Noelle's given birth in Afghanistan, California and dozens of points in between. She's a lifelike, pregnant robot used in increasing numbers of medical schools and hospital maternity wards.
The full-sized, blond, pale mannequin is in demand because medicine is rapidly abandoning centuries-old training methods that use patients as guinea pigs, turning instead to high-tech simulations. It's better to make a mistake on a $20,000 robot than a live patient.
The Institute of Medicine, an arm of the National Academy of Sciences, estimates that as many as 98,000 U.S. patients die annually from preventable medical errors.
"We're trying to engineer out some of the errors," said Dr. Paul Preston, an anesthesiologist at Kaiser Permanente and architect of the hospital chain's 4-year-old pregnancy-care training program, in which Noelle plays a starring role. "We steal shamelessly from everybody and everywhere that has good training programs."
Noelle, from Miami-based Gaumard Scientific Co. Inc., is used in most of Kaiser's 30 hospitals nationwide, and other hospitals are putting in orders. The Northwest Physicians Insurance Co. is sponsoring similar training programs in 22 hospitals in Oregon and Idaho, rolling out Noelle initially at five of them.
Other companies make lifelike mannequins to train paramedics in emergencies, but Noelle appears to be the only high-tech, pregnant model available.
Noelle models range from a $3,200 basic version to a $20,000 computerized Noelle that best approximates a live birth.
Programmed for complications
She can be programmed for a variety of complications and for cervix dilation. She can labor for hours and produce a breach baby or unexpectedly give birth in a matter of minutes.
She ultimately delivers a plastic doll that can change colors, from a healthy pink glow to the deadly blue of oxygen deficiency. The baby mannequin is wired to flash vital signs when hooked up to monitors.
The computerized mannequins emit realistic pulse rates and can urinate and breathe.
"If she is bleeding, there will be ample blood in evidence everywhere," Preston said one rainy day recently as he put Noelle through her paces at Kaiser Permanente's Vallejo hospital.
About 50 doctors, nurses and others involved in caring for pregnant women attended the training session, which started with Noelle hooked up to standard delivery monitoring machines and tended to by nurses and doctors.
David Isaza, an engineer with Gaumard, sat in a corner with a laptop, sending wireless signals to Noelle. With a keystroke, he can inflict all sorts of complications, overriding any preprogrammed instructions.
Giving birth to twins
As Noelle's heart rate increased, a nurse examined her under the sheets. An umbilical cord was visible — not a good thing. Immediately, the nurse called a "code 777." Several more medical personnel burst into the room and wheeled Noelle off to the operating room where she gave regular birth to twins after a frenzied 20-minute operation.
Then it was time for the debriefing back in a conference room.
"We wheeled her through the hallway with her gown open," complained one nurse.
"It was too loud," another said of the chaotic scene that include more than 30 people jammed into a small operating room.
And so it went for another 30 minutes until it was a second group's turn with Noelle.
"The mannequins are cool," Preston said. "But it is only one training tool."
Nobody knows this better than Robbie Prepas, a Laguna Beach midwife who is a consultant to Gaumard.
In 2004, Prepas was working for the Centers for Disease Control and Prevention on a $1 million Gates Foundation grant to train Afghan medical personnel in the care of women and children. Afghanistan has the world's second-highest infant mortality rate, according to the U.S. State Department.
Prepas and her colleagues hauled three different models of Noelle, including one that worked by hand crank to move the mechanical parts, for medical training at the only women's hospital in Kabul. But while the Noelle mannequins were helpful, power failures and other technological glitches hindered the mannequins' effectiveness.
Still, Prepas said Noelle is becoming standard issue in the United States.
"It's a really effective way to teach people how to take care of patients without harming actual patients," Prepas said.