1. birthing simulator abdomen system, such as MamaNatalie
2. boggy and a firm fundus ball (these can be foam/rubber balls whose firmness represents the desired effect)
3. towel to roll up and use as a fundus positioning aid
4. 1 disposable pastry bag per trial
5. 1 reusable pastry bag per trial
6. 1 pastry bag coupler set (see picture) per trial (these are reusable)
7. 1 can of cherry pie filling per Simulation trial (sugar-free is desirable)
8. disposable underpad
9. birthing manikin genitalia part
10. can opener
11. rubber bands
12. Press'n seal wrap
13. 18 gauge needle
14. scissors
15. 2 wash cloths per trial used
16. 2 medium-sized binder clips

1. 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.

2. 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.

3. 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.

4. 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.

5. Roll up a wash cloth and circle around your hand as shown in Photo A. Place this rolled wash cloth in the cavity of the simulated vagina, leaving a central opening as shown in Photo 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. See Photos B and C.

6. Peel back the neoprene cover to expose the inside of the birthing simulator abdomen. Drop the vagina/pastry bag set-up into the vaginal slit of the birthing simulator abdomen and use the neoprene fabric of the slit to conform around the vaginal piece. See Photos D, E, and F.

7. Secure the top of the pastry bag to the black, inner bag of the birthing simulator abdomen 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. See Photo D.

8. Load the simulated abdomen belly follows:

• Place a rolled towel in the lower portion of the belly to support appropriate fundal height desired.
• Place the fundal ball (of desired firmness) on top of the rolled towel. Maintain position using a large rubber band.
• Place optional (change-out fundal balls) in the side pockets of the birthing simulator abdomen. This allows for easy change-out by the SP.
• Replace the neoprene cover back over the birthing simulator chest area. See Photos D, E, and F.

9. To use:

• Place the birthing simulator around the abdomen of the standardized participant (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 Photos 1-3.
• SP should also wear leggings or other snug-fitting shorts/pants to protect SP's privacy and minimizing potential for staining clothing. Cherry pie filling may stain clothing. Place an disposable pad between the back of the birthing simulator and the SP’s body to contain spillage.
• When hemorrhage is desired, the SP should be instructed to a squeeze the pastry bag by placing hands within the sides of the birthing simulator abdomen. This will release the cherry pie filling (hemorrhage with clots) out of the vagina and into the bed on to the disposable pads. See Photos 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.