For more than half of all women, pregnancy/postpartum and pee problems go together like newborns and sleep deprivation. It’s ubiquitous! But just because it’s a common experience doesn’t mean it needs to be your new normal. Dr. Marcy Crouch, The Down There Doc, is an incredible educator and healthcare provider changing the conversation around pelvic floor dysfunction, especially in the pregnancy and postpartum period, and we’re eager to gain her perspective for this week’s Q+A session.
AG: Dr. Marcy, thank you for taking the time to answer a few questions for our readers! To kick this off, can you tell us about your journey to becoming a Pelvic Floor PT? How did you decide this would be your focus?
MC: The pleasure is mine! First of all, I didn’t know anything about the pelvic floor when I went to PT school. I thought I was going to be your typical orthopedic therapist. But during one anatomy lesson at the end of our first year, the teacher went over the anatomy of the pelvic floor and used the example of a woman who had a very significant injury during delivery and lifelong muscular skeletal problems afterward.
At that time in my life, I was not having kids. None of my friends were having kids. This was completely new territory for me. The more research I did into this field the more I realized that it is a huge need that affects almost every woman who decides to have a baby. I became obsessed with the pelvic floor, women’s health, pregnancy and postpartum, and making lives easier for women worldwide. This was something that I felt I was called to do.
AG: You have a practice and a huge community of followers who look to you for advice and guidance on how to take care of themselves throughout pregnancy. What are the common issues women want guidance on?
MC: There are a few main things that women are looking for help with. When a woman is pregnant for the first time there tends to be a big feeling of overwhelm, nervousness, fear, and general uneasiness about the upcoming delivery. I think this is mainly due to the fact that we aren’t educating women properly about their bodies and their upcoming delivery. Information that is available to women and birthing persons is really focused on the baby and the baby’s needs. What ends up happening is that most women are told horror stories around delivery and what happens after, so they’re going into their own experience with a pre-written narrative of fear, danger, and big injury.
The first thing that women are looking for when they find my page and my team—is the truth. They are looking for guidance and help on having a different birth story than the horror stories they have heard, and to gain an understanding of how to prepare for delivery so they’re in the best possible place both physically and mentally.
For any timeframe after having a baby, women are needing help with physical recovery, leaking urine or stool, pelvic organ prolapse, sexual dysfunction, and any sort of scar pain or dysfunction from either a vaginal tear or a C-section.
AG: Let’s talk a bit about postpartum care and why it’s so lacking! Why are women still struggling to find support during this critical time in their recovery?
MC: This is the million-dollar question! I actually just did a TEDTalk on this point. Part of the problem is that society and the medical community considers anything related to the pelvic floor, bladder, bowel, or sexual dysfunction to be “taboo” which frankly, is dangerous. When we keep issues like this taboo, it continues to bring shame and stigma around a very important part of our body that is responsible for bringing in the entire world’s population.
The other part of the problem is normalization of these dysfunctions. Because they are common experiences, it’s considered normal that women are struggling with issues like urinary leakage and bowel leakage, when in fact leaking urine is not normal at all. But once a baby comes out of your body it’s now considered to be “just what happens after you have a baby.” So when somebody like a mom or somebody in menopause goes to their medical provider and discusses leaking urine, the answer often is to wear a pad or have surgery. There are millions of women every year with urinary leakage and the treatment is “wear pads and be quiet about it.”
So I think the main problems are that: (1) it’s considered taboo, (2) these dysfunctions are thought of as “normal” even though they are not, and (3) we don’t take care of women the way that we should in our healthcare system.
AG: The conversations taking place around women’s health and some of the “taboo” topics like menopause, HRT, and bladder leakage have definitely evolved. How do you and your team normalize these life stages with your work?
MC: I think the biggest piece of the puzzle here is to simply talk about them in a very normal unstigmatized way. For example, I talk about vulvas and vaginas and perineum and rectum just as comfortably and as easily as we would talk about knees or shoulder joints or ankles. Naming them appropriately instead of giving [euphemistic] names for these body parts makes it real and important to understand.
It’s really about the “truth shall set you free”, giving people permission, and providing a safe space to openly talk about these issues without any shame, judgment, or negativity. Because there’s nothing negative about it.
AG: The Down There Doc is an incredible resource for women. How was the idea born and what’s next for the community you are building?
MC: The Down There Doc online platform has come from my 13+ years in the clinic treating women and birthing persons all over the country. Realizing that this is a problem that cannot only be solved exclusively in clinic work, we started to think globally about this and provide answers, help, and resources in a digestible, effective way with a much wider net.
Currently, we host our programs on an online platform. It’s such a wonderful community and the programs are unbelievable. Women are having amazing experiences and it just makes my heart sing to know that we’re able to help even just one woman who had no idea about birth, her pelvic floor, or what to expect.
As for the future, this needs to be a standard of care for every single person who is thinking about having a baby, full stop. We have plans to hopefully expand into the corporate space, providing this to businesses that have women and birthing person employees who are looking to grow their families as well as designing and creating an AI-based app to help women from conception through menopause.
We have big plans over here at The Down There Doc and we can’t wait to continue to help more women.
AG: Thanks, Dr. Marcy!
One thing that stands out is the truth that delivery is a part of the story for, as Dr. Marcy put it, “the entire world’s population”. We feel strongly about the importance of destigmatizing the labor and recovery experience, and the common changes almost all women face as they move through the different stages of their life.
For many, incontinence products are a stepping stone in the journey of pelvic floor repair and recovery after having a baby. All the products in our shop are designed to support you along the way, with powerful, plant-based ingredients that are safe for your skin and gentler on our planet.
Attn: Grace has consulted with numerous experts in the field to create vetted resources for your wellness journey during pregnancy and postpartum. Explore more:
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Postpartum "Down There": From Bodily Changes to Postpartum Pads
Disclaimer: This content is for informational purposes only, even if and regardless of whether it features the advice of physicians and medical practitioners. This content is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice.