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Aiming to Avoid the Scalpel

The Unkindest Cut

WebMD Feature
Reviewed by Craig H. Kliger, MD

March 19, 2001 -- Kathy Schuler dreaded the thought of a cesarean section. She had seen friends struggle through recovery and hated the idea of being cut open. But after five hours of labor and signs that her baby might be in trouble, there usually was no other choice in cases such as hers. Until now.

A new device called the fetal oxygen saturation monitor, designed to measure the level of oxygen in a fetus' blood, is giving doctors, nurses, and expectant mothers the reassurance that babies who may seem to be struggling during labor are actually fine.

"From my perspective, this is one of the most significant technological advancements in obstetrics in a long time," says Thomas J. Garite, MD, professor and chairman of obstetrics and gynecology at the University of California-Irvine. "It is technology that allows us to do the right thing for the right reason, and that is an important advance."

For the past 30 years, doctors and nurses have monitored fetal condition through the heart rate monitor -- a belted device that is strapped around the mother's belly. However, about 30% of all labors (about 1.2 million births per year) will produce an abnormal or "nonreassuring" heart rate at some point, according to the CDC. Such an abnormal rate could be due to a serious concern such as the baby receiving an insufficient amount of oxygen. But it also could be due to an inconsequential one like the baby falling asleep. Unfortunately, the heart monitor is usually not capable of distinguishing between the two, leaving the obstetrical team with the difficult decision of whether to allow labor to continue or proceed with a C-section.

About seven of every 10 cesarean sections performed because of presumed fetal distress are unnecessary, says Kathleen Simpson, PhD, RN, a nurse researcher in labor and delivery at St. John's Mercy Medical Center in St. Louis. However, the fetal oxygen saturation monitor, approved by the FDA last year, has the potential to change that. Called by the FDA "the first major technological development in fetal monitoring" in decades, the OxiFirst system takes some of the guesswork out of deliveries.

"It gives more information and objective information so we can say, 'This baby needs to come out and needs to come out in an emergency fashion,' or 'This baby can tolerate labor a little longer and perhaps have a vaginal birth,'" says Simpson, a co-investigator in the multicenter study on fetal oxygen monitors.

In the past, medical teams have used fetal scalp blood sampling to determine fetal oxygen levels, but Simpson tells WebMD the process of obtaining the blood from the baby's scalp is invasive, and often must be repeated several times.

The fetal oxygen monitor, on the other hand, usually causes no more discomfort than a traditional vaginal exam, Simpson says. A disposable sensor connected to a cable is inserted through the birth canal after rupture of the amniotic membranes ("breaking of water"), and rests against the baby's cheek, temple, or forehead, pressing up against the uterine wall. Using red and infrared light, the sensor analyzes the fetus' blood oxygen level, and this information is displayed on a monitor, providing real-time data to the OB team.

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