title: Physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery: a protocol for a mixed-methods prospective cohort study.
abstract: Pelvic floor disorders (PFDs), including pelvic organ prolapse (POP), stress and urgency urinary incontinence, and faecal incontinence, are common and arise from loss of pelvic support. Although severe disease often does not occur until women become older, pregnancy and childbirth are major risk factors for PFDs, especially POP. We understand little about modifiable factors that impact pelvic floor function recovery after vaginal birth. This National Institutes of Health (NIH)-funded Program Project, 'Bridging physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery', uses mixed-methods research to study the influences of intra-abdominal pressure, physical activity, body habitus and muscle fitness on pelvic floor support and symptoms as well as the cultural context in which women experience those changes.
  
  
  
  Using quantitative methods, we will evaluate whether pelvic floor support and symptoms 1 year after the first vaginal delivery are affected by biologically plausible factors that may impact muscle, nerve and connective tissue healing during recovery (first 8 weeks postpartum) and strengthening (remainder of the first postpartum year). Using qualitative methods, we will examine cultural aspects of perceptions, explanations of changes in pelvic floor support, and actions taken by Mexican-American and Euro-American primipara, emphasising early changes after childbirth. We will summarise project results in a resource toolkit that will enhance opportunities for dialogue between women, their families and providers, and across lay and medical discourses. We anticipate enrolling up to 1530 nulliparous women into the prospective cohort study during the third trimester, following those who deliver vaginally 1 year postpartum. Participants will be drawn from this cohort to meet the project's aims.
  
  
  
  The University of Utah and Intermountain Healthcare Institutional Review Boards approved this study. Data are stored in a secure password-protected database. Papers summarising the primary results and ancillary analyses will be published in peer-reviewed journals.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Ingrid E
authors.initials: IE
authors.lastname: Nygaard
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Clark
authors.affiliation: College of Nursing, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Clark
authors.affiliation: Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Marlene J
authors.initials: MJ
authors.lastname: Egger
authors.affiliation: Department of Bioengineering, College of Engineering, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Hitchcock
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Hsu
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Peggy
authors.initials: P
authors.lastname: Norton
authors.affiliation: College of Nursing, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Ana
authors.initials: A
authors.lastname: Sanchez-Birkhead
authors.affiliation: Department of Health, Kinesiology, and Recreation, College of Health, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Shaw
authors.affiliation: Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Sheng
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Varner
mesh_terms: D000328:Adult; D003466:Cultural Characteristics; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D053580:Muscle Strength / Q000502:physiology; D036801:Parturition / Q000502:physiology; D017773:Pelvic Floor / Q000503:physiopathology*; D059952:Pelvic Floor Disorders / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D056887:Pelvic Organ Prolapse / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D036301:Qualitative Research; D011788:Quality of Life; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D064890:Social Determinants of Health; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D014589:Utah / Q000453:epidemiology
keywords: Pelvic organ prolapse; childbirth injury; intra-abdominal pressure; pelvic floor disorders; physical activity; urinary incontinence