Bikes · Parenting

Adventures in bike and transit commuting: breast pumping edition (A review of the Willow breast pump)

This post is going to talk a lot about breastfeeding, pumping, and specifics about my breast/nipples/nursing+pumping situation. It’s rather personal territory, and less bike related, than most of what I talk about here but I think it’s important and I’m excited about having had the chance to try this product. More than most of my posts this one hits at the intersection of balancing motherhood, biking, and my scientific career. All the products were purchased by me for my own personal use (no freebies).

I LOVE my bike commute. Which is good because driving instead isn’t remotely feasible. It would cost an extra $400-500/month and take me at least 20 minutes longer in each direction on average. Plus we lack a car that would be able to reliably do my commute, so tack on money for the purchase of said car and we’re getting close to $1000/month extra to car commute. Not happening. I do take the bus on occasion, and it’s wonderful to have a backup option, but it takes longer, is less flexible, and gives me less exercise than biking. With 3 kids at home, time is at a premium for me and being able to have the shortest possible commute AND get exercise at the same time is a pretty sweet deal. So every morning I bike 5 miles to the ferry terminal, take a water taxi (think floating bus) to downtown, and then bike another mile to my work. In the afternoon I do the reverse. In total it takes about an hour and 10 minutes each way and due to steep hills on both sides I get a good workout from it (yes, even with an ebike).

There’s a problem, however. My youngest is still nursing and I need to pump milk for her when I’m away if I want to continue to breastfeed. Since I’m gone 9.5 hours a day or more that means I need to pump at *least* 3 times while I’m away, and on longer days I may need to pump 4 times. It takes at least 15 minutes to pump (longer if I’ve gone longer than 3 hours between sessions), plus a similar amount of time to deal with setup, washing everything, and getting to and from the pumping room. Trying to fit 3-4 rounds of that into a work day is a lot of time away from work, meaning I might need to stay later to get everything done or work more after the kids go to bed (when I’m already exhausted). Even with a supportive boss and flexible work I was dreading trying to manage the pumping schedule and getting enough done. With my previous two kids I mostly managed until 6 months or so, then the demands of work started to win out and I started missing a lot of pumping sessions. By 9-10 months I was no longer coming close to keeping up with their needs, despite an early oversupply, and it led to the decline of our nursing relationships (not the sole reason, but a contributer). I really didn’t want that to happen this time, particularly because I experienced my first case of mastitis at 6 weeks postpartum this time and I don’t want to increase the chances of that happening again, which skipping pumping sessions will do.

Baby J, AKA the reason I pump

I started looking for ways to fit pumping into my commute because if I could move 1-2 pump sessions to my commute then I would be able to spend less time pumping at work, come home earlier, and be less likely to need to work at night or on weekends. A bike-ferry-bike or bus-ferry-bus commute doesn’t really lend itself to pumping though. While there is a bathroom on the ferry I can use for setup/break down of the pumping gear, I definitely can’t tie it up for the entire ferry ride every day, and it would be pretty miserable to spend that long in there each day anyway (they’re similar to airplane bathrooms, complete with 200+ other people wanting to use them). So that rules out a standard pumping setup where you need a decent amount of privacy for the entire pump session. I was aware of the option of Freemie cups that you can attach to your regular pump for pumping more discreetly (popular for women who want to pump in their car while commuting), but even with the Spectra S9 portable pump I got through insurance the sound of the pump is still quite loud and the cups themselves are quite large under clothing. Your ability to move around is also fairly limited with Freemie cups. You can sit up and move around a bit, but there are still tubes to deal with and they will leak or lose suction if you move too much or lean over. Definitely not feasible for biking and not ideal for the ferry or bus, where I’m usually sitting right next to someone (or standing and dealing with the movements of the bus/boat). I had heard about some new pumps where the entire thing goes into your bra and decided it was time to learn more.

Currently there are two “in-the-bra” or “wireless/tubeless” pumps available: Willow and Elvie. Willow is a US based manufacturer and Elvie is UK based. Both devices look a bit like a plastic boob that you stick in your bra and turn on for it to pump and collect milk. Both have batteries and milk collection containers within the device, so there are no tubes and no wires to manage while pumping. Both have apps and attempt to track how much milk you’ve pumped. When I started looking at them I was fairly certain I was going to end up getting the Elvie because I liked that it was smaller, lighter, quieter, and had reusable milk collection containers. Once I dug deeper though, I discovered a lot of complaints about leaking, loss of suction, and insufficient suction with the Elvie. I was less worried about insufficient suction, since I already use most pumps on a low level of suction, but the risk of leaking was a problem for me if I ever ended up needing to pump while biking, and loss of suction seemed to be especially problematic for women with a strong letdown, which I have. Those factors turned me off of the Elvie. Reading reviews and learning about the Willow I found almost no complaints about leaking or lost suction. I did see complaints about the lack of flange size options and the suction being very strong. These were a bit of a concern for me because I knew my nipples were smaller than 24mm (the size of the smallest Willow flange) and I typically use low suction on most pumps. I also did not really like that I was going to be stuck using single-use bags for all my pumping with the Willow, both because they were pricy and because they meant more waste associated with my using the pump compared to reusable containers like the Elvie had. The overall features of Willow seemed like a better fit for my needs though, so I decided to go with Willow.

Although the Affordable Care Act requires coverage of breast pumps and most insurers now cover a double electric pump as part of that, Willow and Elvie are very new and not yet on the radar of most companies. Some will provide partial coverage (perhaps up to the max amount they would cover for other pumps, perhaps less) while others won’t cover them at all and will only pay for pumps off a particular list of approved devices. Because of this and their high price (~$500 for a dual pump set) Willow and Elvie are still hard for most women to get. I didn’t even bother finding out if my insurance would have covered either of them because I’d already used my insurance benefit to get a Spectra S9 which was decent but clearly not going to suffice for my commute. Even when insurance won’t cover the cost of the pump, however, you should be able to use funds from Health Savings Accounts or Flexible Spending Accounts for the Elvie or Willow. We have an HSA, so this was the option I went with for puchasing Willow. Willow is an approved vendor for our HSA, so I was able to pay directly with the card we have linked to that account, and the overall transaction was really easy. I went with the 24mm flanges because it was the smallest option available and I knew my nipples were smaller than that. I later found out that if you select the 27mm flange at purchase you actually receive both the 24mm (which are packaged in the box) and 27mm flanges, so it might be better to do that if you have any doubt about your size or simply want the 27s to have as a backup in a pinch. I was able to get a discount and 48 free bags with the Willow (in addition to the 24 bags that come in the box), so the total for the pumps and my first 72 bags was a little under $500.

My pumps arrived in about 3 days, the week before I was starting back to work. Honestly, I was a little afraid to open the box, knowing that if Willow did not work for me I wouldn’t be able to return it once it had been opened, and of course having no way to truly know if it would work for me without opening it. I got over it and opened it up fairly quickly though. I put the pumps on to charge (annoyingly, they only give you one charger) and sat down to read both the quick start guide and the manual, because a lot of the reviews had mentioned a relatively steep learning curve. I watched a couple of videos, installed the app, paired and updated the pumps, and then it was time to get set up for the first pumping session. The Willow system includes the pump itself (which contains the pump motor and battery), a flextube that connects the flange to both the pump and the milk collection bag and performs the roles that both the tube and the valve do on a traditional pump, a flange that is the interface between your nipple and the pump, and a donut shaped bag with a one way valve that stores the collected milk. To assemble Willow you attach the Flextube to the flange in two places, attach the valve on the milk bag to the top of the Flextube, and then squish the bag into place around the edges of the flange so that it doesn’t stick out and get in the way of attaching the flange to the pump. That last bit is the most annoying but once you’ve done it a few times becomes fairly straightforward.

With the pumps assembled, app installed, and instructions watched, I was ready to pump. I decided to start by pumping just one side, since I’d just fed the baby on the other but didn’t want to wait for another chance. Using the recommended strategy of disconnecting the flange from the pump to apply it to my nipple (so you can see what you are doing through the clear flange) and then attaching the pump while the flange was already lined up I felt like I got fairly good alignment. Actually pumping was a failure though. I stayed in stimulation mode (a faster pumping meant to stimulate letdown to happen) for the entire 25 minute session and never got letdown. This is a thing for me though, so I wasn’t overly surprised. While some women report that they get much better output if they pump each breast individually, I am often unable to get letdown if I’m only pumping one breast. It’s also possible that there were alignment issues I didn’t notice. I decided I was going to have to make it a double pumping session if I wanted it to work, so I waited about an hour and then pumped both sides with Willow. And this time it worked! I only got a couple of ounces total, but it was a start. Despite my worries about the suction level it wasn’t particularly painful, though it definitely felt different from my usual pumps.

First milk from using Willow!

The next day I pumped during a particularly long nap the baby was taking and got >8 oz. While watching my kids ride bikes in the street outside our house. In front of the neighbors. I even got on the GSD and rode a couple of laps with them for bonus points. I put on a nursing hoodie a friend gave me so that I felt a little less self conscious about how large the pumps made my breasts look and pretty much no one but my partner noticed. A few days later I pumped in the middle of Target while back to school shopping with the two big kids and got 9oz. I wore the nursing hoodie each time because my shirts looked ridiculous with it on but otherwise it was pretty discreet. As someone with smaller breasts I tend to own mostly shirts that don’t work well with large ones and are pretty much already stretched to their limit from my breasts being larger while nursing, which makes the Willow present a bit of a challenge in that regard. With the hoodie on though, I looked pretty normal and the noise from the Willow was a bit muffled, leaving it noticeable to me but not anyone else. At least not with normal background noise. The biggest challenge was learning to not spill milk during the “flip to finish” that you do at the end of a session, and just getting everything coordinated enough that I could do it fairly quickly. For the Target trip I forgot to bring anything to put the milk bags in after I took them out of the pumps and ended up nestling them within a spare pair of clean underwear I’d brought for Little T. Not my finest moment. With each use it got a little easier to figure out what I was doing and what I needed to have with me but it definitely left me feeling like a new mom all over again.

The next week I started back to work and on Monday had my first attempt at pumping while on the ferry. It was a bit of a challenge to get set up without dropping a pump in the tiny bathroom, but I managed it. It was also rather hot so the hoodie was not the most comfortable, but I wore it anyway and stood on the deck in the wind and vowed to come up with another option. I got about 3 oz in 18 min, which is less than I might get with my Spectra pump (probably more like 4-5 in 15 min) but still fairly good. That week I used it every day on the ferry ride home and usually got ~4 oz. As I got used to the process it got easier to get the pumps on and off in the bathroom and do everything quickly enough to have time for a decent pump session. So far the plan was going well but I still questioned whether it was worth the money just for this one session each day.

On the ferry, pumping during that first week

Friday was the first time that I did something I probably would not have done if I had only had my Spectra pump as an option: I attended a 3 hour workshop at a different research center than the one where I work. Folks who have never pumped are probably asking themselves why I would have skipped it right about now, while those who have pumped are nodding their heads. You see, normally in order to attend an event like this while pumping I would have had to contact the organizers ahead of time to find out about pumping accommodations. Then when I arrived I would have needed to find someone who knew about the pumping accommodations, get them to let me in to wherever I could pump, likely rush through pumping because it would inevitably take longer than I expected to get to the right place, then rush to join the workshop, all while carrying around a giant bag of pump supplies. I would have had a ton of pieces to wash (where?) and have needed to carry extra bottles to store the milk. As soon as it was over I would have needed to rush back to the pump room to pump again. It would also force me into a position where I’m primarily known to the workshop organizer as “that woman who is breastfeeding” rather than by any sort of scientific credentials. As someone still at a trainee level, that’s a very difficult place to be much of the time. Not to mention the added load of all of that on top of it being my first week back to work. It’s unlikely I would have done all that.

With the Willow it was different. I brought my Willow and my insulated bag for holding milk, just like usual for heading to work but with extra bags and the brushes and wipes for cleaning the flanges and flextubes. I arrived about 30 minutes before the workshop was set to start and went to the bathroom to pop the pumps into my bra. Then I hung out in the lobby and outside while I pumped, even running into a lab mate who was also attending the workshop who did not notice anything. When I finished pumping I went back to the bathroom, popped the pumps out and put the bags straight into my insulated cooler, wiped down the parts and put them in the cooler, put the pumps in my backpack, and headed into the workshop. At the end of the workshop I stepped into the bathroom briefly to put the pumps in, then hopped on my bike and rode down the street to meet my partner at a restaurant for lunch. While waiting for our food I went to the bathroom and did the same pump removal and milk storage procedure as before. After lunch I headed back to work, where I was able to wash pump parts and put the milk in the fridge until it was time to head home at the end of the day. This might not seem that big a deal, but for me it was huge. In total I’d only taken about 15 minutes dealing with pumping, despite being in a different place than normal and not having pumping facilities easily available. I was able to go have lunch instead of spending that time sequestered in a room and having to rush straight back to work. Altogether in the 3 sessions I pumped that day I got ~19oz, comparable to the 20oz I get doing 2 Spectra sessions and one Willow session on my normal days. The sense of freedom was incredible. I think that was when I fell in love with Willow.

Pumping while biking! Really need to get something other than this hoodie.

There was only one problem: while my nipples were OK with the 24mm flanges and 1 pumping session a day with Willow, 3 was pushing it. They were decidedly sore for the next day or two when I did my morning pump session with my Spectra. If I wanted to make Willow work as an all day pump I needed to make it easier on my nipples. At that point I decided to join a couple of Willow-related Facebook groups to see what others had come up with and ended up joining two: one specific for Willow and one for Willow and Elvie.

These groups were a bit overwhelming at first, and they can make it seem like no one is happy with their pump because most people arrive there while trying to troubleshoot some sort of issue. There’s a lot of good advice to be found, however, and I quickly discovered the thing I was looking for. After getting some advice on measuring my nipples properly (the “coin method” that Willow recommends is not very good) I was directed toward inserts that I could put into the flanges (Willow flanges, but also basically any flange) to bring them down to a size much closer to that of my nipples. For the first time I was also advised to size based on the exact pre-pumping size of my nipples rather than the post-pump size or pre-pumping size with a 2-3mm added. This seems to be particularly important with Willow, which operates on a light suction/strong suction pattern instead of the no suction/suction pattern most pumps use, but it’s worked well for me with my Spectra pumps too. There are a couple of options for inserts and confusingly both are marketed as being for Freemie cups. Maymom makes inserts in 17/19/21mm sizes that are sold on Amazon and Freemie makes their own Fitmie inserts in 15/16/17/18/19/20/21/22/23/24/25/26mm sizes available for sale on their website (15-22mm inserts fit into 24-25mm flanges, 23-26mm inserts fit into 27-28mm flanges). With Maymom you are buying a pair of inserts in a single size for $14. With the Fitmie inserts you are buying 2 pairs of inserts, one pair in each of the sizes listed for the pack you buy (15-16/17-18/19-20/21-22/23-24/25-26) for $25. So in some ways the Maymom inserts are cheaper and in others the Fitmies are. Based on the fact that it seemed like more people liked the way the Fitmie inserts fit in the Willow flanges, and that they were offered in more sizes, I decided to go with those. My nipples are two different sizes that aren’t covered within the same set of Fitmies, so I ended up with 4 pairs of inserts.

When I first started pumping after H was born 6.5 years ago I realized my nipples were smaller than the 24mm flanges seemed to work for. So I went to the Medela website, found that the only smaller size for the flanges was 21mm, and bought a set (a stretch at the time on a grad student budget) and found that they didn’t really work much better. When I switched to using a Spectra pump after little T was born they didn’t even have 21mm flanges and 24 seemed to work well enough, so I just didn’t even bother. It seemed like an expensive hassle to try to find smaller flanges made by other manufacturers that would work with my pump. And besides, I found it hard enough to align my nipples (so that the tip didn’t end up rubbing on the side of the flange tunnel during pumping) with the 24mm flanges, surely it would be worse with smaller ones? Yet here I was buying inserts anyway in the desperate hope to untether myself from pumps needing tubes and wires. The inserts arrived and seemed pretty simple and easy to use (albeit another piece to wash). I tested them out for the first time with my Spectra S9 and learned 2 things: 1) while I could get away without lubrication on the hard plastic flanges it was absolutely needed for me while using the slightly “sticky” silicone inserts, and 2) alignment was actually easier because if my nipple fit then it was basically aligned, at least well enough that with a little lubrication inside the insert it would sort itself out. With the S9 it was maybe a little more comfortable but I didn’t notice a huge difference and the volume of milk I expressed was similar to my norm. Testing with Willow had to wait for the next day when I was at work.

The next day I pumped for all 3 sessions with Willow + inserts instead of using my Spectra for 2 of the pump sessions like usual. Success! More comfortable during pumping (no pinching feeling), a little bit more milk pumped than usual (except during the session where I decided to test to be 100% sure I needed the lubrication), and at the end of the day after 3 sessions I did not notice any of the nipple pain and sensitivity I had experienced the last time I did multiple Willow pump sessions in one day. I haven’t used Willow without the inserts since, and I’ve rarely used my Spectra without them either. The only drawbacks I’ve found are that they make it a little harder for me to get letdown for Willow (because they result in less stimulation of my nipples and I can’t adjust the suction during the stimulation phase to counteract that, hint hint, fix this Willow) and that they are one extra thing to clean. The overall benefits are well worth it though!

With the fit issues worked out there was now only one thing holding me back from using Willow as my primary pump: the bags. The single-use bags meant that each pumping session with Willow cost ~$1 and generated 2 bags worth of extra waste because my freezing and milk use system meant I needed to transfer the milk out of the bags before freezing and into another type of bag where I could fill them with a specific amount of milk (I tried to come up with a way to make my system work with the Willow bags but it was just not feasible for me). Through the Willow group I found that a lot of moms *do* reuse the bags, by emptying them via a toothpick or similar object to prop the valve open, followed by putting them in the fridge until the next pump session. This makes the cost less onerous but it represents a risk of contamination of the milk/increased bacteria levels in the milk because of the toothpick itself and the fact that warm milk is being added to cold milk when you pump into the emptied bags in subsequent pumping sessions. Though unlikely to cause issues for healthy, full term infants, this type of thing is not recommended by the CDC. It’s also not recommended by the milk bank I donated for when Little T was a baby (because milk going to premature babies needs to be extra safe), so I knew if I wanted to donate again I should avoid it. So I stuck with just using Willow once a day, during my commute, when I couldn’t use another pump.

It worked well for that. I also used it while biking, while working at the coffee shop, while going to doctor’s appointments, and a few times while working at the lab bench when I just didn’t have time to fit pumping in around experiments while still making it to my ferry. And then Willow changed the game by releasing reusable containers. They went on presale near the end of September and I bought two sets the day they were announced. Although they offered them with a 21mm flange size I opted to stick with the 24mm size so that I could use my inserts to get the size exactly right, rather than settling for “closer but still not right” with the 21mms. They arrived in early October and I would say that about 80% of my Willow pumping since that time has been with the containers rather than the bags. I’ve also used Willow for almost all of my pumping since the containers came. There’s definitely a learning curve with them, on top of the regular Willow learning curve. I have spilled milk multiple times while getting the hang of them. Once you master it though it’s so nice having the option to pump without bags. The containers are easier to put together than the bag setup, they reduce the cost of pumping, and they give a flange size option not available otherwise. Although they aren’t cheap, at $50/set, they pay for themselves relative to the bags in ~50 pumps. For me that’s ~3 weeks of pumping/set if I were doing all my pumping with Willow and ~2 months of pumping/set if I stuck to my previous “only when absolutely needed” use of Willow. The biggest downside of the containers is that they will leak if you lean over, because a vent hole is needed in order for pumping into a hard sided container to work. This hole is very small and located at the very top of the container, so they don’t *easily* leak, but it does happen. I likely won’t use the containers for biking but they replace the bags for most of pumping I do with Willow because I don’t have much need to lean over far enough to make the containers leak. Having the ability to pick between the reusable but not leakproof containers and the leakproof but single use bags is perfect and really sets Willow apart from all other pumps in terms of what you can do while pumping.

Pumping into the milk containters. Instead of a donut shaped bag, now it’s a donut shaped container.

Two months in I only have two remaining reservations with Willow. The first is the price/availability for most women. This is a very pricy pump and since most insurance won’t cover it most women won’t be able to afford it. I’d also like to see options where it comes with the containers for those who never need to use bags, so they don’t have to purchase it with accessories they don’t need (the bag flanges and bags) and pay extra for the parts they do need (containers and container flanges). Also, to be able to really use the Willow or Elvie to minimize how much time you spend pumping while out and about you need to buy extra sets of all the parts, which adds up. And some of the parts, especially the flextubes for Willow, will wear out and need to be replaced every 3-4 months. Frankly, by the time you’ve bought this pump and extra parts for it you will likely have spent as much money as if you had used formula in the first place, especially if you need to use bags a lot. I like nursing my babies and that helps make the pumping worth the time, energy, and money it costs me, but we need to stop pretending that breastfeeding is “free”, especially for working moms or moms who need to exclusively pump. The second reservation is part of a much larger conversation: should women need these? On the one hand I absolutely love the freedom that Willow gives me. On the other I worry that pumps like these will be used to excuse continuing terrible maternity leave policies, not giving women time and space to pump at work, and a host of other issues with the way we treat mothers, especially in the US. Willow did not create these issues but they stand to profit off of it. It’s important to realize that this isn’t just a product for working mothers though. There are many, many people who can benefit from access to this pump and ones like it. We just need to make sure we don’t let it become an excuse to not address bigger issues. Technology is amazing but it isn’t a substitute for creating family-friendly policies.

Am I glad I purchased Willow (was it worth the money)?

Unequivocally yes. I’m much happier pumping than I was with either of my other two kids and I’m managing to not miss pumping sessions.

Can you bike or transit commute and pump breastmilk while commuting?

Yes. Willow works well for pumping on the bike, though I don’t often need to do that in practice. I can’t imagine trying to use anything else to pump on the ferry. I haven’t used it on the bus yet but I’m confident it would work for many bus commutes once you got comfortable with it (and I’ll probably be testing it on the bus soon).

Closing thoughts?

What’s been amazing is how many other situations beyond my commute Willow has proven to be wonderful for. I don’t have to stress about how to manage my pumping sessions when I go to a doctor’s appointment because I can pop the pumps in in any restroom and take them out under my nursing scarf without even needing a private room. I can pump in the car or during a meal at a restaurant. I’ve been able to work from coffee shops, something that was basically impossible while pumping for my previous two kids. Right now I’m pumping 4-8 oz more milk per day than Baby J is eating, enough that I’m working through the approval process so that I can donate milk for the milk bank because I’m running out of freezer space. If I get approved my milk will be able to help give premature babies an easier start in life, and Willow is playing a role in that.

The app tracks the volume pumped on each side, how long you’ve pumped, and any alerts you should be aware of (low battery, full milk collection device, etc.). Some report that the milk volume estimates tend to be off but for me they’ve always been within half an ounce of reality.
I got this hard sided makeup case to carry Willow on the bike. It lets me keep them set up and ready to go. I also carry a cooler bag that I put the milk bags or bottles into.

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