A Novel Hand‐Sewn Cervical Model for Perinatal Skills Training

Accurate assessment of cervical dilation is an essential part of perinatal skills training for physicians, midwives, and nurses. Beginning learners typically learn the sterile vaginal examination (SVE) to evaluate cervical dilation by examining women in labor. That approach requires consent of the patient and can be uncomfortable for the patient and challenging for the learner. With ruptured amniotic membranes, increasing the number of examiners may increase the risk of infection. 1 Internal cervical examinations and procedures performed through the cervix using SVE are not visible and are challenging to teach. Simulation models for teaching SVE can improve the accuracy of cervical examination, 2 and silicone-based models are used most often because they have closer tactile sensation to the cervix in labor and are commercially available, costing at least 300 to more than 1000 USD. We are unaware of official reports of the expected life span for these models. However, the authors have observed that many silicone models used in training develop significant tears, requiring costly replacement of parts and limiting their use. We developed a lightweight, portable, durable cervical examination model that can be machine or hand sewn. This model was tested for accuracy and acceptability among medical trainees. 3 Our model allows learners to visualize the instructor, and the instructor can observe the learners to coach on the technique when used without vaginal cover. After learners become comfortable, they can practice procedures with a vaginal cover to simulate the procedure without direct visualization. The purpose of this article is to describe exactly how to replicate the models and use them effectively. The senior author crafted a “beanie” hat with an opening on top using recycled athletic shirts. The hats can be placed over a newborn manikin or doll head to simulate the cervix over the fetal head. Based on informal feedback of the initial prototype, we developed a series of cervical “beanie” hats, each with varying dilatations, thicknesses, and orientation (anterior or posterior cervix) (Appendix S1). The model also includes a vaginal cover, which is a fabric bucket with an opening to simulate the vaginal introitus, made from canvas fabric and a foam sheet. With this vaginal cover, trainees can practice conducting tactile-only examinations as they would in actual patient care and how to position the hand relative to vaginal opening. The first author experienced this workshop twice as a learner and is proficient in sewing. She created a printable sewing pattern (Appendix S2) with instructions (Appendix S3) for 8 different cervical examination models. The pattern can easily be distributed and replicated, and the instructions can be modified to create other cervical examination models. (Appendix S1). Depending on experience, we expect the time to create one vaginal cover and 8 beanie hats to be approximately 4 to 6 hours (longer if exclusively using hand sewing). To start, one vaginal cover, one newborn manikin, and 4 to 8 beanie hats will be sufficient to teach the learners, and additional hats can be created later as needed. Materials to make a model were estimated at about 80, including reusing donated athletic shirts (we used a cotton/polyester blend jersey with 60% horizontal and 50% vertical stretch) and purchasing pipe cleaners, bias tape, yarn, foam sheets, and canvas fabric. Beanie hats and vaginal covers were made using a sewing machine, whereas individual cervical openings required hand stitching. The complete model is lightweight and portable. After creation, all beanie hats are measured for cervical dilatation and thickness and labeled. Effacement was calculated with the formula as 4 cm equals 0% effacement (Effacement = 100 - thickness/4 × 100). We use this model in the workshops for learners who have not experienced perinatal cervical examinations or procedures through the cervix. We divide the learners into 3 groups and allotted 18 to 30 minutes at each station. One instructor skilled with cervical examination is needed to run each station (Appendix S4). We teach 2 to 5 learners at a time and use 3 stations if the number of learners is 6 to 15. Station 1 is for cervical examination, station 2 is for placement of an intrauterine pressure catheter and a fetal scalp electrode, and station 3 is for artificial rupture of membranes and insertion of a transcervical balloon catheter. Instructors present indications and procedures, then the learners are shown how to perform procedures without and then with the vaginal cover. The model was formally tested with new family medicine residents in July 2019 and July 2021, and accuracy of the cervical examination improved after the training using this model. 1 Because formal evaluation of this workshop concluded in 2022, 31 fourth-year medical students evaluated the workshops from 2023 to 2025 and rated overall quality score an average 4. 59 on a 5-point scale (SD, 0. 91). Nine students commented positively on the ability to learn and practice cervical examination and procedures, 5 commented that the model was well made, and 3 commented that they had no prior education in cervical examinations or procedures through the cervix. We developed a novel, hand-sewn, durable, low-cost, portable training model for practicing cervical examinations and procedures through the cervix. Learners improved examination accuracy and gave high satisfaction ratings for workshops using the model. 1 Since this model was developed in 2019, we have used it for 7 years without any need for repair or replacement to this date. Although this article describes using the model as part of a workshop, it can also be used during clinical rotations because of its portability and light weight and for other learners, including midwives, nurses, and obstetrics and gynecology residents. The main purpose of this article was to share detailed instructions on how to create and use this model. However, one must have the time and skills with sewing to replicate the model. A “ready to print” pattern file is included in Appendix S2 and an editable Adobe Illustrator pattern file is included in Appendix S5 for those who wish to adapt the pattern. A portion of these study results were previously published in Family Medicine, Little SH, Heinrich LEA, Sen A, Gold KJ. Learning obstetrical cervical exam skills: development of a novel model to demystify blind procedures. Fam Med. 2023;55 (1): 51-55. doi: 10. 22454/FamMed. 55. 284433. The authors have no conflicts of interest to disclose. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.