Breastfeeding Accommodations

September 18th, 2007 by MamaBear

One story that’s been in the news lately is causing me some concern. It’s about a Harvard medical student, Sophie Currier, who isn’t being allowed to take a pumping or breastfeeding break during an exam which is required of all medical students. This news story has caused a division even among lactivists, with some people saying Currier has been offered “enough” accommodations due to her dyslexia and ADHD and therefore doesn’t need the “extra” time to pump/breastfeed. My opinion is that if she has ADHD and dyslexia, then accommodations made for those circumstances aren’t related at all to her lactational state, so why is that being brought up at all? So she’s being given accommodations. Big deal! If a man were to have ADHD and dyslexia, he’d be given the same accommodations. If the same man were to also have cancer, for example, he’d be given accommodations for his ADHD and dyslexia, and, I would think that additional accommodations would be made for his cancer condition as well. And if they weren’t, I wouldn’t be outraged if he tried to rectify that. I wouldn’t say, “Well, he just wants attention!” And I don’t think anyone else would either… Well, not compassionate people anyway.

Why is this case any different (other than the fact that Sophie Currier doesn’t have cancer or other life-threatening condition)? Well, because this is a woman’s issue. And when something is a woman’s issue, then it’s “women needing attention” and “women wanting special treatment.” It doesn’t ever seem to be interpreted as, “Even though it’s never been done before, this is a legitimate issue that needs to be addressed.” Oh no. That would be way too reasonable.

I don’t think letting a woman take pumping breaks during a test, no matter how big and important, is an unreasonable accommodation, given that she’s lactating. I think any woman who is lactating should be allowed pumping or breastfeeding breaks, period. The time between them shouldn’t be longer than three hours, because that’s about the longest a nursing baby would go without breastfeeding (if it’s during a growth spurt, it could be as often as every ten minutes, but I’m compromising here for the sake of reasonableness). Lactating breasts that aren’t emptied regularly, whether by breastfeeding or pumping, become engorged rather quickly, and this engorgement can range from uncomfortable to painful and can be very distracting. I can only imagine what it must be like to take a high-pressure test like the United States Medical Licensing Exam while dealing with a constant throbbing pain in the breasts… Not to mention, if the breasts aren’t emptied, it could cause problems like plugged ducts and a breast infection called mastitis. I’ve experienced dozens of episodes of plugged ducts personally, and a few cases of mastitis. They are both debilitating and painful conditions which I wouldn’t wish on my worst enemy. It’s much better to prevent them than to cure them. In severe cases of mastitis, a breast abscess (link to picture which may not be safe for work) could occur, which could require surgery. It’s a terrible idea to not allow a lactating woman to pump/breastfeed when it’s clear an accommodation must be made for this.

(It’s actually more than a little ironic that an exam which is a requirement of becoming a doctor wouldn’t make accommodations for a lactating mother given that the AAP and AMA both recommend breastfeeding exclusively for the first six months of a baby’s life, and thereafter, continued breastfeeding for twelve months (in addition to the introduction of solids). Most medical institutions don’t give an upper limit for breastfeeding, leaving it at the discretion of the mother and child — “as long as mutually desired by mother and child.” Currier’s baby is four months old now, and in need of exclusive breastfeeding, as per the AAP’s recommendation.)

Some comments I’ve read on the web regarding this: “But she shouldn’t have had kids in the middle of medical school if she was going to need accommodations!” Here’s my response to this: Try being a twentysomething woman who wants to hold off on having kids for x, y, or z reason (could be as simple as “haven’t found the right partner yet.” … Or it could be that she did try to have kids earlier, but she couldn’t get pregnant until she reached her thirties. Not everything in life can be controlled!) Then try being a thirtysomething woman, with your biological clock ticking, while you’re in medical school. Sure, you could wait another decade while you sort out your career fully and then try to have kids…. But you know that if you do that, you’re taking a grave fertility risk. Statistics show that it is much harder to conceive after forty than when you’re in your thirties. It’s actually pretty common knowledge, which is why so many women wind up having kids even while they’re getting their careers sorted. True, some women sacrifice one for the other, as is their prerogative, but other women want to have both, and work hard to achieve both, …and why is that wrong, exactly? Ohhhh… That’s right. I almost forgot. It’s the old “damned if you do and damned if you don’t” conundrum. Of course.

Sophie Currier started her own blog and stated her point of view very eloquently. So far, just one entry, but worth reading.

Personally, I don’t see how giving her (and every other mom who takes that test — and other tests like it for that matter) the very reasonable pumping/breastfeeding accommodation would affect her ability to be a good doctor. If she passes the test, she passes, and she should move on to residency, etc. I just don’t see why giving her this reasonable accommodation is turning into such a tooth-pulling exercise. The only reason why she’s asking for it is because she’s lactating, and stopping lactation is out of the question. It is discriminatory (and hypocritical, considering the institution which this test is for) to not allow pumping breaks. Full stop.

Update: Not surprisingly, the judge ruled against giving her the twenty minute breaks. She asked for twenty minutes for each day she took the test and was not granted them. Ridiculous that she had to go to court to try and get this time, and even more ridiculous that she wasn’t given it, but there you go.

Washington Post article (update).

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10 Responses to “Breastfeeding Accommodations”

  1. Denise Says:

    Let me tell that judge: a mother with a four-month old infant would be driven to distraction during a nine-hour exam with leakage and engorgement. I truly hope she appeals the ruling, for the sake of all women. If the baby were over nine-months old, it would probably be fine, but to say that she should delay her exams is discriminatory.

  2. NursingMom2 Says:

    Let me tell that judge: Thank you for stopping Ms. Currie’s entitlement parade. As a mother, as a nursing mother, as a nursing mother who has managed to get through a LOT of daylong exams without whining recently and as the great-grandaughter of a woman who managed to GO OFF TO WAR with a baby strapped to her back and a string of bullets strapped to the front (and still managed to nurse without whining) I can only say, there is a limit to special entitlements.

    Ms. Currie’s supporters can rant all they want abou,t “Ooh! A MAN would neeevvvvver be put in this situation!” but you know what? As women, we are called on to be BETTER than men. Ms. Currie is simply an example of entitlement gone too far.

  3. MamaBear Says:

    As I said, this is a divisive topic even among lactivists. Glad you both shared your opinions.

  4. mama o'matrices Says:

    Hm. I think I just wrote this post.

    Currier is a bad standardbearer. She’s too complicated, and people are getting distracted by the ADHD/dyslexia. On the other hand, this is a breastfeeding issue, which means that everybody is going to come out of the woodwork - and they are going to come out of it primed and pissy.

    Yup, the discourse here is going to be, well, not discursive at all. People are yelling at other people who have their fingers in their ears, and are yelling back.

    I don’t think Currier asked for much, and given the logistics of her situation, I think it’s reasonable. I also don’t think there’s a good reason not to grant it. She doesn’t fall under the ADA? Dang. Now, let’s carry that argument a little farther…peeing doesn’t fall under the ADA either, right? No, perhaps we should stop right there.

    What’s happening here is that the board is traditionally stubborn on this issue, and they’ve never had a flashlight shone on them before. Currier isn’t new - she’s just louder than most. And, given that the argument has gone legal, I don’t think she’s got a good chance.

    Breastfeeding is so badly understood, both by medical professionals and the public at large, that her chances of finding a knowledgeable judge are slim. I just hope her lawyers are really, really good.

  5. Gina Says:

    While I sympathize with her for nursing her infant and studying, keep in mind she did get lots of extra help during her school days. (Her hubby is an MIT professor).
    She is also getting free assistance and representation from a lawyer!

    Also, since she did not pass the medical exam the first time around - although she was 8 months pregnant and not lactating, is there any chance of passing the 2nd time? Maybe, with the extra 2 days she has been given for a one day test, plus the extra time given for her to lactate/pump her breasts.

    In a way, I am glad this case has come to the attention of the public. Now, other people will get an awareness and learn how to get (necessary?) perks and help when going through the educational system.

  6. MamaBear Says:

    Well, see, I don’t really care that she didn’t pass her exam the first time around (except for the little detail that she was eight months pregnant at the time — my goodness, at eight months pregnant, I could barely walk, let alone sit through and pass a grueling career-determining exam)…

    And honestly, even if she doesn’t pass the second time around, I don’t see how it’s relevant to the issue of making reasonable accommodations for lactating women. I think what she did in pursuing the matter, in making people take lactating women seriously, was very brave and commendable.

    I wish her the very best, and hope she passes, but I don’t think her not passing a second time will make or break the lactivist community. Winning the case, though, is VERY significant. I applaud her for taking this risk; it was enormous (the potential loss to her was huge), but the gains are enormous, too. I truly believe she did it for all lactating women, and I think she’s a hero for doing it. Brava, Sophie Currier!

  7. MD Says:

    Some facts:

    1) She failed the same test in April.

    2) The NBME already went out of their way to accommodate her. They are giving her twice the time to complete the test and a private testing room. Try taking a 9-hour intense exam with other people taking typing tests around you like the other 3000 of us did.

    3) The USMLE is a STANDARDIZED test to assess a minimum competency to assure that you have enough base knowledge to practice medicine and not harm your patients. If you don’t pass, then the exam is doing what it was intended to. Preventing somebody without a core knowledge of medicine to practice medicine on people who’s lives depend on your knowledge.

    4) This test can be taken anytime during your 3rd and 4th year of medical school. You schedule when you take the test. Students have 2 years to schedule it and fit it into their “mom” schedule. She chose to procrastinate until it left her in this predicament. Most students take it during the end of their 3rd year to avoid this exact problem. Failing and not being able to start a residency in July. Yes, most residency programs start in July, not November. Did MGH already accommodate her by pushing her start date back by 4 months?

    So when the surgeon can’t get a pathology report on the margins of a cancer they are resecting and the patient dies on the table, who is going to be supporting her when her excuse is “I needed to breast feed at that moment, otherwise my engorged breast would hurt and I could get mastitis.”

  8. MamaBear Says:

    1) *yawn* How is this relevant to providing lactational accommodations? Let’s say she fails the test the next 20 times she takes it. My question is still: How is this relevant to providing lactational accommodations?

    2) Again, not relevant to *lactation* (you did notice this was a breastfeeding blog, right?).

    3) And never in the history of the USMLE has a person taken the test, failed it the first time, and then passed it a subsequent time? That’s what I thought.

    4) I addressed this concern in this very post (did you even bother to read it?)

    Your last concern is not rational. She already has her Ph.D. and went through medical school to get her M.D. I think if she can handle all that AND go through two pregnancies, I think she can figure out how to prioritize lab reports over pumping time. The nature of this exam is very different from a real-world situation where there’s a lot more leeway day-to-day. As an example, it’s very possible to pump in private while working on the report (the USMLE did NOT give her the option to pump in private while taking the test, which is understandable). Each pumping session can take anywhere from 15-30 minutes. It’s not like she’ll be stuck pumping all day long. Furthermore, she will stop lactating eventually, and this will all be a moot point. FYI.

  9. Elena Says:

    What I don’t understand is why it’s assumed that all women, everywhere must support Sophie Currier just because she’s a woman and is breastfeeding. I get the feeling from quite a few pro-breastfeeding blogs that if we do not wholeheartedly support Sophie then we are somehow anti-woman. Frankly, I think that someone who was only able to garner a degree because other students were paid to share their notes and read textbooks to her shouldn’t be in the position to take this exam in the first place. I find the breastfeeding issue secondary, and (when considered together with the other special considerations she has asked for) simply an indication that she is willing to do anything and everything to gain a few extra moments to study between sections of this exams. What I am most offended by is this insistence that if we don’t speak up for Sophie then we are against all women; the truth is, I feel as if it is my right, as a woman, to voice my own opinion… An my opinion is that this particular student needs to spend a lot more time studying and a lot less time making excuses. For those people who make excuses for her for failing the exam the first time around because she was (gasp!) eight months or so pregnant, all I can say is, listen, you can’t have it both ways. You cannot say that she is equal to a man and not special at all BUT she needs a bunch of special considerations because she is (gasp!) pregnant and therefore very special and needs a bunch of extra considerations. I’ve taken a LOT of exams while pregnant, both professional and academic ones, and I would consider it very shoddy indeed to blame any inability I have to pass those exams on my pregnant state and not on my preparedness or lack thereof. It’s simply a copout to say that she cannot possibly be expected to pass an exam because she is in an advanced state of pregnancy and is somehow exempt from basic acts of thought and reasoning.

  10. MamaBear Says:

    Elena,

    I hear what you’re saying, and I’m glad you were able to express a dissenting opinion in a respectful way. That said, I think it’s great you’re voicing your opinion, even if it differs from mine, because you’re not resorting to personal insults or misogynistic overtones. Why can’t everyone express themselves this way, I don’t know.

    Anyway, if you don’t support her, fine. It’s no skin off my nose, and I can even honestly admit that I’m glad you managed to express that eloquently and with respect. I realize not many people want Sophie Currier as their Lactivist Representative (or Feminist one). However, I don’t see anyone else fighting for lactational accommodations in standardized tests, so this is the choice I’ve been given. I choose to support her in her endeavor to get these breastfeeding/lactating accommodations because I think they’re reasonable. I think the accommodations are reasonable for ANY woman. It just so happens that Sophie Currier is the one asking for them.

    When Rosa Parks did what she did, I’ll bet there were some people in the civil rights movement who probably told themselves they didn’t want Rosa representing them. Maybe at the time, her bold move was “too radical” or “not respectful” enough. Some people probably thought she’d do more harm than good. Now, though, with the benefit of hindsight, everyone can see what she did was exceptionally brave, and marked a turning point in the civil rights movement. We can learn a lot from history, Elena. The landmark decision by the judge to grant Sophie Currier pumping time is very significant. You want to make this all about Sophie Currier, but it’s not. This decision is not about Sophie Currier. It’s about ALL women in her position. It sets a precedent, and that’s why I am in favor of supporting her.

    And who said women are equal to men? What does that mean? Women and men have different needs. Are you going to start arguing that a woman in labor is equal to a man and therefore her temporary state of labor shouldn’t be taken into account for any given situation? That would be ridiculous, right? Well, I see pregnancy in a very similar way. Sure, yes, many women can manage a pregnancy and work/tests/school just fine, but that doesn’t mean every woman will or even should have to. I’m not making excuses for her when I say that I wouldn’t have been able to sit in one position and take a nine hour test (and pass it). I’m only speaking of myself and my own experience, and I sympathize with hers. This doesn’t mean I believe all pregnant women are incapable to accomplishing great things — I’m not sure how you’re justifying that logical leap from the very little I said of that detail.

    For the record: pregnant women are special. Lactating women are special. You will not find a more ardent feminist than me, so don’t go down that path. Women are people. We are human beings, with unique considerations. You would not ask a pregnant woman to run a marathon. It’s possible a pregnant woman could do it, but it is not a reasonable request. If a pregnant woman were to enter a marathon, with the intent of running it, and if she were to not make it to the finish line, what would you tell her? “You shouldn’t have done that; blah blah blah more discouragement…” Or would you recognize, “Hey, it was brave of you to try it! Kudos!” I favor the latter sentiment. We’re just of different minds, and we can agree to disagree.

    I would never say “she cannot possibly be expected to pass an exam because she is in an advanced state of pregnancy and is somehow exempt from basic acts of thought and reasoning.” That would be stupid. What I’m saying is that it’s great that you passed tests while pregnant (I have too, though not career-determining standardized ones). What I’m saying is, it matters not whether she passed or not the first time around… (Though the little detail that she was eight months pregnant when she took it the first time did not slip by me…) What I’m saying is: give her some time to pump her tits. That’s what I’ve always said (you can check).

    I’m not quite sure why this issue is still upsetting people. The ruling has been made. How is it harmful for you to give her pumping time which will now make it easier to give other lactating women pumping time when taking this test? That’s the part I think is misogynistic: that people are upset because of the precedent this sets. How would it hurt anyone to give lactating moms more break time to pump? If you haven’t been there, strapped to a pump multiple times a day out of necessity, you won’t know how heartless not allowing that accommodation sounds.

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