A Choice No Mother Should Have to Make

Update: Nursing moms are now eligible for accommodations! The ABIM has just posted its new policy on its website, making nursing mothers eligible for additional break time and a private place to pump during any of the tests it administers. Thanks to ABIM for doing the right thing, and to Meghan for standing up for herself and fighting for the rights of others!

In September, the ACLU wrote a letter on behalf of Meghan McInerney, a medical doctor doing her fellowship in Pulmonary and Critical Care Medicine, a sub-specialty of internal medicine. Dr. McInerney had been denied additional break time to pump breast milk during her pulmonary medicine licensing examination. She took the examination on Wednesday, November 12.

You wouldn't think that as a medical professional, I'd be asked to choose between the health of my child and the advancement of my medical career, but that's exactly the choice that was put before me.

I am a physician in my third and final year of sub-specialty fellowship training. I am also a first-time mother trying to make my way through the logistical and emotional challenges that come with working 50-70 hours per week and having an infant at home—while remaining committed to breastfeeding.

At the end of our training in Pulmonary and Critical Care Medicine we are required to take sub-specialty certifying exams, which are offered only once a year to all trainees in the country. This exam, which is administered by the American Board of Internal Medicine (ABIM), is a grueling all-day test. After paying the $2,200 exam fee, I wrote to the ABIM to inquire about accommodations for breastfeeding mothers to express milk during breaks on the exam day.

I never anticipated how ABIM—a medical organization—would respond: "we give no accommodations to nursing mothers".

I wrote again to clarify that I was not asking for extra time to take the exam, but extra break time. Again, the response from the ABIM was that the time allotted in the 10 hour exam day should suffice. Their explanation was that as a nursing mother I am not considered a person with a disability, so I don't qualify for protections under the Americans with Disabilities Act. They added that they couldn't even guarantee that there would be a private place for me to pump.

Without the ability to pump, I would face engorgement and extreme discomfort, possible infection, or a diminished milk supply—not to mention not having enough food for my baby. Without the additional break time, I would have to choose between pumping and doing the things the rest of the test takers were able to do with their breaks—for example, eating, using the restroom, getting fresh air, or studying.

I was astounded by ABIM's response. First, how could a medical society take a position so antithetical to the medical evidence (The American Academy of Pediatrics recommends breastfeeding at least one year)? Second, where did the ADA come into this? I don't consider myself disabled and am not requesting accommodations as such. I am simply trying to do what I believe is best for my baby.

Equally shocking was some of the feedback I got from fellow physicians. While some supported me in challenging the ABIM's policy, others suggested I postpone the exam for a year, or even that I stop breastfeeding altogether. Is this what it means to be a working mother? Why should I have to choose between continuing to breastfeed and remaining on track with my career?

I decided I would not make that choice. Instead, I contacted the ACLU, which, along with a private attorney, sent a letter to the ABIM on my behalf, highlighting the fact that the ABIM's policy is discriminatory against women.

I am happy to report that last month the ABIM reversed its decision: They stated that they would allow me the additional break time I requested, and agreed to provide me with a room in which I could pump in private. And, they added, the ABIM will review its policy for nursing mothers.

Thanks to this change, when I took the exam earlier this week I was able to pump twice during the nine-hour test day. My experience made it clear how necessary this extra time was, as there is no way I would have had enough time without the extra break time provided.

The ABIM has done the right thing by not forcing me to choose between the health of my child and staying on track with my chosen career. I hope that they will take this one step further and put into place a policy that applies to all nursing mothers who will sit for the board exams they administer.

Click here for more information on ACLU's past campaigns to eliminate barriers for new moms entering the legal profession.

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Kristin P.

This is EXACTLY what is happening to me right now, except with the Illinois Board of Admissions to the Bar. I was told that nursing mothers have no protected rights and my accommodation was denied. I'm very happy to hear that the ABIM did the right thing.


I am so discouraged sometimes. We in the medical community purport to promote health. We purport to encourage family ties that are well served by mothers who nurse their children. And yet the very organizations that should be doing these things put barriers in our way. It IS discriminatory. It IS wrong. Again, can I say ? , if men were the carriers and deliverers of infant humans, this would be a non-question.


I am incredibly happy that there was finally an accommodation made for this amazing mother.
I am commenting because as a participant in the American Medical Association meeting which occurred last weekend ( Nov, 9-10), the AMA passed policy to strongly advocate for all lactating women to have the testing accommodations that they need!

Zachary T

I disagree with almost every single point made my this article. Refusing to allow extra break time for breastfeeding is not discrimination against women because you are not required to breastfeed your child. Missing one day of breast milk will not harm your child and will not harm you. Unless you are willing to claim that simply being a women is a disability, you have no case. I think that the medical board should have refused to give you the extra break time because if the ACLU had sued, the ACLU would have lost. I will only change my view if show me a law which specifically states that women need extra time off to breastfeed. I checked and no such law exists. I support the ACLU on most issues, but not this one. This sounds to me like the ACLU has been taken over by radical feminists who want women to have more rights than men. I am fine with equal rights, but I am against women getting special treatment simply because of their gender.


I was suspended half way through LPN nurses class for the duration of the class for using the restroom during a break in class.


I had the same experience with ABIM last year when my daughter was just 3 weeks old. Thank you for highlighting this important issue.


send it all to the president. The U.S. Is in the dark ages of breastfeeding, and I do not mean this in a positive way.


it's strange how you are so concerned with the feeding side, when you are willing to be away from your baby for 50-70 hours a week. I think the baby would rather be bottle fed and have more time with mom. Some of these career women should be just that. I can't think of anything worse than trying to enjoy my baby when under so much pressure from my career. We should be more in line with europe and give parents a decent break from work when they have kids so they can give the babies the best start. I'm not putting anyone down for trying to do it all. I just feel sorry for the kids. I have two kids and was lucky to be at home for both of them, that meant we had no money, I did not get into nursing until in my 30's but I wouldn't do it any differently, we don't have to have it all so soon, you've got a long time to establish a career, but only so long to raise a family.


I can not believe you had to advocate for yourself the way that you did. But in retrospect, I should not be shocked. Kudos for you for going the extra mile and paving the way for others.


How long are your breaks? I'm a working mother of two breast fed babies and while I can sort of sympothize, there are many situations that require a little creativity. With a hands free pump you can certainly eat, study and get some fresh air (go pump outside with a nursing cover). Are they supposed to make the exam longer for everyone? If they make exceptions for you, where does it stop? I don't mean to be insensitive, but I can see both sides.


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