Engorgement does not need to happen. Many times women confuse the natural
swelling of breast tissue by blood and lymphus at the beginning of
lactation, with engorgement. If a woman is allowed to room-in and nurse on
response (so much nicer than "demand"), her engorgement should be minimal,
if at all.
I think engorgement is more likely in these hospitals that have restricted
feeds.
Nofia