Thursday, September 10, 2009

And while we're on it . . .

. . . if medical students are being trained using this:


Is it any wonder things like the Labor Pro and the Birth Track are making their way into the delivery room?

I came across this "SIMone Birthing Simulator" while reading the latest comments from Nursing Birth's aforementioned post on the Labor Pro.
Simulate high stress situations with the SIMone™ birthing simulator!

Using patented haptic response technology, SIMone™ gives you a unique training experience. The level of realism is additionally heightened though a specially developed visual and audio interface . . . SIMone™ gives the opportunity to practice an instrumental delivery in a realistic manner - over and over again with little or no set up time! In fact it takes less than 60 seconds to commence a new birthing scenario.

Accessories included:
  • 1 Vacuum extractor Menox 60mm
  • 1 Vacuum hand pump
  • 1 Naegele forceps

So, basically a Real Doll for OB students. Tell me, what's the first thing you notice about the picture above? But of course "Simone" is poised cooperatively in lithotomy position. How else are they going to learn? Their whole catalog could be seen as disturbing by some, but I actually find a lot of these models interesting, and useful in a classroom situation (and not so different in spirit than Madame Coudray's creations). The SIMone Simulator just takes it to a whole new level, revealing a clear - and quite revealing - set of assumptions and beliefs.

But. There's a big but. It's tempting to just react emotionally and recoil in understandable, outraged horror at this dehumanized, computerized, amputated facsimile of the miracle of birth - after all, that was my first response - but: This is something that is being marketed, if one believes the sentiment expressed in the video (there's no separate link, just look for it in the left column on the main page by the top paragraph), specifically to help avoid cesareans. I think it's true that situations that used to call for forceps or vacuum extractors (in the obstetric mindset, of course) are now more frequently just skipping that step and going straight for the c-section, due in part to the fact that these skills aren't being taught as much anymore, from what I understand (like breech birth, which has all but been lost and is only now starting to make its way back into the hospital in Canada; we can only hope the US comes to its senses and follows suit).

Now, the question that's NOT being asked by Simone and her attendants: were the factors that led to the situation that calls for forceps or vacuums often created by hospital practices in the first place? I would say so. Are there other ways of handling these situations, ways practiced by midwives? Ways that, incidentally, usually don't involve being supine with your legs conveniently hoisted and splayed? I would also say yes. But if the mother insists on buying the hospital ticket, and going for the hospital ride, would it not be better to have some of these tools and more importantly, skills in handling these tools, available if the mother wants to avoid a cesarean? I think that's a fair question.

Oh, it's all so complicated. What IF the rate of c-sections were to drop (instead of continuously rising as it has been) as a result of increased vaginal intervention in the form of vacuums and forceps? Would American women - if I can make such a sweeping generalization - be happy with this development? If we were to say that, okay, this is the lesser of two evils, but it's still not great, it's still not addressing the dysfunction of "active management" in the obstetric standard of practice - I could see doctors everywhere throwing up their hands and saying "See? It's impossible to please them! First they complained about forceps and vacuums, and we started doing more c-sections in those circumstances. We did that. Then they wanted the c-section rate to be lowered. We did that. Now they want fewer instrumental deliveries again! WOMEN! Impossible. Whatever."

So maybe Simone isn't all bad, if she/it helps lead to an increase in the lesser of two evils, and a decrease in the greater. But is this really all women should get to choose between?

4 comments:

  1. All of this "high tech birth" stuff really just sickens me. It seems unreal. What is wrong with students just observing birth to learn instead of creating "simulators" this isn't flight school, its labor. You are dealing with REAL PEOPLE, not machinery. There used to be a patient doctor bond and that is being encouraged to disappear. Doctors are being trained to do procedures and negate the human experience of interaction. People should be demanding humane care instead of settling for routine operating procedure. When will doctors realize women aren't objects to work on; they are people! Argh.

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  2. Well, I suppose one big part of it is that androids don't generally sue.

    YET.

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  3. I don't mind so much when they use it to practice high risk situations. But when they want to use technology on moms that is what scares me.

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  4. Has no one seen the cheesy android movie "S1m0ne"? Is this intentional or what?

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