UK-based manufacturer of medical training products, Adam,Rouilly, has worked with leading clinicians to develop an improved simulation model for the teaching of vital skills which can help reduce the risk to mothers and babies during caesarean births.
Debra Enhanced – Impacted Fetal Head Simulator enables clinical teams to learn and practice what to do when a baby’s head becomes lodged deep in the mother’s pelvis during labour.
It has been designed to ensure the multidisciplinary team is equipped with the skills, knowledge and confidence to release an impacted fetal head (IFH).
The simulator allows for realistic hands-on training of various scenarios and techniques, such as manually pushing the baby back up the birth canal, and the use of specialist medical devices including balloon inflation devices and the new Tydeman Tube.
The Royal College of Obstetricians and Gynaecologists (RCOG) has identified IFH as a ‘significant contributor to avoidable brain injury in childbirth’, which can have a devastating impact on babies and families.
As such, it is being targeted as part of RCOG’s Avoiding Brain Injuries in Childbirth (ABC) programme, with trials at nine NHS maternity units in England. The pilot scheme involves training and resources and includes input from clinical trainers, maternity staff, expectant mothers and their partners.
Realistic caesarean section teaching model
Debra Enhanced was initially invented 10 years ago in collaboration with an expert clinical team:
- Dr Annette Briley – Professor of Women’s Health & Midwifery Research, Flinders University and Northern Adelaide Local Health Network, South Australia.
- Dr Graham Tydeman, Consultant in Obstetrics and Gynaecology – NHS Fife
- Professor Andy Shennan – Tommy’s Chair in Maternal and Fetal Health
The original trainer ignited the topic of impacted fetal head to inspire global conversations about training for this emergency, best practice techniques and devices to ensure positive maternal and neonatal outcomes. The model was the first teaching aid of its kind and allowed for the realistic simulation of an impacted fetal head.
The team came back together with Adam,Rouilly to enhance the model so that it is compatible with the latest prescribed techniques and fetal head elevation devices, while providing an even more lifelike training experience and opportunities for experts to compare techniques.
Enhancements to the Debra simulator include significant changes to the baby’s head with more pronounced fontanelles and sutures, as well as skull plates that can be felt moving underneath the silicone head. These are all designed to make identifying the baby’s position as realistic as possible.
The vaginal examination process is also much improved, with a wider birth canal enabling the baby’s head to descend to a lower position for more realistic practice of the treatment techniques.
‘Impacted fetal head is a much bigger issue than we thought’
Dr Tydeman said: “We are really delighted with this simulator. We’ve enhanced the design of the original Debra model in several key ways and for several reasons. There’s been a lot of research over the last decade and we are now aware that impacted fetal head is a much bigger clinical issue than we thought. We now know that of all babies suffering hypoxic injuries at birth, impacted head is a factor in nearly 10% of cases.
“With rising caesarean section rates, this is likely to become even more common. As new devices and training modules become established, there has never been a more important time for a realistic simulator. This multi-disciplinary tool recognises that the whole medical team – including the surgeons, scrub nurses, midwives and anaesthetists – has their part to play in reducing the risk of life-changing complications for mother and baby.”
Adam,Rouilly Product Developer, Daniel Mogentale, said: “Prior to the development of the original Debra model, there wasn’t a simulator for this. Doctors and other clinicians had no opportunity for training before they encountered impacted fetal head in real-life which is far from ideal.
“Graham and the team approached us with his idea and this vital caesarean section teaching aid came into being. Debra Enhanced now reflects advances in clinical practice and allows people to train in the various different methods of delivering the impacted head.
“The latest ABC training from RCOG reinforces just how serious this issue is and we are delighted to be able to assist with this potentially life-saving teaching aid.”
