Desperate Debra

Desperate Debra – It was my first attempt to deliver a baby by caesarean section – and the fetus’s head was crushed and attached to the mother’s pelvis. To be honest, I struggle

Incisions are made in the lower abdomen and uterus I slipped my gloved hand and managed to get my fingers between the baby’s head and the surrounding uterine tissue. But it is difficult The child is firmly pressed in I had to work hard to get my hand to her head, and even though I could now cup her properly, I couldn’t pull her away. Can I hold her head tight? Can I pull harder?

Desperate Debra

The child’s mother – her name is Deborah – remains distraught over the whole tragedy His face doesn’t show what he’s feeling But Deborah has no feelings In fact, he has no face…

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So you can stop worrying Debra – Desperate Debra, to use its full trade name, is a simulator designed to help doctors practice their skills in dealing with damaged fetuses: babies who try to exit the womb in the normal way. It consists of the lower two-thirds (ie from the middle of the chest down) of a life-size female bottom, but without the limbs, made of flesh-colored silicone rubber. She has a vulva, a pre-cut abdomen and, most importantly, a uterus with a fetal head, which should come out freely between her legs as before. But that embryo isn’t going anywhere until the obstetrician—or in this case, me—can successfully pull it out.

The smart and sophisticated simulator I’m playing with started life as a costume in an obstetrician’s home workshop: a Heath Robinson-esque contraption recognized as a model of the human body. But at that stage it is not intended as a simulator for training medical personnel His sole purpose was to test the functionality of a new device called the Tiedemann tube Ironically, although Deborah’s testing equipment is now commercially available, the equipment to test it has not yet hit the market.

The inventor of the tube and ‘desperate Deborah’ is Dr Graeme Tiedemann, consultant in obstetrics and gynecology at the Victoria Hospital in Kirkcaldy, Fife. It was only after he built Deborah that he realized he could serve a purpose beyond his original purpose It’s the story of a decade of inspiring ideas, thwarted goals and transformative goals; But with a good result Although Tiedmann’s tubes are still in the gestational stage, a desperate Deborah continues to push herself.

A brief foray into basic obstetric knowledge is needed to understand Deborah’s frustration and how a Tiedemann tube can help relieve it. Evolution has gifted us with such proportionally large heads that when labor goes according to plan, the bearing process involves a bit of squeezing. Stopping a baby’s head on the way may not be a common occurrence, but it is not uncommon at all

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The standard response is to perform a cesarean section Around 160,000 babies are born in this way every year in the UK, around two-thirds of which are classed as emergencies. One audit suggested that nearly 8,000 babies are stillborn and have to be delivered by caesarean section when their mothers are fully breech. “Some babies will be so close to being born normally that it will be difficult to pick them up and out through the opening in the woman’s abdomen,” Tiedemann says. It often seems unpredictable which women are at risk of this failure “We’ve been seeing it … it’s been discussed in the medical literature since the 1940s, but 10 years ago, and most of my life as a trainer and consultant, it wasn’t really discussed.”

The skin was made from a neoprene wetsuit attached to a plastic tube; The head is cast from silicone; The rest consists of old springs and other small items lying around in his workshop

Childbirth, conflict and the best ways to deal with it are topics that are rarely explored There are strong opinions about why this happens and what to do about it, but the research evidence is scant, Tiedemann says, adding that many of these opinions are contradictory.

In prolonged labor that ends in C-section, the longer the obstetrician may labor before deciding to intervene, the more likely the baby’s head will be affected. However, concerns over the rise in the number of babies born by caesarean section are making doctors more cautious – one result of which is that medical staff may allow labor to go into labor before performing surgery. This can increase the frequency of collisions But, again, no one is sure

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When obstetricians performing an electric C-section open a mother’s abdomen, they usually see the baby’s head. They can easily remove the baby by reaching around and under “When you’re doing a C-section for a traumatized baby, you’re cutting in the same place, but you can hit the shoulder because the baby is so far [in the birth] canal] as I discovered for myself, it’s more difficult to put your hand over the baby’s head,” Tiedemann says. It hurts your toes,” Tiedman says. “It gets your heart rate up to about 200 and you’re sweating because you know you have five to ten minutes before the results come in. The clock is ticking.”

If the baby’s head is attached to the mother’s pelvic area, common sense suggests that it may help if another person gently pushes back the head, which is visible through the mother’s dilated cervix. “In our office, if the woman is fully dilated and you expect the baby to come out normally [but it doesn’t] … the receptionist will ask to push every fifth time,” Tiedman says. – Doctors are still in training, they are still experienced; This means that requests to push during a planned cesarean are not unusual. The Tiedman Tube is designed to make this maneuver safer and more effective

There are many unlikely sources of creativity and innovation What seems to have inspired Tiedemann to develop his device was the distinctive sound of wellington boots being released from wet, muddy ground: a squishy, ​​slipping, gurgling sound. When the affected fetal head is released from the uterus, it is often accompanied by a similar suction sound, the result of air entering between the obstetrician’s fingers to fill the space. “It occurred to me years ago that if air can’t get in, why not put a tube in the vagina so it can come under the baby’s head.” Sometimes, when he felt the baby might attach, Tiedemann would thread a sterile silicone tube through the woman’s vagina and into the uterus near the baby’s head. Passing the air this way releases any suction power that keeps it where it is.

Tiedmann didn’t do much with the idea until 10 years ago, when an intern who was having serious trouble pulling his head asked him to rethink the issue. Around the same time she met Professor of Obstetrics Andrew Shannon and Consultant Midwife Annette Briley from the Women’s Health Academic Center at St Thomas’ Hospital. Together, they came up with a device – the Tiedemann tube – to make the embryo more manageable while releasing any voids.

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The tool consists of a hard plastic tube that is transferred to a soft silicone cup. Pressure on the fetal head is applied through four pads that protrude from the cup Holding the device by the tube, the user applies pressure by opening the cup through the dilated cervix at the head. This pushes the baby back into the uterus while releasing the pressure it holds, making it easier for the midwife to remove. Because pressure is evenly distributed among the four pads with a total surface area greater than the user’s toes, the risk of inadvertent injury is minimized.

The team received the money to hire a product designer using computer-aided design technology and 3D printing to create a prototype. “We were at the point where we were making it out of silicon, when we realized we should really test it in a simulator before we start testing it on women,” Tiedmann says. Such a simulator did not exist, so he decided to make it himself

Tiedemann was able to do this

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