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What You Need to Know about Physiologic Engorgement

Blonde woman holding her breasts with confused expression wondering about physiologic engorgement.

Think you know all about engorgement? Hmm, maybe not. Let’s start with this:

  • Is engorgement a good thing, or a bad thing?
  • Can a formula-feeding mother escape engorgement?
  • Who gets engorged sooner – primiparae or multiparae?  

Let’s tackle those questions, and more.

Parents or professionals who talk about engorgement often assume that it’s a bad thing. In fact, engorgement is normal.  

Engorgement means that an organ in the body has become distended with blood or other fluids. In this case, the mammary gland – the breast – becomes distended with milk.

Engorgement: A good thing, or a bad thing? 

During pregnancy, the breasts were preparing to lactate, which is called Lactogenesis I. But in this phase, the hormones of pregnancy hold back the milk until after the baby is born. Around three days or so after giving birth, breasts fill up with milk. That’s part of Lactogenesis II.

Experiencing engorgement – the “coming in” of milk or distension of the gland, is physiologic. Physiologic engorgement is a good sign that the body is doing what it’s supposed to do.

Understand, engorgement following birth happens whether the mother wants to breastfeed or not. Remember, it’s physiologic. The body knows it’s supposed to milk.

Unfortunately, however, some mothers experience overdistension and retention of milk. That’s called pathologic engorgement. More on that in the next post.  

Onset of engorgement

Technically, engorgement could happen unexpectedly at any time.

However, typically, physiologic engorgement starts around the third day postpartum, but it varies from mother to mother.

The onset of engorgement is affected by several factors. These most likely include:


Parity is the number of times the woman has given birth. Typically, women having their first baby (primiparae) experience engorgement a little later than those who have birthed two or more babies (multiparae).

Timing and frequency of breast stimulation

My mantra has always been “early and often.”

The sooner and more frequently the breast is stimulated, whether by suckling, pumping, or hand expressing, the sooner the onset of engorgement.


Admittedly, “stress” is tough to describe. But overall, I’d say that women who have had a particularly prolonged or difficult labor tend to become engorged a little later than other mothers.

However, I’ve seen mothers who have engorgement within about 18 hours of birth; others may not experience it for as much as seven days.

Illness or complications

This is a broad, sweeping statement, but mothers who have been ill, or experienced some complication of labor, tend to experience a delayed engorgement. For example, if a woman has lost a lot of blood during the birthing process, engorgement may be delayed. Some studies have shown that women with diabetes may experience a delay in engorgement.

Successful or unsuccessful resolution

So, when does the distention resolve?

Engorgement usually resolves when the milk is removed at frequent intervals, around the clock. Generally, the best way to accomplish that is through suckling the baby early and often.

How long will it be before the physiologic engorgement is resolved? Again, it’s tough to say. Generally, though, the distension and swelling are mostly resolved within about 10-14 days.

It’s important to remember, however, that even when the swelling subsides, the milk is still there

Unrelieved engorgement is a real problem. By “unrelieved,” I mean that the milk is first distending the breasts, and then, getting “stuck” there. Unless the milk is removed, it just backs up into the ducts.

Think of it this way. A dam is a barrier that stops or restricts the flow of water; the water accumulates in a reservoir. But try to imagine that there’s too much water in the reservoir, and there’s no way to release the water through the gates. The reservoir gets fuller and fuller and has no place to go. It’s stuck.

Unresolved engorgement can result in many complications. It often results in pathologic engorgement, and/or mastitis or even a breast abscess.

Increased swelling and areolar firmness may increase the baby’s ability to latch on. Typically, the nipples became firmer and shorter. Sometimes, the nipples almost completely disappear. If the baby can’t feel the nipple on his palate, he won’t be suckling well.

On the other hand, increased milk supply may improve latch. With more milk, babies feels more rewarded for their efforts. So, they may be more motivated to continue suckling. Sometimes, it’s hard to predict how all of this will work.

Be sure to read the next post about pathologic engorgement.

Meanwhile, tell me: What facts in this post about physiologic engorgement surprised you?

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