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Board won't relent for breast-feeding mother

She already has a doctorate from Harvard. Now, after five years of medical training, all that stands between Sophie Currier of Brookline and an elite, double-barreled MD-Ph D is a daylong exam and her commitment to breast - feeding her infant daughter.

For Currier to begin her medical residency at Massachusetts General Hospital this fall as scheduled, she must pass the clinical knowledge exam run by the National Board of Medical Examiners by August. The exam is nine hours long and allows a total of only 45 minutes in breaks.

But Currier is still nursing her 7 -week-old daughter, Léa, and if she does not pump milk from her breasts every two or three hours, she could suffer blocked ducts, the discomfort of hard breasts, or an infection called mastitis.

When she called the board last week to ask for extra break time, she said she was told that the test provides special accommodations only for disabilities covered by the federal Americans with Disabilities Act, and breast-feeding was not one of them.

Currier agreed that breast-feeding is not a disability. But it is physically demanding : "What am I going to do, express milk all over your computer?" she asked a board official.

In a statement faxed to the Globe, Catherine Farmer, the board's manager of disability services, wrote that the disabilities act "does not cover temporary conditions, such as pregnancy. . . . Furthermore, lactation, breast-feeding and breast pumping are not disabilities as defined by the ADA."

However, she added, examinees could use their break time outside the testing room for breast pumping, and if they finished sections of the test early, they could gain extra time for break.

Breast-feeding advocates, however, said the medical examiners' stance was unreasonable. Dr. Ruth Lawrence, chair woman of the breast-feeding section of the American Academy of Pediatrics, said the board's decision was "possibly letter-accurate, but totally inhumane and insensitive."

Few women are likely to request such extra time, she said, and breast-feeding is a physical need that should be filled just as the need to eat should be. "One would hope they would accommodate this particular physiological need not just for the individual being examined, but for her child," she said.

Currier's predicament lands her in an area of hot contention nationwide. Medical evidence shows the health benefits of breast-feeding for mother and baby, and the federal government has made increasing breast-feeding a major public health goal.

But society at large often shows less support for breast-feeding than health authorities do, particularly in workplaces and public spaces.

A flight attendant's decision to expel a nursing mother from a plane in Vermont last year, for example, led hundreds of mothers to stage "nurse-ins" at airports.

The Breastfeeding Promotion Act, pending in Congress, would protect working mothers from being fired or punished for pumping or breast-feeding during lunch or breaks. Pregnant women are protected from discrimination federally, but nursing mothers are not.

When told of Currier's problem, the bill's chief sponsor, Democrat Carolyn Maloney of New York, said she was shocked. "The National Board of Medical Examiners should know better," she said. "The board should know that a breast-feeding mother needs to express her milk every two hours or so. It's a natural process. She can't turn it off."

Forty-seven states have passed laws that protect nursing mothers, according to the National Conference of State Legislatures. Many protect the right of mothers to breast-feed in public, and some exempt them from jury duty, where breaks can be few and unpredictable.

Massachusetts has no such laws, but state Senator Susan C. Fargo, a Lincoln Democrat, has filed a bill that would legalize nursing in public and encourage employers to support breast-feeding and pumping.

Asked about Currier's request, the National Board of Medical Examiners responded that it could not comment on her particular case, but could describe its general rules.

The United States Medical Licensing Examination does offer "numerous accommodations" each year to examinees who document that they have a physical or mental impairment that substantially limits life activities -- the standard used in the Americans with Disabilities Act, Farmer wrote in her statement. They may receive extra testing time, extra breaks, or enlarged text.

"Since the general testing room is shared by multiple examinees, the use of a breast pump inside the testing room during the examination would be disruptive to other examinees and is not permitted. Furthermore, the testing rooms do not provide privacy since they are visually monitored," Farmer wrote.

To her knowledge, Farmer added, the board has received few, if any, other requests for accommodations for nursing mothers. She noted that scheduling for the exam is highly flexible.

Currier, 33, said she is receiving some test accommodation. She has serious dyslexia and attention problems -- she was featured in a Globe column last year about adults with attention deficit hyperactivity disorder -- and is thus given twice the usual time to complete the test: two nine-hour days instead of one.

But from a breast-feeding standpoint, she said, that means two days of problems instead of one.

In a letter she is drafting to the medical board, she is going to request an extra 20 minutes of break time per day, she said -- the minimum she thinks she can manage.

Lawrence said the nursing mother of an infant that age should pump at a minimum of every three hours, for about one half-hour each time. The academy recommends that babies be exclusively breast-fed for the first six months .

As for postponing the test, Currier is behind schedule because she failed the test when she took it this spring, when she was eight months ' pregnant , she said.

Combining an MD/PhD program with motherhood is a difficult feat, she and many others have found.

As it is, Currier said, she rushed to have both her children while in medical school.

She believed that the heavy, often overnight schedule of residency would be bad for both a pregnant mother and fetus, and she has seen other young female doctors at Harvard hospitals limiting their maternity leave to a month or six weeks because they felt so much pressure to resume their residencies.

She did not want to wait until her residency was over to have children, she said, for fear advanced age could bring fertility problems and chromosomal defects.

It strikes her as ridiculous, Currier said, when someone like former Harvard president Lawrence Summers spins out hypotheses about why many women may not be making it to the top tiers of science and medicine.

"It's so clearly obvious why women are dropping out in their 30s ," she said. "It's plain as day."

Carey Goldberg can be reached at goldberg@globe.com.

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