Providing state-of-the-art equipment

Life-saving manikin: Desperate Debra

A silicone abdomen that simulates difficulty during advanced labour has been developed for vital training purposes thanks to charitable donations.

Desperate Debra® is a manikin used by clinicians to practise how to deal with emergency situations such as fetal impacted head syndrome, a life-threatening complication associated with having a caesarean-section. Currently, a quarter of all births in the UK are performed this way.

The manikin was developed in 2011 by Annette Briley, a consultant midwife at Guy’s and St Thomas’ along with a team of experts after they were granted £30,000 of funding. It simulates a realistic mother and baby for practising delivery techniques and allows clinicians to confirm the presentation and position of the baby’s head in labour. During emergency caesareans, which affect around 20,000 births per year in the UK, there is a chance the baby’s head may get stuck in the pelvis if the woman is in the advanced stages of labour.

Tool for teaching 

doctor with manikinGenerous donations have been crucial in developing the manikin and rolling it out in medical training. ‘We are confident that it will improve the skills and confidence of obstetricians and midwives who are faced with these challenging deliveries,’ says Annette. 

Other than the real-life experiences of trainee midwives and doctors, there is no alternative sophisticated training model that can be used to prepare for these challenging situations and due to the unpredictable nature of child birth, more experienced staff may not always be on hand to take over. Before this technology was developed, existing simulators missed out several elements that need to be managed when a baby is being delivered after a particularly long labour.

‘The need for an emergency caesarean can develop very quickly and situations can rapidly deteriorate,’ says Professor Andrew Shennan, consultant obstetrician at Guy’s and St Thomas’, who also helped to develop the manikin.

‘Although thankfully these life-threatening situations are rare, this means that doctors often do not get to experience them before they are faced with them for the first time,’ he says.

‘Desperate Debra® will allow doctors to experience and practise dealing with the difficulties of these scenarios. The simulator can be adjusted to different difficulties and is highly realistic in terms of how the baby’s head and neck move,’ he explains.


Measuring its success

A recent research study which featured 30 doctors, trialled the simulator at three different difficulty settings to test the effectiveness of Desperate Debra®. It compared the ability of senior and junior doctors to deliver the baby, as well as their opinions about how realistic the simulator was. The results showed that 87% of doctors think it is realistic and 93% say it is a useful training device. 

‘We are pleased to have such positive feedback from doctors involved in the study,’ says Professor Shennan. ‘We have proven that Desperate Debra® is useful and we hope the use of the simulator will reduce the likelihood of serious complications occurring during emergency caesareans,’ he explains.

Preparing for challenges

This investment is also proving to be a valuable teaching tool for many different childbirth and delivery situations such as internal examinations. By using this manikin to train for demanding clinical situations in an environment that is realistic but safe, staff can become more competent and confident in real-life situations. Experts from Guy’s and St Thomas’ and NHS Fife, who designed Desperate Debra®, have recently taken action to make it a mandatory training device for all gynaecologists and obstetricians. 

‘I wish I’d had the chance to train with a simulator before encountering the real thing,’ says Dr Graham Tydeman, a consultant in obstetrics and gynaecology at NHS Fife.

‘Simulators that accurately recreate a clinical experience, particularly in rare emergency situations where consequences can be catastrophic, must be the way forward,’ he says. ‘This study demonstrates the evidence that this device works and has the potential to really improve safety.’


Donations enable us to buy specialist equipment like Desperate Debra® that improve patient care and even save lives. You can help by making a donation to Guy's and St Thomas' today.

Watch the video below to see how the manikin works.