Okay. I’m feeling a little disturbed watching this. I know there are some good things about “Noel,” the pregnant robot, but I have some questions and concerns about this method of training.
“Everything is as it would be- the patient, the way she’s positioned on the table…”
Lithotomy Position: I just blogged on how uneffective this position is for labor and delivery, and how research has shown that being upright is almost always healthier for mother and baby. Besides, who says that every woman even wants to be on her back? Check out the post “Get Off My Back!” for a summary and additional links to information on this position.
Using her for study purposes…
I’m sure that Noel is an excellent study tool, and I do see the benefit of getting to learn some maneuvers on a robot first, rather than on a real woman. However, a robot can never effectively simulate the realities of interacting with a woman in the throes of the second stage of labor. This study must be supplemented with ample time observing real labors.
“She’s like a real patient in that she’s hooked up to a fetal monitor…
Hmmm, but what if a woman doesn’t want EFM and would rather intermittent listening? EFM has been shown through various studies to not be any more effective than intermittent listening, and can often show false positives of fetal distress. Can students practice intermittent listening on the robot as well?
“We have her hooked up to an IV…”
What if the woman doesn’t want an IV, but would rather have freedom to walk, move, eat, and drink as she pleases? If the woman isn’t receiving antibiotics, pitocin, IV drugs, or an epidural, then there is no real reason for an IV.
“Other complications, such as long labor time…”
Long labors are perfectly normal! In fact, it seems that hospitals’ time constraints on labor are far too tight to allow most mothers to progress naturally in a comfortable time frame (hence, the overuse of pitocin to augment labor in many hospitals). It is important to continue to check on both mother and baby during a long labor for potential problems (and of course take care of mom if she is exhausted), but the length of labor itself shouldn’t be considered a complication.
“Having a breech baby…”
If I’m correct, the ACOG standard for breeches is a c-section. However, I have heard of a late term undetected breech before, when no one knew about the breech until the baby was already on the way out. I doubt that’s a very common scenario, but I wonder if students ever get to try a vaginal breech delivery on Noel in case they encounter it in real life? (Note that there are still some doctors and midwives who practice the art of delivering breeches vaginally.)
Finally…
I understand that there are definitely benefits to using a robot for training purposes. I think that if this is helpful to student doctors and makes for better, healthier experiences for mother and baby, then great! I’m glad that Noel is around! However, as with the advent of any new technology, we must carefully consider all pros and cons of using it. I am concerned that if this is what they are training students to think is the normal pattern of labor and delivery, then what will those students do when they have a woman who wants to squat or get on all fours? What if she won’t lie on her back hooked up to machines? What if she wants to birth naturally in a hospital setting? Can Noel effectively train students for this scenario? If not, will the student doctors get to train with real women with these wishes for birth?
Most importantly, deliviering a robot’s baby quite literally takes the humanity out of attending a birth. A woman in labor is going through probably one of the single most important and personal days of her life. She is facing one of the most difficult challenges she will ever experience, and is about to meet a little one who will change her entire being. I do hope that these student doctors are also getting a chance to train in communication, sensitivity, and patience. It may be silly, but this gives me an uneasy sensation that working mainly with a robot could lead to desensitization of the amazing range of emotions a woman is feeling as she is in labor. I hope that as students get to work with real women, they will learn the careful art of being low profile, gentle, and encouraging as they help the mother through the process of giving new life to the world.
the birth bug 