If a woman doesn't ever notice any change whatsoever in the fullness of her
breasts postpartum I take notice.  But if I am hearing about this it is
because there is a problem.  Mothers without engorgement or fullness who
have happy, thriving babies don't usually seek help from our clinic.  

I've scarcely seen the engorgement my older colleagues recall from the bad
old days, when women would have purply-blue shiny skin on their distended to
twice normal size breasts on day five.  This was before 1990, when it became
routine practice to keep mothers and babies together at all times from
birth.  Before that, babies slept in nurseries and might have been brought
out for one feed in the course of an entire night if they were lucky.  But
nearly all women here will report a palpable change in breast consistency
which coincides with an increase in audible swallowing by the baby, and the
change from transitional stools to grainy, loose, bright yellow ones.  This
includes women who have given birth at home with no IV fluids and no meds
that would affect baby's ability to feed.  Women with known risk factors
have more trouble with engorgement, to be sure. 

I guess my point is that a lack of post partum breast changes **in a woman
with a breastfeeding problem**, is worth investigating more closely.  

Rachel Myr
Kristiansand, Norway

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