Adaptation of Mama Natalie for more realistic postpartum hemorrhage
HomeGrown Solution Number
Identification of the Problem
We needed a method for a Standardized Postpartum Patient to experience a Postpartum Hemorrhage using the Mama Natalie birthing abdomen system. We also needed a way for students to realistically assess a postpartum patient’s fundus. Mama Natalie’s bleeding was too watery. We desired a more realistic consistency to include blood clots.
We utilized the following technique with cherry, pie filling to create a more realistic postpartum hemorrhage experience.
Blending extra mannequin parts and simple medical supplies to create a Simulated Postpartum Hemorrhage Abdomen for a Standardized Patient to wear and puppeteer.
- Mama Natalie birthing abdomen
- A boggy and a firm fundus ball (these can be foam/rubber balls whose firmness represents the desired effect (as in Noelle mannequin)
- Towel to roll up and use as a fundus positioning aid
- 1 disposable pastry bag per trial
- 1 reusable pastry bag per trial
- 1 pastry bag coupler set (see picture) per trial (these are reusable)
- 1 can of cherry pie filling per Simulation trial (sugar-free is desirable)
- Absorbable chux pads
- Birthing mannequin genitalia part (as in Noelle’s)
- Can opener
- Rubber bands
- Plastic, press and seal wrap
- 18 gauge needle
- 2 wash cloths per trial used
- 2 medium-sized binder clips
Steps to Creating the Solution
- Open the cherry pie filling with the can opener. Load a disposable pastry bag with the full can of cherry pie filling. Close the end of the loaded pastry bag with a rubber band. Do NOT cut tip off at this time. Set aside.
- Apply the coupler set to the reusable pastry bag as instructed by product details. Pull reusable pastry bag down to expose the inside ring of the coupler set.
- Cut a square piece of Press-n-seal wrap, large enough to cover the inside coupler opening. Apply wrap to this place securely. Using 18 gauge needle, make several small slits in the newly created film without overstretching or puncturing.
- Cut the tip off of the loaded disposable bag and carefully place into the reusable pastry bag without breaking through the film created with the press-n-seal wrap. Tightly close the reusable pastry bag with a rubber band.
- Roll up a wash cloth and circle around your hand (See Picture A). Place this rolled wash cloth in the cavity of the Noelle Vagina, leaving a central opening (Picture B) Load the tip of the Pastry bag set-up into the central opening of the wash cloth in the vagina and insert it until the tip is just above the vaginal opening. (Picture B & C)
- Peel back the Neoprene cover to expose the inside of the Mama Natalie Belly Drop the vagina/pastry bag set-up into the vaginal slit of the Mama Natalie Belly and use the neoprene fabric of the slit to conform around the vaginal piece. (Pictures D, E, & F)
- Secure the top of the pastry bag to the black, inner bag of the Mama Natalie either with the loop on the top of the reusable bag by placing it through the snap and snapping it closed or with binder clips to keep the bag from falling over. (Picture D)
- Load the Mama Natalie belly follows: a. Place a rolled towel in the lower portion of the belly to support appropriate fundal height desired. b. Place the fundal ball (of desired firmness) on top of the rolled towel. Maintain position using a large rubber band. c. Place optional (change-out fundal balls) in the side pockets of Mama Natalie Belly. This allows for easy change-out by the SP. d. Replace the neoprene cover back over the Mama Natalie chest area. (See Pictures D, E, & F)
- To use:
- Place the Mama Natalie Belly around the abdomen of the standardized patient (SP). Adjust the belt provided to fit comfortably yet snugly. This should be used over clothing to prevent rubbing.
- Have SP don a patient gown to cover belly system. (See Pictures 1-3)
- SP should also be wearing leggings or other snug-fitting shorts/pants (to protect SP's privacy and staining of clothes). Cherry-pie filling may stain clothing. Place an absorbent pad between the back of the Mama Natalie Belly and the Standardized Patient’s body to contain spillage.
- When hemorrhage is desired, SP should be instructed to a squeeze the pastry bag by placing hands within the sides of the Mama Natalie Belly. This will release the cherry-pie filling (hemorrhage with clots) out of the vagina and into the bed on to the chux pads. (See Pictures 4-6)
- To change firmness of fundus, simply remove rubber or foam ball and return to side belly storage. Replace with desired firmness ball, securing with rubber band.