 What is Desperate Debra?
I've pushed my gloved hand inside and managed to slide my fingers between the baby's head and the surrounding uterine tissue. The baby's mother – she's called Debra – remains impassive throughout these agonised fumblings. But then Debra has no feelings. Debra – Desperate Debra to use her full trade name – is a simulator designed to help doctors practise their skill at dealing with impacted foetuses: babies that get stuck trying to exit the womb by the normal route. 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. 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. For the baby's head to get stuck on the way out may not be usual, but it's by no means a rarity. One audit has suggested that roughly 8,000 babies get stuck and have to be delivered by caesarean at a stage when their mothers are fully dilated. "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." Which women are most at risk of this setback seems to be largely unpredictable. 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. In a protracted birth that's destined to end with a caesarean, the longer the labour is allowed to go on before the obstetrician decides to intervene, the greater the likelihood that the baby's head will become impacted. By slipping a hand round and below it they can easily guide the baby out. As I'd discovered for myself, sliding a hand around the baby's head is then far more difficult.
 Desperate Debra is a training device obstetricians use to simulate delivering an impacted fetus.
 Desperate Debra is a training device obstetricians use to simulate delivering babies.  Desperate Debra is a training device obstetricians use to simulate delivering an impacted fetus.  Desperate Debra is a training device used to simulate cesarean deliveries.  Desperate Debra is a training device obstetricians use to simulate delivering a baby when the mother has preeclampsia.