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Aiming to Avoid the Scalpel

The Unkindest Cut


The normal oxygen saturation for a fetus is usually between 30% and 70%, Simpson says. A lack of oxygen for an extended period of time can result in hypoxia, brain damage, or even death.

With the oxygen monitor, Schuler was able to avoid the scalpel and vaginally deliver a healthy baby girl.

"It was kind of scary, because in five minutes they had me numbed up and the operating room ready to go," Schuler says. "But it turned out the baby was fine, which was great because no one wants to get a C-section if you don't have to."

The percentage of C-sections recently has been rising after a steady decline from 1989 to 1995. About 22% of live births in 1999 were delivered by C-section, a 4% increase from 1998, the CDC reports. What's more, the rehospitalization rate after C-sections was 80% compared to the 30% of those rehospitalized following an uncomplicated vaginal birth. In general, women who undergo C-sections risk infections of the uterus or around the incision, as well as urinary and gallbladder complications.

Of the 6,800 babies born annually at St. John's, about 23% are delivered by C-section. Simpson says she is hopeful that the oxygen monitor will reduce that.

A clinical study of more than 1,000 births at nine sites nationwide suggested that fetal oxygen monitors, when used in conjunction with heart rate monitors, could halve the number of C-sections related to a "nonreassuring" heart rate. But the study, published in the November 2000 issue of the American Journal of Obstetrics and Gynecology, also found an increase in the overall number of cesarean deliveries due to dystocia -- failure of the baby to pass through the pelvis. The company that makes the monitors and which funded the study, St. Louis-based Mallinckrodt Inc., is paying for further research to determine what effect the monitors might be having, if any, on women who encounter such difficulties. "It's a very puzzling finding from the study," says Garite, a co-author of the study. "We are doing a follow-up, multicenter study to look at the question."

Researchers also are examining whether the oxygen monitors could be useful in evaluating premature infants, Garite says. Currently, the monitor is employed only in women dilated past two centimeters whose water has broken after a fetal heart monitor shows an abnormal rate. Women who are carrying more than one fetus, who are less than 36 weeks pregnant, or who are carrying a breech baby cannot use the device.

Mallinckrodt declined to disclose the number of hospitals using OxiFirst, but says more and more are adopting the system. At the time of FDA approval, the fetal oxygen monitor had been relied on in more than 35,000 births. The technology has been available in Europe since 1996 and in Canada since 1998.

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