Dr. Marcy Crouch received her Doctorate in Physical Therapy from the University of Southern California in 2010. She then completed a Women’s Health Residency program in Dallas, TX and obtained her WCS, which identifies her as Board Certified Clinical Specialist in Women’s Health Physical Therapy. She has taught pregnancy and sexual health courses in her community, as well as continuing education courses for PT’s both nationally and internationally, and has taught at the University level. Marcy has worked in private practice and hospital outpatient clinics in Texas, California, and Oregon, and now lives in Alabama. She has owned a successful clinic, built a following on social media as @thedowntheredoc, spoken at national events, contributed to popular blogs and magazines, and is having candid and powerful conversations about women’s health and how we NEED to do better.
After being in the clinic for over a decade, she decided to create programs designed for mothers and birthing persons everywhere. She is the founder of The DT Method™, an online program that is the NEW standard for birth prep and recovery. She is changing the way women are preparing for their births and elevating postpartum care for all. #novaginaleftbehind She is the mother to 2 amazing boys, and has first hand experience of pregnancy, birth, and the postpartum period. She loves a good glass of wine, horses, belly laughs, and drives a minivan shamelessly.
The Auburn-Opelika Moms Executive Team had the honor to sit down with Dr. Marcy Crouch for an interview.
How did you decide to become a Pelvic Floor Therapist and what is your background?
“I didn’t know anything about pelvic floor PT when I started PT school. I didn’t even know that there was a pelvic floor, or what it did. When I went to grad school and we were going over the pelvic floor in our anatomy class the professor used the example of a woman who had a pretty significant trauma during a delivery and then she was having all of these problems later, such as leaking urine and pain and very very dysfunctional in terms of quality of life and what she was able to do. At the time I just got married, kids weren’t even on my horizon, none of my friends were having kids yet, this whole idea that something like that could happen I just was completely blown away. I remember my jaw just dropped and I said… YOU TEAR!? WHAT DO YOU TEAR!? I just could not even understand that at all. From that point on, which was my first semester first year, I became very interested in women’s health and pregnancy and postpartum and pelvic floor dysfunction and how that really relates to so many things up and down the chain, when we are talking about rehab, strength and function, and quality of life. My background really is pelvic floor PT. The schools will graduate generalist, but you have to do a lot of different types of PT during your tenure in your program and your clinical rotations. I’ve done lots of different types and I worked in Orthopedics as an aid for many years before I went to grad school, but my real cut of meat and potatoes is pelvic floor, women’s health, and pregnancy and postpartum. Right after graduation I went into residency where I spent an extra year training in this population specifically and touched a little bit on breast cancer, female athletes, and things that are more specific to the women’s and men’s health population for pelvic floor. After residency I sat for my board exam and then I worked all over the country. My husband moves around a lot for work so I was able to move to the Bay Area from Texas. There is wonderful clinic that I worked at for four years. I received a lot of great mentorship and learned how to run a clinic. Afterwards, I went up and down the West Coast for a while and now we’re here. So, in the last I would say 11 years of me doing this, my background really has been really focused on pelvic floor. Pregnancy and postpartum is my favorite. I have worked for other practices. I’ve owned my own practice. I started a company when we moved here that is all my online stuff. I do training for other PT’s. I have a podcast. So, my background is starting to morph into a lot of different things but the meat and potatoes are pregnancy and postpartum.”
Where is my pelvic floor and what does it do?
“The million dollar question! The pelvic floor is at the bottom of the pelvis. It’s a basket of muscles that sit like a hammock at the bottom of your pelvic area. The muscles attach from your pubic bone in the front and back to your tailbone and then side to side. They really are the bottom or the floor of our core and because these muscles lie in this plane, side to side and front to back, they span our body. One main function is to hold us up against gravity and support everything so within the pelvic bowl, we have our organs and our intestines are a little bit higher and for mamas growing uterus, a growing baby, a growing placenta and increase blood volume and increase fluid, and all of these things that the pelvic floor will have to do just to hold us up basically against gravity. Second function is continents. It’s the group of muscles that help keep us dry and keep urine and stool contained in the bladder and rectum. When we have to void or have a bowel movement, the muscles relax and that happens, in a perfect world. Then the third function is the sexual function. Some of the muscles in the first layer attached to the side of the clitoris so they help with orgasm, and they also have to lengthen and open to allow vaginal penetration whether that’s penis, speculum, tampon, or baby coming out, all of those things. They’re really actually an amazing group of muscles. They are the only type of muscle in our body, they are made up of skeletal muscle which is the same as our biceps and quad, all the muscles we work out, but because they go in this plane, they are the only type of muscles that are on all the time. They don’t really get to rest. If we hurt them, we don’t get to just put a boot on it and go on crutches for six weeks. These muscles still have to function, and then these muscles have to open and stretch to the entire circumference of the bottom of the pelvis to allow a baby to come out and then they have to go back to where they were previously to be functional and that doesn’t happen with our biceps. With pregnancy, we aren’t holding something with our biceps for nine months and then making it stretch and open and then come back to here. (insert flex) So, there’s a lot of demand and stress and strain on the pelvic floor but that’s a whole other episode.”
What is pelvic floor therapy?
“Pelvic floor physical therapy is exactly the same as other physical therapy that you would see if you had shoulder surgery, if you had a sore back, or if you had knee pain after running. Same principles. Same science. We’re just working in a different part of the body, but because the pelvic floor is skeletal muscle and because it has to be so functional for us it really does require correct rehab and pelvic floor physical therapy should somebody have any sort of these problems that we commonly see after baby. For example: leaking urine, painful sex, prolapse, constipation and that sort of thing, especially if there was some sort of trauma to the pelvic floor, if there was a tear, or episiotomy, because these muscles are made up of the same stuff, they heal in the same way. If you have a surgery for your shoulder for example, where you have tearing or you tear a rotator cuff muscle, or your ACL in your knee, you need to have rehab after that to regain strength and function and motor control and balance and all those things, and the same thing has to happen for the pelvic floor. It’s not standardly happening but it’s the same structures and arguably more important because they have to hold us up against gravity and keep continents and all these things. Pelvic floor PT really assesses how these muscles are functioning, what are the causes of pain, where is the dysfunction in terms of strength, endurance, motor control, sensation, and what’s going on in the system as a whole. PT’s are the experts in musculoskeletal rehab and function so we should really be in this area rehabbing these muscles and these issues after birth whether traumatic or not. Same with c-section, scar tissue being formed. A lot of times people think pelvic floor PT is doing kegels but it’s not and that’s only one tiny super small piece of it and oftentimes that doesn’t even happen the way that we think it should. A lot of times we have a preconceived notion of what a kegel is but what we teach in therapy is much different and unique to each person and what their specific goals are. You should think about pelvic floor PT as necessary and as important as going to physical therapy after knee surgery or if you sprain your ankle.”
What is the DT method?
“Ah! My third child. The DT Method is my online program and stands for the Down There Method because I’m the “Down there Doc” and it is a series of online courses. I started the DT Method last year around COVID time when we moved here. I’ve been wanting to do this for a while but I had my own practice in LA and it just didn’t work out time wise, so COVID kind of jump started this a little bit. The DTM is basically the standard of birth-prep and postpartum recovery with what everybody should be getting when they’re pregnant and after they have a baby whether or not they’re symptomatic. The way that I look at birth is the way other PT’s look at games or races or big time events that we train for. Birth should be in that category as well because it is a lot of physical demand on the body and there’s lots of things that PT can do to help make that process easier and make recovery better and make the whole thing a little more comfortable. Women need to be more supported and have more resources and knowledge. I have one course called Prep and Prevent, this is for my pregnant mamas who are going through pregnancy and about to have a baby, so it’s really for any stage during pregnancy. This is how we prepare for delivery. We cover vaginal birth, VBAC, c-section, and we go over birthing positions. I teach you everything in the course that you don’t get in regular child birth courses that are offered at local hospitals. This is all centered on preventing trauma, giving you the tools and resources for positions, pain relief, what type of medications are out there, and questions you should ask your provider, who you should be talking to, and all of the things people have said and told me and that I have experienced myself, saying, “man, I wish I knew this”. It’s like everything we get later, again saying, “DUDE SOMEONE SHOULD’VE TOLD ME ABOUT THIS”. That is what I’m teaching. Even how to do that first poop after baby. How to get out of bed and do the first poop when you have a water bed for an abdomen. Acute recovery; like what you should be doing that day one, products that you need to have in your bag for mama and not for baby, and that sort of thing. That’s Prep and Prevent. My second course is called Foundations: Build A Better Core. This is our postpartum recovery course. Designed for mamas who are at least six weeks postpartum, when you’re cleared for sex and exercise. It is foundation building blocks for proper rehab and recovery. This is for C-section mamas, vaginal birth mamas, first time mamas, 5th to 10th time mamas. I’ve got some grandma’s in there and it’s all about really making sure that you’re setting up for success so you can do whatever goals you may have. Whether you want to go to CrossFit or whether you just want to walk around the house, it doesn’t matter this is all essential rehab recovery, things that women do not get but should be standard. Super simple rehab principles, like how to carry that darn car seat that’s so heavy and so hard to put in the car, what position you should be in nursing, how to get your pelvic floor engaged, there is a while week on back to sex and what you need to be doing for that, if you’re having pain or not having pain. We do very simple exercises and functional movements that help mamas rehab and get stronger. If they want to run or they want to do other things, they are not just doing that at the six-week mark, they have a roadmap to recovery and getting those foundational building blocks in place. That’s my postpartum course. I have one more course that is for professionals. I teach other PT’s this method, I teach other birth professionals what we’re doing to support women and that’s more from a professional standpoint.”
What are options for how your PT is offered?
“Personally, I am doing virtual wellness sessions which are online Zoom appointments. My assistant does them, she is amazing. She does pelvic floor PT in Wisconsin. She does all the virtual sessions. The courses are not considered physical therapy, because we’re not accessing and putting our hands on them but it’s a lot of the same principles. I don’t have a brick-and-mortar anymore. I don’t have a physical clinic space since we moved here and COVID and the kids and everything, but there are a few local pelvic floor PT’s. In the state of Alabama I believe you do not have direct access, which means that you need a referral from your physician to see a pelvic floor PT, but it is the same as other Physical Therapy it’s not considered a specialist. It is considered a specialist in terms of training but it’s not different. I think you do need a physician referral for that and insurance coverage varies based on your plan.”
Can pain during sex be a pelvic floor problem? What about back and sciatica pain?
“Yes. All of it. 100% Yes. For sure. Most of the women who I see who have pain with sex after baby often times it is a pelvic floor issue combined with some hormones and scar tissue but that’s all stuff that we address in the course and virtual session. It’s not something you have to live with and that’s just what happens now. It’s a musculoskeletal issue most of the time. It’s like a charlie horse but in your vagina.”
I was told leaking during or after pregnancy was just a normal part of being a woman is it true?
“[Insert BIG EYES] NO!!!
That’s what I hear all the time. NO! I think the distinction that we have to make is common isn’t the same as normal, and this is what we say a lot in my field. Urinary incontinence is very very common. Some studies say 1 in 3 women have leakage of some sort, some say 1 in 4. That’s a lot of women. That’s the three of us here, at least one of us and probably all three of us. Just because it’s common doesn’t mean it’s normal, right? If you didn’t have a baby and you told your doctor or your medical professional that you’re leaking urine that would be a problem. They’d say, “Oh, we need to figure that out” but then if you are pregnant or had a baby, they say, “Oh yeah, yeah, that’s normal.” It’s not normal because that wasn’t happening prior to pregnancy, so something is going on. Even though it is common does not mean it is a normal physiological response of the system it means that something is going on that wasn’t going on before. SO NO!! NOT A REGULAR PART OF BEING A WOMAN!”
Is Pelvic Floor Therapy Only for Women? (Pre-Pregnancy and Postpartum)
“No, it is for anyone who has any sort of pelvic issue. Men as well. We see a lot of men, usually it’s pain, pelvic pain issues, urinary bladder or bowel issues, or any abdominal surgeries. Same with women. We are seeing leakage in some of our younger population, like our female athletes as young as high school and college age women who are in dynamic sports. For example: jumping, gymnastics, running, cheerleading, and volleyball. They are not having babies at this age, but the demand on their pelvic floor is higher maybe than someone not in those sports. We are starting to see that in the younger population. It really is for anybody. There are pediatric pelvic floor PT’s that help kiddos who have nighttime bedwetting, constipation, and frequent UTIs. Those pediatric PT’s are amazing and they help a lot of kids and families and they are really really great. My oldest patient I had in residency was 98. She was leaking urine and she said “I’m sick of this”. So it’s really anyone at any stage!!”
What are the benefits of therapy before pregnancy, during pregnancy, and after?
“Before pregnancy, it’s really great to get a baseline to have something to compare to for after to see where you are strength function, endurance wise, and where we should be focusing our efforts if needed for birth prep and postpartum. If you get into the same pelvic floor PT prior to the baby, we can look back and say this is where we were, this is probably a realistic goal to get around similar to where you were prior. We know that was functional. During pregnancy, pelvic floor PT can be awesome because it helps with preparing for delivery, and push practice. Some women don’t know how to push all the time so we find what position is the most advantageous for pushing for that particular person. We do perineal massage and other techniques to reduce the risk of significant trauma to the pelvic floor, like a grade 3 or 4 tear or episiotomy. We talk about different positions. We are preparing you for delivery and labor like we would prepare an athlete for a race or a game. Even if you were having a scheduled C-section or if you go into C-section there’s a lot of things that we can do to educate and support in terms of prep and surgical recovery which is so important and a lot of times not given. The other thing that we can help during pregnancy too is with typical back pain, sciatic issues, pubic bone pain, things that happened musculoskeletal-wise just from being pregnant. What compression garments you should be wearing and if you need some sort of support belt. What shoes are you wearing, you know things that make that pregnancy a little bit more functional, like positions for sleeping. If you have another toddler at home, how are you lifting a toddler when you’re nine months pregnant. Also, safe exercise. We go off ACOG guidelines, we use all the current literature to help mamas get into an exercise program that is safe and appropriate for them and monitoring any sort of problems that may arise as they are going to exercise. Postpartum – that’s two parts. One part is acute recovery, this is from hour one to those first couple weeks. This is all about pain reduction, inflammation, pooping, peeing, what products do you need to help your vagina and your c-section scar feel better. For example; peri bottles versus wiping, what do we do about hemorrhoids, how are we getting out of bed with a waterbed for an abdomen, and how do you hold a baby when you’re nursing. All of these things that are happening in those first couple of weeks we can help a lot with. Then the other part is that 4th trimester – 6 weeks on. They say the 4th trimester ends around 12 weeks but I say it goes on forever. Postpartum is forever. From six weeks on what do we need to be doing to regain strength, decrease pain, motor control, get ready for other pregnancies, strengthen your core, that sort of thing. I really like to break postpartum up into those two categories. The acute recovery is so important, especially if there was a c-section, because that’s a major surgery that no one gets any sort of guidance for afterwards, most of the time.”
What are the costs associated with your program and is there a payment plan?
“The courses are $197 a course and then virtual sessions we do bundled. There is a little bit of a discount if you do 3 bundle or 5 bundle packages for virtual sessions. We offer complimentary consults, those are free and they’re about 15 minutes or so. We just get to know each other, see how we can help you and if it’s going to be a good fit. I often run specials on the courses so we’ll do a flash sale or Mother’s Day sale. I have a bundle for both so if you’re pregnant I really want people to get both courses, because they need both. I don’t have payment plans set up now. I use to when I had them at a higher price point, but were flexible, there’s always a way to make it work for people. If you get on my email list we often will run sales and special coupons for people that are a part of the community”
Marcy, we are thrilled to have you as a resource for our community and to be among ours as an ‘Auburn-Opelika Mom’. We were so encouraged by our conversation and learned so much crucial information along the way. Thank you again.
We want to encourage you to find her on IG @thedowntheredoc and subscribe to her community to learn more than you want to know about vaginas, motherhood, and everything in between!