For the Irony Files: Medical Licensing Organization Tells Med Student Bathroom Is Suitable for Pumping Breastmilk During Exam

How is it possible that nursing mothers still have to battle for a safe and appropriate place to pump breast milk?  And because the ability to regularly express breast milk contributes significantly to mothers' and babies' health and well-being, how is it possible that the National Board of Medical Examiners, of all entities — which administers tests that every medical student in the U.S. must take —is still not addressing this basic need when it administers its licensing tests?

Like many women today, I wear multiple hats. In addition to being a wife and mother, I am also a medical student and just gave birth to my second child earlier this week.

Having finished my second year of medical school, I am scheduled to take Step 1 of my licensing exam on August 10, 2015. I knew that with a 7-8 week old baby at home, I would have to pump breast milk during the 8-hour exam to avoid discomfort and possible infection. I was pleased to find that NBME grants extra break time for this reason, and I quickly applied for and was granted this accommodation.

However, I was shocked to learn that the only location NBME and Prometric, the company that provides the testing centers where the exams are taken, could offer me in which to pump was the public restroom at the test center.

I find it ironic that a medical licensing organization like NBME would suggest that a bathroom is an acceptable location to pump breast milk at any time, let alone during a high-stakes, lengthy exam. Not only is a bathroom unhygienic, but it would be uncomfortable and non-conducive to the pumping process, which requires 15-20 minutes of pumping, a quiet environment, the ability to balance the pump and bottles, and may require an electric outlet. Sitting on a toilet while other test-takers do their business around me is far from a clean, quiet, or appropriate environment.

When I followed up with NBME and Prometric, I was informed that there was a private room that Prometric employees use for expressing milk, in compliance with the federal law protecting its employees, but was told that "[d]ue to security considerations, Prometric will neither extend a nursing station reserved for its employees . . . to exam candidates, nor is it required to do so." The Prometric test site administrator further advised me:


It is still up to you to find a place suitable to you to nurse; whether it is your car, a restroom, or any other public space accessible to you as an exam candidate


Needless to say, neither a public bathroom nor my car — in Maryland, in August, no less — is a suitable spot for pumping.

I also learned from my own research that this is not the first time that NBME and Prometric have done this sort of thing. In 2007, a medical student at Harvard, Sophie Currier, was denied accommodations for pumping and had to bring NBME and Prometric to court. She took her case all the way to the Massachusetts Supreme Court and won.

Since neither the NBME nor the Prometric test center would accommodate my request, I decided to contact the ACLU for help.  This week, they sent a letter to NBME and Prometric on my behalf and are prepared to take my case further if they don't back down.

My hope is that the NBME and the Prometric test center will change their policy regarding breastfeeding mothers, for me as well as for other future physicians, so that we can access the simple accommodations that basic hygiene, and basic human decency, require.

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What is the matter with people? Why do Amerikans love their wars and bloodbaths in the name of patriotism, nationalism and smug xenophobia with it all reflected in the media? They love Chuck Norris movies and Jason Voorhees movies, but howl with rage at the sight of a mammary. The sight of a boob to feed a hungry baby is a better thing than the GOP boobs who are like Charles Keating the bank robber with his high morality and equating a mammary with 'porn'. Of course, it is perfectly alright for his type to steal the savings of depositors' money. Please do us all a favor and get these GOP and Puritanical boobs out of sight!

Barbara Davis

Totally agree! As retired OB-Gyn nurse, trained as lactation consultant, 70 year old gramma who breastfed my children, this is beyond rediculous and utterly intolerable. Why do these opinionated idiots think women have breasts? For a group catering to medical associations to try to relegate this laudable activity to the unsanitary, uncomfortable, inhospitable atmosphere of a public bathroom is downright criminal. I hope this lady wins a lawsuit against the company providing the testing facility and the people who knowingly signed up with such an organization. We need to be enlightened enough to support mothers who make the considerable effort it takes to do right by their children. Shame on all who brought her to such a place.

NBME Communications

As a matter of policy, the NBME grants extra break time to nursing mothers to express breast milk, and we fully support the student's request for an appropriate, sanitary space to do so. The NBME is disappointed that Prometric has not yet responded favorably to our repeated requests to make available to Ms. Hesselgrave a private space in which she can express breast milk during her USMLE administration. We will continue to urge Prometric to find an appropriate location for Ms. Hesselgrave and other nursing mothers with the goal of having a nationwide practice in place in the near future.

Cynthia Nordstrom

Unlike the first person to post a comment, I see no need to be Anonymous. Perhaps its their intolerance, stereotyping and comments that are in direct conflict with the message ACLU members want to convey. No group, or country, is one size fits all. The majority of US residents will agree NBME is misogynist and just plain stupid. Mr/Ms Anonymous is intolerant, ignorant and narrow-minded. Perhaps they are also 'Amerikan' who hate their life, or is from another country with an agenda of jealousy..whatever their reason for their beliefs that they must know are ridiculous, otherwise why remain anonymous, we could easily turn the tables..Hmmm, let's combine some stereotypes: this person must be from a country that is cowardly, collectively narcissistic, upset because the US has saved their butts a couple times and are defensive over their own failures, had a leader that took all the glory for others accomplishments, defines xenophobia, has taken rudeness to an art, doesn't take baths, major pickpockets/thieves, obsessed with male genitals, haven't accomplished anything of value in about 200 years, etc etc. They just picked at one example of stupid - ignoring the fact most Americans support nursing mothers - and made a complete ass of themselves. I have a little patience with generalizing small minds as I do with all narrow-minded fools.


What an unbelievable knee jerk reaction. Did someone insult her poodle or mother? Do get help for this neurosis.


I would pump in the lobby or other public place. Most state laws say bf and whatever that means exposing breasts. You have to pump to nurse it is part of breastfeeding. Or use a hand pump during the test. ;-) but I do pump on the drive to work so hoping that one works for me! :-)


I just took step 3 and had to pump on the floor of the bathroom. I was offered the stair well as an alternative. absolutely ridiculous.


And yet above the NBME says they support mothers being able to pump? There are so many awful stories like this, I don't get how they can pretend they're doing all they can. the ACLU is collecting stories, maybe you should write them if you havent yet

Sonia Collins

Perhaps the NBME members would like to take their lunch break in a public restroom? Or have the public come relieve themselves in their kitchen facility.

45 years ago my infant son needed an operation, and the nurses in the pediatric ward made me breastfeed in a broom closet instead of in a chair next to his crib. Now my daughter in law is breastfeeding and pumping milk. I wish things had changed more so there is general recognition that breast feeding is natural and healthful. It should be accommodated like any natural human function.

NBME Communications

The NBME is delighted to learn that Prometric has offered, and Ms. Hesselgrave has accepted, an appropriate, sanitary space in which she can express breast milk during breaks in her upcoming Step 1 examination. The NBME will continue its policy of providing extra break time to lactating women and will continue to urge Prometric to provide appropriate space for them to do so.


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