Reader Question: Breastfeeding and USMLE

Update: NBME recently changed their policy on breastfeeding during USMLE test sessions to allow extra break time for breastfeeding moms. More information on the new policy can be found in my update post here

Warning: This post is about the gory details of breastfeeding and breast pumping during USMLE exams, the things I wish someone had told me. If you don’t want to read about breastfeeding, stop reading now and check back on Friday for a boob-free post.

I recently got this user question about breastfeeding during USMLE, after I posted about breastfeeding in medical school a few weeks ago:

Thank you for sharing your experience.. I read its been a while since that. Im having my test soon so I hope it works for me as well. What kind of pump did you have? How long did it took you for the sign in/out process? Thanks!

Ok, let’s break it down. What do you need to know about taking USMLE while breastfeeding? If you haven’t read it already, I definitely recommend looking over my post on breastfeeding in medical school for a lot of general tips and things to know. That being said, pumping during USMLE is a whole different ball game. Why?

NBME, the organization responsible for the USMLE, insists that they are not obligated to make accommodations for breastfeeding test-takers.

That’s right. They have been sued over this, and they continue to insist that they are under no obligation to make any sort of accommodations for breastfeeding test-takers.

Specifically, they will not

  • Give you extra break time
  • Guarantee you a private space to pump
  • Allow you to use your pump during the test

Depending on the test center, they may or may not give you a semi-private place to pump during your breaks, like an employee lunch room or a conference room. Or they may refer you to the bathroom. Pro tip #1: Call ahead to the test center where you will be taking your test to find out what space they can make available to you. My particular double-electric pump ran on rechargeable batteries (more on my pump below), so I didn’t need a power outlet, which gave me a lot more flexibility about pumping spaces. If your pump needs a power outlet in order to run, make sure there will be an outlet available.

Finishing the test is more important than how much milk you bring home at the end of the day.

No matter how young your baby is, or how little milk you have in the freezer, for this one day you need to focus on getting through the day, not on how much milk you bring home. It’s hard to get yourself to believe that, but it’s the truth. You need to get through an 8-hour test without being distracted by painful engorgement or plugged ducts. I’m one of those people who also hate having to pee during a test, so I took a break between each test section to pee. To make absolutely sure I wouldn’t be distracted by painful engorgement, I also manually expressed a few drops of milk during each pee break. That milk went to waste. It went into a paper towel and into the trash can. The point wasn’t to bring the milk home to baby, the point was to make sure I wouldn’t be in pain during my next question block. Pro tip #2: Express a few drops of breast milk on each break to prevent engorgement. 

Finding the time to pump during the test.

You cannot pump during the question blocks, only during your break time. You get the same amount of break time as anyone else taking the test, so you need to plan your break time very carefully. You get 45 minutes of break time and a 15-minute tutorial. If you finish the tutorial early, that is added to your break time. So, pro tip #3: Click through the tutorial as fast as you can to get the extra break time. 

If you finish a block early, those minutes also get added to your break time. Pro tip #4: If you have given each question your best shot, don’t keep staring at it – end the block and get the extra break time.  

What to bring

Remember that your pump and pumping equipment will stay in a locker in the lobby of the testing center, so you don’t have to worry about your stuff being inspected or messed with. Bring everything you think you might need, and bring spares of anything important. If you read the first article on breastfeeding in med school, bring everything in the pump bag. If you haven’t read the first article, here’s a recap of what to bring:

  • Your pump (double-electric – rent one if you need to, and make sure you know how to assemble, disassemble, and troubleshoot)
  • Any necessary power cables and battery packs
  • Horns, tubing, bottles
  • If you have a Medela pump that uses the little yellow connectors with the white rubber flaps, bring extras of the rubber flaps – they tear sometimes, and the pump won’t work without tehm
  • Pump cleaning wipes
  • Gallon zip-top bag (you can put your dirty parts in the bag and put the whole thing in the fridge between pumping sessions instead of cleaning everything)
  • Hands-free pump bra, so you can eat lunch while you pump
  • Sign for the door, in case you are using a conference room or employee break room

The right tool for the job

Efficiency is very important when it comes to pumping during your exam. I don’t recommend attempting this with anything other than a high-quality, double-electric pump. I had a Lucina Melodi pump paid for by my insurance. It runs on rechargeable batteries and it’s very effective. Genadyne, the company that owns Lucina, makes portable wound vacs, so they know a little something about making reliable, portable suction devices. I loved it and would recommend it to anyone, especially those who work in healthcare. The biggest, most important feature? NO POWER CORD NEEDED! I could get through a 30-hour shift without needing to recharge the batteries. More on that pump, and how to get a pump paid for by your insurance, in a future post.

If you have another double electric pump, it will probably be just fine, but I was asked which pump I have, so there it is!

Using your break time wisely

There are 7 blocks of questions. Each block lasts one hour. Make a plan for how to use your break time in advance. Here is what I did, your mileage may vary:

  • Block 1: 60 minutes
  • Break: 5 minutes – pee, stretch, drink of water, manually express a few drops in the bathroom
  • Block 2: 60 minutes
  • Break:20 minutes – stretch, pump for 20 minutes while eating, put tubing and parts in the fridge if available or wipe down with a cleaning wipe, stretch, pee again
  • Block 3: 60 minutes
  • Break:5 minutes – pee, stretch, drink of water, manually express a few drops in the bathroom
  • Block 4: 60 minutes
  • Break: 5 minutes – pee, stretch, drink of water, manually express a few drops in the bathroom
  • Block 5: 60 minutes
  • Break: 20 minutes – stretch, pump for 20 minutes while eating, put tubing and parts in the fridge if available or wipe down with a cleaning wipe, stretch, pee again
  • Block 6: 60 minutes
  • Break: 5 minutes – pee, stretch, drink of water, manually express a few drops in the bathroom
  • Block 7: 60 minutes

On the morning of test day

You want to start your first block with your breasts empty. I pumped in the car while I was driving – I had a battery-operated pump and a hands-free pump bra. Or you can pump in your car in the parking lot (you can get a car adapter for Medela pumps), or get to the test center early and ask to pump for a few minutes either before checking in or between checking in and starting the test.

Dressing for success

You may or may not have a private space to pump in, so be prepared for that. Dress in clothes that allow you to expose the necessary parts quickly and easily, without totally undressing. I liked the option of a tank top and a low-cut sweater – pull up the tank top and pull down the sweater neckline just enough to sneak the pump parts in. You may also want to bring a nursing cover-up or a shawl just in case. If you take a layer off during the test, you need to take it out of the testing room and put it in your locker, so wear thin layers.

Signing in and out

The pump stays in your locker outside the testing room so it doesn’t have to be inspected. When you go into the testing room you have to be fingerprinted and sign in/out, and they have to see your ankles and you have to turn out your pockets. I wore pants without pockets so I didn’t have to turn any pockets inside out. I felt really bad for the guy who showed up in cargo pants… The sign in/out process took about 1 minute per trip out of the testing room (30 sec out, 30 sec back in). If I had it to do again, I would wear leggings so my ankles would be visible.

 

Ok, folks, what questions do you have about getting through USMLE while breastfeeding? Comment below!

Happy testing!

Indy

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3 comments

  • Jessica

    I am scheduled to take the test in a couple of weeks. I just found out I can ask for extra time to pump but in order to do that I would have to postpone the test. I’m really not into the idea of postponing, do you think it is worth it? Or should I just take the normal break time.

    • Indy (admin)

      That’s really up to you. I took the test before they started allowing extra break time and I did fine. I had plenty of break time and I didn’t feel like my performance was affected. How long does it usually take you to pump? When you take practice tests, do you have any extra time at the end of your blocks? My daughter was 5 months old when I took the test, I was normally pumping for 20 minutes every 3 hours, so I did just fine with the standard hour of break time.

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