Modeling childbirth: elucidating the mechanisms of labour

Abstract

The process of childbirth and the mechanisms of labour have been studied for over a century, beginning with simple measurements of fetal skull and maternal pelvis dimensions. More recently X-rays, ultrasound, and magnetic resonance imaging have been used to try and quantify the biomechanics of labour. With the development of computational technologies, biomechanical models have emerged as a quantitative analysis tool for modeling childbirth. These methods are well known for their capabilities to analyze function at the organ scale. This review provides an overview of the state-of-the-art in childbirth modeling, with detailed descriptions of the data sources, modeling frameworks, and results. We also discuss the limitations and improvements required in order for the models to be more realistic, robust, and user friendly. Some of the major challenges include: modeling the complex geometry of the maternal pelvic floor muscles and fetal head motion during the second stage of labour; the lack of experimental data on the pelvic floor structures; and development of methods for clinical validation. To-date, models have had limited success in helping clinicians understand possible factors leading to birth-induced pelvic floor muscle injuries and dysfunction. However, much more can be achieved with a quantitative modeling framework, such as the development of tools for birth planning (e.g. elective caesareans) and teaching assistance.