Breastfeeding and Pelvic Floor Recovery Are Happening in the Same Body By: Dr. Danaya Kauwe, PT, DPT, PRPC, Cert-DN (Guest Blog)

Breastfeeding and Pelvic Floor Recovery Are Happening in the Same Body 

By Dr. Danaya Kauwe, PT, DPT, PRPC, Cert-DN 

Postpartum recovery tends to get handed to you in pieces. Your lactation consultant helps with positioning, supply, and preventing mastitis. Your OB says to rest and come back at six weeks. The internet hands you exercises, vitamins, and water bottles. 

What gets lost in the handoff is that these systems aren't separate. The way you breathe while you nurse interacts with your pelvic floor. The way you hold tension shows up in your core. The way a C-section incision heals can shape how your bladder feels for a long time afterward. 

I'm a pelvic floor physical therapist who works with breastfeeding moms every day, and the throughline I keep coming back to is this: breastfeeding and pelvic floor recovery happen in the same body, at the same time, using overlapping systems. When the people supporting you treat them as one process instead of two, recovery tends to go better. 

Your diaphragm and pelvic floor work as a team 

Your diaphragm sits at the top of your trunk and your pelvic floor sits at the bottom. Together they form a pressure system — think of a canister with a piston on top and a soft, responsive floor below. 

When you inhale, the diaphragm drops and the pelvic floor gently descends with it. When you exhale, both rise back up. This coordination repeats with every breath, all day long. 

Posture changes how well that system moves. When you're stacked and upright, the diaphragm and pelvic floor line up over each other and breathing is easy and full. When you collapse forward — which is exactly what a long nursing session invites — your breath tends to get shallow and high in the chest, and the diaphragm doesn't travel as far. The pelvic floor still works; it just isn't getting the same full, rhythmic signal from above. 

How nursing posture fits in 

Nursing posture usually makes itself known in your neck and shoulders first. But the same forward-collapsed position also makes it harder to breathe well and to feel your deep core engage while you're sitting in it.

That's an important distinction. A slumped position doesn't break your core or permanently switch anything off. When you change position, your body can breathe and engage normally again. The issue is more about how many hours a day you spend collapsed forward, and how that constant shallow-breathing, rounded posture leaves you stiff, achy, and feeling disconnected from your middle. 

This is also why "core exercises" can feel frustrating in early postpartum. The exercises are usually fine. It's just hard to feel your deep core when most of your waking hours are spent in a position that works against it. Setting up your nursing posture well does more for that feeling of connection than most people expect. 

You don't have to wait until you wean to start 

There's a common belief that you can't really rebuild your core or address pelvic floor symptoms until you've stopped breastfeeding. That isn't the case. 

Pelvic floor PT, core retraining, breath work, and scar mobilization are all safe and effective while you're nursing. In fact, waiting tends to backfire — the longer symptoms go unaddressed, the more your body settles into compensation patterns to work around them, and the more there is to untangle later. Starting sooner, with appropriate clearance, generally means an easier path. 

C-section recovery asks a lot of the same muscles 

If you're recovering from a C-section, you're asking your body to do two things at once: heal a major abdominal surgery and establish breastfeeding while holding a baby right on top of that incision. 

The fascia and muscle layers involved in a C-section are part of your deep core. While they're healing, they don't fire normally, so other areas pick up the slack — your back, your shoulders, your pelvic floor. By the time the scar is considered healed at six to eight weeks, it's common to have built movement habits that quietly route around the incision. 

Those patterns can be hard to shift on your own. Scar mobilization, retraining the deep core to engage across the incision, and rebuilding the connection between the pelvic floor and diaphragm are the kinds of things pelvic floor PT is built for. The earlier you start (with medical clearance), the less compensation gets baked in. 

Stress, tension, and the pelvic floor 

Postpartum stress has a physical signature, not just an emotional one.

When you're sleep-deprived, on high alert for a tiny human, and running on adrenaline, your nervous system spends a lot of time in fight-or-flight. In that state, your body braces. Shoulders rise, jaw tightens, and the pelvic floor often clenches and holds. 

A pelvic floor that stays clenched can't fully relax for normal bladder emptying, can't expand to absorb a cough or a laugh, and can't coordinate smoothly with your breath. That shows up as the symptoms we tend to blame on weakness: leaking, urgency, pressure, or pain. Breastfeeding moms are especially prone to this because the stress is steady and the rest is fragmented. The reassuring part is that pelvic floor PT addresses both the tension pattern itself and the nervous system piece underneath it. 

A few things that help day to day 

You don't need to overhaul anything. A handful of small habits make a real difference: 

• Breathe while you nurse. If your chest feels locked and your breath is shallow, take three or four slow belly breaths during letdown. It helps your whole pressure system stay online. 
• Set up your position so you're not collapsed forward. Pillows, a footstool, and back support all the way up to your shoulder blades. Less hunch, less downstream stiffness. 
•  Don't wait until you wean to address core or pelvic floor symptoms. Earlier is easier.
•  If you had a C-section, ask about starting scar mobilization around eight weeks postpartum, or sooner with clearance.
• Notice if you hold your breath when you stand up or lift the baby. That's a coordination habit, not a sign of weakness, and it's very fixable. 

When to see a pelvic floor PT 

You don't need a diagnosis or a referral to come in. Any of these is a good reason: 

• You leak urine when you cough, laugh, lift, or run
• You feel pelvic heaviness or pressure
• Your core feels disconnected, or you notice doming or instability 
• You're months past delivery and your C-section scar still feels tight or numb 
• You have symptoms that started in pregnancy and haven't resolved 
•  You want to return to running or lifting and aren't sure your body is ready 

And to say it plainly: you can do all of this while breastfeeding. Pelvic floor PT is safe, evidence-based, and fully compatible with nursing. There's no need to wait. 

Recovery is one process, not two

The same body that's feeding your baby is also healing from birth, rebuilding stability, and learning to move under new loads. When breastfeeding support and pelvic floor support work together instead of in separate lanes, recovery tends to happen faster and hold up better. 

If you're in Utah Valley and want to talk through what you're experiencing, I offer a free 15-minute consultation. We can figure out whether pelvic floor PT is the right fit for you. 

About Dr. Danaya Kauwe: Dr. Danaya is a Doctor of Physical Therapy, board-certified Pelvic Rehabilitation Practitioner (PRPC), and Certified in Dry Needling. She's a four-time postpartum mother and former NCAA Division I athlete. She founded Radiant Pelvic Health & Wellness to bring whole-person pelvic floor care directly into the homes of women throughout Utah Valley.