Medical group needed convincing to let mom pump breast milk

By Randi Belisomo (Reuters Health) - Dr. Megan McInerney, a physician at Indiana University, did not anticipate a conflict this summer when she asked to be allowed to pump breast milk for her infant son during a ten-hour licensing examination. But the third year pulmonary and critical care fellow was shocked by the response from the American Board of Internal Medicine (ABIM), a certification body for internists and internal sub-specialists, to which she had paid a $2,200 exam fee. “We give no accommodations to nursing mothers,” the ABIM wrote, citing the Americans with Disabilities Act and explaining that nursing mothers do not qualify for protections under that law. The irony of such a message from a medical organization was not lost on McInerney, who had committed herself to breastfeeding her son for one year. “This is what my biology is, I have a responsibility to provide for my son, and I am supported by medical literature,” McInerney told Reuters Health. Without time to pump during the exam, she feared engorgement, extreme discomfort, possible infection or a diminished milk supply. After six “unsatisfying” e-mail exchanges with the ABIM, McInerney contacted a lawyer, and then, the American Civil Liberties Union. “You can’t look at it outside of the context of the stereotype that women with babies belong in the home and have no business trying to further their careers,” said ACLU attorney Galen Sherwin, who made a formal demand to the ABIM on McInerney’s behalf. “To deny these requests puts women at a serious disadvantage.” Following the ACLU’s request, the ABIM reversed its decision in September, agreeing to allow McInerney an additional 30 minutes of break time and to provide a private room where she could express breast milk. McInerney took the examination on November 12 in Indianapolis. She pumped breast milk twice during the day, one more time than she says she would have been able to otherwise, within scheduled breaks. “I still would have pumped, but I probably would have had to sacrifice doing all the other things like eating lunch, getting enough to drink and using the restroom,” she said. The ACLU maintains McInerney’s request was protected by both state and federal civil rights law, as well as by Indiana’s public accommodations law. “It shouldn’t take the intervention of the ACLU to get a test administrator to do this,” Sherwin said. “It is leveling the playing field, and without it, women taking these grueling, all-day exams would be in very distracting and medically risky situations.” In a statement to Reuters Health, the ABIM thanked McInerney for voicing such concerns and stated an aim to balance its obligation to providing an “equitable exam experience” while meeting candidates’ diverse needs. “Our initial reply to her inquiry to provide additional time or space to pump her breast milk did not adequately address her needs,” the statement read. “Because of Dr. McInerney, we have re-evaluated and changed our procedures as they relate to nursing mothers.” The ABIM’s new policy requires that nursing mothers request accommodation by an examination’s registration deadline. Requests must include documentation from a medical provider demonstrating the need for such an accommodation, such as a physician’s letter stating the candidate’s delivery date and the anticipated frequency and durations of sessions to express breast milk. This policy change came as welcome news to both McInerney and her counsel at the ACLU, but lawyers there are concerned that other professionals taking licensing exams may still face similar challenges. “The medical profession is not uniformly walking the walk when supporting women coming back to work after childbirth,” Sherwin said. McInerney said her legal challenge was “the right thing to do,” not only to address her own needs- but those of female colleagues. “As a medical community,” she added, “we should be leading the way in providing accommodations for women to be able to provide breast milk to their infants in their first year of life.”