Birth simulation vehicle to help rural hospitals train delivery room workers

“How much longer?” asks Lucy, who is in the painful throes of giving birth.

“Two more minutes,” said the nurse with such certainty it raises suspicion. “Don’t worry. You’re doing fine.”

Lucy screams. “Stop yelling,” said a second nurse. “You can’t push when you’re yelling. Put all of your strength into pushing.”

And at precisely two minutes, the baby’s head pushes out. A few seconds and one small twist later, the baby is all the way out. Within a few more seconds, the baby is resting on Lucy’s chest.

It’s a technological miracle that can happen every few minutes in the mobile SimCOACH, a new vehicle equipped with lifelike manikins that simulate birth for the mother and the neonatal moments for the child. The SimCOACH is the latest component of the South Carolina Birth Outcomes Initiative, an effort led by the S.C. Department of Health and Human Services to improve the health of newborns.

While birth simulating manikins have been used for training at the major teaching hospitals in the state for years, it has been difficult for clinical professionals at rural hospitals to get to those sites, said BZ Giese, director of the initiative. The state agency spent $75,000 on Lucy. Palmetto Health is helping pay for the full SimCOACH setup, which, including staff, is budgeted for $1.1 million over the next two years. It’s one of fewer than 10 such vehicles in the country.

The vehicle, which looks like a standard recreational vehicle, took test runs to five hospitals last year. Monday’s demonstration for the media at KershawHealth marked the start of a two-year tour of 45 hospitals statewide. The goal is to hit every hospital in the first year, then return to as many as possible in the second year.

“Especially in rural areas of the state, limited resources can make it challenging for hospitals to purchase high-tech training equipment or to let staff participate in additional training off-site,” Giese said. The SimCOACH tour will give “all labor and delivery teams the valuable opportunity to learn best practices that will improve health outcomes for moms and babies in our state.”

One major goal is to reduce the number of C-sections that aren’t medically necessary. Vaginal birth, especially at full term of 39 weeks, leads to much healthier babies.

The first nurse in the earlier scenario was Giese, who led the demonstration. The second was Patti Shuler, who typically works in the nursery unit at KershawHealth. She sounded like a pro, but she isn’t a labor and delivery nurse.

“This is great because a lot of people never see babies being born, like ER nurses,” Shuler said. “It’s awesome because you can actually practice something that can happen and does happen.”

For instance, Lucy can be set up to mimic shoulder dystocia, where the baby’s shoulder becomes lodged behind the mother’s pubic bone. Even in a relatively busy hospital such as KershawHealth, where about 25 babies are born each month, doctors and nurses in the delivery room might not deal with certain unusual situations more than once a year.

“It’s good to have a controlled environment to practice in,” Shuler said.

Lucy’s eyes blink and she talks – with typical comments recorded by a Palmetto Health employee and controlled by somebody at a computer behind a window in the SimCOACH. Lucy might shout, “Don’t touch me!” or “Give me an epidural!” In the special bedside manner required in the delivery room, there are right and wrong ways to respond to those requests. It’s good to practice those, even if you might never need to use them.

Joe Young works as a nurse on the medical observation floor at KershawHealth and has no plan to work in labor and delivery. “It’s still good to keep up on it,” he said. “On my floor, we might have a pregnant patient. ... You can learn a whole lot from this.”

Lucy is a $75,000 manikin built by CAE, a Canadian company that got its start in flight simulators. The baby, when it moves on to the nursery unit in the SimCOACH, is named Hal. The nursery manikin is actually about six years old, through he’s still the same size as six years ago and simulates the vital signs of a newborn.

The SimCOACH team will lead 90-minute training sessions several times a day on each of its hospital visits. In addition to standard births, the training can address other obstetric and neonatal emergencies.

However, Lucy isn’t set up to mimic a C-section.

“If we do have to cut her, we’ll have to spend a lot of money to sew her back up,” Giese joked.

This story was originally published March 30, 2015 at 8:00 AM.