 What inspired Tydeman to develop his device?
I've pushed my gloved hand inside and managed to slide my fingers between the baby's head and the surrounding uterine tissue. She comes with a vulva, a pre-cut incision in her abdomen and, most importantly, a uterus containing a foetal head that should, in the normal way of things, be free to emerge between her legs. The clever and sophisticated simulator I'm playing with started life as a lash-up in an obstetrician's home workshop: a Heath Robinson-style contraption barely recognisable as a model of the human body. But it wasn't at that stage intended as a simulator for training medical staff. Its sole purpose was to test the effectiveness of a novel device called a Tydeman tube. Paradoxically, although the testing equipment, Debra, is now commercially available, the device it was intended to test has yet to reach the market. The inventor of the tube and of Desperate Debra is Dr Graham Tydeman, a consultant in obstetrics and gynaecology at Victoria Hospital in Kirkcaldy, Fife. Only after he'd built Debra did he realise that she might serve a purpose beyond his original intention. Although the Tydeman tube is still in gestation, Desperate Debra herself is now thriving. To understand the desperation of Debra and how the Tydeman tube might help to relieve it requires a brief foray into basic obstetric knowhow. Evolution has endowed us with heads proportionally so large that even when labour runs according to plan, the delivery process involves a bit of a squeeze. For the baby's head to get stuck on the way out may not be usual, but it's by no means a rarity. "Some of the babies will be so close to coming out by the normal route," says Tydeman, "that it's then difficult to get them back up and remove them through the hole in the woman's tummy." "We just observe that it happens… It's been discussed in the medical literature since the 1940s, but until 10 years ago, and throughout my training and most of my life as a consultant, it wasn't really talked about." Considering the universality of childbirth, impaction and the best way of dealing with it are topics that seem to have gone remarkably unstudied. "There are strong opinions about why it happens and what to do, but very little research evidence," says Tydeman, adding that many of these opinions are contradictory.
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