colleague can have one day off. Teachers also, when necessary and if they can afford it, go without a paycheck.
Not only does this leave teachers exhausted and financially stressed, it means they're going to school when they're sick, when their children are sick and when they're heavily pregnant.
"I was exhausted every single day. I was in pain. I wasn't sleeping well," said Carolyn Rehak, a teacher in the Chicago area who worked up until her due date. "I just don't think that's fair to either me or my students, because they're not getting the highest quality teacher."
Carly Klareich, a guidance counselor at a public school in the Bronx, was hit particularly hard by New York City's lack of a paid leave policy in 2016. She had been racking up sick days long before she met her husband in the hopes that one day, she would have a baby and she would be able to take as much time off as she needed. But when she was 22 weeks pregnant in 2016, she received the devastating news that she had breast cancer.
Klareich's first thought: She was scared for her life. Her second thought: "I definitely did not have enough days for a cancer diagnosis and to be pregnant at the same time."
Before the diagnosis, Klareich planned to have her baby in October and return to work in December. But suddenly, she had to prepare for a different reality, one in which she would need her sick days for when she was actually sick.
Klareich decided to forgo treatment until after she gave birth. Eight days after her son, Jack, was born, she began chemotherapy. Later, she underwent a double mastectomy and radiation. The treatment put her at high risk for infection, and she decided she couldn't go back to work. Klareich didn't return to work until five weeks before the school year ended. After burning through all her sick days, and even after several colleagues volunteered their own days, she still had to go six weeks without a paycheck.
Katie Allen, a fourth-grade teacher in Denver, was also forced to weigh what was more important, her health or her paycheck. The 2018-19 school year is Allen's second in the Denver school district. As a relatively new teacher in the district, she was given only 10 days off after the birth of her daughter last month, even though she had a C-section. Doctors recommend eight weeks recovery time from that surgery, but Allen is the primary breadwinner of her family, and she and her husband can't afford for her to take more time off from work.
"I don't know that it's often wise to go against medical advice," Allen said, "but it's just something that I have to do for my family."
Sapphira, a teacher in Brooklyn who asked to use only her first name, tried to avoid the lack of policy altogether by trying to plan her pregnancy so she would give birth during the summer.
In October 2015, she began to trying to conceive, but she didn't get pregnant. So she and her husband had to put their plans on hold.
"It was very stressful," she said. "And I knew come October 2016 that if I didn't conceive, I would have to wait another year."
Luckily, Sapphira did get pregnant in October 2016 and gave birth to a girl according to plan the following summer.
On June 20, some teachers got some good news. After a long battle with the United Federation of Teachers union, New York City implemented a policy giving public school teachers six weeks of paid parental leave.
New York state, by comparison, offers its employees eight weeks paid parental leave. California offers its state employees six weeks of paid parental leave. New Jersey's program offers six weeks of paid leave, but employees are paid only two-thirds of their normal paychecks, according to the National Conference of State Legislatures.
New York City's new policy is in line with those of more generous cities such as Austin, Texas, and Pittsburgh, which also offer its teachers six weeks of paid parental leave.
"It's a huge victory," Klareich said of New York City's new policy.
But, she emphasized, it's just the first step toward giving teachers what they need.
"I don't want to sound ungrateful, but I still don't think it's enough time."
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