What is reasonable accomodation for a test-taking, breast-feeding mother?

Hat-tip to a reader for bringing this to my attention.

Should a breast-feeing woman be allowed extra long breaks during her nine-hour medical licensing exam?

That's been the question in the case of an MD/PhD student and her four month old baby.

The medical student, Sophie Currier, requested extra break time so that she could pump her breasts during the exam. The national Medical Board of Examiners denied her request, so she sued. On Wednesday, an appeals court overturned an earlier decision that denied her request.

A Superior Court judge last week rejected Currier's request to order the board to give her an additional 60 minutes of break time. Appeals Court Judge Gary Katzmann overturned that ruling, finding that Currier needs the break time to put her on "equal footing" with the men and non-lactating women who take the exam.

"I think it's a big step for women, all nursing and working moms," Currier said.

The board had cited a need to be consistent in the amount of break time given and said other nursing mothers who have taken the exam found 45 minutes sufficient.

But Katzmann said that amount of break time was "insufficient" for Currier to nurse her baby, properly express breast milk, eat, drink and use the restroom over the course of the nine-hour exam.

Without extra time, Currier would have to choose between pumping breast milk and ignoring her bodily functions or foregoing pumping and causing herself significant pain, the judge said.

"Under either avenue, (Currier) is placed at significant disadvantage in comparison to her peers," Katzmann wrote in his 26-page ruling.

You would think that a bunch of doctors would recognize that 45 minutes of break time over the course of a 9 hour day is not enough for a woman to adequately pump, eat, and pee, and that the consequences of not getting to do any one of those three things adequately would be painful and make it hard for Currier to perform well on the exam. That other women have (somehow) managed to survive (no word whether they passed) is not an excuse for an inhumane lack of respect for bodily functions. At least the appeals judge had some sense.

Why is 45 minutes inadequate? Let's imagine that those 45 minutes are divided into a 15 minute break after 3 hours and a 30 minute break after the 6th hour. (There's no word in the article how the breaks arranged). A non-lactating person would probably use the first 15 minute break to go to the bathroom, eat a snack and stretch their legs. Maybe they'd go outside to see a bit of sunshine. During the half hour break, a non-lactating person would do the same thing, only they'd spend a bit more time eating a light meal rather than a snack.

Now, what would Currier do during those breaks? Assuming she was able to feed her daughter or pump immediately before beginning the test, her breasts would be feeling pretty full at 3 hours and so would her bladder (because her last bathroom break would have been before feeding/pumping before the test.) She'd probably rush to the bathroom and then rush to the designated pumping room, where, by the time she got the tubing hooked up, she'd have approximately 5 minutes to pump, before she had to take everything apart and put the milk in a cooler. In 5 minutes of pumping, she might manage to get 1 oz. (Her daughter meanwhile has probably drunk 4 oz.) At the 30 minute break, Currier would skip the bathroom stop because her breasts would be rock hard and painful. She'd manage about 20-25 minutes of pumping - maybe enough time to get 2-3 oz. (Her daughter meanwhile has drunk another 4 oz.) Maybe, Currier would eat a granola bar on her way back into the exam. By the time the exam was over, Currier would be extremely hungry and her bladder would be awfully full again. And her daughter would be hungry.

Yet, somehow Currier's need to express milk doesn't qualify her for extra break time?

Aha, some of you are saying. We read the whole article - the examiners are already giving Currier lots of accommodation. She's taking the test over two days AND she can pump while she's testing. Yes, it's true, they are making some accommodations - in part because Currier has other disabilities that require the two day test. But the pumping while testing thing is just plain ridiculous. When pumping, your shirt is wide open or off and you've got plastic cones and tubing sticking out of your chest. Your nipples are being sucked in and out by a machine-made vacuum. It's not all that comfortable. While you can jerry-rig a hands-free setup using some hair rubber bands, if you twist or turn the vacuum seal will be broken until you use your hands to readjust it. When you are done pumping, you need to disassemble the cones/tubing/bottles, cap up the bottles and put them in a cooler. You need to at least rinse the pump parts prior to their next use. Oh, and you need to think about your baby to help the milk get flowing. Asking Currier to pump while taking the exam is like asking a man to take the exam while he is continually pinched in the arm and periodically shown of his girlfriend. Do you think that man would do as well as a guy down the hall who actually got to concentrate?

So, how long a breaks does Currier need in order not to be penalized for being a nursing mother? In my opinion, she needs about one hour after every three hours of test-taking, and that's based on my own pumping rhythms. It takes me about 35 minutes to set up, pump, and dismantle, plus another 5 minutes or so to clean up the pump parts and store the milk. That would give Currier 20 minutes or so to go the bathroom and get something to eat. But I am told that I am lucky enough pump faster than some women, so Currier's hour "break" might involve more time pumping and less time eating/peeing.

Having been put in their place by a judge, have the doctors seen the error of their ways?

The board plans to appeal, board attorney Joseph Savage said.

... "If the tests aren't fair and comparable, the boards don't have the information they need to only license doctors who are properly trained."

Currier has finished a joint M.D.-Ph.D. program at Harvard University while having two babies in the past two years. She has been offered a residency in clinical pathology at Massachusetts General Hospital beginning in November but cannot accept it unless she passes the test. Her goal is a career in medical research.