Emergency caesarean model could benefit junior doctors

A new emergency caesarean birth simulator could for the first time allow doctors to practise the procedure before operating on a real patient.

The life-size device, known as Desperate Debra, simulates how a baby’s head can become stuck in the mother’s pelvis, needing to be pushed back into the uterus before being removed through an incision in the abdomen.

The British team that developed the simulator says that, until now, junior doctors have had no way of practising emergency caesareans, which are carried out an estimated 10–20 times a day in the UK.

‘Of all the women who reach full dilatation, somewhere between about two and five per cent will end up needing this type of operation,’ said Andy Shennan, professor of obstetrics at Guy’s and St Thomas’ Hospital and academic lead on the project.

‘And because caesareans are any time day or night, it is very likely that the doctor who’s doing this is not that experienced and may not have come across a similar delivery before. So the first time you’re exposed to this problem is often in a real-life situation.’

He added: ‘There are other teaching models a bit like it, but certainly nothing that mimics the difficulty of getting the head out during a caesarean.’

The plastic and silicon device, designed by Dr Graham Tydeman of NHS Fife and developed with UK company Adam,Rouilly, features a moving baby’s head that can be pulled out of a lubricated pre-made incision and is attached to a display mechanism at the opposite end of the mother’s body to indicate the baby’s position.

Gabriel Ogwo, product development manager at Adam,Rouilly, said the biggest challenge was developing a way for the baby’s head to become stuck and recreating the experience and difficulty of pulling the baby out in a very realistic way.

‘It was the combination of materials; that was the trick,’ he said. ‘Trying different materials, different anatomies, which had to be correct, and making sure we kept the overall feel. Some materials fell apart. They were great initially but when you combined them with the gels we use there were issues.’

Debra was originally designed as a way to test a tube for releasing the pressure inside the uterus when a baby becomes stuck. But the doctors at Guy’s and St Thomas’ found it to be so realistic that they thought it could be used as a training device, although it had to be redesigned with the correct anatomical proportions.

‘We mimicked all the aspects of the real-life situation — things such as the way the baby’s head moved, tilted, felt,’ said Shennan. ‘It’s quite technically difficult because the bones aren’t fused, they’re quite soft and mobile, the skin has to mimic and so on.

‘We had to also mimic the right pressures and tensions to keep the head in and ways of showing the movements while the delivery is happening.’

The device is nearly ready to go into mass production and has entered an evaluation phase at the hospital, where the team believes it could also help doctors define optimal techniques for emergency caesareans.

Adam,Rouilly is also examining the possibility of developing it for other types of pregnancy and birth simulators.

‘The model is really attractive in the sense that you don’t have lots of calibration and electronics and keyboards and things to go wrong, which has been an issue with other models,’ said Ogwo.