Pumping breast milk during Step 1

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    Hey everyone! I’m a current M2 and excited to be having a baby girl in March. I’m also scheduled to take Step 1 at the end of June (as late as possible at my school). When I asked the NBME about my options for pumping breast milk during the exam, they told me that I can bring my pump, but I will only be able to pump during my breaks (45min total). Since this is my first baby, I have no idea whether that will be enough time (especially since those 45min also include lunch and bathroom breaks). I will have a hospital-grade double electric pump with a hands-free pumping bra. I saw that NBME lost a lawsuit last year over not granting a breastfeeding mother additional break time to pump, but it looks like they are still working on updating their policies.

    Does anyone have recent experience with this?
    Will 45min be enough time to pump for a 3 month old? If so, what is the best way to split up the time?
    If I could convince them to let me pump during the exam (not just on breaks) would that work, or is pumping too much of a distraction?



    During the exam is way too much a distraction. Your fellow test takers would really be pissed!

    I had a 7mo old and pumped during step 1. I pumped in my car under a cover before the test. Then I took quick five minute breaks to clear my head then four hours into the test – pumped with a hands free bra and ate lunch using 20 min. Then cont to take five min breaks after sections til I finished. Then pumped again right after.

    I pumped every three hours normally, so every four for one day wasn’t horrible. It worked just fine.

    You’ll be fine. You don’t need extra time – I had plenty!

    On my phone or I’d write more.


    I think this varies from person to person – ideally you would want time to pump twice during the test with a baby of that age, probably, and it would be nice to have at least 20 minutes each time, not including getting to wherever you’re going to pump and all the time signing in/out of the test. Some people find it pretty easy to pump in 10 minutes, for some people it’s harder. So, if you were able to get more time, that’d be lovely.

    On the other hand, while it’s lame to on top of everything else be distracted by feeling like you’re overdue to pump, and then being rushed when you do pump, I think you’ll find that you CAN go 4 hours ok if you have to, and that even if you don’t pump quite as much as you would like that whatever you can pump in 20 minutes or even 15 min will be enough to let you feel better again when you get back to the test. So, it may be nonideal, but it won’t be a terrible.

    So, all in all, my take would be that if there were a way a couple of phone calls and letters could buy you a little extra time, that’d be worth it – but if that doesn’t work out, you’ll be fine.

    (But do make sure you can eat and drink while pumping – that part will matter!)


    Is having your babe brought to you to nurse in any way an option? I pumped during step 2, but for boards i had my husband (who is truly amazing) hang out near the test center with our 3 week old (yes, i am completely insane) – that way i just nursed during breaks – she’s not likely to turn you down, and theres no setup/cleanup/etc

    Just a thought, but requires another person 🙂


    Thanks so much for all the tips!

    Is directly breastfeeding faster than pumping? I had assumed that pumping would be faster because I can drain both breasts at the same time. My mom is coming to visit for 3 weeks right before the test to help while I study, and my husband has offered to bring the baby to school so I can breastfeed, so having one of them bring her to the test center should be possible…

    How long does it take to set up and take down the pumping equipment?

    I saw that NBME was sued a few years ago over not providing breastfeeding mothers with extra break time to pump, and the mom won. The Massachusetts supreme court ordered NBME to provide breastfeeding moms with extra break time in a ruling released in April 2012, but when I emailed NBME to ask about it they said they don’t give extra break time after all… I’m totally confused.


    It took me 10-15 minutes to set up, pump both sides and take down…but clearly this seems to be nonstandard. I practiced a bunch before clerkships started. I don’t know. It just wasn’t that big of a deal.


    For my first, pumping was faster (slow nurser), for my second, nursing was faster (even though my pumping was faster that time around, too). He ate like it was a race.

    This whole kids-are-unpredictably-variable thing sure makes it darn hard to plan, sometimes….!


    I know! I wish they would be more predictable 🙂 I guess that’s what makes it fun, though.

    I know I won’t really know what I’m dealing with until a few weeks before the test, but at the same time I feel like if I end up needing some sort of accommodation, I need to get on it soon. It sounds like I should be ok, though. I just don’t want to hurt my performance on the exam because it’s been too long and I’m bursting.

    Once the little one gets here, I’ll practice assembling and disassembling the pump and see how long it takes to get through a pumping session vs a breastfeeding session so I can plan ahead.

    Thanks so much to everyone for sharing your experiences!


    Practicing helps a lot. I felt dumb practicing how fast I could be setting up, taking down and packing, but it made a big difference in my time and ability to get a good pump in.

    Good luck! You’ll figure out what works for you!


    Maybe I am an outlier here, but I took step 1 while pumping for an 11 mo old and found it unpleasant. I am a slow test taker, and slow to let down for the pump, even though I was pretty engorged and leaking through my pads. I was able to pump once during the whole test (~25″) because I wanted to save time for bathroom breaks between blocks.

    Definitely practice set up and take town; you won’t have time to fully wash the parts, so don’t worry about it. Have everything preassembled and have a car charger as backup. My testing center only had 1 bathroom, so I did not want to hog the bathroom since other people would be needing it who were also pressed for time. I pumped in my car with a cover and had everything ready to go. Also–go through the tutorial on the USMLE website so you can cruise through it on test day and buy yourself some extra break time. Remember that signing in and out will also eat up a few minutes of your time during your break.

    I have next to zero faith that the NBME will make any accommodations for you unless you live in MA. They fought that case tooth and nail. This is their official statement:

    “On April 13, 2012, the Massachusetts Supreme Judicial Court issued its opinion in the matter of Currier v. National Board of Medical Examiners. We are carefully reviewing the court’s opinion. The NBME understands the needs of breastfeeding mothers and does not dispute the merits of breastfeeding. Our first priority continues to be protecting the health of the public by ensuring rigorous and consistent standards for assessing the competence of physicians and other healthcare professionals.” http://www.usmle.org/announcements/?ContentId=95

    No promises there, even though they lost the case!


    I read the court verdict and it was pretty clear that NBME needs to provide extra time for breastfeeding moms, but NBME seems to be dragging their feet on implementation and sadly, I don’t live in MA.

    The pump that my insurance company is providing for me is battery powered, so luckily I won’t need a power outlet to pump. I’m a little afraid, though, that the stress of the test will make it hard to relax and get my milk to let down.


    I’d suggest pumping at least once per day for a few weeks beforehand so you get used to the pump, setup, etc. Even pumping a few mins on the day of the test should help with comfort.

    Also a note, I found that I would get anxious if I had gone too long without pumping/breast feeding, especially in those early months. My guess is some sort of hormonal thing.

    I pumped in the bathroom during my step 3 when my baby was 5 months old. No problems at all. You can make it work!


    I got two cones, extra bottles,and a double tubing setup, and a special bra that holds both in place for hands-free, so I pumped twice as fast and could work or flip through pics of my baby and relax.

    I was annoyed/distracted by having wet nursing pads on from random leaks, so I changed them constantly (even in public,super stealth swap,lol) and kept a baggie handy for wet ones.


    Thanks to everyone for the tips! I talked to a local lactation consultant and she said not to worry about it, so I’m trying to focus on studying (and washing baby clothes) for now.


    How did it go? Any advice or updates?

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