Childbirth is never one size fits all

Dr Jenny Kruger and Dr Alys Clark of University of Auckland’s Auckland Bioengineering Institute address some of the most pressing questions of mothers and mothers-to-be

Pregnancy and childbirth is a unique experience. For most women it goes well, but others are left with questions they can be reluctant to ask – why did I miscarry, why wasn’t my baby’s birth like I planned, am I a failure for having a C-section, why haven’t I been able to control my bladder since childbirth, why do I sometimes feel like my insides are falling out? 

Women can feel alone in needing answers to these questions, but the facts are: one in four pregnancies ends in miscarriage, one in three births are defined as clinically normal (without medical intervention), more than one-tenth of births are by emergency caesarean section, and around 25 percent of women who have vaginal births have injury that leads to urinary incontinence.

Fortunately, most pregnancies and births do go well, but it is important to remember that things do go wrong – every pregnancy is different. We know there are risk factors (e.g. smoking, obesity) related to poor pregnancy health and childbirth itself can trigger the development of conditions such as urinary incontinence and pelvic organ prolapse. However, predicting who is at risk from the unexpected, and managing the therapies that will help them, is difficult.  Antenatal tests can let us know when things are going wrong, but the unexpected still happens and even low-risk pregnancies can have problems.  

So, what are we doing at Auckland Bioengineering Institute to help women understand what is happening to their bodies and what they can do to improve their situation?  

In short, our researchers, and teams world-wide, are using technology to develop tools that will treat every pregnancy, delivery and postnatal period as the uniquely individual experience that it is. We are developing resources that will give women personalised assessments of their risks during pregnancy and childbirth, and the treatment options available to them.  

This research combines an understanding of the physiology of pregnancy and childbirth, the mechanism behind the development of disorders and how to create patient-specific treatment options and risk assessment using technology, intelligently and innovatively.  

For example, we know the position of a baby during childbirth is an indicator of risk for pelvic floor injury leading to incontinence, but what is it about the shape and size of a woman’s pelvis and the strength of the muscles within it, along with the baby’s size and position, that leads to injury? And what kind of physiotherapy is needed to rehabilitate when injury has happened? Similarly, we know the size of the placenta relative to the size of the fetus is an indicator of pregnancy health, but is this enough information on its own to tell us if a baby’s growth will slow later in pregnancy? Or do we need to measure something else, like the extent of oxygen-rich blood circulating in mum’s uterus?

The good news is, we can measure all these things thanks to engineering, maths and rapidly-advancing clinical imaging technologies that are helping us discover what we need to measure and track to identify and treat potential problems.

We already know that pregnant women are high users of mobile apps and are receptive to health interventions perceived to be beneficial for their baby and themselves. Future health strategies can make use of this engagement to help women understand health issues before they become problematic. 

Aside from pregnancy and childbirth, the way we monitor and perceive our own health is changing for most of the population. We learn from “Dr Google” and download apps that cover every health condition. We use our phones to monitor our heart-rate, and keep a record of our steps and diet. Maybe these new technologies will provide a way to assess risk, personalise therapies and educate? Truly personalised tools to help pregnant women are further in the future, but technologies are emerging that will enable women to take better control of their own pre- and post-natal health.

For example, we are developing a pressure-sensing device (FemFit®) for women with urinary incontinence. It will couple to your mobile and help with your pelvic floor exercises, monitor your pelvic floor function, and identify activities you can do without increasing risk of pelvic organ prolapse. 

Engaging technology is the future of health management and many women are already using what is available to monitor their health. While technology will never eliminate risk – the unexpected will always happen – maybe we can reduce the effect of the unexpected and provide a more personalised service to women by focusing on health problems that impact them the most. 

Dr Kruger and Dr Clark are speakers at ABI’s public talk, “Women’s Health: Communication. Comprehension. Solution”, on October 26, 5pm, at the Royal New Zealand Yacht Squadron, 181 Westhaven Drive, Auckland.

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