Birth Prep

True Confessions of a Pelvic Floor Physical Therapist

After 12 years of hearing the same thing from uninformed mamas, I want to give you the tools to confidently step into your next birth.
Dr. Marcy Crouch
Posted on
September 30, 2022
Minute Read

What I’ve learned over 12 years of practice

I could share so many different “clinical pearls” (as we like to say in the biz), but I’m not going to — at least, not right now. Don’t get me wrong, the details are important, but I want to focus on something else, something much bigger.

I want to talk about a phrase that I hear almost daily. I hear it as much today as I did when I first started in the field. It doesn’t matter the location, I promise you would hear it there too. It doesn’t matter if you are financially struggling or have money—this phrase doesn’t care. This phrase is a common thread that weaves through the collective group of women and mamas, it’s universal.

“Why didn’t they tell me about this?”

We are connected by the frustration, the lack of understanding, the fear, and the overwhelm of this phrase.

“Why didn’t anyone tell me?”

Every time I hear some iteration of, “Why didn’t they tell me about this?,” it strikes a chord in my Mama and clinician's heart.

As a Mama, I want to cry with you and hug you, pour you a coffee, and say, “I know it’s so fucked up, but it’s going to be ok.”

And as a clinician I get mad. Still, after all these years—I get angry and frustrated. I am STILL shocked, after all these years, thousands of patients, different cities, states, and clinics.

The crux of the issue is this: pelvic floor education, rehab, training, and comprehensive recovery are not important in the medical community, especially in this country.

It’s true.

I hear it in so many ways…

“I didn’t know that this could happen.”

“Why don’t they talk about this during my birth classes?”

“How come no one talks about this?”

And on and on it goes…

In most cases, these mamas are referring to pelvic floor problems, leaking pee, pain with sex, prolapse, abdominal separation, and core weakness.

They also reflect on their births and wonder why certain things were done, what choices they did (or didn’t) have, and why things went the way they did.

This frustration, this pain, this feeling of “being duped” or unprepared can be avoided entirely if we do 2 things (and they aren’t that hard):

  1. Make pelvic floor rehab and birth prep a standard of care.
  2. Recognize the actual breadth of this issue: women, and mothers not getting the education, resources, and support they need.

However, very little has changed over my 12 years in practice as a pelvic floor PT.

3 Reasons Why We Don’t See Change

In my opinion, it comes down to the patriarchy, money, and the rush to return to work.

  1. Mothers have to return to work quickly because we don’t have paid leave and childcare is difficult to find, not to mention very expensive.
  2. Having the proper time to recover is imperative for long-term health and success, but, frankly, most mothers don’t have that luxury. There are plenty of moms who have to return to work after only 4 weeks even though they are usually still bleeding.
  3. Another reason is that women and mothers are almost always not seen as important as the fetus that they’re carrying. Think about all the appointments mothers have during the pregnancy, and then all the appointments babies have. After the baby comes out, Mama gets seen ONE time, at 6 weeks—this is not enough. Read more on why here.

What Can We Do?

The frustration you may feel in my words is exactly what keeps me going. Through the stress of running a business, raising my kids, and trying to stay afloat—this is bigger than me.

Women, mothers, and birthing persons everywhere need and deserve better.


It’s time we as a country and as a collective of health care providers from every disciple, start listening and really caring about a mother’s health. It’s not only our job but our responsibility.

Mama, Don’t Panic!

Want to be informed but don’t know where to start? If you are a future mama or planning on getting pregnant again soon, don’t panic!

Now is the time to absorb all of the info you can get your hands on and The Down There Doc is here to help you do that. We will provide you with all of the resources you need and the support of someone who truly cares.

Follow us on Instagram and Tiktok for daily education and tips on labor prep and postpartum recovery. And make sure you check out some of our free trainings here.

Dr. Marcy Crouch

Known as The Down There Doc on Instagram and TikTok, Dr. Marcy Crouch is a board-certified women’s health physical therapist working to elevate pregnancy and postpartum care for women everywhere.