Simulating childbirth

Delivery: A $3,000 baby-making machine helps nursing students train for the real thing.

Medicine & Science

December 22, 2003|By Dennis O'Brien | Dennis O'Brien,SUN STAFF

HER NAME IS NOELLE, AND HER JOB IS TO GIVE BIRTH — Her hair is unnaturally white, her eyes are two different colors and her expression is a combination of joy and agony.

Her name is Noelle, and her job is to give birth - over and over again - at the University of Maryland Nursing School, where she has joined a growing legion of high-tech instructional dummies that help train medical personnel.

For the past decade, medical and nursing schools have used robotic simulators to expose students to the complications that can occur on operating tables and in emergency rooms.

But Noelle is different. She is one of the few simulators designed exclusively for delivery - and she comes complete with dilating cervix, plastic newborn and placenta.

The school purchased Noelle about a month ago for $3,000. The a 5-foot, 8-inch doll has plastic skin, one blue eye and one brown, movable joints and an adjustable womb that can produce a birth with any complication known to modern medicine. The platinum hair is optional, though - she is also available as a brunette and redhead.

The baby - somewhat like child's toy doll - can arrive quickly or after hours of hard labor. It can be delivered by breech or in a head-first fetal position, after an epidural anaesthetic or without any painkiller.

That may be why Noelle always looks as if she's on the edge of a scream. "You'd scream, too, if you just had a baby," said Debra L. Spunt, director of the school's clinical simulation lab.

The school has a number of mannequins to simulate bedridden patients, but Noelle is the institution's only baby-making machine. Just be careful what you call her: "She's not a dummy; she's a human simulator, with moving parts," Spunt said.

Student nurses at UM routinely witness live births as part of their clinical training. But Noelle gives them a chance to ask questions during the process and allows instructors to invent complex delivery scenarios.

"You can't stop and analyze what's going on in a live birth - with Noelle you can," said Lillian Fountain, a nurse and midwife who teaches at the school.

Spunt said all 345 first-year students in UM's nursing programs in Baltimore and Shady Grove will get a chance to work with Noelle this year. The nursing school is one of eight participating in a study to determine how effective simulators are.

Noelle is marketed by the Laerdal Medical Corp. and built by Gaumard Scientific, one of two Florida-based companies that make patient simulators. Both pitch them as tools - like flight simulators in the airline industry.

"With a simulator, if the student makes a mistake, it's OK because you can just reboot the computer and try again, until they get it right," said Tess Mitchell, a spokeswoman for Medical Education Technologies, Gaumard's main competitor.

About 100 nursing schools and other training facilities have purchased the Noelle.

In a simulation this month, Noelle was placed in a birthing bed with her legs in stirrups and a retinue of a half-dozen students from Fountain's Maternal Newborn and Women's Health class.

The students, at Fountain's instruction, made up Noelle's medical history and proceeded as if they had a live mother-to-be in the stirrups. Noelle, the students said, is a smoker who has given birth twice before. Both babies weighed about 7 pounds, slightly underweight.

As they would in a real delivery, Fountain and her students applied surgical gloves and slipped a monitor belt around Noelle's expanded waistline to help time her contractions. A pelvic examination determined that she was 5 centimeters dilated.

Then the questions began.

"Now what can we do to help Noelle deal with this labor pain?" Fountain asked.

One student, remembering her classwork, suggested asking Noelle to rate her pain on a scale of one to ten, with one being the most severe. There's no clear consensus from the class about an answer, and Fountain's questions continue.

"What else do I want to ask her about?" Fountain asks.

"Does she want an epidural?" says Melissa McBride, a student who has positioned herself near Noelle's legs. "Good," says Fountain.

The mock delivery proceeds quickly from here, as students coach Noelle in the breathing techniques.

Noelle makes for a cooperative, if unusually quiet, birth mother. Although the manufacturer might add speakers to future simulators, for now Noelle doesn't talk.

"I better put on my mask and gown and get ready for this birth," Fountain tells the class.

The only complication occurs when the baby's head emerges face down, which requires Noelle to sit up higher in bed to keep the head from being pushed into the mattress.

The baby emerges - perhaps more quickly and definitely more fluid-free than most real births.

"Oooh, congratulations," one student gushes.

Once the umbilical cord is clamped and severed, the baby is placed in a warming table, where students can monitor his progress. It's a boy, smaller than average - about 7 pounds and 16 inches long - but otherwise healthy. Eventually, the nurses hand him to Noelle, who accepts him with characteristic stoicism. In fact, she hasn't even broken a sweat.

Fountain realizes that a placenta hasn't been passed and inserts one into Noelle, so she can finish the job for the students. "It's always good to have an emergency placenta on hand," she says.

After the session, the students said the half-hour exercise helps them remember the elements of a process they had studied in textbooks and witnessed once in real life this term.

"Nothing can take the place of witnessing a real childbirth," said Kelly Burton, a nursing student from Carney. "But it really helps, I think because reading about it in a textbook and seeing it happen in a lab are like two different things."

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