{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T11:45:37Z","timestamp":1790768737520,"version":"4.1.0"},"reference-count":59,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2009,10,2]],"date-time":"2009-10-02T00:00:00Z","timestamp":1254441600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["WIREs Mechanisms of Disease"],"published-print":{"date-parts":[[2010,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The process of childbirth and the mechanisms of labor have been studied for over a century, beginning with simple measurements of fetal skull and maternal pelvis dimensions. More recently, X\u2010rays, ultrasound, and magnetic resonance imaging have been used to try and quantify the biomechanics of labor. 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\u2010of\u2010the\u2010art finite element models of the mechanics of vaginal delivery, 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 accurate and clinically useful. 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 labor; 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\u2010induced pelvic floor muscle injuries and dysfunction. However, much more can be achieved with further development of these quantitative modeling frameworks, such as tools for birth planning and medical education. Copyright \u00a9 2009 John Wiley &amp; Sons, Inc.<\/jats:p><jats:p>This article is categorized under:<jats:list list-type=\"explicit-label\"><jats:list-item><jats:p>Models of Systems Properties and Processes &gt; Mechanistic Models<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p>","DOI":"10.1002\/wsbm.65","type":"journal-article","created":{"date-parts":[[2009,10,3]],"date-time":"2009-10-03T11:08:50Z","timestamp":1254568130000},"page":"460-470","source":"Crossref","is-referenced-by-count":37,"title":["Modeling childbirth: elucidating the mechanisms of labor"],"prefix":"10.1002","volume":"2","author":[{"given":"Xinshan","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Kruger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martyn P.","family":"Nash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poul M.F.","family":"Nielsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2010,6,15]]},"reference":[{"key":"e_1_2_7_2_2_2","volume-title":"Varney's Midwifery","author":"Varney H","year":"2004"},{"key":"e_1_2_7_2_3_2","volume-title":"Anatomy and Physiology Applied to Obstetrics","author":"Verralls S","year":"1969"},{"key":"e_1_2_7_2_4_2","first-page":"540","article-title":"Ask not what childbirth can do to your pelvic floor but what your pelvic floor can do in childbirth","volume":"22","author":"Balmforth J","year":"2003","journal-title":"Neurourol Urodyn"},{"key":"e_1_2_7_2_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2007.00714.x"},{"key":"e_1_2_7_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-200301000-00012"},{"key":"e_1_2_7_2_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000178779.62181.01"},{"key":"e_1_2_7_2_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000194063.63206.1c"},{"key":"e_1_2_7_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.12.044"},{"key":"e_1_2_7_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.02.040"},{"key":"e_1_2_7_2_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-007-0491-9"},{"key":"e_1_2_7_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.02.005"},{"key":"e_1_2_7_2_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000250901.57095.ba"},{"key":"e_1_2_7_2_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2006.00819.x"},{"key":"e_1_2_7_2_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01751.x"},{"key":"e_1_2_7_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2009.03.004"},{"key":"e_1_2_7_2_17_2","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2003.101"},{"key":"e_1_2_7_2_18_2","volume-title":"A Set of Anatomical Tables, with Explanations: and an Abridgment of the Practice of Midwifery","author":"Smellie W","year":"1793"},{"key":"e_1_2_7_2_19_2","doi-asserted-by":"publisher","DOI":"10.3109\/00016345709157405"},{"key":"e_1_2_7_2_20_2","doi-asserted-by":"publisher","DOI":"10.3109\/00016345709161052"},{"key":"e_1_2_7_2_21_2","doi-asserted-by":"publisher","DOI":"10.3109\/00016345809157428"},{"key":"e_1_2_7_2_22_2","doi-asserted-by":"publisher","DOI":"10.3109\/00016345909157969"},{"key":"e_1_2_7_2_23_2","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/S0033-8389(22)01989-3","article-title":"The mechanism of labour","volume":"5","author":"Borell U","year":"1967","journal-title":"Radiol Clin North Am"},{"key":"e_1_2_7_2_24_2","first-page":"3","article-title":"A re\u2010evaluation of the mechanism of labour for contemporary midwifery practice","author":"Dietze M","year":"2001","journal-title":"Midwifery Matters"},{"key":"e_1_2_7_2_25_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2007.00748.x"},{"key":"e_1_2_7_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.07.094"},{"key":"e_1_2_7_2_27_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2005.00349.x"},{"key":"e_1_2_7_2_28_2","first-page":"105","article-title":"Fetal head molding diagnosis by ultrasound and a review of the literature","author":"Carlan SJ","year":"1991","journal-title":"J Perinatol"},{"key":"e_1_2_7_2_29_2","doi-asserted-by":"publisher","DOI":"10.1023\/B:ABME.0000012749.79488.d6"},{"key":"e_1_2_7_2_30_2","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.174.3.1740657"},{"key":"e_1_2_7_2_31_2","doi-asserted-by":"crossref","unstructured":"LiX KrugerJ ChungJ NashMP NielsenPMF. Modelling the pelvic floor for investigating difficulties during childbirth. Proceedings of SPIE 6916(69160V) San Diego CA February 17\u201321 2008.","DOI":"10.1117\/12.769898"},{"key":"e_1_2_7_2_32_2","doi-asserted-by":"crossref","unstructured":"KheddarA DevineC BrunelM DuriezC. Preliminary design of a childbirth simulator with haptic feedback. Proceedings of 2004 IEEE\/RSJ International Conference on Intelligent Robots and Systems Sendai Japan September 2\u201328 2004 31:3270\u20133275.","DOI":"10.1109\/IROS.2004.1389921"},{"key":"e_1_2_7_2_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-9290(03)00008-3"},{"key":"e_1_2_7_2_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9290(86)90105-3"},{"key":"e_1_2_7_2_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9290(70)90059-X"},{"key":"e_1_2_7_2_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9290(80)90003-2"},{"key":"e_1_2_7_2_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9290(80)90004-4"},{"key":"e_1_2_7_2_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-9290(01)00070-7"},{"key":"e_1_2_7_2_39_2","first-page":"750","article-title":"Modelling childbirth: comparing athlete and non\u2010athlete pelvic floor mechanics","volume":"5242","author":"Li X","year":"2008","journal-title":"Med Image Comput Comput Assist Interv"},{"key":"e_1_2_7_2_40_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-007-0388-7"},{"key":"e_1_2_7_2_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.04.027"},{"key":"e_1_2_7_2_42_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000109207.22354.65"},{"key":"e_1_2_7_2_43_2","doi-asserted-by":"publisher","DOI":"10.1196\/annals.1389.019"},{"key":"e_1_2_7_2_44_2","doi-asserted-by":"publisher","DOI":"10.1007\/11566465_45"},{"key":"e_1_2_7_2_45_2","unstructured":"JingD LienK Ashton\u2010MillerJA DeLanceyJOL. Visco\u2010hyperelastic properties of the pelvic floor muscles in healthy women. Podium Session 26 North American Congress on Biomechanics Ann Arbor Michigan USA 5\u20139 August 2008."},{"key":"e_1_2_7_2_46_2","doi-asserted-by":"publisher","DOI":"10.1080\/17452750601040626"},{"key":"e_1_2_7_2_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2009.03.011"},{"key":"e_1_2_7_2_48_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2009.02.033"},{"key":"e_1_2_7_2_49_2","unstructured":"JingD Ashton\u2010MillerJA DeLanceyJOL. How different maternal volitional pushing profiles affect the duration of the second stage of labor: A 3\u2010D visco\u2010hyperoelastic finite element model. Podium Session 26 North American Congress on Biomechanics Ann Arbor Michigan USA August 5\u20139 2008."},{"key":"e_1_2_7_2_50_2","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00015.2007"},{"key":"e_1_2_7_2_51_2","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2008.155424"},{"key":"e_1_2_7_2_52_2","unstructured":"PearlRK EvenhouseR RasmussenM DechF SilversteinJC et al.The virtual pelvic floor a tele\u2010immersive educational environment. Proceedings of AMIA Annual Symposium Washington D.C. November 6\u201310 1999 345\u2013348."},{"key":"e_1_2_7_2_53_2","unstructured":"LiX KrugerJ NashMP NielsenPMF. Modelling fetal head motion and its mechanical interaction with the pelvic floor during childbirth. Abstract in the 39th Annual Meeting of the International Continence Society San Francisco CA 29 September to 3 October 2009. In press."},{"key":"e_1_2_7_2_54_2","doi-asserted-by":"publisher","DOI":"10.1080\/10255840500405378"},{"key":"e_1_2_7_2_55_2","volume-title":"Mayes' Midwifery: A Textbook for Midwives","author":"Henderson C","year":"2004"},{"key":"e_1_2_7_2_56_2","doi-asserted-by":"publisher","DOI":"10.1115\/1.3138684"},{"key":"e_1_2_7_2_57_2","doi-asserted-by":"publisher","DOI":"10.1098\/rsta.1951.0004"},{"key":"e_1_2_7_2_58_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1098-2353(1997)10:4<223::AID-CA1>3.0.CO;2-T"},{"key":"e_1_2_7_2_59_2","first-page":"667","article-title":"How much does the puborectalis muscle have to stretch during childbirth?","volume":"27","author":"Svabik K","year":"2008","journal-title":"Neurourol Urodyn"},{"key":"e_1_2_7_2_60_2","unstructured":"KrugerJ MurphyB NielsenPMF. Pelvic floor muscle compliance in elite athletes Abstract in the 38th Annual Meeting of the International Continence Society Cairo Egypt October 20\u201324 2008."}],"container-title":["WIREs Systems Biology and Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fwsbm.65","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fwsbm.65","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wsbm.65","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/wsbm.65","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wires.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wsbm.65","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T14:20:11Z","timestamp":1739370011000},"score":1,"resource":{"primary":{"URL":"https:\/\/wires.onlinelibrary.wiley.com\/doi\/10.1002\/wsbm.65"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2010,6,15]]},"references-count":59,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2010,7]]}},"alternative-id":["10.1002\/wsbm.65"],"URL":"https:\/\/doi.org\/10.1002\/wsbm.65","archive":["Portico"],"relation":{},"ISSN":["1939-5094","1939-005X"],"issn-type":[{"value":"1939-5094","type":"print"},{"value":"1939-005X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,6,15]]}}}