In case any of you haven’t heard about this case, I would like to bring it to your attention and weigh in on some of the misconceptions and knee-jerk reactions that are traveling around the internet. I apologize, in advance, for the length of this post, but this issue has me FIRED UP.
Sophie Currier is a 33-year old student at Harvard Medical School (she has also studied at MIT and also already has a PhD) who is taking her medical board exams AS I TYPE THIS. Sophie has two children: an almost 2-year old son and a 4-month old daughter. She is currently nursing her young daughter (as is recommended by the American Medical Association and the American Academy of Pediatrics) and requested extra break time between sections of the exams to use a breast pump during the 8+ hours long exam. The National Board of Medical Examiners (the organization that does the testing) denied her request. They told her that she could only have the amount of time that is available in the existing testing schedule; an amount of time that is really only sufficient for eating and using the bathroom.
Sophie has a prestigious, but grueling residency waiting for her at Massachusetts General Hospital after she passes her board exams. Sophie intentionally planned to have her two children very close together so that she would not be pregnant during her residency, which, with the long hours and physical demands required, could be harmful to her and to her baby. To wait to have children until AFTER her residency would have put her in her late 30s, when she would be at greater risk of infertility problems or complications with the baby, not to mention the fact that it would be difficult for her to have children later, when her post-school career would just be beginning.
Complicating this issue, for some people, is the fact that Sophie has Attention Deficit Disorder dyslexia and has also received a testing accommodation (as legally allowed under the Americans with Disabilities Act) to take the test over a two-day period, rather than the usual one day. To me, this is a completely separate and irrelevant issue. That accommodation is mandated by law and is something that thousands of people have access to every day. To say that any one person is only allowed to have one condition requiring special accommodation is asinine. My dedicated sister-in-law is a special education teacher and works with many children that have multiple “conditions”, for example: learning differences AND a physical condition necessitating a wheelchair or a learning difference AND a visual impairment.
Sophie sued the NBME to be granted some extra break time and, initially lost, but then the judgment was voided on appeal and Sophie WAS, in the end, granted the right to begin the testing yesterday, without worrying about engorgement or premature weaning. In case my opinion on this matter isn’t already clear, let me address a few of the arguments that I’ve seen floating around:
Q: Why can’t she just pump milk ahead of time and have someone else use it to feed her baby that day? Why can’t she just have someone feed her daughter formula while she’s taking the test?
When you are nursing (as I know from personal experience), your body responds to the demands that are placed upon it: the more than your baby nurses (or the more that you pump), the more milk you will produce. If that milk is not pumped out (or nursed out by the baby), then your breasts will become engorged, hardened and VERY painful. A 4-month old child typically nurses every few hours, so to go without nursing for the 9-hour testing day would be excruciating and the inevitable leaking would be very distracting. It would also put her at risk for infection or having an interruption in her future milk supply. Yes, there are ways to work out the milk supply situation for the baby, that is not the issue; the issue is the discomfort that Sophie would feel during the testing if she could not relieve the need to release the milk.
Q: Won’t this extra time give her an advantage over the other candidates taking the exam?
The extra break time would NOT, in any way, constitute an unfair advantage, but would merely put her on an equal footing. She would be at a disadvantage if she had to put up with engorgement, pain, leaking, etc.. The breaks would occur between sections of the test, so she would not be able to look at the questions and then go think about them over a break. She would also not be allowed to change any of her previously-completed answers after a break.
Q: How have other breast-feeding candidates handled this exam?
There have been other women that have had to deal with this situation. Many of them have written letters of support to Sophie, describing the difficulties that they had in the testing procedure, that have been used to bolster her legal battle. Some of them said that the pain of engorgement was so great that it actually caused them to vomit. Can you imagine taking an important career-influencing exam under those conditions? Sophie is not the only women that has been impacted by this difficulty; she is just the first one to come forward and ask for accommodation.
Q: Isn’t there too much litigation going on in our country today? Couldn’t this have been handled without a lawsuit?
Yes, it would definitely have been preferably for the NBME to have given Sophie the accommodations that she needed without it being necessary for her to seek legal counsel. Her attorneys believed so strongly in her legal rights that they are working on her case free of charge.
Q: So how is this woman going to care for her children once she starts to work? Why doesn’t she just stay home and take care of her kids?
I wouldn’t presume to guess what Sophie’s future breastfeeding plans are, but her residency doesn’t start until November, when her daughter will be over 6 months old. She may choose to wean her daughter before that time; she may not. Many employers provide workplace accommodations for nursing mothers to pump and refrigerate their breast milk so that it may be carried home for future use. I don’t know whether or not Massachusetts General Hospital has these facilities or not. I hope so.
As for the suggestion that Sophie should delay the test for a year or give up her residency or even her whole career and be a stay-at-home mom: I’m really tired of the whole “us vs. them” mentality regarding working moms and stay-at-home moms and also regarding nursing moms vs. non-nursing moms, too, for that matter. Some moms work because they love their careers and feel driven to give something to society as a whole through their work (but also love their families and are able to be good moms at the same time); some moms work because they have to for economic reasons. Some moms breastfeed because they’ve heard it’s best and are able to do it; some moms try and try and just aren’t able to breastfeed (it happens, and it’s nobody’s fault), some moms choose not to breastfeed for personal reasons (or they’re just not comfortable with it, and that’s OK, too). I am glad that we live in a society where women can be moms AND have a career. I choose to be a stay-at-home mom, but I grew up with a working mom who managed career and kid admirably well. Everyone has to do what’s right for their own life. I wouldn’t want anyone telling me that I couldn’t have a career because I was a mom, just as I wouldn’t want anyone telling me that I couldn’t have children because I had a career. Just as importantly, I wouldn’t want anyone else forcing either of these opinions on my daughter when she is old enough to be pondering careers and children. Can you imagine anyone suggesting to a man that he give up his career (or delay it a year) because he has a child? Sorry, guys – I don’t want to make this a “men vs. women” thing, either, but making that point does illustrate the absurdity of the argument.
Q: How is she going to handle her responsibilities with her ADD and dyslexia?
Sophie has been able to make it through MIT undergrad and Harvard Medical School with only the same accommodations that are afforded any other students with ADD and dyslexia (there are lots of others). Just to be admitted into MIT and Harvard is an accomplishment that most people can only dream of. I, for one, have no concerns about her intelligence. I personally know three individuals that have ADD and they are among the most competent people that I know. There are medications and other things that can be done to help them focus on their tasks and they are all able to perform very successfully in their careers. Sophie is planning on becoming a research pathologist and is not planning to work face-to-face with patients, but, if she were, I would be the first to line up to be one of her patients. That being said, the fact that she has ADD and dyslexia still has NO bearing on the breastfeeding issue.
Q: What about other people that have special medical conditions, for example, someone with diabetes that needed to test their blood sugar level and/or administer insulin or someone that needed to empty a colostomy bag? Would they be given extra break time during the exam?
Those conditions (a colostomy, diabetes and other similar conditions) would fall under the protection of the Americans with Disabilities Act (ADA) and the testing centers would be required to make the necessary accommodations, without legal action. Certain complication of pregnancy even fall under this category. For example: if a pregnant woman was having circulation problems (a common condition during pregnancy) and needed to get up every hour or so during the test and walk around, to prevent dangerous blood clots in her legs, she would have to be allowed to do so. Breastfeeding is not given this same protection under the law.
I realize that people have very strong opinions about this issue and not everyone will agree with me, but I did feel that I had to weigh in. There are so many people spouting off on other blogs and in discussion forums that clearly have no idea what breastfeeding entails. If you’d like to read more about this, here are some links to news stories and other opinions:
The Boston Globe
The New York Times
Lone Star Times blog
The Lactivist blog
Fox News