Behind Breastfeeding Victory: ‘Motherhood And Career Collided’

In 2007, when Dr. Sophie Currier’s daughter, Lea, was four months old and still exclusively breast-fed, Sophie requested extra break time during an all-day medical licensing exam to pump her breasts. The test’s overseers, the National Board of Medical Examiners, said no, that breastfeeding was not federally recognized as a legal disability and therefore could not be accommodated.

Sophie, who has an MD and PhD from Harvard, fought that decision, and just last Friday the Massachusetts Supreme Judicial Court ruled in her favor, citing "barriers" to breastfeeding and saying the medical board did indeed have to give nursing mothers extra break time to express milk. Since only women breastfeed, the issue is one of gender discrimination, the court found.

Though the decision was narrowly oriented toward Sophie’s specific case, it “potentially impacts any testing organization that administers these types of professional exams,” said Sophie’s pro-bono lawyer, Marisa Pizzi of the firm Bowditch and Dewey. “The court was very clear that we’re talking about a lengthy exam, in this case one that extends nine hours. So any professional exam that takes course over such a long period of time could potentially be subject to these new protections.”

For Sophie, now 38, the classic career-family crunch time of life has included the added complication of a major lawsuit. She now lives in London with her husband and two children, has passed the British medical licensing exam and is planning to run the 26-mile London Marathon on Sunday. The lawsuit has been a nearly five-year journey for her, and though she won, she has also paid a personal price. We spoke by phone; our conversation, edited and distilled:

Your lawsuit turned into a long fight for you. What made you step into this fray?

I might be overly idealistic, but I believe very strongly that you cannot make progress and improve the world if you’re just going through the motions and taking whatever injustice comes your way. I believe fundamentally that if we don’t stand up against injustice, civilization falls apart. I would not have birth control or be a physician scientist if other women had not stood up for justice in the past.

How did the board’s denial and the lawsuit affect your career? Did you feel as if you were penalized?

The scientific way to look at it is that before the lawsuit, I had gotten into a very prestigious residency program. All the programs I applied to in 2006 and early 2007 had called and told me I was a top candidate in pathology, and I got my first choice of programs.

After the lawsuit, I applied two more times to about 30 residency training programs. Despite later getting a strong score on the exam in question, I got two interviews and one acceptance. Unfortunately, this acceptance was in a location that was not possible for my family.

So you were effectively blackballed?

Clearly there was a huge discrepancy in my ability to attain a position before and then after the lawsuit. It should be noted that I did obtain a very prestigious internship position in general surgery at a great hospital. It was a stepping stone. I just keep moving forward.

It’s been four years since, and I haven’t really been able to get back on track with my career; but I have made steps. I have since passed both USMLE [United States Medical Licensing Examination] Step 2 and 3 with strong scores as well as receiving a top score on a United Kingdom medical licensing exam. I am in a new country with great opportunities for physician scientists. Fundamentally, I have strong credentials and thus I am very hopeful.

In all of this, I’m lucky I had my family’s support throughout, and I’m lucky to have had financial support; my partner has always been very supportive and had a stable income. This loss of income for four years has been hard on us, it was a setback, but we haven’t had to be looking for where we’d get our next meal. When my partner got a very good job offer in London, I also saw it as an opportunity to start again in a new environment.

Some critics have said that you wouldn't have needed extra time on the test if you had planned your family to fit in with your career better --?

As an MD-PhD, I had been advised to have children between medical school and residency. So that is what I did. Unfortunately, I was ill and even hospitalized at one point during my second pregnancy, which forced me to postpone my exam. I finally ended up taking it when I was eight months pregnant and missed passing it by a couple of points. Now I was in a very bad situation: I had to pass the test in order to start my residency. I knew I didn’t want to take it when I was breastfeeding because they didn’t accommodate it, and it’s very hard with a newborn who’s still waking up at night.

Many suggest to ‘Just wait until you’re done breastfeeding’-- but between two kids and two pregnancies that’s at least two years. Not everyone can afford that. And it’s a competitive field; if you drop out for even one year you don’t have the same opportunities you did before.

So what advice would you have for a twentysomething woman who wants both a career in medicine and a family?

The complication in my case was that I did a combined MD-PhD program. Most doctors (MD only) take the USMLE exam when they’re about 27, and then wait until they're done with their residencies to have children (in their early thirties). That works well. The problem for MD-PhDs is that the timing is such that you hit the late end of your reproductive years when you’re trying to
start your residency. Residency training is a minimum of three but often four to six years of training at 80 hours a week.

When I applied to residency programs I was already 31. I knew from watching my friends go through residency training that it was not family friendly at all. Many programs only offered six or eight weeks of maternity leave, and often the program would take that out of their only vacation time, and it’s absolutely not breastfeeding-friendly. So I was trying to squeeze my reproductive years into the last years of medical school before starting residency.

On paper it looked perfect, but I didn’t plan to get sick during my second pregnancy. I had gotten all my credentials done, everything was all lined up, I had my interviews and top programs calling me and telling me I was their top candidate — everything was going smoothly until this exam and my inability to pass it due to pregnancy and then breast-feeding. Motherhood and the career path collided at that point.

Couldn’t you have just waited to take the test?

If I didn’t pass the test that summer I lost my position at Massachusetts General Hospital and couldn’t graduate from Harvard. There was no flexibility at that point.

You’ve taken some flak because the test’s overseers were already giving you an extra day to take the exam because of a learning disability; some say you were just seeking an advantage.

My reading disability has nothing to do with this law suit; it is just a distraction from the important issues at hand. If I had no legs, would people say that I should not get break time to nurse my baby because I am also getting a wheel chair? It makes no sense.

There is no dispute from any of the courts that my disability is unrelated to this case. But I do think having a disability helped me recognize, ‘Wait, my learning disability is being recognized while my need to express milk is not?’ I didn’t understand that discrepancy.

What prompted you to challenge the board’s decision?

I felt very strongly that this was a discriminatory policy and I believed very strongly they were wrong not to accommodate lactating women. The structure of the exam, with just 45 minutes of break time over nine hours, made it impossible for a lactating woman to take care of her physical needs. She either had to not breastfeed or take the test at another time, or take the exam in painful engorgement and thus at an unfair disadvantage relative to her non-lactating peers.

The case had national resonance in the media...

What brought attention to the story was the irony, the fact that a medical institution would be making it difficult to do what the medical community itself was strongly recommending.

And I think that beyond the legal and medical reasons, you have to look at what you’re doing morally, and it’s morally incorrect to put a group of woman at a disadvantage. We received ten letters from women who said they’d requested time to breast-feed during the USMLE exam and been denied. One woman wrote up a petition that was signed by faculty in her medical school. One woman wrote that she was in so much pain she was vomiting because during her single 25-minute break time for pumping, someone was in the bathroom and she couldn’t express milk there. She had to go the whole nine hours without pumping. Someone taking an extremely difficult exam shouldn’t be painfully engorged, leaking milk on herself and at risk of getting mastitis.

I had gone to parenting classes and heard over and over again, ‘I can’t continue breastfeeding because my employer will not let me take breaks to express milk.’ These stories moved me and motivated me to say, ‘This is not okay. Society should not be impeding women from doing what’s healthiest and actually economically best for their families.' That was really a turning point for me: It wasn’t about me and advancing my career, it was a public health and women’s rights issue — and in a way, it’s a child’s rights issue: The care of the children is being altered.

Yes, it is possible to argue that a trauma surgeon may at times not be able to take breaks to express milk because someone might die, that’s one thing. But this is a test. It’s an artificial environment and there’s absolutely no reason you can’t alter it.

Q: The Breastfeeding Promotion Act seems to be a perennial in Congress but never passes. Do you see change happening on breastfeeding and the workplace?

From when I started medical school to now, a lot of things have changed. As far as I know Harvard didn’t have many lactation rooms and now they’re placed everywhere. I do think we’re in a changing time when people are recognizing that women are 50% of the workforce and sometimes they need to lactate. And we can’t just say, ‘Go home for two years.’ Do you want 50% of the doctors to just disappear? We have to accommodate the fact that women are the ones who do most of the work of reproduction and there are physiological needs associated with that. We are not the same as men. We have needs and those needs must be recognized.