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Avbirth – Shoulder Dystocia Simulation Guidance & Tips

This article outlines recommended setup, positioning, and facilitation practices to help you run safe and effective shoulder dystocia simulations.

The Avbirth supports realistic shoulder dystocia scenarios, allowing learners to practice time-critical clinical interventions in a controlled environment. Because these maneuvers involve applied pressure and repositioning, proper preparation is essential to maintain both scenario realism and Standardized Patient (SP) safety.

Shoulder Dystocia: Safety & Pre-Simulation Setup

Shoulder dystocia simulations require applied force and movement of the SP. A thorough pre-brief and equipment check help prevent injury and ensure the scenario runs smoothly.

Required Setup

Always use the comfort foam during shoulder dystocia scenarios.
The comfort foam:

  • Distributes force across a wider surface area
  • Stabilizes the device during maneuvers
  • Reduces pressure on the SP’s abdomen and pelvis

Test Before the SP Wears the Device

Before the SP dons the Avbirth:

  • Practice applying suprapubic pressure on the device to understand how much force is required to achieve the desired effect.
  • This prevents learners from discovering the pressure threshold while the SP is wearing the device.
  • Confirm that:
    • Fluid connections are secure
    • Scenario settings are correctly configured

Completing these checks beforehand reduces delays and improves SP comfort.

SP Communication

Clear communication with the SP is a critical safety measure.

Before the simulation:

  • Review scenario expectations and planned maneuvers.
  • Explain how and when physical pressure may be applied.

During the simulation:

  • Encourage the SP to provide real-time feedback about discomfort or strain.
  • Remind the SP that they may use the Avband emergency button at any time if they need to pause or stop the scenario.

Positioning Guidance

Proper positioning ensures the simulation remains clinically realistic while minimizing strain on the SP.

Device Positioning

When fitting the Avbirth:

  • Ensure the simulated genitalia extends slightly past the SP’s pelvis for proper visual alignment.
  • Confirm that straps are secure but not restrictive.
  • Reassess device alignment after the SP moves into the final birth position, as positioning may shift during transitions.

McRoberts Maneuver

The McRoberts maneuver involves significant movement of the SP’s legs and hips, so preparation is essential.

Before the scenario:

  • Assess the SP’s hip mobility and comfort range.
  • Identify any limitations that may affect positioning.

During the maneuver:

  • Lift the SP’s legs in a controlled and coordinated manner.
  • Avoid overextending the hips.
  • Continuously monitor the SP’s comfort, particularly in the:
    • Hips
    • Lower back
    • Shoulders

Suprapubic Pressure

When facilitating or coaching learners:

  • Reinforce correct hand placement just above the pubic bone.
  • Instruct learners to apply controlled downward and lateral pressure, rather than excessive vertical force.
  • Emphasize technique over strength to prevent unnecessary discomfort.

Scenario Enhancement & Realism Tips

Simulation realism can be increased through intentional use of fluids and visual elements. These enhancements should always align with the scenario’s learning objectives.

Fluid Configuration

For scenarios involving increased bleeding:

  • Connect two blood bags instead of one blood bag and one amniotic fluid bag.
  • Verify all tubing connections are secure before loading the bags into the fluidics chamber.

Blood Clots for Visual Assessment

To simulate realistic blood loss:

  • Place simulated blood clots onto a blue pad to provide learners with a visual cue for assessing bleeding volume and characteristics.
  • Position an additional blue pad between the SP and the device prior to the scenario to simplify cleanup and protect clothing.

Facilitation Reminders

To maintain control of the scenario:

  • Avoid running fluids during advanced fetal descent unless it is intentionally part of the learning objectives.
  • Guide learners to focus on correct technique rather than forceful manipulation.
  • Continuously balance clinical realism with SP safety.

Best Practices Summary

Effective shoulder dystocia simulations require preparation, communication, and careful monitoring throughout the scenario.

Key practices include:

  • Using the comfort foam at all times
  • Pre-testing applied pressure before the SP wears the device
  • Confirming proper SP and device positioning
  • Encouraging open communication and use of the Avband emergency button

By following these guidelines, educators can deliver high-fidelity shoulder dystocia training while maintaining a safe and supportive environment for Standardized Patients.