If it's day 5 and she's still expressing small volumes of COLOSTRUM, 
lactogenesis II is delayed. Perhaps moms has an issue, an perhaps the 
baby is not feeding well. In this case, I would worry way more about the 
delayed onset of copious milk production than the lumpy breasts, which 
will likely resolve once the supply gets going. I suspect this 
represents a less severe variant of engorgement. I'd scrutinize the 
feeding management and the baby's feeding skills, the mother's health 
history (obesity, CAH, hypo or hyperthyroidism and infertility can all 
affect milk production) and kick up the demand...

Catherine Watson Genna, BS, IBCLC   NYC

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