- The Washington Times - Tuesday, May 15, 2007

Noelle recently underwent an emergency Caesarean section at the Washington Hospital Center in Northwest. She was just 26 weeks pregnant, so the situation was tense, but mother and baby are doing fine.

Noelle recovered quickly from her ordeal — she is a simulator made by Gaumard Scientific Co., designed to help doctors train for obstetrical dilemmas. Her name means “day of birth.”

Similar to how pilots use simulators to train for air travel, doctors at Washington Hospital Center have been using birthing simulators over the past 1 years to hone their skills. Humanlike robots help the staff learn how to handle various obstetrical emergencies.

Alease Young, a staff nurse at the hospital center, acted as the voice of Noelle during the drill.

“As the patient, I was doing something I shouldn’t have been doing. I went to the bathroom,” she says. “My water had ruptured. Because it was so early in my pregnancy, there was the possibility that the cord could come out the cervix.”

While Ms. Young voiced the role of the patient, she was able to look at the situation from a new perspective, she says.

“It helped me to feel the other side as a patient,” Ms. Young says. “It helped my nursing skills as far as delivery, realizing how important it is to communicate to patients.”

According to the fictional scenario, Noelle had been in the high-risk unit for a few days. Though her doctor had told her not to get out of bed to use the bathroom, she did. That’s when the trouble began. Apparently, the umbilical cord slipped through the cervix and into the vaginal canal. If the baby were to roll onto the cord, the oxygen supply to the child could have been cut off.

After Noelle reached the operating room, it took about three minutes for the baby to be delivered via Caesarean section, says Dr. Tamika Auguste, an obstetrician and gynecologist at the hospital center.

Once in the delivery room, the staff completed the drill on a SimMan, a type of patient simulator made by Laerdal Medical Corp.

“If you were in labor and delivery, you probably wouldn’t want someone who has never done a forceps delivery to practice on you and your baby,” Dr. Auguste says. “If we are faced with an emergency delivery, you want to know that the doctors and nurses have practiced so it runs smoothly.”

The drills on the $20,000 to $30,000 robot should help the entire department work better as a team, Dr. Auguste says. Practicing delivery skills alone is not as effective as practicing them with the other staff members, including nurses, the resident doctor, the anesthesiologist and the neonatologist.

“This is very much the way of the future,” Dr. Auguste says. “It’s new. We have a lot of support from the administration. We would not have been able to do this without their support.”

The team training is a component of the Perinatal Patient Safety Project, a Kaiser Permanente initiative being conducted at the hospital center, says Dr. Stacey Anderson, an obstetrician and gynecologist who sees patients at Kaiser Permanente hospitals in the District and Southern Maryland. She also delivers babies at Washington Hospital Center.

After a recent drill, Dr. Anderson said she thinks the staff is on the right track but she would like to see improvements in communication.

“Of course, there is a learning curve,” she says. “People tend to work around system errors instead of correcting them.”

The drill will be assessed, she says, and a steering committee will make any suggestions for improvement. One possibility would be for the department to outline who plays what role during an emergency. Although the exact same emergency usually doesn’t happen twice, it’s good to be prepared.

“It gets chaotic during an emergency,” Dr. Anderson says. “The goal is to eliminate the chaos and have a better outcome for mom and baby.”

The biggest problem during the drill seemed to be assertiveness, says Nalini Cherian, clinical manager for labor and delivery at the hospital center. She played the role of the charge nurse, the nurse in charge of the ward during the practice session.

“There was a problem with people speaking up and stating things clearly,” Ms. Cherian says. “It helped to point out strengths and weaknesses of a real emergency. I wish we had done this years ago. It was very valuable.”

A new version of Noelle will be released next month, says John Heinlein, a territory sales manager for Gaumard. The new Noelle will feature a fetus that descends and rotates internally as it moves down the birth canal and a cervix that dilates. The baby is delivered by a motor-track system.

The new simulator can mimic shoulder dystocia, in which the baby’s shoulder gets caught on the mother’s pubic bone during delivery. Doctors and nurses can practice vaginal breech deliveries and C-sections. Fetal heart rates and patterns also can be displayed and recorded.

“The original birthing simulator was designed for midwives in Third World countries in 1946,” Mr. Heinlein says. “The latest models are by far the most realistic. The texture is fleshlike and responds like the human body would respond.”

Although most births in the United States are uneventful, 1 percent to 2 percent are complicated by an obstetrical emergency, says Lucy Wilcox, a registered nurse and clinical specialist in women’s and infants’ services at Washington Hospital Center. She is making sure that all staff members in the department participate in at least one drill with the simulators.

“You want to practice in an environment that is very real,” Mrs. Wilcox says. “It’s like you’re not in a classroom. You’re using a real labor room and operating room. You’re taking the situation and making it come to life. After the drills, the powerful part is debriefing.”

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