Behind Breastfeeding Victory: 'Motherhood And Career Collided'

Sophie Currier and Lea

Sophie Currier and her daughter Lea, now almost five. (Photo courtesy of Ali Smith, from her upcoming book, "Momma Love: How the Mother Half Lives,"

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.

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  • Outside looking in

    I’ve got to say that my bias on this matter is this: I am not a mother. But I am a woman and I don’t think that she’s made any kind of groundbreaking movement. I consider these kinds of exams to be a level playing field as they are.
    Everyone there, in that exam room, has had to work hard and fight through their own personal adversities to just be there. There may be others breastfeeding in the exam. I’m sure there have been others before her breastfeeding that have rallied through. Or someone who has had a loss in the family, someone fighting an illness determined to make it through the exam. She already had one extra day due to a reading disability and she needed more time because she was breastfeeding.

    I would much rather she fought to have exams at this length be done in two parts and extend over a two day period or longer breaks (ex. two, thirty-minute breaks and one hour long break) Nine/ ten hours is a long time. I’d say the moment an exam exceeds 6 hours you might as well make it an all day event. Besides, arguing for more time for everyone might not be a bad thing and she might find even more support. I just don’t feel that this keeps the playing field level.

    Women have fought damn hard for equality in the past and endured so to push to accommodate breastfeeding mothers I think is actually a setback. It’s not about equality anymore, the rules are now being altered for women. And this i think this now may give way for men to argue (or validate) gender biases in critical exams.
    If women are allowed extra time to breastfeed what balances this? What becomes of non-breastfeeding women and men?

  • harry

    Possibly the stupidest and most indefensible argument I have ever heard (is she really a Harvard MD/PHD?). You people need to check other blog-sites!

    The wheel chair analogy is DUMB and non-sense. The woman is getting 2X the allotted time to test already. Her argument is predicated on the fact that the wheel chair is not germane, but it is. Her wheel chair argument is using time as a substitute for mobility, HOWEVER, she is already getting double the allotted time.

    Doing background research on this issue is enlightening. She has attended elite institutions utilizing tutors & extra time ad-nauseam. That’s okay, but Ms. Currier is a repeat offender who always wants & needs more. Pure & simple: this is an entitlement issue. Perhaps her parents should ease up on her. She is swimming in deep water. She needs to be in the kiddie pool.
    FYI. I am a recovering alcoholic who did not finish my degree. It has never once occurred to me to go back to my university and plead my case because of my “addiction – issues”. Plenty of folks head addictions too. They managed to do what was expected of them.

  • James

    She is milking the system. I took the USMLE Steps 1-3 and passed, but have known failure on standardized exams due to a lack of preparation and/or underestimating the exam. She did not deserve to pass, and had a taste of sour grapes, expecting the NBME to ‘pay for her failures’ just like Harvard were expected to ‘pay’ for a free medical education while giving her more of an advantage on every times exam due to stated dyslexia. Good luck in the U.K. (where i was trained, I am now in America); you’ll find the medical community less tolerant of your nonsense, Sophie.

    • harry

      Another thank-God! Your comments ring-out truth the way the liberty-bell rung- out freedom. The others will pay you no-heed because you are “not a woman”.
      It is nonsense, you are so right. In the US, our elite colleges make a bad habit of educating the uneducable.

  • Erin Corral

    Wow! This is amazing. I had something similar happen- in nursing however. I was not allowed to leave an exam when I started to lactate all over my clothes- unless I forfeited my test. I would also routinely get locked out of my class by the instructor when I would come back from pumping. I was told by the civil rights commission in ohio that they could not rule in my favor because there was “nothing to compare my situation to”, maybe now there finally is!

  • Indian Doc

    I honestly believe that if you have had no prior experience breastfeeding and are here to comment on this article negatively, don’t bother giving your opinion. For anyone who has taken the USMLE would know that last last month into the test is an extremely testing, tough time for ANYONE. Add that stress to someone who is lactating and you get an even harder situation. I can’t follow 2 things: How can someone who is not remotely related to you ask you to ‘plan’ your pregnancy in such a way that it doesn’t ‘interfere’ with your test day/career. On the other hand, there are those skeptics who think that by having extra breaktime would put her at an advantage?! How?! It is not like she is walking out in the middle of a 46qs/50qs block to go and breastfeed and may possibly take a peek at her books while handling her breastpump ? Nonsensical for someone to even insinuate the same. 
    The second thing I don’t get is that this is America! Most people pride on the fact that this is the world’s most developed country with the biggest advancements in medical research every yr. Has there been no research to cite an increase in cases of mastitis, engorgement and possibly discomfort for a breast feeding woman to go without pumping for longer than 3-4hrs? All it boils down to is the NBME and the Courts that are mostly ruled by men or possibly women who chose their careers over families and get to make these rulings on behalf of those who are currently enduring all the hardships and yet persevering in their careers at the cost of mental anguish and possibly guilt at the end of this journey.

    • harry

      So is 2 days not enough time? How much time does this require. Honestly, what about the father that can not coach little league because he can not get off work by 4PM? Careers do cause sacrifice. Sophie’s constant need for advantage is disadvantaging everyone else (especially other women doctors).

  • Catgirl

    The “why didn’tshe she plan better” question annoys me.  Even if  a woman “plans” her family, she won’t always get pregnant when she wants.  And, we don’t ask men to choose between family and career.

  • Ednjoey2007

    I applaud her for her struggles and shame on society blackballing her. They should be proud to have a leader. This world is such a tough place to live in. I’m so sorry.

  • CatF

    I think you’re very brave Dr Currier and on behalf of all us women, I thank you for your commitment. Good luck for your career in England.

    • harry

      You seriously want to call her brave? Brave would be testing like everyone else. Acceptably noble would be taking the test in 2 days without complaining. Sophie went overboard with the extra-extra time.

  • Dr Peggydixon

    Hope she keeps on trying to make changes–we need people like Dr Currier to continue to fight for what is right–our country is still backward when it comes to breastfeeding, but things keep happening to change that and should continue until all mothers can breastfeed without discrimination!!!!

  • K

    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 –?”

    And this is what’s wrong with society – if there’s an injustice, the woman should simply be more accommodating to the injustice?  I’m guessing it was mostly men saying she should plan around a work schedule because most don’t understand what it means for a woman.  Not putting men down – I believe in paternity leave – just that the physical REQUIREMENTS they have are not as specific as women’s, and it’s difficult to understand where someone else is coming from unless you walk in their shoes.

  • Axonbob

    To docMD:  Unless you’re a *mother* in medical school, hush.  This is not the same thing as having to go pee, although I suppose an analogy could be made to urinary incontinence or a UTI.  It’s not like having a little rumble in your tummy.  (Although, in all honesty, if you were going to pee your pants, they’d probably let you use the bathroom.)  The level of stress and the amount of endurance that moms (and really all parents) in medical school have on the daily makes the Steps just another interesting day.  Every single mom in medical school who’s taking Step II with a kid young enough to need breast milk is more bad ass than you are, no matter how many times they have to express milk while taking it.  Seriously, how is that not a given? 

    To Dr. Currier: I applaud you, and I wish you every bit of happiness in your life.  You deserve it. 

    • harry

      I say again ‘she had a whole extra day!”

  • American Mom


  • docMD

    While I applaud Dr. Currier, for taking a stand for an issue she saw as discriminatory, as a medical student that is preparing to take the test in question (the USMLE Step 2) in a few months, it should be made much more clear that the NMBE’s refusal to grant her extra time was Not Unreasonable At All.  This is a speed and endurance test, not so much a content test. Its a 9 hr exam and they give you an hr that you can spend between each of the 9 sections, however you want.  The difficulty of the test is primarily the speed at which the questions are given and the fact that as soon as you’ve done block of 50, you take 5 min and they give you another 50, and again and again.  5 hrs in and you are mentally shot, but you still have hours left. The difficulty level of the test Collapses when you add additional time.  The fact that they had already given her an extra day, means the test had already been made remarkably easier for her. I do not believe she deserved more time on top of the day they had already given her. This is an extremely competitive exam that people spend thousands of dolars preparing for and frankly it sounds like she was just manipulating the system to get a better score.  

    • dyslexic 21

      The opening and closing statements of this post are in direct conflict with one another. You say you applaud her for taking a stand against discrimination but then say you feel that stand is an attempt at manipulation. Therefore you are not applauding her at all you resent her and feel disenfranchised yourself. 
      Someone with a disability, such as reading, is not having the test made easier for them by being given accommodation, rather the playing field is being leveled so that they may compete with others.How embarrassing for you that you are so well educated and yet didn’t know realize that!

      • harry

        You need to go back and take some course-work yourself. Your reasoning is fallacious and unsound. BTW, how do you know that docMD feels disenfranchised? Let me guess. You are an illogically trained psychoanalyst as well?

    • Jose Zavalaperez

       docMD my guess is you have no personal experience with breastfeeding or expressing milk.  It is not extra time, it is necessary time. 

      If you are so worried about someone having extra time because they are breastfeeding/expressing milk, allow me to put your mind at ease:  That same person more than likely gets *infinitely* less sleep than you do, say 5-6 hours maximum of *interrupted* sleep. 

      So focus on your studying, and please, do not go into any field requiring compassion or empathy. 

    • Kate Foran

      It’s important to realize that the “extra time” she would be given to pump is not extra time she received on the exam. She still had to answer questions at the same pace as any other Dr (with dyslexia) taking the exam–she was only granted time to pump. 

      And frankly, if you want to talk about endurance and a grueling exam experience, you should try being a breastfeeding mother of a 4 month old taking the Step 2–AND who lengthens an exam day to 10 hours so that she can squeeze in 2 rapid pumping sessions between exam sections. That, docMD, is true endurance.

      • harry

        Thank-God. There is at least one woman who does not require extra dispensation!

    • harry

      Finally, someone with sense weighs-in. It is really sad to watch this woman try and game the system. This was an injustice not only to other students, but women students especially.

  • Nancy Muehllehner

    I am SO GRATEFUL for YOUR sacrifice.  I truly believe it is up to us, who have the monetary means, the family support, and the brains, to fight for for the common good, to fight for what is right. But that doesn’t make it easy, or fair to shoulder that burden.  You did it. You made the world a better place.  That is the biggest and best achievement of a lifetime.  (on top of being a mother)   THANK YOU for your sacrifice and your battle!

  • Noblebeck

    This is wonderful.  As a woman preparing for my first child, and having been told by my (female) employer that I can only have a two-week maternity leave, these stories really resonate with me.  Women’s rights relating to reproduction–from the funding of Planned Parenthood to affordable contraception, prenatal and post-natal care, to mothers in the work place–there is still so much work to be done.  Thank you for fighting.

  • Elewisg39

    With only one bathroom break in a 9 hour exam,  i would guess that many men and women would be uncomfortable.    

    I would also guess that the right to breast feed is not absolute; probably not safe to do that and drive a car at the same time.      

    An enlightened society will make accommodations for breast feeding women in all sorts of work places, and also public places.

    But no where in the articles have I heard of any concern for the patients, who are supposed to come first in our consideration.

    Doctors go without sleep, food, and with full bladders to take care of their patients.
    It may become a question of whose comfort has first priority


    • Maria Lauro

      I’d like to be treated by the doctor who isn’t tired, has stable blood sugar and doesn’t have to pee. 

      • Kristen Ehrenberger

        I take it yours is a part-serious, part-facetious answer. Because really, folks, let’s confront the Dr. Hero stereotype right where it ceases to make sense. MOST medical practice is not life or death. When it is, let’s be heroes. When it’s not, let’s be reasonable HUMAN BEINGS who have biological and psychological needs as well. How can we counsel our patients to give up smoking, when at work they get a much-needed extra 15-minute break for that? And then we tell them to breastfeed for 6 MONTHS (when they’re lucky to get 6 WEEKS of maternity leave), but IF they can get a break to pump, they have to do it in a restroom stall. We can’t even give ourselves pumping breaks during an exam that looks nothing medical practice. What are we really testing there, hm? Brava, Dr. Currier. I’m right behind you.  (MD/PhD Candidate)

    • BostonMD

      As a physician and mother to a breastfed toddler, I can tell you that no doctor will walk out on a dying or critically ill patient to express breast milk. We happen to have common sense AND compassion for our patients. 

    • Kate Foran

      As Dr. Currier acknowledges in her interview and the Massachusetts Supreme Court states in its opinion, there are plenty of situations where a woman’s right to express milk will not win out over everything, just like any other right. 

      The point of the legal opinion is that it’s discriminatory to force breastfeeding women to endure extreme discomfort in addition to all the discomfort that non-breastfeeding men and women experience during the exam. It’s not an equal testing experience. The court felt it would be easy for the NBME to make the experience more equal without causing damage to the interests of the examiners. 

      • harry

        For God’s-sake. test taking is supposed to be rigorous. After everything that you’ve read here, would you really want to be Sophie’s patient?
        Her extreme distaste for discomfort and rule-following makes her so ill-equipped for medicine of any sort.

  • Laeh Maggie Garfield

    As a woman pioneer of the second wave I applaud Dr. Currier for doing what I could never have done. In 1970 I and 16 other plaintiffs went to federal court for women in sports.  Yes, we won.
    I did get blacklisted but I had another profession waiting in alternative medicine. 
    My grandmother who fought for the vote and ran her own business would be very proud of you too.  
    Sophie Currier has joined a long line of women who have made women’s health and rights in the work force better. She deserves every kind of praise the future progeny of our nation can bestow.   Women’s rights is a long battle.  She took the hard road so that other women and their babies won’t have to.

    • harry

      Sophie was never denied a ticket to the event. She just refused to play by the rules. I bet you that at least 40% of the test-takers were women. I am sure that there were mothers in that group of testers as well.

      Leah you weaken your argument by siding with this very odd Sophie. I would not hitch my star to this odd-bird!

      • Laeh Maggie Garfield

        Harry you are another male fool parading your sexism. Shame on you!

        • Outside Looking In

          Now hang on. If you’re going to make an argument you’re going to have to do better than shout “sexist!”
          I see his point and you never presented a counter argument.
          You begun giving this statement about breaking the glass ceiling in sports and rising to any challenge thrown at you only to end by saying ‘so other women and their babies won’t have to’.
          1. you’re forgetting that women have sons too, she not doing anything for them. According to your argument they’re already set.
          2. I find that the praise you are giving this woman is not for shattering any kind of ceiling but for validating future arguments men might make that women have it easier than they do. ie I feel that your praise, and others here, is misplaced. If only breastfeeding women can take an extra break- it’s still a break that men will never have despite being under the same academic/ mental stress or an illness that might have them feeling unwell yet present at the exam nonetheless.

  • working mama

    Thank you for your work. Its hard enough being a working mother, but you worked for all of us during this fight. It was worth your long effort and appreciated by many hard working, pumping mamas. 

  • Malaga21

    thank you, i am in a very similar situation right now to what you went through and I appreciate your efforts 

    • harry

      I hope your career gets off to a much better start than hers did.

  • Emily

    Thank you for the sacrifices you made for women, Sophie.  I have tremendous respect for your decision.  You are an inspiration and a reminder that by continuing to accept injustices, we are not helping ourselves or others who come after us.

  • elementary teacher

    I am an elementary teacher currently breastfeeding my 2nd child (20 months old); I also breastfed my first child until he was 18 months old.  We need to turn the tide of public opinion and understanding in favor of breastfeeding since it is so incredibly beneficial to both babies and moms.  It is hard to believe how far behind other countries we are on this issue.  Thank you for a great article and for what you have done to advocate for breastfeeding moms, Dr. Currier.

  • Kate Foran

    Sophie – I am so grateful for what you and your lawyers did. I took the bar exam while breastfeeding and wrote about it on my blog–and every day women are finding my website while looking for information about getting testing accommodations to pump. Your decision to fight for what is right despite criticism, career risks, etc, will help so many women. Thank you.

  • Been there too.

    Thank you for your sacrifices on behalf of us women. I took my ABIM specialty exam in 2009 while breastfeeding. Since I couldn’t pump during the exam, I powered through the 9 hour scheduled exam with only one 5 minute bathroom break so I could go home early and pump. I was in so much pain and discomfort, I could barely lift my arms to drive home afterwards. I hope no one has to go though that in the future. 

    • harry

      Perhaps Sophie should have lent you some of her time so that you could breast-feed. She had plenty and still did not pass!
      Actually, you needed & deserved breaks. The Sophie case merely weakens and challenges the rights of other breast-feeding woman doctors. I really think the governing board was just tired of the endless exemptions. Can we blame them?

  • A Woman

    Thanks for doing this on behalf of all women! I’m sorry that your career had to suffer because of it, but I applaud your courage and conviction!

    • harry

      Thank-God her career suffered and not the patients!