Tell us a little bit about yourself? Who you are, and what kind of work do you do? 

My name is Amanda Guarniere, and I am a nurse practitioner in both clinical practice and entrepreneurship as a career mentor. As an NP, I have worked in various clinical settings, including emergency medicine, primary care, and aesthetics. I am also a mom of three little girls! Becoming a parent was the catalyst for me to pivot from clinical work into entrepreneurship. 

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What beliefs did you have about feeding before you had kids? 

I always heard that “breast is best,” and of course, I wanted to provide the best to my kids! I knew that I wanted to breastfeed, and I remember my mom telling me when I was younger how she breastfed me. The story she told often went hand-in-hand with some judgment of others who chose not to breastfeed. As a nurse herself, my mom also believed that breastfeeding was always the best option for everyone. 

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Were you confident in your knowledge of infant feeding going into parenting? 

Actually, no. Even though I am both an adult and women’s health nurse practitioner, I never had much experience working with birthing people or babies. My training didn’t include any focus on infant feeding. 

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Tell us about your first feeding journey? 

My first pregnancy was twins! They were born early at 31 weeks after I had PPROM (preterm premature rupture of membranes).

Even though they were premature and intubated right after birth, I requested a breast pump right away. I was not shown how to use it beyond the basics. I hooked right up, and nothing came out.

I used the pump every two hours as instructed, especially since the neonatologists told me how important breastmilk was for premature babies. I never expressed any colostrum, and after 30-45 minutes on the pump, I would get maybe 10cc of breast milk. I kept waiting for my milk to “come in,” thinking my body was just confused because of the PPROM, but it never did. 

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I met with lactation counselors, who thought maybe the pump was the problem, and that my milk supply would increase once I could put the babies on the breast. But since I couldn’t do that for a while, I kept trying the pump. I would snuggle with the blankets I took home from the NICU every night while they were still in the hospital, waking up every two hours to pump for the few drops I could get.

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When it eventually became clear that I was not going to produce enough milk, I looked into breast milk donation and milk sharing. We were able to use donor milk for 6 months, and much of that time I also fed with formula, alternating bottles of each and sometimes mixing both in the same bottle. This seemed to be a good idea in the long run, as the babies transitioned well to exclusive formula without complaints.

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How did this experience impact your future feeding journeys? 

When I was pregnant with my third, I had concerns that I would struggle again with breastfeeding, but I was still hoping that my troubles were due to the twins’ prematurity. She was born full-term and latched well. I never felt that sensation of “milk coming in,” so I didn’t know how much I was producing in those early days. Unfortunately, she had signs of dehydration at her first pediatrician appointment, and I knew that she wasn’t getting enough milk. 

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How did your care team support you in that experience? 

I had the most amazing pediatrician who reassured me that it absolutely did not matter how I fed her as long as she was being fed. Hearing that allowed me to release the emotions I felt, and I gave myself permission to stop trying to make it happen.

I ultimately learned that I had IGT - insufficient glandular tissue - which is where the milk-making tissue in the breast has not developed as expected. This causes a low-milk supply that cannot be increased beyond a certain point by any interventions. 

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How did being a clinician, your experience, and your training impact your feeding journey? 

Honestly, it felt like I had the professional knowledge of what was “better” for my kids but then none of the knowledge of how to actually achieve what was most important - them being fed and me being happy. I often wanted to be treated like a non-medical person because the two sides of my brain (nurse practitioner vs. new mom) felt very conflicting.

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Did you feel supported by other healthcare professionals in your feeding journey? Why or why not? 

The first time I felt truly supported by other healthcare professionals was by the pediatrician of my third daughter. I wish someone like her would have been part of our care team during my first feeding experience.

In hindsight, there was too much “problem-solving” with my twins when what I needed was someone to recognize my condition and give me permission to stop forcing something that wasn’t working. I needed someone to see how much it was taking a toll on me emotionally and physically. 

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As a clinician, what is the biggest takeaway from your feeding experience? 

My biggest takeaway is the importance of meeting patients (and people in general) where they are at. When we care for patients, we should always be asking questions to get to the root of the problem and understand our patients' needs. This allows us to better come up with an individualized plan and make sure that we aren’t imposing our own desire to solve a problem on the patient or our own ideas about what is “best” for them. If someone had done that for me earlier on, I think we would have identified what was going on sooner and improved my infant feeding experience. 

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To learn more about how to support parents in all feeding journeys, join our Feeding Friendly clinician network.

To share your own clinician feeding journey, email medical@hibobbie.com

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