Giving Birth — An Athletic Event?

By applying a sports medicine eye to labor and delivery recovery, a team of scientists finds never-before-detected fractures and injuries. 

9:48 AM

Author | Beata Mostafavi

As a researcher and nurse practitioner helping women recover after giving birth, Janis Miller struggled answering some of the most common questions she and other medical professionals get from new moms.

"Many women say they feel like something has changed 'down there,'" says Miller, who is faculty at the University of Michigan School of Nursing and part of the Healthy Healing After Delivery clinic at the U-M Health System. "What has happened to me? Is this normal?' Our best answer so far has been 'well, you did just give birth.'"

Miller, Ph.D., admitted to patients that she didn't know why it took some women longer than others to feel normal again. Was there a muscle tear? A strain? Should they do Kegel exercises or rest the muscle for longer?

The Michigan team already knew about some of the physiological changes that some women experience after birthing. But Miller wanted to know if there was a way to learn even more details about these complex births that could help her help patients. That's when U-M Health System's musculoskeletal radiologist Catherine Brandon stepped in with a seemingly obvious suggestion.

"She said 'why not examine women's bodies after birth the way we do with athletes?'" Miller recalls. "It made perfect sense. Childbirth is arguably one of the most dramatic musculoskeletal events the human body undergoes."

So Miller, Brandon and a multispecialty team that includes experts from U-M's division of Obstetrics and Gynecology embarked on a unique type of research to learn more about how childbirth changes a woman's body. Using highly sensitive MRIs commonly used to scan for sports-related bone and muscle injuries, they evaluated childbirth among a certain group of high-risk women.

Childbirth is arguably one of the most dramatic musculoskeletal events the human body undergoes.
Janis Miller, Ph.D.

What researchers studied — and what they found

To identify women most likely to have had a complex birth that could have induced musculoskeletal changes, Miller and her colleagues chose to study only women who had a forceps-assisted birth, pushed for longer than 150 minutes, had an extended tear, were older than 33 when birthing or had several of these factors.

The team used special magnetic resonance scans to evaluate the women, taking detailed pictures of pelvic muscles, surrounding tissues and bones. Participants were scanned at about seven weeks after delivery and again eight months later.

Results showed that, as expected, the stretch on soft tissues and stress of the passage of newborns through the pelvis did result in changes — the types of changes that athletes may experience after a particularly intense event, such as stress fractures.

It turned out that athletics was an appropriate comparison for birthing moms.

"Eight months after giving birth, some women still had physical evidence of having 'run a marathon,'" Miller says. "We often hear women liken giving birth to something like a marathon and now we can tell them that when it comes to changes in your muscles, some of the post-event soreness is actually very similar."

Through the specialized imaging scans — which are fluid-sensitive and reveal damage that would not be visible otherwise — researchers found that one-quarter of women showed microscopic extra-cellular fluid in the pubic bone marrow (edema) or sustained fractures similar to a sports-related stress fracture. Two-thirds showed edema in the muscle, which indicates injury similar to a severe muscle strain. Forty-one percent sustained pelvic muscle tears, with the muscle detaching partially or fully from the pubic bone.

The good news? For the majority of women, these signs of birth taking its toll on the tissues were gone after eight months with no intervention — proving the incredible recuperative powers of the woman's body after birth.

"Rehab therapy gives carte blanche to every woman who has had a baby without evaluating what has happened to that individual woman. They are often told they'll be ready to return to work and other normal activities after six weeks and now we know that some women may need more time," Miller says.

"There are obviously wide, varying degrees of tissue injury and strain among women and no standard timeline for recovery. If a woman is feeling like she is slower to recover, we may need to evaluate for these injuries to help explain why. We can also tell women that most of these types of injuries do go away over time without any intervention at all. It just may take longer for some. That's incredibly empowering for them to hear."

Roughly 40 percent of the women in the study, recruited for their higher risk of having had an injury, also showed a tear of the Kegel muscle at the pubic bone that did not go away. The team is following the women longer term to investigate what happens over time and after a second birth.

Miller and her colleagues hope the findings contribute to further research on pelvic floor disorders.


More Articles About: Body Work childbirth High-Risk Pregnancy obstetrics
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Subscribe
Featured News & Stories Illustration of a doctor and patient looking at ultrasound
Health Lab
Novel device detects cervix “ripening” to predict normal and abnormal labor
Multi-specialty team is studying a non-invasive method to measure underlying cervical tissue changes that precede birth with the hopes of predicting timing of birth.
Woman grasps at pelvic area, indicating pain
Health Lab
Pelvic floor injury during vaginal birth is life-altering and preventable, experts say
New technology can prevent pelvic floor conditions associated with childbirth.
person with pink shirt blue background pregnant
Health Lab
Transgender people show similar pregnancy outcomes to cisgender people
A Michigan Medicine-led study found that transgender individuals show similar rates of severe parental morbidity and preterm birth and lower rates of cesarean delivery when compared to cisgender people.
woman next to pregnant womens bed
Health Lab
What is placenta accreta? An expert explains
Jourdan Triebwasser, M.D., medical director of the University of Michigan Health Von Voigtlander Women's Hospital Birth Center and a maternal-fetal medicine specialist with a particular interest in this condition, shares more about detecting and treating the condition, and the importance of multidisciplinary collaboration in maternal-fetal outcomes.
stork with baby in bag with dollar sign
Health Lab
Childbirth associated with significant medical debt
Postpartum individuals are more likely to have medical debt than those who are pregnant, suggests a Michigan Medicine led study that evaluated collections among a statewide commercially insured cohort of 14,560 pregnant people and 12,157 people in the postpartum period.
Pregnant woman getting teeth clean with tools by dentist
Health Lab
7 things to know about dental care during your pregnancy
A Michigan Medicine OB-GYN explains seven things you should know about dental care during pregnancy.