Large study to look at injuries that afflict millions of women as a result of childbirth

A group of researchers from the University of Michigan Health System has been awarded a $6 million federal grant to study the serious injuries that afflict millions of women as a result of childbirth.

More than 300,000 women require surgery each year for problems such as incontinence and pelvic organ prolapse that arise from injuries sustained during vaginal birth.

A team that includes a unique multidisciplinary team of U-M gynecologists, engineers, nurses and other researchers will use the grant from the Office of Research on Women's Health – part of the National Institutes of Health – to examine the damage that can be done to pelvic muscles during vaginal deliveries. The Specialized Centers of Research (SCOR) grant is funded for five years.

Of the 3 to 4 million women who give birth each year, about 10 percent (300,000 per year) eventually will require surgery for a problem attributable to the birth. These injuries are known as pelvic floor disorders, and they include urinary incontinence and pelvic organ prolapse – conditions that can be debilitating for women.

“Twice as many women suffer a major injury to the muscles near the birth canal per hour of labor as women suffer injuries in major college athletics. Despite this high number of injuries, preventive strategies to reduce the injury rate have not been previously developed,” says John O.L. DeLancey, M.D., director of Pelvic Floor Research, Norman F. Miller Professor of Obstetrics and Gynecology, and principal investigator on the SCOR grant.

“Although the process of labor is well-studied, the mechanical changes that must take place that allows the baby to emerge from a woman's body have, until recently, escaped scientific study.”

U-M is at the forefront nationally in the research and treatment of pelvic floor disorders with its Pelvic Floor Research and Pelvic Floor Disorders Clinic. With the SCOR grant, the researchers will advance the knowledge about these conditions by studying the changes that muscles undergo in preparation for birth, how they are injured, and how they either recover or do not.

This unique effort couples the knowledge of obstetrician-gynecologists with the expertise of biomechanical engineers, who use complex three-dimensional computer simulations to study the changes in birth.

The research also will include new state-of-the-art MRI technology for the purpose of studying birth injuries and structural mechanics of the problems that arise later in life. Simulating birth in advanced biomechanical models will allow the research team to isolate specific situations that may increase the chances of a woman being injured, says DeLancey.

In addition to DeLancey, the primary members of the interdisciplinary SCOR grant team include: James A. Ashton-Miller, Ph.D., director of the Biomechanics Research Laboratories, research professor and distinguished research scientist, Mechanical Engineering Department, U-M College of Engineering, and senior research scientist, U-M Institute of Gerontology; Dee Fenner, M.D., Harold A Furlong Professor of Obstetrics and Gynecology and director of gynecology; Janis M. Miller, R.N., A.N.P., Ph.D., assistant research scientist in School of Nursing and research assistant professor of obstetrics and gynecology; Morton Brown, Ph.D., professor of biostatistics in the U-M School of Public Health; Carolyn M. Sampselle, MSN, Ph.D., Carolyne K. Davis Collegiate Professor of Nursing and associate dean for research at the U-M School of Nursing, professor of women's studies, and professor of obstetrics and gynecology; Lisa Kane Low, R.N., C.N.M., Ph.D., assistant professor of nursing and of women's studies; and Catherine Brandon, M.D., assistant professor of radiology.