Patent Publication Number: US-2023154354-A1

Title: Wearable birthing simulators

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This application claims priority from U.S. Provisional Application Ser. No. 63/278,580, titled “WEARABLE BIRTHING SIMULATORS,” filed Nov. 12, 2021, incorporated herein by reference in its entirety for all purposes. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates generally to medical simulations, and more particularly, to simulation devices for training care providers to manage basic and advanced situations relevant to various stages of pregnancy, labor, and delivery. 
     BACKGROUND OF THE INVENTION 
     Conventionally, the training process for nursing or medical students related to patient care and treatment may employ mannequins or static models that do not simulate realistic conditions or provide realistic patient feedback. This lack of realistic conditions and feedback makes it difficult for nursing or medical students to gain the education and experience needed to perform proper care or interventions when working with actual patients. Accordingly, improved systems and devices are desired for training medical care providers to manage basic and advanced situations relevant to the stages of pregnancy and childbirth, as well as provide care to maternal and fetal patients. 
     SUMMARY OF THE INVENTION 
     Aspects of the present invention are directed to birthing simulation systems and devices. 
     In accordance with one aspect of the present invention, a wearable birthing simulator is disclosed. The birthing simulator includes a housing that is configured to be secured to a subject and the housing defines an opening and an outer layer. Positioned within the housing is a uterus simulator, which is configured to contain a removable fetal model. Also positioned within the housing is a birth canal simulator, which is configured to be coupled to the uterus simulator. The birthing simulator further comprises a controller and a birthing device configured to move the removable fetal model towards the birth canal simulator. The birthing device comprises an actuator assembly in communication with the controller for automatically moving the fetal model towards the birth canal simulator. One or more sensors are mounted to the housing and are electrically connected to the controller. The one or more sensors are configured to detect movement of the fetal model by the birthing device. A feedback device is in communication with the controller and is configured to provide haptic feedback to the subject. The controller is configured to activate the feedback device to provide the haptic feedback to the subject in response to sensing the movement of the fetal model toward the birth canal simulator. 
     In accordance with yet another aspect of the present invention, a method for using a wearable birthing simulator is disclosed. The method includes the step of positioning a fetal model in a uterus simulator, which is positioned within a housing configured to be securable to a subject. The method further includes the step of activating an actuator to automatically move the fetal model out of the uterus simulator and toward a birth canal simulator, which is coupled to the uterus simulator. The method comprises the step of detecting a position of the fetal model relative to the birth canal simulator. Based on the detected position of the fetal model, a feedback device is activated to provide haptic feedback to the subject. The method also includes the step of evacuating a simulated biological fluid out of the housing as the fetal model moves towards the birth canal simulator. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The invention is best understood from the following detailed description when read in connection with the accompanying drawings, with like elements having the same reference numerals. When a plurality of similar elements is present, a single reference numeral may be assigned to the plurality of similar elements with a small letter designation referring to specific elements. When referring to the elements collectively or to a non-specific one or more of the elements, the small letter designation may be dropped. This emphasizes that according to common practice, the various features of the drawings are not drawn to scale unless otherwise indicated. On the contrary, the dimensions of the various features may be expanded or reduced for clarity. Included in the drawings are the following figures: 
         FIG.  1 A  depicts an exemplary wearable birthing simulator in accordance with aspects of the present invention; 
         FIG.  1 B  depicts the wearable birthing simulator configured to be secured to a subject; 
         FIG.  1 C  is a partially exploded view of the wearable birthing simulator; 
         FIG.  1 D  is a cross-sectional view of the wearable birthing simulator; 
         FIG.  2 A  is a perspective view of an exemplary housing; 
         FIGS.  2 B- 2 C  depict exploded views of the housing; 
         FIGS.  2 D- 2 F  are diagrams illustrating an exemplary latch; 
         FIGS.  3 A- 3 B  depict an exemplary birth canal simulator; 
         FIGS.  4 A- 4 E  depict an exemplary simulated cervix of the birth canal simulator; 
         FIGS.  5 A- 5 E  depict an exemplary simulated birth canal, an exemplary pelvic ring, and an exemplary simulated genitalia; 
         FIGS.  6 A- 6 B  depict an exemplary vise assembly; 
         FIGS.  7 A- 7 F  depict components of the birth canal simulator; 
         FIGS.  8 A- 8 E  depict an exemplary contraction simulator; 
         FIG.  9    depicts an exemplary uterus simulator; 
         FIG.  10 A- 10 D  depict an exemplary birthing device of the uterus simulator; 
         FIGS.  11 A- 11 E  depict an exemplary tube assembly; 
         FIG.  12 A- 12 C  depict an exemplary cover, showing an exemplary placenta holder; 
         FIG.  13    is an image showing an exemplary fetal model; 
         FIGS.  14 A- 14 C  depict an exemplary simulated umbilical cord connected to an exemplary simulated placenta; 
         FIGS.  15 A- 15 B  depict the simulated placenta having an exemplary removeable simulated cotyledon; 
         FIGS.  16 A- 16 L  depict an exemplary fluid handling system; 
         FIG.  17    is a schematic showing operation of the fluid handling system; 
         FIGS.  18 A- 18 B  depict exemplary straps attached to the housing for securing the wearable birthing simulator to the subject; 
         FIG.  19 A- 19 B  depict an exemplary support structure; 
         FIG.  20 A- 20 C  depict the support structure, showing one or more rails; 
         FIG.  21 A- 21 C  are images illustrating the support structure, showing one or more inflatable rails; 
         FIG.  21 D- 21 E  are diagrams illustrating the one or more inflatable rails for simulating shoulder dystocia; 
         FIG.  22    depicts another exemplary uterus simulator; 
         FIG.  23 A- 23 C  depict the uterus simulator of  FIG.  22    and the support structure, showing attachment and contraction of the uterus simulator; 
         FIG.  24    depict an exemplary method of operating the wearable birthing simulator; 
         FIGS.  25 A- 25 J  depict another exemplary simulated umbilical cord connected to an exemplary simulated placenta; and 
         FIGS.  26 A- 26 D  depict an exemplary boggy uterus simulator. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Aspects of the invention are described herein with reference to simulating specific care and management of maternal and fetal patients during various stages of pregnancy, labor and delivery, including any complications related thereto. It will be understood by one of ordinary skill in the art that the example devices described herein may be used to simulate care and management of a variety of medical situations relevant to pregnancy and childbirth, and are not limited to any particular situation disclosed herein. Other medical situations suitable for simulation with the disclosed devices will be known to one of ordinary skill in the art from the description herein. 
     The example devices disclosed herein may be particularly suitable for providing an enhanced level of realism and/or feedback to the subject and the treatment provider relative to conventional training devices. Haptic feedback may be provided to the simulated subject, such as a simulated maternal patient, during the simulated medical situation in order to encourage the subject to mimic realistic patient reactions, and thereby reinforce proper care techniques and establish realistic expectations of the various stages of labor and delivery. Likewise, this feedback may be provided to correct errors that the care provider may otherwise struggle to detect during the simulated medical situation. The provision of feedback using the example device of the present invention may desirably improve the ability of care providers to comfortably and effectively manage the care of maternal and fetal patients, without risking harm or injury to the maternal or fetal patient. 
     It will be appreciated that throughout this specification the term treatment or care provider is to be broadly construed to include any provider of care, management or treatment related to pregnancy and childbirth. The term may include trainees and professionals in the field of medicine, particularly in the fields of obstetrics, midwifery, nursing, and emergency medical services, as well as non-health care professionals. Further, mentions of a fetus, organs, and other segments of human anatomy are intended to refer to anatomical models simulating or emulating functions or responses of their biological counterparts. 
     The term childbirth scenario includes all situations relevant to various stages of labor and delivery. As non-limiting examples, the term encompasses the following simulated medical situations: normal delivery (without complications), abnormal delivery (with complications), breech delivery, shoulder dystocia, postpartum hemorrhage (PPH), retained placental fragments (RPF), complete or incomplete placenta, uterine contraction, and blood loss. 
     With reference to the drawings,  FIGS.  1 A- 1 D  illustrate an example birthing simulator  100  in accordance with aspects of the present invention. Simulator  100  is usable to train medical care providers to treat maternal and fetal patients by enabling the performance of one or more simulated childbirth scenarios. The simulator  100  can be adjusted to simulate realistic conditions of childbirth scenarios in various environments (e.g. hospital or other sterile settings, trauma or critical care sites, etc.). In general, simulator  100  can include a housing  102 , a birthing device  104 , and a fetal model  106 . Additional details of simulator  100  are described below. 
     Housing  102  houses components which simulate the one or more childbirth scenarios, including the birthing device  104  and the removable fetal model  106 . In an example, as seen in  FIGS.  1 A- 1 D , the housing  102  has a size and shape that is intended to simulate a protruding belly, upper abdomen, or stomach of a subject  108 , such as a patient simulating pregnancy. In some examples, housing  102  incorporates or is connected to a number of separate components designed to best simulate a realistic childbirth scenario. 
     As shown in  FIGS.  1 A- 1 D , the housing  102  can be formed from one or more structures which together define a cavity or space  110 , with the birthing device  104  and the fetal model  106  being positioned within the space  110  in the housing  102 . Specifically, the housing  102  includes multiple structures which together define a cavity or space  110 , including a top portion  112  and a bottom portion  114 , as shown in  FIGS.  2 B and  2 C . As seen in  FIG.  1 C , the operational components of the simulator (e.g. fluidics, controller, etc.) are provided or positioned within this cavity or space  110  of the housing  102 , thereby providing protection for at least these components and concealing wiring and other items that may detrimentally impact realism of the medical treatment simulation. Additional details of these operational components are discussed further below. Although the housing  102  is illustrated as being comprised of separate components, e.g. top portion  112  and bottom portion  114 , one of ordinary skill in the art would understand from the description herein that the housing  102  may be integrally formed as a single body of unitary construction. 
     In an exemplary embodiment, the top portion  112  and the bottom portion  114  are each made of more durable or rigid material  516  (e.g. carbon fiber), and the top portion  112  additionally includes an overlay  514  comprising material intended to mimic the patient&#39;s skin. The more rigid material  516  (e.g. carbon fiber) is intended to provide support and/or a mounting structure for the components of the simulator  100 . In an alternative embodiment, the top portion  112  may be made of material intended to mimic the patient&#39;s skin, whereas the bottom portion  114  may be made of more durable material. The bottom portion  114  may be formed from a more rigid material intended to provide support and/or a mounting structure for the components of the simulator  100 . Although  FIGS.  1 A- 1 D and  2 B- 2 C  illustrate that the top portion  112  and the bottom portion  114  are made of different materials, it would be understood from the description herein that optionally, the top portion  112  and bottom portion  114  may comprise the same material. The top portion  112  is useful to conceal components of simulator  100 , such as the birthing device  104  and the fetal model  106 , and thereby increase the realistic appearance of simulator  100 . The material of top portion  112  or overlay  514  of the top portion  112  is customizable in coloring and texturing to match a variety of skin tones. In one example, the material of the top portion  112  or overlay  514  of the top portion  112  is selected to simulate the look and feel of a patient&#39;s skin. This material may comprise an elastic material such as silicone. Other suitable materials for use in simulating a patient&#39;s skin will be generally known to one of ordinary skill in the art from the description herein. 
     Further, as shown in  FIGS.  2 A- 2 F , the top portion  112  and the bottom portion  114  may be secured together via at least one latch  508  moveable between unlatched and latched states, each latch  508  comprising a handle portion  517  and a locking surface  518 . The handle portion  517  is moveable between an unlocked position and a locked position. When the handle portion  517  is in the unlocked position, the latch  508  is in the unlatched state. Conversely, when the handle portion  517  is in the locked position, the latch  508  is in the latched state, thereby securing the top portion  112  and the bottom portion  114  of the housing  102  together. 
     As best shown in  FIG.  2 E , which is a cross-section view taken along line  2 E- 2 E of the housing  102  shown in  FIG.  2 A , when the handle portion  517  is in the unlocked position, the handle portion  517  is disengaged from the locking surface  518 . The handle portion  517  is disengaged from the locking surface  518  for example, when the handle portion  517  is positioned obliquely relative to the housing  102 . Conversely, when the handle portion  517  is in the locked position, the handle portion  517  is engaged with the locking surface  518 . When the handle portion  517  is engaged with the locking surface  518 , the handle portion  517  is positioned flush against a surface of the housing  102 . In one example, the handle portion  517  is positioned flush against the surface defined by a recess  510  of the bottom portion  114  and a corresponding recess  512  of the top portion  112 , the surface comprising a pocket formed when the recesses  510  and  512  are aligned. This alignment between the top portion  112  and the bottom portion  114  may be facilitated by one or more magnets disposed within a respective interior surface of both the top portion  112  and the bottom portion  114 . 
     It should be understood that although  FIGS.  2 D- 2 F  illustrate a latch  508  positioned within the pocket formed when recesses  510 / 512  are aligned, an identical latch  508  may additionally or optionally be disposed in other portions of the housing  102 , such that the at least one latch  508  are positioned opposite of each other. For example, an identical recess  510   a  may be positioned opposite recess  510   b  of the bottom portion  114 , as shown in  FIGS.  2 B- 2 C . Thus, an identical latch  508  may be disposed within the pocket defined by recess  510   b  and/or another identical recess  512 . 
     In operation, as illustrated in  FIGS.  2 E and  2 F , when the latch  508  is in the unlatched state, the top portion  112  and the bottom portion  114  are not secured together, such that a gap  522  may exist between at least the recesses  510  and  512 . An application of force or pressure to the handle portion  517  moves the handle portion  517  toward engagement with the locking surface  518  for closing the gap  522 . In particular, engagement between the handle portion  517  and the locking surface  518  causes recess  510  to be positioned flush against recess  512 . Specifically, at least the curved portion  520  of the handle portion  517  is moved toward the locking surface  518  until at least the curved portion  520  of the handle portion  517  engages the locking surface  518 . When the locking surface  518  is engaged by the handle portion  517 , the gap  522  between the recesses  510  and  512  is reduced or eliminated, thereby securing the top portion  112  and the bottom portion  114  together. As shown in  FIG.  2 F , which is a cross-section view taken along line  2 F- 2 F of the housing  102  shown in  FIG.  2 A , when the gap  522  between the recesses  510  and  512  is reduced or eliminated by movement of the latch  508  toward the latched state, the top portion  112  and the bottom portion  114  are thereby secured together. 
     In one non-limiting example, the housing  102  is configured to rest overtop or on top of the subject  108 , who is playing the role of the maternal or pregnant patient. As seen in  FIG.  1 B , the housing  102  is configured to be positionable between the thighs and legs of the subject  108 , such that the bottom portion  114  and the top portion  112  may have a size and shape that accommodate the lower limbs of the subject  108 . Specifically, the position of the simulator  100  relative to the subject is intended to mimic a maternal patient  108  in a birthing position, such as a semi-reclined position. However, various modifications may be made in the size and shape of the housing  102  without departing from the invention, such that the simulator  100  may be positioned relative to the subject  108  in any number of birthing positions, including but not limited to a sitting position, a squatting position, and a birthing ball position. 
     In another example, as illustrated in  FIGS.  18 A- 18 B , the housing  102  may be configured to be secured to the subject  108 . In another non-limiting example, the housing  102  includes one or more attachment mechanisms, including but not limited to straps  502  configured to encircle one or more of the torso or limb(s) of the subject  108 . Straps  502  may be usable to secure simulator  100  to the subject  108  during the simulated childbirth scenario, such that the simulator  100  is wearable and/or movement of simulator  100  relative to the subject  108  is restricted or eliminated. Straps  502  are further configured to be adjustable to accommodate different sizes of subject  108 . In particular, straps  502  may be separate components relative to simulator  100 , such that buckles  506  that are coupled to the housing  102  can be used to secure simulator  100  to subject  108  using straps  502 . In this configuration, straps  502  are removeable relative to the housing  102  via disengagement from buckles  506 . 
     However, one of ordinary skill in the art would understand from the description herein that the straps  502  and housing  102  may be integrally formed as a single body of unitary construction. It should be also understood that the illustrated locations of connection points for the straps  502  to housing  102  (via buckles  506 ) in  FIGS.  18 A- 18 B  are not intended to be limiting. Additionally or optionally, the straps  502  may further provide at least one of lumbar support and shoulder support for the subject  108  during the simulated childbirth scenario. Still further, one or more pads  504  comprising elastomeric material may provide additional cushioning to maintain or increase comfort of the subject  108  during the simulated childbirth scenario. 
     The housing  102  is configured to receive a removable birth canal simulator  116 . In one embodiment, as shown in  FIG.  1 C , the birth canal simulator  116  is configured to be partially enclosed by the top portion  112  and bottom portion  114  of the housing  102 . The bottom portion  114  includes a mounting surface  524  ( FIG.  2 B ) configured to receive and/or secure at least a portion of the removeable birth canal simulator  116 . In one example, as illustrated in  FIGS.  3 A- 3 B , the birth canal simulator  116  comprises a simulated cervix  118 , a simulated birth canal  120 , and a vise assembly  526  configured to attach the simulated cervix  118  to at least the simulated birth canal  120 . Additionally or optionally, the birth canal simulator  116  further comprises a simulated genitalia  122  that is coupled to the simulated birth canal  120 . Alternatively, simulated genitalia  122  and simulated birth canal  120  are integrally formed as a unitary piece. Individual components of the birth canal simulator  116  will now be discussed further below. 
     In one example, the simulated cervix  118  is configured to be removable relative to the simulated birth canal  120  and/or housing  102 . This simulated cervix  118  is intended to be removable relative to the simulated birth canal  120  for simulating various stages of labor based on the degree of cervix dilation. Having a simulated cervix  118  that is removable may be desirable to allow for easy removal, cleaning, and replacement of one or more simulated cervixes  118  of varying sizes and shapes over the course of a childbirth scenario or over the course of one or more training or educational sessions. In an example, the simulated cervix  118  simulates a full dilation of the cervix. In another example, the simulated cervix  118  simulates a lesser degree of dilation. The variation in degrees of dilation of the cervix may be indicated by a variation in the size of opening  124 . Accordingly, the size and shape of the simulated birth canal  120 , through which the simulated cervix  118  is configured to extend when the birth canal simulator  116  is fully assembled, may also vary in size based on degree of cervix dilation during various stages of labor. 
     The simulated cervix  118  is illustrated in  FIGS.  4 A- 4 E . In this illustrated example, the simulated cervix  118  comprises an elastic material  130 , such as silicone. The elastic material  130  is intended to stretch and/or deform to accommodate passage of the fetal model  106  for simulating vaginal delivery. Other suitable elastic materials will be generally known to one of ordinary skill in the art from the description herein. The simulated cervix  118  further comprises at least one ring  132 ,  134  comprising durable or reinforced plastic material. In a non-limiting example, ring  132  defines a groove  136  and the other of the at least one ring  134  defines a corresponding groove  528  that together define a cavity when ring  132  and ring  134  are aligned. Portions  530  of the elastic material  130  are configured to be clamped between the ring  132  and  134 , and more specifically, clamped within the cavity. In this way, the silicone material  130  of the simulated cervix  118  is secured in place relative to one or more components of the simulator, such as the simulated birth canal  120 . 
     Referring now to  FIGS.  5 A- 5 E , the material of the simulated birth canal  120  is an elastic material that is intended to stretch and/or deform to accommodate passage of the fetal model  106  for simulating vaginal delivery. In one example, the simulated birth canal  120  comprises silicone. Other suitable elastic materials will be generally known to one of ordinary skill in the art from the description herein. Preferably, as best illustrated in  FIG.  5 B , the simulated birth canal  120  and the simulated genitalia  122  may be integrally formed as a single body of unitary construction that is separate from the simulated cervix  118 . An advantage of this exemplary configuration is that this creates a closed system wherein the simulated birth canal  120  and the simulated genitalia  122  expand in concert, thereby mitigating the creation of a gap or hole for the fetal model  106  to fall through during the course of the simulated childbirth scenario. Further, this exemplary configuration would require fewer components for the simulator  100 , thereby decreasing unnecessary complexity in manufacture and assembly thereof. Optionally, the simulated birth canal  120  and the simulated genitalia  122  are separate components. An advantage of this exemplary configuration is that it provides ease and flexibility with respect to cleaning and replacing the separate components, in case of individual wear and tear. 
     As stated above, the simulated birth canal  120  may be coupled to simulated genitalia  122 . The material of the simulated genitalia  122  is an elastic material that is intended to stretch and/or deform to accommodate passage of the fetal model  106  for simulating vaginal delivery. As shown in  FIG.  3 B , the material of the simulated genitalia  122  and the material of simulated birth canal  120  may be the same, or may comprise different materials during various simulated stages of labor and delivery. Further, as shown in  FIG.  5 A , simulated genitalia  122  defines an aperture  126  that corresponds to the opening  124  of the simulated cervix  118 , such that the fetal model  106  passes through opening  124  of the simulated cervix  118  and subsequently, through the aperture  126  of the simulated genitalia  122  during the simulation of a childbirth scenario. One of ordinary skill in the art would understand from the description herein that the size and shape of the aperture  126  may vary depending on the childbirth scenario to be simulated. 
     Turning now to  FIG.  5 E , the simulated birth canal  120  may comprise a pelvic ring  146 . The pelvic ring  146  is intended to simulate the shape of the pelvis and may include accurate anatomical landmarks, such as a pelvic bone. A person of ordinary skill in the art would understand that the pelvic ring  146  may vary in diameter from what is illustrated in  FIG.  5 E , for example, based on the size and shape of simulated birth canal  120  and/or the simulated cervix  118 . Elastic material (e.g. silicone) is overmolded over pelvic ring  146  and this elastic material is integrally formed with the elastic material of the simulated birth canal  120 . Although  FIGS.  5 A- 5 E  show that the pelvic ring  146  and the simulated birth canal  120  are integrally formed as a single body of unitary instruction, one of ordinary skill in the art will understand that this component may be a separate component from the simulated cervix  118  and/or the simulated birth canal  120 . Further, the pelvic ring  146  may optionally be integrally formed with other components of the simulator  100 , including but not limited to a uterus simulator  128  (discussed further below). 
     Referring now to  FIGS.  6 A- 6 B , the birth canal simulator  116  includes the vise assembly  526 . The vise assembly  526  comprises a body  534  made of more durable or rigid material to provide support and/or a mounting structure for one or more components of the birth canal simulator  116 . The body  534  has an arc-like shape and geometry, such that the body  534  may conform to a portion of one or more components of the birth canal simulator  116 . For example, as shown in  FIG.  7 A  (which will be discussed below), a pair of vise assemblies  526  having a pair of bodies  534  may extend circumferentially around one or more components of the birth canal simulator  116 , such as the simulated cervix  118  and/or the simulated birth canal  120 . The vise assembly  526  further includes a blocking surface  550  and an opening  536 , which extends through an entire thickness of the vise assembly. Extending through the blocking surface  550  and the opening  536  is a fastening mechanism, such as screw  538 , which defines a rotation axis. Moveable within the opening  536  is a fastening surface  540  which extends along a direction that is perpendicular to the rotation axis of the screw  538 . The fastening surface  540  is further moveable between a locked state and an unlocked state. When the fastening surface  540  is in the unlocked state, the fastening surface  540  is positioned flush against blocking surface  550 . Conversely, when the fastening surface is in the locked state, the fastening surface  540  is positioned away from the block surface  550  and moved toward the pelvic ring  146 . 
     In operation, as illustrated in  FIGS.  7 A- 7 F , the vise assembly  526  is configured to attach the simulated cervix  118  to at least the simulated birth canal  120 . As shown in  FIG.  7 A  and as stated above, the birth canal simulator  116  comprises the simulated cervix  118 , the simulated birth canal  120 , and the vise assembly  526 . As illustrated in  FIG.  7 B , the simulated cervix  118  is attached to the simulated birth canal  120  via the pelvic ring  146 . The locating features  544  of the pelvic ring  146  and respective locating features  546  of the rings  132 ,  134  of the simulated cervix  118  are configured to facilitate this attachment. In particular, alignment of the locating features  544  and the locating features  546  allows for the securing features  548  positioned on ring  132  to be received by apertures  542  ( FIG.  5 C ) of the simulated birth canal  120 . Other suitable attachment mechanisms, such as for example, straps, hook-and-loop fasteners, anchors, adhesives, or double-sided tape, or combinations thereof will be known to one of ordinary skill in the art from the description herein. 
     Turning now to  FIGS.  7 C- 7 F , the engagement between securing features  548  and the apertures  542  allows for the vise assembly  526  to secure the simulated cervix  118  and simulated birth canal  120  together.  FIG.  7 D , which is a cross-section view of a portion of the birth canal simulator  116  of  FIG.  7 C , illustrates the unlocked state of the fastening surface  540 , wherein the fastening surface  540  is positioned flush against the blocking surface  550 . In order to secure the simulated cervix  118  and the simulated birth canal  120  together, the fastening surface  540  is moved away from the blocking surface  550  by actuation of the screw  538 . Actuation of the screw  538  pushes the fastening surface  540  toward the pelvic ring  146  until a mating portion  554  of the fastening surface  540  is received by a corresponding groove  552  of the pelvic ring  146 . As shown in  FIG.  7 F , which is a cross-section view of a portion of the birth canal simulator  116  of  FIG.  7 E , the fastening surface  540  is in the locked state because the fastening surface  540  is moved for a distance (D) away from the blocking surface  550 , or toward the groove  552  of the pelvic ring  146 . When the fastening surface  540  is in the locked state, the simulated cervix  118  is secured to the simulated birth canal  120  by the vise assembly  526 . 
     In yet another embodiment of the birth canal simulator  116 , the birth canal simulator  116  includes similar components to that described above, but may differ in one or more of the following respects. For example, the birth canal simulator  116  comprises the simulated birth canal  120  and the simulated cervix  118 , both of which are discussed in detail below. 
     The simulated cervix  118  is configured to be coupled to a portion of the uterus simulator  128  ( FIG.  9   ), which is further discussed below. The simulated cervix  118  further comprises at least one ring  132 / 134  comprising durable or reinforced plastic material. One of the at least one ring  132  defines a groove and the other of the at least one ring  134  defines a pin or protrusion configured to be received by the groove. In this way, the silicone material of the simulated cervix  118  is secured by the at least one ring  132 / 134 . 
     The simulated birth canal  120  is positionable adjacent to an opening defined by the top portion  112  and/or bottom portion  114  of the housing  102 . Additionally or optionally, the simulated genitalia  122  may be positionable adjacent to the opening. Further, the simulated genitalia  122  may define an aperture  126  that corresponds to the opening. One of ordinary skill in the art would understand that the size and shape of the opening generally corresponds to the size and shape of the simulated genitalia  122 , such that the size and shape of the opening may vary depending on the childbirth scenario to be simulated. Further, the simulated birth canal  120  comprises an elastic material, such as silicone. An exterior surface of the simulated birth canal  120  defines one or more connection points comprising plastic material. 
     The connection points are configured for attachment to the pelvic ring  146 . The pelvic ring  146  may be a separate component from the simulated cervix  118  and the simulated birth canal  120 , but one of ordinary skill in the art would understand from the description herein that the pelvic ring  146 , the simulated cervix  118 , and the simulated birth canal may optionally be integrally formed as a single body of unitary instruction. Further, the pelvic ring  146  may optionally be integrally formed with other components of the simulator  100 , including but not limited to the uterus simulator  128  ( FIG.  9   ). 
     The simulated cervix  118  and the simulated birth canal  120  are configured to be attached to one another via the pelvic ring  146 . In particular, the simulated birth canal  120  is configured to receive the simulated cervix  118  within a cavity or space defined therein. The simulated birth canal  120  and the simulated cervix  118  may be attached, for example, by fastening mechanisms such as screws. More specifically, screws are configured to extend through one or more apertures defined by the at least one ring  132 / 134  of the simulated cervix  118 , the pelvic ring  146 , and the exterior surface of the simulated birth canal  120 . Additionally or optionally, the screws may extend through one or more corresponding apertures defined by the elastic material of the simulated birth canal  120  and a plurality of securing features of the simulated birth canal  120 . Other suitable attachment mechanisms, such as for example, straps, hook-and-loop fasteners, anchors, adhesives, or double-sided tape, or combinations thereof will be known to one of ordinary skill in the art from the description herein. 
     Referring now to  FIGS.  1 D and  8 A- 8 E , the birthing simulator  100  comprises a device  154  configured for simulating uterine contractions during various stages of labor in a maternal patient. As seen in  FIGS.  1 D and  8 A , the device  154  is positionable within the housing  102  and adjacent to the top portion  112  of the housing  102 . As illustrated in  FIGS.  8 A- 8 B , the device  154  comprises a rigid platform layer  166  configured to generate a tactile difference perceptible through human touch of an outer surface or overlay  514  ( FIG.  1 C ) of the top portion  112  of the housing  102 . The tactile difference is intended to indicate to the care provider that the subject is experiencing a simulated labor contraction. The tactile difference is perceptible to the care provider when overlay  514  or the outer surface of the top portion  112  of the housing  102  is palpated, for example. 
     The perceptibility of this tactile difference is facilitated by an inflatable bag  158  disposed underneath the platform layer  166 . The inflatable bag  158  has an inflated state and a deflated state. A pump  160  ( FIG.  8 C ) facilitates the movement of the inflatable bag  158  between the inflated and deflated states. Although  FIG.  8 C  illustrates that the pump  160  is connected to the inflatable bag  158  positioned within the housing  102  via at least one port  556  defined in the top portion  112  for manual operation by the maternal subject, it would be understood from the description herein that other structures may be utilized in connection with the inflatable bag  158  to cause the inflatable bag  158  to move between the inflated and deflated states. Additionally, pump  160  may be positioned interior of the housing  102 , for automatic or electronic operation. 
     In operation, when the inflatable bag  158  is in the inflated state ( FIG.  8 B ), the inflatable bag  158  expands, thereby causing the platform layer  166  to be pressed against overlay  514  itself and/or a foam layer  156  underlying the overlay  514 , forming a relatively more rigid section of the top portion  112  that can be palpated to indicate a labor contraction to the care provider. Conversely, when the inflatable bag  158  is in the deflated state ( FIG.  8 A ), the platform layer  166  is positioned away from the foam layer  156 , such that the platform layer  166  is therefore not perceptible through the overlay  514  of the housing  102 . 
     As seen in  FIGS.  8 D- 8 E , the rigid platform layer  166  and the inflatable bag  158  are positioned on or against a plate  168 . In one non-limiting example, the plate  168  comprises plastic material. The plate  168  includes a plurality of connection points  558  disposed around a perimeter of the plate  168  for attaching the plate  168  to the rigid material  516  of the top portion  112 . Further, as shown in  FIGS.  1 D and  8 E , the rigid material  516  of the top portion  112  includes a pocket  561  when the plate  168  is attached to the rigid material  516  ( FIG.  8 A ). One or more components of the contraction device  154 , such as the inflatable bag  158  and platform layer  166 , may be disposed within the pocket  561 . This configuration desirably allows for the separation of the device  154  from one or more components of the simulator  100 , such as the birthing device  104 . In this way the contraction device  154  may be protected as the fetal model  106  is moved through the uterus simulator  128  by the birthing device  104 . The plate  168  may also define a groove  562 , through which a tube for connecting the inflatable bag  158  to the pump  160  may extend. Finally, according to a childbirth scenario involving post-partum hemorrhaging (PPH), a simulated fundus  340  may be disposed within housing  102  and adjacent the birth canal simulator  116 . In particular, the simulated fundus  340  may be disposed beneath foam layer  156  ( FIG.  8 E ). One would understand from the description herein that placement of simulated fundus  340  as illustrated in  FIG.  8 E  is not intended to be limiting, such that simulated fundus  340  may be positioned in another location (different from what is shown) within housing  102  and adjacent birth canal simulator  116 . 
     In another embodiment of the device  154 , configured for simulating uterine contraction, the device  154  includes similar components to that described above, but may differ in one or more of the following respects. For example, the device  154  comprises a foam layer configured to generate a tactile difference perceptible through human touch of the outer surface or layer of the top portion  112  of the housing  102 . The perceptibility of this tactile difference is facilitated by the inflatable bag  158  disposed underneath the foam layer. The inflatable bag  158  has an inflated state and a deflated state. The pump  160  facilitates the movement of the inflatable bag  158  between the inflated and deflated states. The inflatable bag  158  may be connected to the pump  160 , but it would be understood from the description herein that other structures may be utilized in connection with the inflatable bag  158  to cause the inflatable bag  158  to move between the inflated and deflated states. Additionally, pump  160  may be positioned interior of the housing  102 , for automatic or electronic operation. 
     In operation, when the inflatable bag  158  is in the inflated state, the inflatable bag  158  expands, thereby causing the foam layer to extend through an opening defined by a rigid plastic layer disposed over the foam layer. Disposed over the rigid plastic layer is another foam layer having an opening that corresponds to the size and shape of at least one of the foam layer and the opening. During inflation, the foam layer extends through the respective openings and is pressed against the inner surface of top portion  112 , forming a relative more rigid section that can be palpated to simulate a labor contraction. Conversely, when the inflatable bag  158  is in the deflated state, the foam layer does not extend through the respective openings and the foam layer is therefore not perceptible through the outer layer or surface of the housing  102 . Another rigid platform layer may be disposed between the foam layer and the inflatable bag  158 . The inflatable bag  158  may also be positioned on a plastic layer configured to provide support for one or more components of the device  154  and desirably allows for the separation of the device  154  from one or more moveable components of the simulator  100 , such as the birthing device  104 . 
     The embodiment described in  FIGS.  1 D and  8 A- 8 E  is generally similar to the birthing simulator  100  described in  FIGS.  26 A- 26 D , which additionally or optionally includes a boggy uterus simulator  700 . One would understand from the description herein that placement of boggy uterus simulator  700  as illustrated in  FIGS.  26 A- 26 D  is not intended to be limiting, such that boggy uterus simulator  700  may be positioned in another location (different from what is shown) within housing  102  and adjacent birth canal simulator  116 . As used herein and throughout the specification, “boggy uterus” refers to a hypotonic uterus, which is an obstetrical condition that may cause postpartum infection and PPH. 
     As illustrated in  FIGS.  26 A- 26 D , an inflatable bag  1158  is positioned on or against a plate  1168 . In one non-limiting example, the plate  1168  comprises plastic material. The plate  1168  includes a plurality of connection points  1558  disposed around a perimeter of the plate  1168  for attaching the plate  1168  to the rigid material  516  of the top portion  112 . Further, as shown in  FIG.  26 A , the plate  1168  forms a pocket  1561  when the plate  1168  is attached to the rigid material  516  of top portion  112 . One or more components of the boggy uterus simulator  700 , such as the inflatable bag  1158 , may be disposed within the pocket  1561 . This configuration desirably allows for the separation of the boggy uterus simulator  700  from one or more components of the simulator  100 , such as the birthing device  104 . In this way, the boggy uterus simulator  700  may be protected as the fetal model  106  is moved through the uterus simulator  128  by the birthing device  104 . The plate  1168  may also define a groove  1562 , through which a tube for connecting the inflatable bag  1158  to a pump may extend (discussed below). 
     According to a childbirth scenario involving PPH, the inflatable bag  1158  may be disposed beneath foam layer  156  ( FIGS.  26 C- 26 D ) in order to generate a tactile difference perceptible through human touch of an outer surface or overlay  514  of the top portion  112  of the housing  102 . The tactile difference is intended to indicate to the care provider that the subject  108  has a certain simulated condition, such as a firm uterus or a boggy uterus. The tactile difference is perceptible to the care provider when overlay  514  or the outer surface of the top portion  112  of the housing  102  is palpated, for example. 
     To facilitate the perceptibility of this tactile difference, the inflatable bag  1158  has an inflated state and a deflated state. A pump facilitates the movement of the inflatable bag  1158  between the inflated and deflated states. The pump for inflatable bag  1158  may be connected in a similar manner as pump  160  is connected to the inflatable bag  158  described above. The pump may be configured for manual operation by the subject  108 , and/or other structures may be utilized in connection with the inflatable bag  1158  to cause the inflatable bag  1158  to move between the inflated and deflated states. Additionally, the pump may be positioned interior of the housing  102 , for automatic or electronic operation. 
     In operation, when the inflatable bag  1158  is in the inflated state ( FIG.  26 D ), the inflatable bag  1158  expands, thereby causing the inflatable bag  1158  to be pressed against overlay  514  itself and/or a foam layer  156  underlying the overlay  514 , thereby forming a relatively more firm or rigid section of the top portion  112  that can be palpated to indicate a firm uterus. Conversely, when the inflatable bag  1158  is in the deflated state ( FIG.  26 C ), the inflatable bag  1158  is positioned away from the foam layer  156 , such that the inflatable bag  1158  is not perceptible through the overlay  514  of the housing  102 . In this way, a boggy uterus condition may be simulated when the inflatable bag  1158  is in the deflated state. 
     As shown in  FIG.  1 B , a feedback device  178  may be secured to the subject  108  or optionally, may be coupled to the simulator  100 . The feedback device  178  may be positioned in a location where feedback can be provided discretely to the subject  108  wearing the birthing simulator  100 . The feedback device  178  is configured to provide haptic (e.g. vibration) feedback to the maternal subject  108 . 
     Haptic feedback may be provided to the subject  108  via the feedback device  178 , using one or more actuator or vibrating motors provided on a band of the feedback device  178 , which is disposed in contact with the maternal subject  108  (as shown in  FIG.  1 B ). In an exemplary embodiment, a portion (e.g. the band) of the feedback device  178  includes a wireless transceiver configured to transmit/receive wireless signals to/from an external device  332  ( FIG.  17   ) via a network communication interface for communication over a network (e.g. WiFi or Bluetooth®). The band may be worn by subject  108  and the care provider, and may provide visual or tactile feedback indicative of a simulated labor contraction. Further, the type of haptic feedback provided by the band may correspond to various stages of labor based on the frequency, duration, and intensity of uterine contractions. In a non-limiting example, pulsed vibrations or feedback may indicate regular, longer, and/or stronger contractions whereas steady vibrations or feedback may indicate less regular, shorter, and/or weaker contractions. Additionally or optionally, the band of the feedback device  178  comprise visual indicators, at least one light emitting diode (LED), corresponding to predefined behaviors or medical conditions to be simulated or performed by subject  108  and/or care provider (e.g. fainting or passing out). 
     Suitable haptic feedback generators for use as feedback device  178  would be known from the description herein. Feedback device  178  may alternatively or additionally be configured to provide other types of feedback, such as auditory feedback and visual (e.g. LED) feedback. In operation, feedback device  178  receives and processes signals that are wirelessly received from an external device  332  ( FIG.  17   ), which may be controlled by an instructor or a professional that is different from the care provider. 
     The feedback device  178  may preferably be positioned separately from the contraction device  154 , with sufficient separation that the haptic feedback is not transmitted to the treatment provider, who may be performing uterine palpations during a simulated childbirth scenario, such that the treatment provider cannot sense that haptic feedback has been provided to the subject  108 . In some examples, feedback device  178  may be positioned on or within a strap used to secure simulator  100  to the subject  108  (e.g. strap  502  illustrated in  FIGS.  18 A- 18 B ). 
     In one example operation, a vibratory actuator used as feedback device  178  creates haptic feedback or vibration that can be felt by the subject  108  during the simulated childbirth scenario. Specifically, when the fetal model  106  is at a predetermined location within the housing  102  relative to the birth canal simulator  116 , the instructor controls and activates the actuator  178  to provide haptic feedback to the subject  108  to provide realistic feedback based on the position of the fetal model  106  relative to the birth canal simulator  116 . In one example, haptic feedback may indicate to the subject  108  to perform one or more predetermined actions or behavioral patterns that would be expected of a maternal patient undergoing a simulated contraction during labor and delivery. Additionally or optionally, the feedback device  178  creates haptic feedback or vibration that can be felt by another person who is in close proximity to the subject  108  during the simulated childbirth scenario, such as a support person who can provide cues or instructions to subject  108  to perform one or more predetermined actions or behavioral patterns (e.g. react in pain). 
     Additionally or optionally, the feedback device  178  is activated to provide haptic feedback to the subject  108  when the inflatable bag  158  is in the inflated state to indicate a simulated labor contraction, such that the subject  108  can provide realistic feedback during the simulated labor contraction. In one example, a simulated labor contraction may be indicated to a care provider by subject  108  activating a pump connected to the inflatable bag  158 , such as an automatic pump, thereby moving the inflatable bag  158  toward the inflated state (i.e. indicate simulated labor contraction). During this operation of the automatic pump, feedback device  178  may be simultaneously activated to provide haptic feedback to the subject  108  for providing realistic feedback during the simulated labor contraction. In another example, haptic feedback may be adapted to discreetly provide instructions to subject  108 , such as for subject  108  to manually inflate the inflatable bag  158  to the inflated state (i.e. indicate simulated labor contraction). Simultaneously, the fetal model  106  can be moved relative to the birth canal simulator  116  and toward delivery outside the housing  102 . 
     In some alternative embodiments, the contraction device  154  may rely on manual action of the maternal subject  108  to indicate contractions. In these embodiments, the feedback device  178  may be activated to provide haptic feedback to the subject  108 , the haptic feedback being adapted to indicate a simulated labor contraction to the subject  108  as well as instruct the subject  108  to manually inflate the inflatable bag  158  using pump  160 , such as a hand pump, for presenting the simulated labor contraction to the care provider. Alternatively, the feedback device  178  may be activated to provide haptic feedback to another person who is in close proximity to the subject  108  during the simulated childbirth scenario, such as the support person who can manually inflate the inflatable bag  158  using pump  160  and provide cues/instructions to subject  108  for presenting the simulated labor contraction to the care provider. 
     The feedback device  178  may also be configured to provide visual feedback to the maternal subject  108 . Visual feedback may be provided to the subject  108  via one or more light emitting diodes (LED) of various colors of the feedback device  178 , which is disposed in contact with the maternal subject  108  (as shown in  FIG.  1 B ). Each LED color may correspond to various stages of labor based on the frequency, duration, and intensity of uterine contractions. Additionally or optionally, each LED color may correspond to predefined behaviors or medical conditions to be simulated or performed by subject  108  and/or care provider. Similarly, the type of haptic feedback (e.g., pulsed or steady feedback, or predetermined series or sequence of pulses as feedback) may also correspond to various stages of labor based on the frequency, duration, and intensity of uterine contractions. In a non-limiting example, pulsed vibrations or feedback may indicate regular, longer, and/or stronger contractions whereas steady vibrations or feedback may indicate less regular, shorter, and/or weaker contractions. 
     In yet another embodiment of the feedback device  178 , the feedback device  178  includes similar components to that described above, but may differ in one or more of the following respects. For example, the feedback device  178  may be disposed adjacent to the top portion  112  of the housing  102  or may be worn by the subject on a separate structure, such as on the user&#39;s torso or arms. In one example operation, a vibratory actuator used as feedback device  178  creates haptic feedback or vibration that can be felt by the subject  108  during the simulated childbirth scenario. Specifically, when the fetal model  106  is detected at a predetermined location within the housing  102  relative to the birth canal simulator  116 , controller  176  controls actuator  178  to provide haptic feedback to the subject  108  to provide realistic feedback based on the position of the fetal model  106  relative to the birth canal simulator  116 . Additionally or optionally, controller  176  communicates with and sends an instruction or signal to external device  332  ( FIG.  17   ), which in turn activates or controls actuator  178 . The position of the fetal model  106  may be optionally detected by one or more sensors (e.g. encoder, position sensors, movement sensors, force or pressure sensors, or other known types of sensor) disposed within the housing  102  and adjacent the uterus simulator  128 . 
     Additionally or optionally, a controller  176 , which is in communication the feedback device  178  and with one or more sensors, may facilitate operation of the feedback device  178 . Controller  176  may store (e.g. in an associated memory) one or more items of information related to the size and shape of the fetal model  106  for use in controlling a feedback element, such as feedback device  178 . Controller  176  processes the information detected by one or more sensors and sends signals to operate feedback device  178  to provide feedback to the subject  108  wearing simulator  100 . In one example, when the fetal model  106  is detected at a predetermined location relative to the birth canal simulator  116 , the controller  176  sends signals to feedback device  178  to provide feedback to the subject  108  wearing simulator  100 . Additionally or optionally, the controller  176  is configured to activate the feedback device  178  to provide haptic feedback to the subject  108  when the inflatable bag  158  is in the inflated state to indicate a simulated labor contraction. Specifically, the controller  176  may be configured to indicate a simulated labor contraction to a care provider by activating the pump  160  connected to the inflatable bag  158 , such as an automatic pump, thereby moving the inflatable bag  158  toward the inflated state. During this operation, controller  176  may simultaneously send a signal to activate the feedback device  178  to provide haptic feedback to the subject  108  for providing realistic feedback during the simulated labor contraction. Controller  176  may further send signals for operating the birthing device  104  to simulate the birthing process according to a predefined algorithm programmed in controller  176  or an associated memory. 
     In some alternative embodiments, the contraction device  154  may rely on manual action of the maternal subject to indicate contractions. In these embodiments, the controller  176  may be configured to activate the feedback device  178  to provide haptic feedback to the subject  108 , the haptic feedback being adapted to indicate a simulated labor contraction to the subject  108  as well as instruct the subject  108  to manually inflate the inflatable bag  158  using pump  160 , such as a hand pump, for presenting the simulated labor contraction to the care provider. 
     Controller  176  may employ a single feedback signal (e.g., based on a single position of the fetal model  106  relative to the birth canal simulator  116 ), or may utilize multiple signals, each associated with a different position of the fetal model  106  relative to the birth canal simulator  116  and/or a different simulated condition (such as a simulated labor contraction). When multiple signals are used, each signal being of a different type of feedback signal (e.g., pulsed or steady feedback, or predetermined series or sequence of pulses as feedback). In the example comprising multiple signals, the signals may also indicate various stages of labor based on the frequency, duration, and intensity of uterine contractions. 
     One or more sensors  174  are disposed within the housing  102  and configured to be positionable adjacent to the uterus simulator  128  (further discussed below). One or more sensors  174  detect movement of the fetal model  106  within the housing  102 . Specifically, one or more sensors  174  detect movement of the fetal model  106  by the birthing device  104  during a simulated childbirth scenario. In an exemplary embodiment, one or more sensors  174  comprise a motor encoder mounted to motor  182  (as illustrated in  FIG.  10 A ) and configured to track the speed and/or position of a motor shaft to determine position of the fetal model  106 . Additionally or optionally, one or more sensors  174  comprise time of flight (ToF) sensor(s) mounted in a location opposite (or away from) birth canal simulator  116  (as shown in  FIG.  8 E ) and configured to measure distances using the time that it takes for photons to travel between two points. One skilled in the art would understand from the description herein that the locations of one or more sensors  174 , as illustrated in  FIGS.  10 A and  8 E , are not intended to be limiting. One or more sensors  174  may be positioned within housing  102  in order to determine position of fetal model  106  during a simulated childbirth scenario. 
     In an alternative embodiment, the one or more sensors  174  includes a proximity sensor electrically connected to a controller  176  and configured to detect the presence of the fetal model  106  in a predetermined location within the housing  102 . Sensors  174  may be position sensors, movement sensors, force or pressure sensors, or any other known type of sensor. The locations of the one or more sensors  174  may be disposed in one or more predetermined locations within the housing  102 , depending on a location of one or more components of simulator  100 , e.g. fetal model  106 . Suitable proximity sensors  174  for use as described above will be readily known or identifiable from the description herein. It will be understood that any combination of sensors may be used, and that additional types and locations of sensors may be used, without departing from the scope of the invention. Other possible sensors for use in simulator  100  would be known to one of ordinary skill in the art from the description herein. 
     Turning now to  FIG.  9   , the uterus simulator  128  is disclosed. The uterus simulator  128  comprises a tube assembly  564  and a birthing device  104 , both of which are disposed within housing  102 . A portion of the uterus simulator  128  may be coupled to the simulated cervix  118  of the birth canal simulator  116 , such that the simulated cervix  118  may be removable relative to the uterus simulator  128  and/or the housing  102 . Individual components of the tube assembly  564  and the birthing device  104  will now be discussed below. 
     Referring now to  FIGS.  10 A- 10 D , the birthing device  104  is configured to move the fetal model  106  towards the birth canal simulator  116 . The birthing device  104  comprises an actuator assembly  180  in communication with the controller  176  for automatically moving the fetal model  106  towards the birth canal simulator  116 . Controller  176  may store (e.g. in an associated memory) one or more items of information or algorithms related to the components of the actuator assembly  180  for controlling one or more components of the actuator assembly  180 . In one example, controller  176  controls the activation of a motor  182  to cause one or more components of the actuator assembly  180  to move relative to the tube assembly  564  (further discussed below). 
     The actuator assembly  180  comprises a frame  184  positioned within the housing  102 . As seen in  FIG.  10 C , the frame  184  comprises a first plate  192  disposed at one end and a second plate  194  disposed at an opposite end relative to the first plate  192 . The first plate  192  and second plate  194  may be integrally formed as a single body of unitary construction, or may be separate components configured to be attached by known attachment mechanisms. In an example, the frame  184  is configured to be disposed within the housing  102  and secured adjacent the bottom portion  114  of the housing  102 . Additionally or optionally, the actuator assembly  180  and the housing  102  may be integrally formed as a single body of unitary construction. Mounted to the frame  184  is at least one guide rail  186 , preferably two parallel guide rails, each having grooves  188  ( FIG.  10 C ) and an actuator  190 , such as a linear actuator. The actuator  190  extends along a rotation axis ( FIG.  10 B ) that is parallel to the at least one guide rail  186 . In particular, the at least one guide rail  186  and the linear actuator  190  are disposed between the first plate  192  and second plate  194 . Preferably, the at least one guide rail  186  comprises an 80/20 aluminum extrusion material. 
     A sliding carriage  196  is coupled to the actuator  190  and the at least one guide rail  186 . In an example, as shown in  FIG.  10 D , the sliding carriage  196  comprises a flange portion  198  which defines a plurality of openings  200  for attaching one or more ball nuts  202  to the sliding carriage  196 . Fastening mechanisms, such as screws, are configured to extend through the plurality of openings  200  and secures the one or more ball nuts  202  to the sliding carriage  196  for securing the sliding carriage  196  to the actuator  190 . Other suitable attachment mechanisms will be known to one of ordinary skill in the art. In an example, the one or more ball nuts  202  are oriented such that at least one of the respective end portions are each visible (as seen in  FIG.  11 D ) from a surface of the carriage  196  and an opposite surface of the carriage  196 . 
     The sliding carriage  196  comprises at least one linear bearing pad  206 , each of which comprises UHMW plastic material, such as ultra-high molecular weight polyethylene. The material of the at least one linear bearing pad  206  is configured to define a surface that allows the sliding carriage  196  to slide along the at least one guide rail  186 . Specifically, the surface of the at least one linear bearing pad  206  is configured to slide along the at least one guide rail  186  comprising 80/20 aluminum extrusion alloy. Further, the at least one linear bearing pad  206  may include a first linear bearing pad  206   a  positioned toward one (e.g., a right) side of the at least one guide rail  186 , a second linear bearing pad  206   b  positioned toward the opposite (e.g., left) side of the at least one guide rail  186 , and a third linear bearing pad  206   c  positioned above the at least one guide rail  186  and below the actuator  190 . As shown in  FIG.  10 D , a fourth linear bearing pad  206   d  may be utilized when more than one guide rail  186  is used. This exemplary configuration allows the sliding carriage  196  to slide along the at least one guide rail  186  with relatively little friction, thereby allowing for a smoother automatic movement of the fetal model  106  by the actuator  190  of the birthing device  104  during a simulated childbirth scenario. 
     The birthing device  104  comprises a motor  182  configured to drive the actuator  190 . As seen in  FIGS.  10 A- 10 B , the motor  182  is mounted parallel to the actuator assembly  180 . In an example, motion of the actuator  190  is driven by the motor  182 , such as a battery-powered DC motor. As illustrated in  FIGS.  10 A- 10 D , the motor  182  is mounted parallel to the linear actuator  190  to reduce the overall length of the birthing device  104 , thereby allowing for a more economical size and efficient operation of the birthing simulator  100 . In an exemplary embodiment, the length of the linear actuator  190  is 11.75 inches and the fetal model  106  is configured to move 8.75 inches. In this configuration, the rotational motion generated by the motor  182  is transferred to the actuator  190  through a transmission, e.g., pulley system  210 . The actuator assembly  180  includes the pulley system  210 , which comprises a timing belt and at least one timing pulley  208 / 214  mounted on the frame  184 . One of the at least one timing pulley  208  is mounted on an end portion of the motor shaft, and another of the at least one timing pulley  214  is mounted on an end portion of the linear actuator  190 . The pulley system  210  is configured to effectively transfer motion generated by the motor  182  to the actuator  190 , which is configured to rotate along the rotation axis ( FIG.  10 B ). In particular, the motor  182  is connected to the at least one timing pulley  208 / 214  and when the motor  182  is activated, the at least one timing pulley  208 / 214  is configured to rotate, thereby driving the actuator  190  to rotate along the rotation axis ( FIG.  10 B ). The rotation of the actuator  190  thereby moves the sliding carriage  196  along the length of the actuator  190  and along the grooves  188  defined by the at least one guide rail  186 . More specifically, the at least one linear bearing pads  206  of the sliding carriage  196  slide or glide along the grooves  188  of the at least one guide rail  186  for the predetermined length of the actuator  190 . 
     In an example, as seen in  FIGS.  10 B- 10 C , the motor  182  and one or more components of the pulley system  210  are mounted to the second plate  194  of the frame  184 . Specifically, the motor  182  is mounted to one or more openings  216  ( FIG.  10 C ) defined by the second plate  194 . The size and shape of the one or more openings  216  allow for the timing belt to be loaded onto the at least one timing pulleys  208 / 214 . Subsequently, the size and shape of the openings  216  allow for lateral movement of the motor  182  relative to the at least one guide rail  186 , thereby eliminating the slack in the timing belt after the timing belt is loaded onto the at least one timing pulleys  208 / 214 . Fastening mechanisms, such as screws  218 , may extend through the one or more corresponding openings  216  defined by the second plate  194  and the motor (not shown). In particular, the screws  218  may be fully tightened to secure at least the motor  182  to the second plate  194 . Other suitable attachment mechanisms, such as for example, straps, hook-and-loop fasteners, anchors, adhesives, or double-sided tape, or combinations thereof will be known to one of ordinary skill in the art from the description herein. 
     Additionally or optionally, the second plate  194  may include an adjustable assembly that allows for vertical motion of a simplified pulley  220  that is configured to add tension to the timing belt. The adjustable assembly includes a protruding structure  222 , such as a thumb screw, that is mounted to the second plate  194 . Tension is added to the timing belt, for example, by tightening the thumb screw  222 . 
     Although  FIGS.  10 A- 10 D  illustrate the rotational motion generated by the motor  182  is transferred to the actuator  190  through the pulley system  210  having the timing belt and the at least one timing pulley  208 / 214 , it would be understood from the description herein that the motor  182  may be connected rigidly and/or directly to the actuator  190 . In other words, the motor  182  may be configured to directly drive the motion of the actuator  190  without use of a pulley system, such as pulley system  210 . In such embodiments, motor  182  may be connected to actuator  190  by a transmission including one or more gears for transmitting rotary force from motor  182  to actuator  190 . 
     Additionally or optionally, the sliding carriage  196  comprises a pushing paddle  224 . The pushing paddle  224  is configured to contact the fetal model  106  when the fetal model  106  is positioned within the tube assembly  564 . As the sliding carriage  196  moves along the length of the actuator  190 , the pushing paddle  224  moves the fetal model  106  toward the birth canal simulator  116  for delivering the fetal model  106  outside the housing  102 . 
     In an example, the pushing paddle  224  comprises a paddle portion  226  and a paddle support  228 . As seen in  FIGS.  10 B- 10 C , the paddle support  228  has a triangular geometry, wherein the tallest point  228   a  of the paddle support  228  is configured to be positioned behind a surface of the paddle portion  226 . The triangular geometry of the paddle support  228  is configured to increase the stability of the pushing paddle  224  in the direction where the pushing paddle  224  experiences the most force, i.e. movement of the fetal model  106  toward the birth canal simulator  116 . The paddle support  228  further comprises a bottom portion  228   b  ( FIG.  10 B ) defining a plurality of paddle apertures that correspond to a plurality of carriage apertures defined by the sliding carriage  196  for attaching the pushing paddle  224  to the sliding carriage  196 . Fastening mechanisms, such as screws  230 , extend through the plurality of paddle apertures and the plurality of carriage apertures for securing the pushing paddle  224  to the sliding carriage  196 . Other suitable attachment mechanisms, such as for example, straps, hook-and-loop fasteners, anchors, adhesives, or double-sided tape, or combinations thereof will be known to one of ordinary skill in the art from the description herein. Although the pushing paddle  224  is illustrated in  FIG.  10 A- 10 B  as comprising the paddle portion  226  and the paddle support  228  as separate components, the paddle portion  226  and the paddle support  228  may optionally be integrally formed as a single body of unitary construction. Likewise, while paddle  224  is depicted as a separate structure from carriage  196 , it will be understood that carriage  196  and paddle  224  may be formed as a single body of unitary construction. 
     Referring now to  FIGS.  11 A- 11 E , the tube assembly  564  comprises more durable or rigid material configured to provide support or a mounting surface to one or more components of the simulator  100 , such as the fetal model  106 . Thus, the removable fetal model  106  is configured to be positioned within tube assembly  564  to simulate a childbirth scenario, such as at least one of a normal and an abnormal labor childbirth scenario. In another example, the uterus simulator  128  may comprise an elastic membrane configured to enclose and secure the removable fetal model  106 . 
     The tube assembly  564  has a size and shape that corresponds with the overall size and shape of at least the birthing device  104 , as seen in  FIG.  9   , and one or more components of the birthing simulator  100 . The tube assembly  564  comprises a base  568  and a plurality of legs  570  extending downwardly from the base  568 . The base  568  is configured to position the fetal model  106  above the moving parts of the birthing device  104 , such as the actuator assembly  180 . In this configuration, the moving parts of the birthing device  104  is also protected from movement of the fetal model  106  during a simulated childbirth scenario. Further, the tube assembly  564  is configured to be stationary relative to at least the actuator assembly  180  and the fetal model  106 , thereby providing a stabilizing feature to the simulator  100 . This stability is facilitated by each leg  570  comprising at least one connection point  566  configured for attaching and/or securing at least the base  568  of the tube assembly  564  to the bottom portion  114  of the housing  102 . 
     The base  568  has a generally tubular geometry and has a shape and/or size configured to stabilize and secure the fetal model  106  within the uterus simulator  128 . Further, the base  568  is configured to place the fetal model  106  in a position corresponding to the intended childbirth scenario to be simulated. For example, the fetal model  106  may be loaded within the tube assembly  564  in one alignment for the occiput or cephalic posterior position birthing position and another alignment for the breech birthing position. However, it should be understood that without departing from the spirit and scope of the invention, the base  568  may be further configured to facilitate one or more specific alignments by preventing unwanted movement of the fetal model  106  that detracts from the intended childbirth scenario to be simulated, based on the fetal model&#39;s  106  birthing position. In other words, in addition to providing stability for the fetal model  106 , the tube assembly  564  may be further configured to guide movement of the fetal model  106 . In one example, the base  568  or the tube assembly  564  generally may have a tapered shape at one end portion and a non-tapered opposite end portion. This configuration may allow for selective restriction of the fetal model&#39;s  106  movement, at certain stages of labor. For example, the tapered end portion, i.e. tighter region, of the uterus simulator  128  helps ensure the limbs of the fetal model  106  are held in the proper position, particularly as the fetal model  106  transitions into the birth canal simulator  116 . 
     Additionally or optionally, as shown in  FIGS.  11 B- 11 E , a cover or lid  574  may be engageably coupled to the base  568  via a pair of hinges  578  and a latch  576 . The cover or lid  574  may have a size and shape that corresponds to the size and shape of the base  568 , such that together, the cover  574  and the base  568  together define a cavity or space  584  through which the fetal model  106 , and additionally a simulated umbilical cord  282  and a simulated placenta  280 , may be positioned within the simulator  100 . The cover  574  may be moveable relative to the base  568 , as the latch  576  moves between an unlatched state and a latched state. In operation, when the latch  576  is in the unlatched state, the cover  574  is moveable relative to the base  568  and the cover  574  is moveable between a partially open position ( FIG.  11 D ) and a fully open ( FIG.  11 E ) position. When the cover  574  is in the partially open or fully open position, one or more components of the simulator  100 , such as the fetal model  106 , may be positioned within space  584 , according to a simulated childbirth scenario as discussed above. Still further, the cover  574  may have a relatively shorter length than a length of the base  568 , such that a mounting surface  586  is formed based on the difference in length. The mounting surface  586  is configured to receive and/or secure at least a portion of the birth canal simulator  116  within the housing  102  (as best shown in  FIG.  1 C ). 
     Turning now to  FIGS.  11 B and  12 A- 12 C , with respect to positioning and/or securing the at least one of the simulated placenta  280  within the tube assembly  564 , the cover  574  may include a placenta holder  580 . The placenta holder  580  may include a pocket  582  in which at least the simulated placenta  280  may be received and/or secured. The pocket  582  may have a size and shape to restrict or limit the movement of the placenta when the fetal model  106  is stationary within the tube assembly  564 . However, when the fetal model  106  is moved out of the tube assembly  564  and toward the birth canal simulator  116 , the pocket  582  may be configured to permit movement of the simulated placenta  280  along with movement of the fetal model  106 . With respect to positioning and/or securing the simulated umbilical cord  282  within the tube assembly  564 , a trench  572  having a serpentine geometry is formed along an interior surface of the base  568 . The trench  572  is configured to receive and/or secure a simulated umbilical cord  282  (discussed further below), such that movement of the simulated umbilical cord  282  and/or disengagement of the simulated umbilical cord from the tube assembly  564  is restricted or limited when the fetal model  106  is stationary within the tube assembly  564 . However, the simulated umbilical cord  282  may be releasably removed from the trench  572  after an application of force is exerted by movement of the fetal model  106  toward the birth canal simulator  116 . 
     Although the tube assembly  564  is illustrated and discussed above as being comprised of separate components, e.g. cover  574  and base  568 , one of ordinary skill in the art would understand from the description herein that the tube assembly  564  may be integrally formed as a single body of unitary construction. 
     Referring now to  FIGS.  13  and  14 A- 14 C , the simulator  100  further includes the simulated placenta  280  and the simulated umbilical cord  282 , both of which are positioned within the uterus simulator  128 . The simulated placenta  280  comprises a fetal surface  284  and a maternal surface  286  opposite the fetal surface  284 . The simulated umbilical cord  282  includes one or more tubes  288 / 300 , each of the one or more tubes  288 / 300  having an end portion coupled to the simulated placenta  280  and another end portion coupled to the fetal model  106  ( FIG.  13   ). As illustrated in  FIG.  14 B , the one or more tubes  288 / 300  comprises a simulated vein  300  that carries oxygen and nutrients from the placenta to the baby and at least one simulated artery  288  that carry waste from the baby to the placenta. The simulated arteries  288  are adapted to wrap around the simulated vein  300 . 
     In an exemplary embodiment (as illustrated in  FIGS.  14 A- 14 C ), the one or more tubes  288 / 300  may be attached to the fetal surface  284  of the simulated placenta  280  via engagement between a removeable simulated cotyledon  308  and a locker  306 . Other suitable attachment mechanisms, such as for example, straps, hook-and-loop fasteners, screws, anchors, adhesives, or double-sided tape, or combinations thereof will be known to one of ordinary skill in the art from the description herein. In another embodiment, an end portion of the one or more tubes  288 / 300  are coupled to a plug for attaching the one or more tubes  288 / 300  to the fetal surface  284  of the placenta  280 . The one or more tubes  288 / 300  may be attached to the plug via fastening means, such as a zip tie. 
     The simulated umbilical cord  282  is configured to be releasable from at least one of the simulated placenta  280  and the fetal model  106 . For example, and as seen in  FIG.  14 B , the one or more tubes  288 / 300  of the simulated umbilical cord  282  are removable from the simulated placenta  280  via the removeable simulated cotyledon  308 . In particular, the one or more tubes  288 / 300  are configured to be removable from a mating cavity  312  extending through the fetal surface  284  and the maternal surface  286  of the simulated placenta  280 . This facilitates easy cleaning, removal, reuse, and replacement of the simulated umbilical cord  282 , which may be desirable based on the simulated childbirth scenario. The removeable cotyledon  308  may be connected to or received in cavity  312  through a friction fit, through engagement surfaces, detents, or other known structures. 
     Further, the simulated umbilical cord  282  may be of any length, such as a sufficient length to simulate a childbirth scenario wherein the simulated umbilical cord  282  is wrapped around the fetal model&#39;s  106  neck, i.e. a nuchal cord complication. Additionally or optionally, the simulated umbilical cord  282  may be of a sufficient length and of a material such that the simulated umbilical cord  282  may be cut, at any desired position along the length of the umbilical cord  282  to simulate cutting/tying of the umbilical cord following birth. 
     Finally, the material of the one or more tubes  288 / 300  of the simulated umbilical cord  282  is customizable in coloring and texturing. In one example, the material selected to simulate the look and feel of the simulated umbilical cord  282  comprises an elastic material such as silicone. In a further example, the simulated vein  300  is configured to be red in color and the simulated arteries  288  are configured to be blue in color. 
     As stated above, the simulated placenta  280  comprises the fetal surface  284  and the maternal surface  286  opposite the fetal surface  284 . The maternal surface  286  is configured to define a surface to which the uterus simulator  128  or pocket  582  of the cover  574  may optionally be attached. The fetal surface  284  is configured to define a surface to which the simulated umbilical cord  282  is adapted to connect. Further, the fetal surface  284  is configured to have at least one visual difference relative to the maternal surface  286 . For example, the fetal surface  284  is adapted to include one or more of a glossy or shiny surface, or a translucent surface, such that underlying villous tissue may be visually perceptible. In another example, the fetal surface  284  may be gray in color. 
     In another example, the visual difference may comprise the maternal surface  286  having a plurality of simulated cotyledons  308 . As illustrated in  FIG.  14 A , the simulated cotyledon  308  has a size and shape that is configured to correspond to a mating cavity  312  defined by the simulated placenta  280 . As seen in  FIGS.  15 A- 15 B , the simulated cotyledons  308  comprise a plastic locker  306  and a silicone material of removeable cotyledon  308 . The silicone material allows for a more realistic look and feel of the maternal surface  286  of the simulated placenta  280 . The locker  306  may have a geometry that correspond to the mating cavity  312  of the simulated placenta  280 . In an alternative embodiment, the simulated cotyledons  308  comprise a plastic plug insert and a silicone cover. The plug insert may have a geometry that correspond to the mating cavity. 
     As illustrated in  FIGS.  25 A- 25 J , another exemplary embodiment of one or more tubes  1288 / 1300  may be attached to the fetal surface  1284  of the simulated placenta  1280  via engagement between a removeable simulated cotyledon  1308  and a locker  1306   a.  This embodiment is generally similar to the embodiment described above in relation to  FIGS.  14 A- 14 C , except in some respects. For example, the removeable simulated cotyledon  1308   a  and a locker  1306   a  are respectively separate and distinct from the removeable simulated cotyledon  308  and locker  306 . In a non-limiting example, the locker  1306   a  is configured for engagement with connector  1282   a  of simulated umbilical cord  1282  (as best shown in  FIGS.  25 B and  25 G ). To facilitate this connection, as best shown in  FIGS.  25 H- 25 I , locker  1306   a  comprises a plastic cotyledon insert  1310  disposed at least partially within a body of the cotyledon  1308   a , a lock cap  1312  (e.g. a Female Luer Cap) coupled to the plastic insert  1310  via a fastening means such as screw  1314  and heat-set threaded insert  1316 . The lock cap  1312  is adapted to be engaged to connect  1282   a  of the umbilical cord  11282 . Further, the one or more tubes  1288 / 1300  may be attached to the removeable simulated cotyledon  1308   a  via fastening means, such as a zip tie. Other suitable attachment mechanisms, such as for example, straps, hook-and-loop fasteners, screws, anchors, adhesives, or double-sided tape, or combinations thereof will be known to one of ordinary skill in the art from the description herein. 
     As discussed above, at least one of the plurality of simulated cotyledons  308  is configured to be removable. According to one childbirth scenario, such as postpartum hemorrhage (PPH) caused by retained placental fragments (RPF), one or more simulated cotyledon  308  is configured to be detached from the simulated placenta  280  and remains inside the uterus simulator  128 , e.g., through attachment of the removable cotyledon  308  to an interior of the uterus simulator or any of the structures contained therein, such as the pocket  582 . The detachment of the one or more simulated cotyledon  308  indicates an incomplete placenta and represents to the care provider that there is a high risk for PPH. Identification of a PPH may signify to a trainee or student that the uterus must be massaged externally until the trainee or student feels a tactile difference perceptible through human touch, as described above with reference to  FIGS.  26 A- 26 D . For example, the subject  108  may be instructed to manually inflate the inflatable bag  1158 , such that the massaged portion of the birthing simulator  100  may feel relatively more rigid or “boggy” to the trainee or student. This massaging technique used on PPH patients may also help the maternal body to deliver or evacuate blood clots, which may be simulated by evacuating simulated biological fluid, the details of which are further discussed below), such that simulated blood clots may be delivered during or after the massaging technique is performed. The blood clots may be identified when they come in contact with an external pad, configured to provide a visual or tactile difference/confirmation of the delivery of blood clots. 
     The simulator  100  comprises a fluid handling system  318 , which comprise a fluid driver  314  and a fluid reservoir  316 . The fluid driver  314  includes at least one fluid driver, such as a pump  323 , configured to drive fluid into or out of the fluid reservoir  316 . The fluid driver  314  includes pump housing  326  and pump cover  328 . The individual components of the fluid handling system  318  are discussed below. 
     Referring now to  FIGS.  16 A- 16 F , the fluid driver  314  and the fluid reservoir  316  are disposed within housing  102 . In one embodiment, as shown in  FIG.  16 A , the fluid driver  314  and the fluid reservoir  316  are mounted on or secured to bottom portion  114  of the housing  102 . In particular, the fluid driver  314  is positioned adjacent motor  182 . The fluid reservoir  316  is positioned opposite fluid driver  314 . 
     Certain components of simulator  100  are mounted on or secured to bottom portion  114  of the housing  102  via base plate  334  ( FIG.  16 G ), such that base plate  334  provides a stabilizing feature for at least one other component of the simulator  100 . Base plate  334  may be relatively thin compared to other components of simulator  100 . In an exemplary embodiment, base plate  334  may have a thickness between 1/16 inches to ⅛ inches. Base plate  334  comprises more durable or rigid material (e.g. metal) configured to provide a mounting and/or supporting surface for at least one other component of simulator  100 . Accordingly, base plate  334  has a generally irregular geometry that is configured to correspond to the size and shapes of at least one other component of simulator  100 , e.g. bottom portion  114 , fluid driver  314 , and/or fluid reservoir  316 . Specifically, base plate  334  has a generally rounded (i.e. non-sharp) corners to accommodate the contours of bottom portion  114 . This configuration may also avoid undesirable interference by base plate  334  with other components enclosed within housing  102 . In addition, base plate  334  includes a bespoke design of a plurality of openings  336 , with the design corresponding to mounting surfaces defined by at least one other component of simulator  100 , as best shown in  FIGS.  16 D and  16 E . 
     Further, base plate  334  is configured to be secured to bottom portion  114  via a plurality of connectors  338  disposed along an inner perimeter of bottom portion  114 . As shown in  FIGS.  16 A and  16 H , connectors  338  may be secured to bottom portion  114  via known attachment mechanisms, such as screws. Further, connectors  338  comprise a planar surface on which a portion of base plate  334  may rest. Base plate  334  may be secured to the connectors  338  via known attachment mechanism, such as screws. 
     As shown in  FIGS.  16 I- 16 J , the one or more fluid containers  276  are configured to be stored within the fluid reservoir  316 . The containers  276   a,    276   b  each store a respective simulated biological fluid  278   a,    278   b.  The containers  276   a,    276   b  may be adapted to store fluid having a volume adapted for a simulated childbirth scenario. In a non-limiting example, the containers  276   a,    276   b  each have a volume capacity of 500 milliliters and are each filled with up to 250 milliliters of respective simulated biological fluid  278   a,    278   b.  The fluid storage  316  may have a volume capacity corresponding to the volume capacity of the fluid containers  276 . Further, the containers  276   a,    276   b  may be adapted to store fluid having a viscosity corresponding to one or more simulated biological fluids  278   a,    278   b  found in a maternal or fetal patient. In one example, the first container  276   a  stores a first simulated biological fluid  278   a  having a first viscosity and the second container  276   b  stores a second simulated biological fluid  278   b  having a second viscosity that is different from the first viscosity. The first container  276   a  stores simulated blood and the second container  276   b  stores one or more of simulated amniotic fluid or other bodily fluids and discharges related to labor and delivery. For example, the simulated blood  278   a  and amniotic fluid  278   b  may be each formed from a combination of water and one or more viscous gels, lubricants, or dyes to achieve the desired viscosity, flow, and color to simulate blood and amniotic fluid, respectively. 
     As shown in  FIGS.  16 I- 16 L , the fluid driver  314  comprises at least one pump  323  configured to drive fluid into or out of the fluid containers  276 . In an exemplary embodiment, as illustrated in  FIGS.  16 I- 16 L , a pair of pumps  323  are configured to drive simulated biological fluid  278   a,    278   b  out of fluid containers  276   a ,  276   b  and into fluid driver  314  via a tubing system  320  disposed beneath base plate  334 . In particular, the first and second fluid containers  276   a,    276   b  are each coupled to one or more input tubes  320   a,    320   b  in order to provide the simulated blood and amniotic fluid respectively, to one or more output tubes, each of which may be coupled to a connector on one end and to a fluid port  532  ( FIG.  5 D ) on another end. In an exemplary embodiment, the one or more output tubes  320   c,    320   d  are routed from beneath the base plate  334  and connects to the fluid port  532 . The fluid port  532  comprises a fluid connector insert disposed within or adjacent the birth canal simulator  116 . In one non-limiting example, as shown in  FIG.  5 D , the fluid connector insert is coupled to or disposed on the pelvic ring  146 . Along this fluid pathway defined by tubing system  320 , simulated biological fluid  278   a,    278   b  flows from fluid reservoir  316 , toward the birth canal simulator  116 , and out of aperture  126  of simulated genitalia  122 . 
     In operation, the fluid handling system  318  comprises at least one fluid driver, such as a pump  323 , configured to drive fluid into and out of the fluid reservoir  316 . The at least one pump  323  may be driven by a common power supply, or by individual power supplies, and the one or more power supplies for driving the pump, motor, or other electronic components of the simulator may be stored within receptacle  324  ( FIG.  16 F ). The pump  323  may be disposed on pump housing  326  and concealed by pump cover  328 . The one or more input tubes  320   a,    320   b  may be respectively coupled to one or more pumps  323  for pushing fluid  278   a,    278   b  through the one or more input tubes  320   a,    320   b  and into the one or more output tubes  320   c,    320   d.  The one or more pumps  323  may be driven by a common power supply or by individual power supplies. In one example, as shown in  FIGS.  16 K- 16 L , a pair of pumps  323  are each adapted to apply pressure to the respective simulated biological fluid  278   a,    278   b  in the respective fluid containers  276   a,    276   b  in order to cause the respective simulated biological fluid  278   a,    278   b  to flow into and through the one or more input tubes  320   a ,  320   b.  The pumps  323  may further apply pressure through the one or more output tubes  320   c,    320   d,  so that the simulated biological fluid  278   a,    278   b  is evacuated through simulated birth canal  120  and out of aperture  126  of simulated genitalia  122  during a simulated childbirth scenario. 
     To facilitate the operation of the fluid handling system  318 , a schematic of the operation of discharging simulated biological fluids (e.g. fluids  278   a / 278   b ) related to labor and delivery is disclosed in  FIG.  17   . First, the external device  332  ( FIG.  17   ) is in communication with a controller  176  disposed within housing  102 . In the exemplary embodiment shown in  FIGS.  16 K- 16 L and  18   , the controller  176  is disposed on pump cover  328  and concealed by circuit board cover  330 . Relative to other components adjacent the fluid driver  314 , controller  176  may be positioned above pumps  323  and/or behind or above motor  182 . Controller  176  may store (e.g. in an associated memory) one or more items of information for use in controlling one or more components of the simulator  100 , such as the pumps  323 . Controller  176  is configured to process signals wirelessly received from the external device  332  in order to operate the pumps  323 . In one example, when the fetal model  106  is at a predetermined location relative to the birth canal simulator  116  (i.e. as determined by one or more sensors  174  discussed above), the external device  332  may be used to control a volume and flow rate of simulated biological fluids  278   a,    278   b  into the simulated birth canal  120  and out of aperture  126  of the simulated genitalia  122 . In operation, controller  176  wirelessly receives a signal from the external device  332  and activates the pumps  323  to evacuate the respective simulated biological fluid  278   a ,  278   b  from the containers  276   a,    276   b  as the fetal model  106  moves towards the birth canal simulator  116  and out of the aperture  126  of the simulated genitalia  122 . Additionally or optionally, controller  176  may be configured to hydraulically control the release of fluids from containers  276   a,    276   b  (generically referred to as a Fluid Bag in  FIG.  17   ) through control of one or more valves. Fluids may further be released from containers  276   a,    276   b  either due to the fluids being stored under pressure, or due to the application of pressure through one or more pumps  323 , substantially as described above. Controller  176  may further send signals for operating the birthing device  104  to simulate the childbirth scenario according to a predefined algorithm programmed in controller  176  or an associated memory (discussed below). 
     According to a simulated childbirth scenario, labor and delivery of the fetal model  106  comprises at least one simulated complication. In one example, the at least one simulated complication comprises shoulder dystocia, wherein movement of the fetus is impeded by one or more its shoulders contacting the pubic bone of the mother. In an exemplary embodiment, the controller  176  may send signals to actuator assembly  180  for operating the birthing device  104  to simulate a childbirth scenario involving shoulder dystocia. In particular, the controller  176  may send signals for operating the birthing device  104  according to a predefined algorithm programmed in controller  176  or an associated memory. The predefined algorithm may comprise the sliding carriage  196  moving along a portion of the length of the actuator  190 , such that the pushing paddle  224  moves the fetal model  106  toward the birth canal simulator  116 . Then, at a predetermined location prior to complete delivery of the fetal model  106  out of simulated genitalia  122 , the sliding carriage  196  retreats and moves away from the birth canal simulator  116 , such that a later subsequent movement of the shoulder portion of the fetal model  106  toward the birth canal simulator  116  is blocked. In a non-limiting example, at least one limit switch is utilized to define the predetermined location. Specifically, at least one limit switch is disposed adjacent both ends of actuator  190  or both end portions of a travel path of sliding carriage  196 . In this way, contact between sliding carriage  196  or paddle  224  and the at least one limit switch provides a signal to the controller  176  to cease operation or movement of sliding carriage  196  or paddle  124 . In this embodiment, the housing  102  may include a gap between the outer layer of top portion  112  and operational components of housing  102  (e.g. birthing device  104 , birth canal simulator  116 , etc.), such that the care provider may apply suprapubic pressure to the top portion  112  of housing  102  for releasing the blocked shoulder portion of the fetal model  106 . 
     Another embodiment of the simulator according to the present invention is illustrated in  FIGS.  19 A- 23 C . The components of this embodiment generally correspond to the components of simulator  100  as discussed above. 
     However, this embodiment is different from the first embodiment described above in several respects. The fetal model  106  is positioned on a support structure  648  ( FIGS.  19 A- 19 B ) and thus, the pushing paddle  224  has a shape intended to correspond to the internal geometry of a support structure  648 . As the sliding carriage  196  moves along the length of the actuator  190 , the pushing paddle  224  moves the fetal model  106  toward the birth canal simulator  116  for delivering the fetal model  106  outside the housing  102 . 
     The support structure  648  is configured to provide support to at least the fetal model  106  while the fetal model  106  is disposed within the housing  102 . The support structure  648  has a size and shape that corresponds with the overall size and shape of at least the birthing device  104 , as seen in  FIG.  19 A , and one or more components of the birthing simulator. In an example, the support structure  648  comprises a rigid platform  630  that is configured to position the fetal model  106  above the moving parts of the birthing device  104 , such as the actuator assembly  180 . In this configuration, the moving parts of the birthing device  104  is also protected from movement of the fetal model  106  during a simulated childbirth scenario. 
     The support structure  648  is configured to be stationary relative to at least the actuator assembly  180  and the fetal model  106 , thereby providing a stabilizing feature to the simulator  500  ( FIG.  18 A ). This stability is facilitated by one or more rails  632  ( FIGS.  20 A- 20 C ) configured to be coupled to the uterus simulator  628  ( FIGS.  22 ,  23 A- 23 C ). The one or more rails  632  are used to secure the fetal model  106  within the uterus simulator  628 . In an example, the uterus simulator  628  comprises an elastic membrane  634  and the removable fetal model  106  is configured to be positioned within the elastic membrane  634  to simulate a childbirth scenario, such as at least one of a normal and an abnormal labor childbirth scenario. In another example, the uterus simulator  628  may comprise a solid structure or non-elastic membrane configured to enclose and secure the removable fetal model  106 . 
     As seen in  FIGS.  20 A- 20 C , the one or more rails  632  are coupled to the support structure  648  via one or more connectors  636 / 638 . Each of the one or more connectors  636 / 638  define at least one aperture  640 / 642 , through which a fastening mechanism, such as screws (not shown), extend to secure the one or more rails  632  to the support structure  648 . Further, the connectors  636 / 638  each define blind holes  648 / 650  through which the one or more rails  632  is configured to extend. In an example, the elastic membrane  634  of the uterus simulator  628  defines at least one opening  644  ( FIG.  23 A ) through which each of the one or more rails  632  are configured to extend, In another example, as seen in  FIG.  22   , the at least one opening  644  comprises one or more pockets  646  that may be formed from an exterior surface of the elastic membrane  634  and each of the one or more pockets  646  is configured to receive a respective one of the one or more rails  632 . In yet another example, the one or more pockets  646  may be tapered in one end portion  646   a  and the tapered end portion  646   a  (as seen in  FIGS.  23 A- 23 C ) is adjacent the birth canal simulator  116 . In particular, the tapered end portion  646   a  is positioned a distance, D, from the birth canal simulator  116  comprising the pelvic ring  676  and the non-tapered opposite end portion  646   b,  is positioned a distance, d, from the pushing paddle  624 . 
     Although  FIGS.  20 B- 20 C  indicate that more than one type of connector  636 / 638  may be used, it would be understood from the description herein that the same type of connector, or any other combinations thereof may be used. Other suitable attachment mechanisms for attaching the one or more rails  632  to the support structure  648 , such as for example, straps, hook-and-loop fasteners, anchors, adhesives, or double-sided tape, or combinations thereof will be known to one of ordinary skill in the art from the description herein. Optionally, the one or more rails  632  and the support structure  648  may be integrally formed as a single body of unitary construction. As another alternative, the one or more rails  632 , the support structure  648  and the elastic membrane  634  may be integrally formed as a single body of unitary construction. 
     Referring now to  FIGS.  21 A- 21 E , a simulated childbirth scenario comprises a labor and delivery of the fetal model  106  with at least one simulated complication. In one example, the at least one simulated complication comprises shoulder dystocia, wherein movement of the fetus is impeded by one or more its shoulders from making contact with the pubic bone of the mother. In this childbirth scenario, the one or more rails  632  comprise inflatable rails  652  configured to elevate the fetal model  106  relative to the actuator assembly  180 , moving the fetal model  106  out of alignment with the birth canal simulator  116 , and causing forward movement of the fetal model  106  to be blocked. In particular, the forward movement of the fetal model  106  is blocked because the elevation of the fetal model  106  caused by the one or more inflatable rails  652  causes a portion of the fetal model  106 , such as at least a shoulder, to be blocked by a portion of the birth canal simulator  116 , such as the pelvic ring  676 . In the example shown in  FIG.  21 D , the one or more inflatable rails  652  is attached to a plastic layer  654  via an elastic attachment  656 . 
     In an example, a pelvic insert  658  that is positioned adjacent to the birth canal simulator  116  facilitates blocking the forward movement of the fetal model  106 . The pelvic insert  658  is intended to simulate a mother&#39;s pubic bone, against which the baby&#39;s shoulder makes contact in a shoulder dystocia simulation. In an example, as seen in  FIG.  21 B , the pelvic insert  658  is attached to a top portion of the pelvic ring  676 . Although  FIGS.  21 A- 21 C  illustrate that the pelvic insert  658  is attached via fastening means, such as screws, other suitable attachment mechanisms, such as for example, straps, hook-and-loop fasteners, anchors, adhesives, or double-sided tape, or combinations thereof will be known to one of ordinary skill in the art from the description herein. Optionally, the pelvic insert  658  is removable to facilitate easy cleaning and replacement, as well as allow for a simulation of a normal childbirth scenario without at least a shoulder dystocia complication. 
     As illustrated in  FIG.  21 D , the fetal model  106  is configured to rest on one or more inflatable rails  652  disposed above the actuator assembly  180  of the birthing device  104 . The one or more inflatable rails  652  have a deflated state ( FIG.  21 B ) and an inflated state ( FIG.  21 C ). The one or more inflatable rails  652  may be positioned within the housing  102 , particularly within the uterus simulator  628 . As seen in  FIG.  21 A , the one or more inflatable rails  652  comprise at least one inflatable rail  652  that correspond to the length of the actuator assembly  180 . However, one of ordinary skill in the art would understand from the description herein that the one or more inflatable rails  652  may have any size necessary to permit the intended simulation of shoulder dystocia. For example, the one or more inflatable rails  652  may have a shorter length relative to the actuator  190  and are positioned adjacent to the birth canal simulator  116 . Although  FIGS.  21 A- 21 C  illustrate that the at least one inflatable rail  652  is attached via fastening means, such as screws, other suitable attachment mechanisms, such as for example, straps, hook-and-loop fasteners, anchors, adhesives, or double-sided tape, or combinations thereof will be known to one of ordinary skill in the art from the description herein. 
     To accommodate the inflated state of the one or more inflatable rails  652 , the shape of the birthing device  104  and its components, such as the pushing paddle  224 , is configured to allow for the one or more inflatable rails  652  to increase in size when they are in the inflated state ( FIGS.  21 B- 21 C ). The one or more inflatable rails  652  may be inflated by a pump  660  via one or more tubes  662 / 664 , as illustrated in an exemplary layout of  FIG.  21 E . The pump  660  may be configured to be automatically actuated, e.g., by signal from controller  176 , or may be manually actuated by the maternal subject  108 , e.g., in response to a feedback signal. The one or more tubes  662 / 664  include an input tube  662  and a pair of output tubes  664  that extend from a connector  668 , such as T connector. The pair of output tubes  664  are configured to connect to the at least one inflatable rail  652  via inflation valves  670 . In this layout, the pair of output tubes  664  are connected to the at least one inflatable rail  652  from a posterior portion  672  of the birthing device  104  relative to the birth canal simulator  116 . Additionally or optionally, the pump  660 , input tube  662 , T connector  668 , and a portion of the pair of output tubes  664  may be positioned outside of the housing  102 . 
     Referring now to  FIGS.  22  and  23 A- 23 C , the one or more rails  632  are further configured to guide movement of the fetal model  106 . As the fetal model  106  is moved toward the birth canal simulator  116  by activation of the actuator assembly  180 , the elastic membrane  634  is configured to be in a compressed or contracted condition. As seen in  FIGS.  22  and  23 A , when at least the fetal model  106  (not shown) is positioned within the elastic membrane  634  and secured via fastening means, such as a zipper  674  ( FIG.  23 B ), the elastic membrane  634  is in an expanded or extended condition. As the fetal model  106  is pushed toward the birth canal simulator  116 , the elastic membrane  634  automatically moves or is moved toward a compressed condition ( FIG.  23 C ). The above described movement of the elastic membrane of the uterus simulator may assist in simulating the expulsion of the fetal model  106  from the uterus and into the birth canal simulator  116 . 
     For each simulated childbirth scenario, the uterus simulator  628 , particularly the elastic membrane  634  of the uterus simulator  628 , is configured to stabilize and secure the fetal model  106  in a position corresponding to the intended childbirth scenario to be simulated. For example, the fetal model  106  may be loaded within the uterus simulator  628  in one alignment for the occiput or cephalic posterior position birthing position and another alignment for the breech birthing position. Further, the one or more rails  632  facilitate one or more specific alignments by preventing unwanted movement of the fetal model  106  that detracts from the intended childbirth scenario to be simulated, based on the fetal model&#39;s  106  birthing position. As discussed above, the tapered shape of the one end portion  646   a  of the one or more pockets  646  extending from the exterior surface of the elastic membrane  634  and the non-tapered opposite end portion  646   b  allow for selective restriction of the fetal model&#39;s  106  movement, at certain stages of labor. For example, the tapered end portion  646   a,  i.e. tighter region, of the uterus simulator  628  helps ensure the limbs of the fetal model  106  are held in the proper position, particularly as the uterus simulator  628  moves toward and reaches the compressed condition ( FIG.  23 C ) and the fetal model  106  transitions into the birth canal simulator  116 . 
     In an exemplary embodiment, the fetal model  106  comprises electronic circuitry housed within (e.g. simulated head of fetal model  106 , or other simulated anatomical regions or limbs). Further, some or all of the electronic circuitry of the fetal model  106  may have protective coating (e.g. acrylic coating) and/or additional protective layers for safeguarding the electronic circuitry from damage or contaminants. Additionally or optionally, the electronic circuitry housed within the fetal model  106  is powered by an integrated power source (e.g. a battery, such as an NiMH battery) and/or an external power source via a charging port disposed in a simulated anatomical region of the fetal model  106  (e.g. simulated foot). Still further, the electronic circuitry comprises a sound chip (e.g. VS1010 sound chip as manufactured and designed by VLSI Solution of Tampere, Finland), an audio amplifier, and at least one sound file and at least one audio exciter. The electronic circuitry further comprises a Bluetooth® chip to enable wireless communication protocol, such as Bluetooth®, between the electronic circuitry of fetal model  106  and the compatible external device  332  ( FIG.  17   ), which may be controlled by an instructor or a professional that is different from the care provider/trainee/student. 
     Moreover, one or more items of information or algorithms related to the fetal model  106  may be optionally programmed in the electronic circuitry of the fetal model  106  or stored in an associated memory. Execution of the one or more items of information or algorithms causes at least the fetal model  106  to perform predefined functions. According to one childbirth scenario, the integrated power source may be activated to supply power to the electronic circuitry of fetal model  106  via an actuator (e.g. a button) housed in a simulated foot of the fetal model  106 , or may be controlled remotely by external device  332  ( FIG.  17   ) through known wireless communication means. According to another childbirth scenario, the external device  332  may be used to control a duration, pitch, frequency, and/or volume of simulated cries from the fetal model  106  at certain stages of labor and delivery. 
     Referring now to  FIG.  24   , a method of using the wearable birthing simulator is provided. The method  400  includes one or more steps including positioning a fetal model in a uterus simulator, activating an actuator to automatically move the fetal model out of the uterus simulator and toward a birth canal simulator activating a feedback device to provide haptic feedback to the subject based on the position of the fetal model, and evacuating a simulated biological fluid out of the housing as the fetal model moves towards the birth canal simulator. Optionally, method  400  includes detecting a position of the fetal model relative to the birth canal simulator. Additional details of method  400  are set forth below with respect to the elements of simulator  100 . 
     In step  402 , a fetal model is positioned in a uterus simulator. In an example, uterus simulator  128  is positioned within a housing  102  configured to be securable to a maternal subject  108 . In this example, the uterus simulator  128  includes a tube assembly  564  adapted to contain at least the fetal model  106  therein. In a preferred example, the fetal model  106  is secured within the space  584  defined by the base  568  and the cover  574  of the tube assembly  564 . Optionally, the uterus simulator  128  includes an elastic membrane having a zipper to secure the fetal model  106  therein. Step  402  may further include securing the fetal model  106  connected to a simulated placenta  280  via a simulated umbilical cord  282 , within the uterus simulator  128 . 
     In step  404 , an actuator is activated to automatically move the fetal model out of the uterus simulator and toward a birth canal simulator. In an example, a birthing device  104  is configured to move the fetal model  106  towards a birth canal simulator  116 . The birthing device  104  comprises an actuator assembly  180  that is configured to be in communication with a controller  176  for automatically moving the fetal model  106  towards the birth canal simulator  116  and out of the uterus simulator, e.g., in accordance with an algorithm or programmed stored in a memory associated with controller  176 . 
     In an optional step  406 , a position of the fetal model relative to the birth canal simulator is detected. In an example, one or more sensors  174  are mounted to the housing  102  and are electrically connected to the controller  176 . The one or more sensors are configured to detect movement of the fetal model  106  by the birthing device  104  relative to the birth canal simulator  116 . 
     In step  408 , a feedback device is actuated to provide haptic feedback to the subject based on the detected or determined position of the fetal model. In an example, feedback device  178  is in communication with an external device and is configured to provide haptic feedback to the subject  108 . Additionally or optionally, the feedback device  178  is in communication with the controller  176 , which is configured to activate the feedback device  178  to provide the haptic feedback to the subject  108  in response to sensing e.g., the movement or position of the fetal model  106  relative to the birth canal simulator  116 . 
     In step  410 , a simulated biological fluid is evacuated out of the housing as the fetal model moves towards the birth canal simulator. In an example, the uterus simulator  128  comprises one or more containers  276   a / 276   b,  the one or more containers  276   a / 276   b  each storing a respective simulated biological fluid  278   a / 278   b . The external device is configured to evacuate the respective simulated biological fluid  278   a / 278   b  from the one or more containers  276   a / 276   b,  into the simulated birth canal  120 , and out of the aperture  126 , as the fetal model  106  towards the birth canal simulator  116 . Optionally, the controller  176  is configured to evacuate the respective simulated biological fluid  278   a / 278   b  from the one or more containers  276   a / 276   b  and out of the opening of the housing  102 , as the sensors detect movement of the fetal model  106  to the birth canal simulator  116 . 
       FIG.  24    depicts an example method comprising steps that are performed sequentially in the order recited. However, it should be understood from the description herein that one or more steps may be omitted and/or performed out of the described sequence of the process while still achieving the desired result. Additionally, additional operations of simulator  100  described herein (e.g., with respect to simulating contractions or complications during the birth process) may be included within the steps of method  400 . 
     Turning now to the operation of birthing simulator  100  with the external device  332  ( FIG.  17   ), an exemplary embodiment of the birthing simulator  100  includes electronic circuitry having a controller  176  and a wireless transmitter/receiver for transmitting/receiving wireless signals (e.g. WiFi or Bluetooth®) to/from external device  332 , which may be controlled by an instructor or a professional that is different from the care provider/trainee/student. Further, external device  332  may comprise an electronic device, such as a computer, laptop, a mobile device (e.g. smart phone, tablet, or similar device configured for connection via a wireless connection described above), or a compatible display device. As already discussed above, one or more items of information or algorithms related to components of birthing simulator  100  may be programmed in controller  176  or stored in an associated memory. 
     Execution of the one or more items of information or algorithms causes one or more components of birthing simulator  100  to perform predefined functions. According to one childbirth scenario, the external device  332  ( FIG.  17   ) may be used to control a volume and flow rate of simulated biological fluids  278   a,    278   b  into the simulated birth canal  120  and out of aperture  126  of the simulated genitalia  122 . Specifically, controller  176  wirelessly receives a signal from the external device  332  and activates the pumps  323  to evacuate the respective simulated biological fluid  278   a ,  278   b  from the containers  276   a,    276   b  to push the simulated biological fluid  278   a,    278   b  toward the simulated genitalia  122 , in preparation for movement of the fetal model  106  towards the birth canal simulator  116  and out of the aperture  126 . Additionally or optionally, controller  176  may be configured to hydraulically control the release of fluids from containers  276   a,    276   b  (generically referred to as a Fluid Bag in  FIG.  17   ) through control of one or more valves. 
     According to another childbirth scenario (i.e. “Prebuilt scenario”), controller  176  is configured to process signals wirelessly received from the external device  332  ( FIG.  17   ) in order to automatically operate pumps  323  to evacuate a predefined volume and rate of respective simulated biological fluid  278   a,    278   b  from the containers  276   a,    276   b.  Additionally or optionally, external device  332  automatically activates the actuator  178  to provide haptic feedback to the subject  108  at a predefined time during the simulation period and for a predefined duration. The haptic feedback may discreetly instruct subject  108  to manually inflate the inflatable bag  158  to simulate a contraction and/or provide realistic feedback based on the position of the fetal model  106  relative to the birth canal simulator  116 . Additionally or optionally, controller  176  is configured to process signals wirelessly received from the external device  332 , to operate actuator assembly  180  for operating the birthing device  104  to simulate a normal childbirth scenario or abnormal childbirth scenario (e.g. involving shoulder dystocia). In particular, controller  176  may cause sliding carriage  196  to move along a portion of the length of the actuator  190 , such that the pushing paddle  224  moves the fetal model  106  toward the birth canal simulator  116  in accordance with predefined parameters (e.g. rate, start/stop, etc.). In the case of a normal childbirth scenario, the fetal model  106  is delivered out of aperture  126  of the simulated genitalia  122 . Then, in the case of shoulder dystocia complication, at a predetermined location prior to complete delivery of the fetal model  106  out of simulated genitalia  122 , the sliding carriage  196  retreats and moves away from the birth canal simulator  116 , and a later subsequent movement of the sliding carriage  196  toward the aperture  126  causes the shoulder portion of the fetal model  106  to be blocked by the simulated cervix  118 . Other childbirth scenarios include, but are not limited to PPH (as described above), a water break scenario, etc. Simultaneously, the external device  332  is configured to display information related to the childbirth scenario, including but not limited to, elapsed time of the simulation, percentage of total travel completed by the fetal model  106 , current contraction state (low/beginning, mid/rising, high/peak, mid/falling, low/ending), etc. 
     According to still another childbirth scenario (i.e. “Custom built scenario”), controller  176  is configured to process signals wirelessly received from the external device  332  ( FIG.  17   ) in a similar manner as discussed above regarding the “prebuilt scenario,” except that the instructor may customize parameters of the labor and delivery, including but not limited to, length of contraction, rate of contraction, volume and rate of simulated biological fluid (e.g. blood and amniotic fluid) evacuation. 
     According to yet another childbirth scenario (i.e. “Direct control of device”), controller  176  is configured to process signals wirelessly received from the external device  332  ( FIG.  17   ) in a similar manner as discussed above, except that the instructor may exert greater control or customization of one or more parameters of the labor and delivery, including but not limited to, speed and direction of motor  182  for driving actuator  190 , length of contraction, rate of contraction, volume and rate of simulated biological fluid  278   a,    278   b  (e.g. blood and amniotic fluid) evacuation. This scenario may be particularly helpful for test/demo purposes, troubleshooting, or assessment of tech support requirements. 
     According to another childbirth scenario (i.e. “iSimulate scenario”), controller  176  is configured to process signals wirelessly received from the external device  332  ( FIG.  17   ) in a similar manner as discussed above, except that external device  332  comprises a device powered by the iOS operating system, such as an iSimulate iPad. 
     Although the invention is illustrated and described herein with reference to specific embodiments, the invention is not intended to be limited to the details shown. Rather, various modifications may be made in the details within the scope and range of equivalents of the claims and without departing from the invention.