Teaching Childbirth: Top 5 Tools of the Trade

How did people --- doctors, midwives --- learn about childbirth in the past, and how is it done currently? Of course, illustrations depicting what was assumed and known about the female reproductive system have been around for centuries.  My interest is in three-dimensional models.  I will outline a few in the post below.

#5: The antique dolls

These 19th-century dolls were used to teach midwives about the mechanics of childbirth [1].  They were typically made from leather, catgut, and porcelain.  These dolls have limited stretch, mobility, and, frankly, realism, although the attention to detail is present (check out the stretch marks).  The baby is unable to pass through the vaginal canal in these models; instead, a panel on the stomach opens and the baby is lifted out.

There are other dolls, made out of other materials.  Most interestingly is the crochet doll shown below.  Benefits of crochet is that it is stretchy; on the other hand, it is hardly realistic (unless you add copious amounts of pubic hair, as shown).

#4: The Made-in-China childbirth skills training model

Four models in one package are now available for purchase by the general public, so if you ever wanted your own special vagina, this is your chance [3].  This package includes a cervical check model, a childbirth model with fetus, and a perineum cutting simulation.  Wait, what was that?  Oh, yes, an episiotomy model.  Known as "the unkindest cut," episiotomy is a surgical incision in the perineum.  The idea is that such a cut will help the baby be born faster, will prevent tearing, and will be easier to sew up.  Although the baby usually does flop out after the perineal opening is widened, the incision typically tears further, creating both a cut and a tear.  And it has been shown that a clean cut is just as easy to sew up and is just as quick to heal as a natural tear.  Episiotomy is a topic of great debate (and great ridicule) in the West, including the US and most European countries.  But in China, the episiotomy rate ranges between 65% to 93% with a mean of 82% in 2001.  By comparison, the US episiotomy rate was found to be around 33%; the UK rate, the lowest in any European country, was 13%.


#3: The $50,000 pelvis named SIMone

SIMone is probably the most comprehensive pelvis money can buy.  You can practice birthing scenarios at your heart's delight with this amazing computerized model [5].  SIMone's makers suggest that this pelvis also imitates sounds of maternal distress.  I am not quite sure where the speakers are; to be honest, if a pelvis started moaning and crying, I may moan and cry too.


#2: The UK model pelvis and associated childbirth training

This model pelvis and newborn is used to teach obstetricians and any doctor that works around newborns.  The doctors train in delivering the baby in different complicated situations (e.g., shoulder dystocia), and are required to complete this training annually [2].  The doctors may benefit from this training (at least temporarily) because they practice real techniques in real time with a real audience, which simulates the intensely stressful situation that the doctors might encounter with a real woman.

This is actually pretty cool, and I am glad to see some rigorous training being done with these models.


#1: The Japanese Robotic Vagina

Oh, the Japanese.  They come up with amazing things, like the boyfriend arm pillow for women, the woman's lap pillow for men, and Le Trung's perfect woman named Aiko.  Now, we cut to the chase, eliminating the middle-man: the robotic vagina.

I must say that I searched far and wide for a reputable source for the robotic vagina, but came up with pages of URLs of the form "Japanese Robotic Vagina: Now Making Childbirth Even More Horrifying."  A still picture makes little sense; you have to see the video.  With the sound off.  Those servo motors are ridiculously loud.

Conclusion

With the exception of the early birth dolls, which contained a full body and an expressionless face, the models of modern-day have, at best, only a torso, a highly realistic and anatomically correct vagina, and sometimes stumps for legs.  Why is this unsettling?  Well.  Pregnant women, and women in labor, frequently complain about doctors not really seeing them as people.  Doctors come in, look at the belly, look at the chart, bark some orders, and leave.  "He didn't even look at my face," women complain, without loss of generality to gender of the physician.  This fragmentation between woman and her body, between woman and her genitalia, transcends the physician boundary and permeates women.  Women describe their bodies as outside themselves.  "The uterus contracts," they say, de-emphasizing that the uterus is part of themselves [6].

Using this faceless, limbless, body-less model of a vagina, and training doctors to look only there, with total disregard to the rest of the woman as a person, perpetuates the notion that women are invisible: only the reproductive tract is important, and only the product of the production model of childbirth (i.e., the baby) is important.  But to many women in Western society, the experience of birth is just as important as the outcome (the healthy baby).  If we, women, are treated by what amounts to medical superiors as a limbless abdomen, we are made to feel insignificant.

Of course, building a full-body model, complete with a face capable of emotion, is prohibitive.  But perhaps incorporating sensitivity to the concerns and emotions of women in labor into the training, when using these models, will make a step in the right direction.  Perhaps it will help.

Note

There are many other childbirth models available for purchase both by hospitals and by individuals.  This list is not intended to be exhaustive.

References

[1] Wright, A. (2009) Birthing Dolls. ProfoundlySuperficial (blog), May 24, 2009. Accessed 11/3/2010
[2] Bavley, A. (2008) KU Hospital First in Nation to Use Course for Childbirth Emergencies. The Kansas City Star via NursingLink, August 14, 2008. Accessed 11/3/2010
[3] Childbirth Skills Training Model. Accessed 11/3/2010.
[4] Graham, I. D., Carroli, G., Davies, C. and Medves, J. M. (2005), Episiotomy Rates Around the World: An Update. Birth, 32: 219–223. doi: 10.1111/j.0730-7659.2005.00373.x
[5] Gynecological Models, Obstetric Models, and Childbirth Models. Accessed 11/3/2010
[6] Martin, E. (1987) The Woman in the Body. Beacon Press, Boston.