Lu Ann asks:

< If a mother presents with full blown
engorgement, is that always a sign that there is major milk production? Is
it possible to have fairly significant engorgement without milk production?>

My first question is:

How and what are you defining as "full-blown engorgement"?

It is my contention that engorgement has escaped a clear-cut definition, and
the term is just a label that is actually no more helpful than if it were
just called "breast swelling". The swelling itself proceeds to change from
day to day in the first 10-14 days after birth, and of course, from feeding
to feeding, depending on how efficiently any secreted milk has been
transferred within and out of the breast.

That's at least partly because there are many different fluid
classifications that might contribute to swelling of the breast.

   1. First, there will be Increased blood supply to bring raw materials
   into the breast through the arterial system. The concentration ot the raw
   materials in the blood stream is one of the factors that determines how
   rapidly the raw materials will reach the alveoli.
   2. This increase in the blood supply will continue at least for
   several days, gradually joined by an increase in the amount of interstitial
   fluid, which forms in the connective tissue around the glandular tissue, and
   is normally in the form of a gel. The function of the interstital fluid is
   to serve as an "intracellular lake" by which to transfer raw materials,
   hormones, etc. from the arterial capillaries to the basement membrane of the
   individual alveoli, and transfer waste products of cellular metabolism from
   the glandular cells back into the venous and lymphatic capillaries. Once
   again, the concentration of these substances that collect in
   the interstitial fluid is one factor which influences how rapidly the
   exchanges take place across cell membranes and capillary walls. When
   overhydration occurs, interstitial fluid forms more rapidly than it can
   be absorbed by the alveoli or evacuated from the breast. Once the amount is
   30-50% above the normal amount, it is labeled "edema" and the extra volume
   in the connective tissue compartment can crowd the circulatory vessels
   and/or the lobes and ducts, possibly interfering with their function.
   3. The third fluid that begins to contribute to the swelling is
   (theoretically) the milk in the process of synthesis (in the alveoli) and
   secretion into the ducts, the amount ebbing and flowing with the MER and
   milk removal.

So, with the information I found in your post, my answer is "It depends!"

Jean
*********
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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