Motherhood is one feisty, complex, complete, hot, empowering, inspiring, never-ending-disputably topic. Pregnancy is not always a walk in the park, but is definitely seen as such. Giving birth is not always fun and games, but more like a marathon. The first few weeks after delivery are not only cuddles and giggles, but mostly running on little to no sleep, engorged breasts, oversupply of milk, and endless diaper changes. All this while the mother is recovering from pregnancy and birth. When it comes to women’s health both pre- and postpartum, sometimes friends and family are not enough of a resource to discover the path to true wellbeing, and that is when a professional comes in. Today we sit down with Dr. Marcy Crouch, founder of The Down There Doc, a board-certified women’s health physical therapist working to elevate pregnancy and postpartum care for women everywhere.
The Down There Doc was born out of necessity to fill the gaps in our current medical system that leave women feeling isolated, dismissed, overwhelmed, and underprepared for childbirth and recovery.
Pelvic Floor health is at the top of the list for things that “slip through the cracks” within our healthcare system, and the negative effects can impact women for a lifetime.
Dr. Marcy Crouch is here to raise the standard of care for pregnant and postpartum women everywhere with affordable, accessible, hassle-free resources, education, and training. And some real-ass naked truth!
Marcy, please tell us who you are what you do to help women; things women maybe don’t know about you (yet) and how you can help them through what you do during their pregnancy or early on after giving birth…
There’s kind of a big gap in maternal help care- both from a preventive side of things for delivery and from a postpartum side of things. I am a physical therapist specialised in prevention and improving recovery and function. When I was in PT school I didn’t know about pelvic floor or pregnancy or post part care or even think about birth as this event that is very similar to an athletic event. We don’t really think about birth and pregnancy in that way. When I got into PT school I was introduced in this pelvic floor training and back then they were teaching pelvic floor in the curriculum but there wasn’t specific classes and wasn’t part of the general curriculum so I was fascinated by the topic. When I graduated and completed my doctorate I went out and did a residency to specialise in pelvic floor and women’s health training.
What I’ve come to realise in all these years of training is that there really is this huge gap in this maternal physical healthcare stuff. PT are the best people who need to be preparing women for birth and early recovery. For surgeries we have all these recovery systems in place, but there’s nothing for moms. And pregnancy itself is hard on the body and there are a lot of issues that continue through life, like public floor problems, even just from the pregnancy.
There is this huge gap in what we’re offering for women, and most of the maternal care is really just focusing on baby and not on MOM and mom’s body and recovery. Just the fact that after a C-section there’s no in patient education and resources for moms even to just get out of bed or hold a baby after your stomach has been cut open or how to lift a car seat when you walk out of the hospital. For moms there is almost nothing in place that is standard postpartum or even pre-partum care and this is really what I’m trying to change and what my specialty in the last 13 years, breaking this gap and making this maternal care really about MOM.
So when do YOU come in?
Anytime! All times! Usually you go see a physical therapist when you’re leaking pee when your kids are older, but now I am seeing women during pregnancy who don’t have any issues yet and they want to get ready for birth. So what I’m trying to capture is getting women when they re pregnant to prevent issues that could come up after baby- like incontinence, pain with sex, prolapse, back pain, etc. We teach them how to push effectively, what positions they push the best in, prepping the body for delivery, which translates in less tearing trauma, less pain during childbirth.
Do you think there is a lot of misconception and fear related to birth? Maybe because of a lack of information or misinformation? Is birth still a scary thing?
It’s a little bit of both. The way birth is portrayed in movies plants the seed. I remember when when I was pregnant, strangers would come to me and say oh my god, I have this, I have that… Like why are you telling me this?! It’s insane! There is this pre-conceived perception and we know from pain and neuroscience that when we have that thought as the first exposure, that sets us up for expecting it to happen, to anticipate fear, and be scared about it!
And secondly, I think that women are dismissed a lot if they have concerns or questions about what’s really going to happen during delivery and how can we prepare for it. It’s this culture of dismissal and invalidation and not valuing preventative measures and then we get this idea that “OH, maybe I should know how to do this innately because we’ve been having babies for millions of years”. But then when we don’t have a good experience we internalise it like it’s our fault that we messed up somehow and then when we go back to the doctor with pain with sex or holding pee, they’re like “oh it’s normal, it’s what happens”. It doesn’t make any sense!
Obstetrics and gynaecology and how we treat moms it’s like it’s in this own parallel universe compared to any other injury in how we treat it.
So when does the change start? With you maybe…
I think starting to really educate women and not sugar coat and dismiss it, is really important. When we talk about childbirth classes people go to in hospitals don’t include what I’m teaching, it’s only about what’s a C-section, this is how to swaddle, your baby will have black poop…
Making pelvic floor preparation part of the normal pre-natal and post-natal visits is really where we will see a lot of change. If we could have a pelvic floor PT working along midwives and OB’s starting 34 weeks e.g and work on perineal massage and see them until delivery. Or having in-patient physical therapy for instance with C-sections of moms that are in the hospital – hey I know you’re super overwhelmed and a baby just flew out of you and you haven’t slept and milk is coming out of your boobs and your vagina is ripped. But let me help you with pain, and swelling and how to sit. It’s like the little things.
You were talking about post-natal care which is almost non-existent, and if there is, all the focus is on the baby- how they sleep, breastfeed, but nothing about the person who actually makes it all HAPPEN.
In the US we get one visit around 6 weeks, super short, and then they ask you about birth control. Here we have a visit at 3 weeks and then that’s it. At 3 weeks you’re still bleeding. It’s really hard to tell where you are from a symptoms standpoint of view because you’re really still in a fog of it all.
France does the best job- they have what they call a perineal rehab at 6 weeks post they send a PV physio at your house and we see there s lot less PV problems because it’s treated right way. This also shows a decrease in postpartum anxiety and depression because the physical side of things are being addressed, which allows us to not be isolated, to go and be social with family and friends, and move our bodies, and go outside, and not be afraid that we will leak urine when we walk, or it’s too painful to walk. It really is a big problem because this feeds into postpartum anxiety, depression, isolation, feeling of losing your identity. You’ve already lost your identity in new motherhood and now you’re also losing what brought you joy, something that was only yours- like walking or running because it hurts.
So do you address this topic and have discussions about other areas surrounding motherhood with your patients? Like mothers are usually expected to do everything and heal and get back on their feet and take care of the house, raise kids, and a lot of moms put a lot of pressure on doing it all, sometimes with very little help, but also they already fear during pregnancy that that will happen.
For sure. Our sessions are basically like going to your favourite bartender and kind of like tell them everything.:)) I know A LOT about my patients, a lot! I love that part because you really get that connection with them. And I don’t have the therapist training but I can empathise and share stories from other patients or my own experience and I think that is very powerful and we come together in that room in a way that is safe and I give them permission to not do X, Y or Z so they can heal themselves. Like if the doctor tells them “okay, you’re good to have sex”, and they’re like “Oh God, my husband’s ready to flex but I don’t want to” I tell them “then you don’t have TO, it’s OK, give yourself some grace and time”. Sometimes you need someone to give you permission to say no to some things.
They are like “Oh, okay, I don’t have to run this race that I signed up for, that I’m not ready for, don’t wanna run but all my friends are running”. No, you can just chill and go do something else.
Totally, just like with breastfeeding, it’s a lot of pressure because you see and hear you have to do it, everyone does it, so I need to as well…
And it’s wild. I see it here in the States, and I have clients in the UK or South Africa, it’s everywhere like this. Moms are just struggling and it’s not getting better and there’s so many moms going through this.
What would you say they struggling with the most, from what you have experienced so far in this trip called pregnancy and new motherhood?
It’s a lot of things… But my immediate response is being dismissed, and being forgotten. By society, by their doctors.
Think about all this attention you get while you’re pregnant and then all of a sudden… nothing. And here’s the thing- when you’re invisible and still expected to keep the baby alive and heal the body with no resources and being told that it’s normal to have all these problems, I think that’s what is so struggling. That you don’t have a voice anymore. and you’re struggling with this new identity of being a mom and nobody’s listening to you and they re just telling you that you’re fine. And you’re not fine.
And they often don’t know who to turn to- friends who have kids have their own problems, friends who don’t have kids don’t get it, it can be a very alienating and lonely trip.
I don’t know if I have enough experience to really compare every country, but I would say the pandemic has really affected moms in a way that’s not good, and I think what I have seen is that there’s the lack of knowledge and resources is very similar in the UK or USA, its this overall sense of not teaching women what they need when it comes to birth and pregnancy from a PT standpoint. It’s really shocking to me.
But I think that’s a great starting point, because that’s when you come in, and when people realise there’s options to be well, to know better, to have a good experience. Because I think having a good experience with pregnancy and birth really sets the tone for everything that’s to come.
Totally. And even if you don’t have “a good delivery experience”, if you know that those are possibilities, they have better outcomes. What is more traumatic in my experience is when women feel like they’re out of control, and they didn’t know any of that could happen- like an episiotomy or vacuum, they’ve never heard those words before.. they just hear doctors come in “oh we’ve gotta get the baby out, I’m gonna cut your asshole”. But if you know all this when you go in, they trust it, they know it’s gonna be fine, they’re gonna have a better outcome regardless of the birth process itself.
The feedback I’ve gotten from some women is that I’m scaring women. I’m like… I’m not scaring nobody, I’m telling the truth. They can handle it. Moms can handle it. If they’re about to have a baby, they can handle anything. And it’s disrespectful to not tell them the truth and to not arm them with knowledge. My job as a medical professional is to give them facts. Not my biased opinion. It’s not scary, or not scary, it just is. I think it’s worse when they don’t talk about this stuff.
And when it comes to educating women, the one book that we have is that shitty, old “What to Expect” book that won’t tell you anything about anything and it’s so outdated. It’s all the same thing, it’s baby-centric. “Your baby is the size of a watermelon. You need to drink water. Don’t lay on your left side”. But nothing on how to actually get that baby out of you? I don’t care about what type of swaddle to buy, I will figure that out later. Target is open all the time, and so is Amazon. But the window of time to learn how to prepare your body is fine aged. We don’t need to be spending all this time researching what swaddles to buy, we need to be spending that time on preparing women for delivery.
There are also so many moms who are hesitating when it comes to asking questions, and think they should already know that, or are afraid of what people will think if they do ask..
We as a society, we’re always dismissive of women, no matter what. And we as women, we always feel like we’re taking up too much space or that we’re being an inconvenience or we’ll just figure out on our own the answers to our questions. We’ll just Google it on our own.
And the other side of this is the TABU-ness of it, and the danger of subscribing to it being tabu is that it gets ignored and it’s inappropriate or it’s not a big deal. It’s a cycle, a cylon of crap.
Tell me one last thing. Maybe some women don’t know how to start, and not everyone has access to someone like you, physically. Where do women start this quest for getting the truth and the knowledge?
It’s kind of a double edges sword: I think social media is a good place to start, it’s user friendly and easy to search. You can start to filter through good and bad accounts. The reason why I went online is because not everyone has access or the means to physically see a Pelvic Floor PT in person for various reasons- time, lack of resources, coverage, expense, child care, etc. I had people fly in just to see me for a couple of days. So I am limited by a time in the clinic, and by geography. So the answer can not be that or nothing. And so the pandemic really kind of forced us to get creative in how we’re delivering what we do. I was like “what can I do that can reach more people and that is limitless in terms of reaching people?”. How can we package what works in the clinic in the way that can reach more people so they can get at least something that is proven to make this experience easier, better and more holistic?
In the end, that’s really what it’s about. You wanna be the mom that you wanna be, whatever that means for everybody. You need to be able to do that and you need to be able to now worry about your vagina. That’s ridiculous. So it’s very rewarding, I am very grateful that I get to share this part of their lives. It’s wonderful.
I love that you give TMI, you say things as they are, without sugarcoating anything. It’s so refreshing, I wish I would be pregnant now again just to be able to have access to you and experience pregnancy and birth through this point of view.
If you are pregnant, or about to give birth, or have just welcomed your baby, and you feel like you could know more, be better, improve your well-being (both physically and emotionally), I think Dr. Marcy Crouch is here to answer ANY and ALL of your questions. Think about her like having a best friend who also is a professional PT and pelvic floor specialist, who knows everything about everything related to pregnancy, birth, vaginas, motherhood, and everything in between. No question is too TABU, and no information is TMI.
In the end, all that matters most is YOU, Mama. When you are doing well, everyone else around you is doing well. Never forget that.
You can check out more about Dr. Marcy’s programmes, courses and blog, as well as her podcast about motherhood on her website, thedowntheredoc.com. And never hesitate to reach out on her Instagram page too!