laerdal SimMom Directions For Use Manual Download Page 25

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Intr

oduction

Setup

Softwar

Maintenance

Spar

e Par

Specifications

Performing Simulations

Perf

orming

Sim

ulations

– If the limbs were properly aligned beforehand, they should follow

their own path and emerge realistically through the birth canal.

– This technique allows the puppeteer to perform other functions,

such as midwife, birthing partner, etc.

Two-Handed Delivery

– With one hand, grasp the baby by the back of the trunk. This hand

performs most of the pushing.

– Place the palm of the second hand along the chest of the baby.

Use the tips of two fingers to manipulate the baby’s chin or mouth
and to rotate the baby’s head when required. The second hand
can also hold the umbilical cord and arms in position.

– As the head descends further, the puppeteer can adjust the

second hand grip to push up under the chin and better extend
the baby’s head.

– This techniques allows the puppeteer to better control the head.

Note:

The trainer should practice and become familiar with

the delivery process prior to any training situation.

Deliveries

SimMom is capable of simulating normal, breech, instrumental, and
shoulder dystocia deliveries.

Normal Delivery

For normal delivery simulation, see “one-handed” or “two-handed
delivery” in the Delivery Techniques section.

Breech Delivery

A breech delivery can be performed using one or two-handed
delivery technique.  The second hand manipulates the baby’s limbs
and umbilical cord.  To perform a breech delivery:
1.  Apply extra lubrication in the lowest part of the birth canal so the

baby’s bottom can slip up over the J-shape of this part of the canal.

2. Change grip on the baby’s trunk so the delivery can be controlled

by holding the head.

3. Flex the baby’s neck so the head passes more easily through the

birth canal.

4. The baby can now be delivered using Moriceau-Smellie-Viet

maneuver.

Note:

It is easier to perform a breech delivery if the cervix is

not installed.

Forceps Delivery

To perform a delivery with forceps instrumentation:
1. Reduce lubrication on the baby’s head and in the birth canal to

prevent the forceps from slipping off the scalp.

2. Flex the head so the forceps can be positioned correctly.
3. Coordinate the trainees so that they only pull on the forceps

when the puppeteer is simulating the mother’s expulsive effort.
Otherwise, the forceps may slip off the head.

4. During the rotational part of forceps delivery, coordinate the

actions of the puppeteer and trainee so that the rotation of the
baby’s body follows the rotation of the forceps. Otherwise, the
forceps may slip off the scalp.

Suction Delivery

To perform a suction delivery using Kiwi/Ventouse instrumentation:
1. Reduce lubrication on the baby’s head to prevent the suction

cups from slipping off the scalp.

2. A facilitator may be needed to coordinate the trainees as they

pull and the puppeteers as they push.

Note:

Step 2 is less critical for suction delivery than for forceps

delivery.

All Fours Delivery

All four delivery can be performed using one or two-handed delivery
technique, though the latter is recommended. To perform a delivery
on all fours:

Note:

All fours delivery requires more force and involves a

different technique than other delivery types. It should be
practiced several times before being used in a scenario.

1. Push diagonally upwards, into the pelvic floor following the J-shape

of the birth canal.

2. Guide baby horizontally through birth canal opening.

– If using two-handed technique, apply continuous upward

pressure with the second hand in order to keep the head
flexed and to prevent baby’s body from sagging.

Note:

For more stability, the puppeteer should consider resting

his or her elbows on the bed or on a pillow positioned on the
bed.

Shoulder Dystocia Delivery

A shoulder dystocia delivery is usually performed using two-handed
technique. Control of the baby’s arms is important because the
posterior arm must be placed in the proper position. To perform a
shoulder dystocia delivery:

1. Wedge anterior shoulder against the pubis while descending the

baby down the birth canal;

2. Coordinate the rotational maneuvers of the puppeteer and the

student so their movements match each other.

Note:

Depending on the level of supra-pubic pressure applied

by the trainee, the puppeteer may experience discomfort. The
puppeteer may find it more comfortable to hold the baby in a
more anterior position so that the hand is between the baby
and the anterior abdomen wall.

Note:

It is easier to perform a shoulder dystocia delivery if the

cervix is not installed.