Airline pilots use flight simulators to train for rare and dangerous situations like engine failures in a realistic but safe and controlled environment. Doctors do the same, practicing lifesaving surgical techniques using simulators to keep their skills sharp for operating on a real person in rare types of emergencies.
“It’s vital to practice for serious emergencies,” says Dr. Esther Chin, a Hamilton Health Sciences (HHS) gynecological surgeon and global health lead in McMaster University’s department of obstetrics and gynecology. “You can’t be a fair-weather surgeon, just like you can’t be a fair-weather pilot.”
Globally, postpartum hemorrhage, or serious bleeding after a birth, affects 14 million people per year. It’s the leading cause of maternal death worldwide, causing 70 thousand deaths annually. Chin led the creation of a surgical simulator called STITCH (Surgical Trainer for Interventions to Control Postpartum Hemorrhage) for health-care providers who deliver babies. STITCH’s base is modeled on an MRI of a female pelvis, making it a very realistic training tool. It’s used for practising three types of emergency surgeries considered to be last resorts when a patient develops life-threatening bleeding after childbirth.
Two of those surgeries – compression sutures and tying off arteries – aim to save the uterus while stopping out-of-control bleeding. Compression stitches control severe bleeding by applying direct pressure to the uterus, while tying off arteries to the uterus reduces the main blood supply. The third surgery, an emergency hysterectomy, removes the uterus as a last resort to save the patient.
“Regular practice using a simulator helps ensure that emergency procedures are performed instinctively,” says Chin. “There’s no reason for health-care providers to be learning on the fly when we have simulators.”
In Canada, severe postpartum bleeding that requires surgery may be classified as ‘high acuity, low occurrence’ (HALO). This means it’s extremely serious and potentially life-threatening, but doesn’t happen very often.
As a result, keeping skills sharp by practising on a simulator can save lives. “No maternal death is ever expected nor accepted,” says Chin.
An award-winning idea
Chin was one of three HHS innovators to receive a 2025 DRIVE Spark grant of $50,000 to support commercialization of new, game-changing health-care innovations. The other winners were Dr. Guillaume Paré and Pareon Biosystems, for a project that uses artificial intelligence to develop state-of-the-the-art precision blood tests; and HHS gynecological surgeon and ultrasound specialist Dr. Mathew Leonardi for the development of a digital tool to improve treatment plans for patients diagnosed with endometriosis.
HHS DRIVE Spark grants support original, new projects aimed at improving health-care delivery. DRIVE – which stands for Dare, Research, Innovate, VenturE – cultivates the development of HHS research and innovation into medical technologies and solutions with the goal of transforming new ideas into real commercial solutions aimed at improving patient outcomes and advancing healthcare.
STITCH is currently manufactured in Vancouver, where Chin developed it with biomedical engineers Yiting Wu, Noah Stewart, Vincent Levandier, Tara Kemper, and Yong Hui Chan from the . It’s the same university where Chin completed a master’s degree in global surgical care.
With demand for STITCH units now outpacing supply, Chin will use the DRIVE Spark grant to step up production for worldwide distribution. “One of our major challenges now is keeping up with orders,” she says.
Inspired to save lives
Chin witnessed preventable deaths of women and babies firsthand while working in a remote Rwandan hospital during a medical school elective. “That elective was pivotal in altering my career trajectory towards obstetrics and gynecology,” she says, adding that her experiences with postpartum hemorrhage as both a resident and staff surgeon catalyzed the development of STITCH as a worldwide solution for saving mothers’ lives.
“The fact that people were dying while giving birth to new life struck me as highly inequitable,” says Chin, who has witnessed mothers dying from excessive bleeding in multiple settings around the world.
While there are other simulators on the market specializing in this kind of training, they’re astronomically expensive and larger, heavier and difficult to transport, says Chin. STITCH’s price point and compact size make it more accessible and also portable to remote communities in Canada and globally.
STITCH simulators have been used in Rwanda, Tanzania, South Sudan, and South Africa. In Canada, McMaster and McGill universities have units, as well as the Society of Rural Physicians of Canada, which oversees rural family doctors who practice emergency obstetrics.
Many people assume that dangerous bleeds from childbirth are limited to low- and middle-income countries but in Ontario, it’s still a major cause of maternal death, says Chin. A 2024 study in Ontario found that about 27 per cent of pregnancy-related deaths were caused by obstetric bleeding.
Chin recently visited Cape Town, South Africa where STITCH engineer, Noah Stewart, presented a study on the simulator at the FIGO World Congress of Gynecology and Obstetrics, a global platform for sharing the latest research, clinical practices, and innovations in obstetrics and gynecology. STITCH was used in a Pre-Congress workshop, and the trip also included visiting Rwanda for mobile training workshops.
“It was marvelous to see all the interest and uptake,” says Chin, adding that she’s grateful for the DRIVE Spark award to help meet the growing demand worldwide.