$5.2 million grant to fund U-M research into pelvic injuries to mothers during childbirth

A $5.2 million federal grant awarded to the University of Michigan is the largest for research into birth-related pelvic floor injuries and their relationship to pelvic floor disorders like urinary incontinence and pelvic organ prolapse.

This is the third National Institutes of Health grant for U-M, bringing the total investment to over $15 million for the research that focuses on a very common, but poorly understood muscle injury that occurs during childbirth. It's this type of injury that U-M researchers are studying, hoping to find ways to reduce the 300,000 surgeries each year performed on women who develop pelvic organ prolapse and urinary incontinence caused by injuries sustained during childbirth.

The grant is from the Office for Research on Women's Health and Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health for Specialized Centers of Research (SCOR) on Sex Differences.

"Although it has been known for millennia that many women who give birth vaginally will suffer from disabling pelvic organ prolapse, the factors linking these two events has remained a mystery," says John DeLancey, director of Pelvic Floor Research, Norman F. Miller Professor of Obstetrics and Gynecology, and principal investigator on the SCOR grant.

"Not knowing how birth-induced injury occurs and how it produces subsequent prolapse has hampered efforts to improve prevention and treatment. We hope this grant will continue to help us establish the scientific basis for new strategies to improve treatment, identify important prevention opportunities, and train a new generation of researchers."

For mothers like Joan Mason, a 54-year-old from Grosse Pointe Woods, Mich., the research is very important. As a young mother with two little kids, Mason thought her postpartum discomfort was just the "new normal" for her.

For years after her deliveries, she didn't pay much attention to herself and hardly visited a doctor. But slowly the problems worsened: urine leakage bad enough that she had to wear a pad; pelvic pressure and pain that forced her to change her exercise routine; increasing discomfort with every laugh, cough or sneeze.

Mason was suffering from uterine prolapse likely caused during a muscle injury in childbirth and eventually needed surgery.

The research team uses MRI technology to determine the nature of these birth injuries and the structural mechanics of the problems that arise later in life, as they did for Mason. Simulating birth using advanced biomechanical computer simulation helps the research team to identify the specific situations that increase the chances of a woman being injured, says DeLancey.

This is the third award from SCOR for the U-M research team, which brings together knowledge from obstetrician-gynecologists, biomechanical engineers and nurses. The engineers use complex three-dimensional computer simulations to study the changes in birth. Nurse scientists are collaborating with radiologists in using advanced imaging. New techniques allow tracking potential injury progression when a woman gives birth a second time. The information should lead to new prevention strategies.

"It may provide more insight into how to treat women like Mason", says DeLancey. In the future, caregivers might know to do something different – stretching the muscles before birth; slowing down the birth process at the end in order to reduce prevent muscle rupture or altering the chance of worsening the injury in her second delivery.

"The project led by Janis Miller out of the School of Nursing, is aimed at determining how often a partial injury goes to a complete injury and what about the birth process causes these tears," says DeLancey. "Then nurse practitioners, midwives, and obstetricians/gynecologists can better talk to our patients about the risk of subsequent prolapse."

Mason says she hopes the research can shed light and understanding on a problem that women often feel uncomfortable discussing and often ignore until it becomes very serious.

"The image of the silently suffering mother who continues caring for her family is strong, but that should not be stopping physicians from having discussions on the topic," says Mason. "Since a lot of women do not consistently see a physician for themselves after child bearing, it would be helpful to arm delivering physicians with tools to diagnose and treat the problem since it may be years before a mother will see a doctor again."

In addition to DeLancey, the interdisciplinary SCOR grant team includes two other project leaders: James A. Ashton-Miller, Ph.D., director of the Biomechanics Research Laboratory, the Albert Schultz Collegiate Research Professor and distinguished research scientist, Departments of Mechanical and Biomedical Engineering, U-M College of Engineering, the U-M Institute of Gerontology and the School of Kinesiology; and Janis M. Miller, R.N., A.N.P., Ph.D., associate research scientist in School of Nursing and research associate professor of obstetrics and gynecology. Other faculty involved include Dee Fenner, M.D., Harold A Furlong Professor of Obstetrics and Gynecology and director of gynecology; Carolyn M. Sampselle, MSN, Ph.D., Carolyne K. Davis Collegiate Professor of Nursing, 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; Catherine Brandon, M.D., clinical associate professor of radiology; and Andrzej Galecki, M.D., Ph.D, research professor, Institute of Gerontology and research scientist in biostatistics.

Provided by University of Michigan Health System