Just four years ago, pregnant women scored what looked like a victory at the Supreme Court.

In a case called Young v. UPS, the court appeared to make it harder for companies to deny expecting mothers the kinds of accommodations they need to keep working: things like extra bathroom breaks, a reprieve from heavy lifting, or even a stool to sit on while working a shift at the cash register.

At least that’s what it seemed like. Instead, women have lost two-thirds of the accommodation cases decided since Young, according to a new analysis of federal lawsuits released on Thursday by A Better Balance, an advocacy group that provides legal representation to caregivers and families.

“Pregnant workers are still being forced to choose between their job and a healthy pregnancy,” write the authors of the report.

The United States has a long way to go when it comes to truly celebrating mothers. Women take a pay hit simply for having children — a 4 percent reduction in pay per child, according to one 2014 study. Mothers aren’t guaranteed paid time off to recover from childbirth or bond with a new baby. As a result, one-quarter of women go back to work within two weeks of giving birth.

Pregnant women, especially those in physically demanding jobs, have a hard time even just doing their work. Often, if they can’t get those extra breaks or a schedule that provides time off for doctor visits or severe morning sickness, they wind up leaving the workplace ― some are fired, some quit, and others are forced out on unpaid leave.

Just this week, CNET reported on seven Amazon warehouse workers who say they were fired after asking for things like more bathroom breaks and less time on their feet. Amazon has consistently denied the allegations.

Forty percent of mothers today are their family’s sole or primary breadwinner, and families depend on their income. Getting fired when pregnant puts these women in a particularly precarious position.

“We know when women are pushed out, it often spirals into a deep circle of poverty that they have a tough time climbing out of,” Dina Bakst, co-founder and co-president of A Better Balance who co-authored the report, told reporters on a conference call Thursday afternoon.

The Better Balance report is loaded with examples of women who just needed a little slack to get through their pregnancy but instead got pushed out of work and then lost their fight for justice in court: a daycare worker who needed a bathroom break; a shift leader at a convenience store who asked for light duty; a nurse aid who couldn’t lift anything too heavy.

For their analysis, researchers identified more than 200 cases filed under the federal Pregnancy Discrimination Act and decided since the Young decision. Researchers then narrowed those down by looking only at the 43 cases that specifically covered workplace accommodation claims and cited Young.

The number of cases may seem small, but represents a problem that’s affecting women from Alabama to Michigan to Wyoming, said Sarah Brafman, a staff attorney at Better Balance who also co-authored the report. “Over and over, courts are dismissing cases.”

And for every woman who went to court, there are hundreds more without the resources and time to file a case.