Inside the Collection

Midwifery training simulator

Obstetric phantom
2001/55/1 Anatomical model, female abdomen and foetus, ‘obstetric phantom’, maker unknown, [United Kingdom], [1900] Collection: Powerhouse Museum
Many objects in the Powerhouse Museum’s health and medicine collection have a visceral, unique and incidental beauty to them. The skull saw , the mortuary table, even the speculums.  And some objects engender an inspired beauty in both form and function, such as the obstetric phantom.

Even at a glance the viewer can determine that the obstetric phantom, or birthing simulator relates to a certain area of the female anatomy. Though without seeing the model infant that accompanies the phantom, some viewers may need more than a glance to ascertain its intended purpose. And although not anywhere near as naturally marvellous as the real thing, the birthing simulator is actually an excellent midwifery teaching tool. So good in fact that barely a change was made in the design of these tools in the hundred or so years prior to the manufacture of this example. There is also an interesting story that goes with this design of obstetric phantom.

Medical simulation has been has been recorded in Sanskrit up to 2000 years ago. And of course the Ancient Egyptians had comprehensive knowledge of anatomy garnered from the practice of mummification which they articulated prolifically, and many cultures made clay models of human dissection, presumably both for art and education. Specifically female anatomical models were used by the Chinese from the mid 1600; however this had more to do with the morality code that disabled male doctors from touching female patients than training in medicine. Although not the first birthing simulators made, pragmatic obstetric simulators were developed in France in the late 1750s by the midwife Madame du Coudray, and the story of her teaching, success and demise is quite a drame.

In 1759 France was suffering demoralising losses in the Seven Years War, compounding the impasse, and great loss of life, of the War of Austrian Succession ten years earlier. France’s population had been greatly reduced, and many of the men not serving in her armies were those severely disabled by war wounds. The people were growing more discontented as the country’s debt rose, and thus taxes. France’s population needed to recover and King Louis XV began to see France’s femmes utérus as a national asset. High infant mortality was seen as another war to win, and this is where Madame du Coudray became of interest to the king.

Madame du Coudray’s life was remarkable, and Nina Rattner Gelbart has written a volume on her life, The King’s Midwife: A History and Mystery Madame du Coudray, 1998, painting du Coudray as an unsung French national heroine, which may well be true, but it is the midwife’s training methods, and use of simulators which is particularly inimitable. Du Coudray was an established midwife who had been teaching her skills in Paris when Louis XV granted her a letter giving her access to all of France to teach women, particularly peasant women, skills in midwifery. As much of France’s peasantry were illiterate, manuals and the like were out of the question. However, all the skills required for farming, food preparation, cooking and sewing were learned by demonstration; thus du Coudray developed a highly detailed didactic model with which she could demonstrate not only how to birth and infant, but the multifarious situations that can occur during labour. Like the Powerhouse Museum’s example, du Coudray’s simulator, or machine, was made of leather, cut precisely to mimic a woman’s pelvis, stuffed with horse hair. The model infant was likewise very realistic.

Many of the machines were left in the towns du Coudray visited, and her skills were passed on to all the capable women of the districts. Of course a simulator can never match up to actual experience, and there is no room for complacency in birthing, but du Coudrey’s obstetric phantoms must have had an effect, as infant mortality began to lessen. This cannot be solely attributed to one thing, but a knowledge of obstetrics amongst a growing group of the population must have been a factor.

The French Revolution eventually disposed of the omnipotence of the French monarchy, and of course Mme du Coudrey’s royally endorsed program ended. She avoided the guillotine, but du Coudrey died shortly after the revolution in 1794, and it seems that her structured method of using simulators and teaching so others can pass on the skills waned – at least as a program. The design of her machine though was adopted across the continent and the UK by the medical profession, quite unchanged in design, as the Powerhouse Museum’s example can confirm. In fact, the concept of du Coudray’s machine is still used in obstetric simulators today. Only the materials have changed.

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