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Training System for Vaginal Examination and Fetal Head Assessment

Team Members:
  • Kimber Ashman
  • Aaron Chang
  • Ian Graham
  • Nichaluk Leartprapun
  • Patience Osei
  • Mihika Reddy
  • Barrett Yates, MSE
  • Sunny Chen
  • Tor Inge Garvik, MSc
  • Cherrie Evans, CNM
  • Kusum Thapa, MD
  • Blami Dao, MD
  • Annie Clark, CNM
  • Harshad Sanghvi, MD


Many caesarean sections are preventable. During our August field immersion trips in Nepal and India, we witnessed high rates of caesarean sections and low rates of instrumental deliveries. In low- and middle-income countries, caesarean sections not only increase costs, but also maternal and fetal morbidities. From the discussions we have had with OBGYNs and midwives in India and Nepal, along with members in the public health sector, we have recognized that a key contributor to the high prevalence of caesarean sections is the lack of training in managing the progression of the second stage of labor and performing assisted deliveries. Many midwives and skilled birth attendants do not have the confidence to perform proper fetal head assessments during vaginal exams, which is critical to the decision-making process for appropriate referral for assisted delivery. Currently, there are no low-cost labor management training simulators for LMICs that adequately teach fetal head assessment.

Our team is creating a low-cost simulation tool that provides a method of safely practicing the vaginal examination skills that are essential to clinical decision making during the second stage of labor. Our device will help teach proper assessment of fetal head position, station, orientation, and moulding during a vaginal exam. We hope to enable midwives and SBAs to feel more confident in managing labor by allowing them to practice the skills that are vital to appropriate decision making and thereby prevent unnecessary caesarean sections.

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