• Storage space for individual breast pumps.
• Sanitizing wipes for surfaces in the pumping room and gloves to wear while cleaning up.
• Multi-user (hospital-grade) breast pump(s) that conference participants can use—these can be rented—with advertising about the type of pump in advance so participants can bring appropriate adapters.
• Information on conference hotels that can guarantee cold storage for guests.
• Breast milk donation. Facilitating expressed milk donation gives participants the option of skipping transport home. The American Academy of Pediatrics has a Donor Milk Drive toolkit available to those interested in organizing this.⁹

For estimating the amount of space required for lactation, organizers should ask registrants about their lactation needs. Estimating that women will use these spaces for 20–30 minutes every three to four hours, with disproportionate use during break time, a reasonable starting point would be to offer one lactation station for every four women who will need to pump during the event.

Breastfeeding at Conferences: Mothers with Infants On-Site

The best lactation support includes providing accommodations for mothers who prefer to bring their infants with them and breastfeed at conferences and other events. Very young infants are rarely disruptive, and conferences should allow them in sessions.

• Signs such as “Mothers with Breastfeeding Infants Are Welcome” or “Breastfeeding and/or Pumping Are Welcome Here” signal all participants to accept the mild disruption of hearing noises from infants or from pumps being used by women who are comfortable pumping in public (with subtle wearable pumps or covered traditional pumps).
• Remote viewing options, such as a separate room where the conference content is live-streamed, allow parents to step out or share child-care responsibility among multiple care providers.
• Advertising inclusion of young children and breastfeeding in addition to pumping will support all early parents, not just lactating women, during a time of early career development that is often overlooked.

Special Considerations for Testing Centers

No matter the specialty, becoming a licensed physician requires sitting for multi-hour examinations. Given that lactating women have a physiological need to express breast milk at least once or twice during a full-day examination, testing centers must allow for pumping as a matter of gender equity for all participants. This can be accomplished with the same rigor as other test accommodations.

• Timing: Lactating women need additional break time to allow for pumping (approximately 30 minutes every three to four hours). Test administrators can increase total available break time for all participants to maintain parity among test takers, acknowledging this will likely be utilized only by those who need to pump or have another extenuating reason.
• Administrative barriers: Currently, there are significant hurdles to being allowed to pump during testing. These should be removed. One example: In addition to a three-page application for obtaining extra break time during USMLE examinations, mothers who want to pump during the exam must submit, weeks ahead of time, photos of their personal equipment and a letter from their personal physician stating the medical necessity of pumping.¹⁰ For any lactating woman, pumping is a medical necessity. These barriers must be reexamined and removed.
• Storage: Testing centers are unlikely to be able to provide durable lactation stations with multi-user devices, making it critical to allow for the safe storage of personal breast pumps within the testing center. Regulations regarding in-center storage and a test taker’s access to their personal equipment need to be altered for lactating health professionals. In addition, testing centers should provide access to a refrigerator in which lactating women may store breast milk throughout their testing day(s).

Conclusion

Support for lactating women during clinical shifts has been a focus of gender equity in emergency medicine in recent years.¹¹ Though there is still much to accomplish, it is critical to recognize that support for lactating professionals in other settings, including episodic events like standardized testing and medical conferences, is part of supporting the professional development of women in our field. The accommodations described here supplement several ways emergency medicine is moving to support work-family balance, including child care at medical conferences and family-friendly networking events. Parents with young families make up a considerable segment of our early career professional group. By showing support for lactating women and those with young children, we can all benefit from the inclusion of some of the most active members in our field.

For a more extensive discussion, please see our related article “Best Practices for Lactation Support at Conferences and Standardized Testing Centers” in Obstetrics & Gynecology, doi: 10.1097/AOG.0000000000003661.