We also bought our NOELLE several years ago. The EFM was included. We use it every semester in our skills fair to demonstrate a normal vaginal birth and nursing responsibilities. The object is to familiarize students with the process, it is always a success. We have decided not to upgrade because the cost does not meet the benefit. The facility we take our students to uses their NOELLE to help staff members practice responses to specific obstetric emergencies such as shoulder dystocia or PPH. The staff feel better prepared to perform the specific maneuvers to improve patient outcomes.