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    Aiming to Avoid the Scalpel

    The Unkindest Cut


    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.

    Garite says he envisions every hospital eventually making use of the technology, which could improve what he considers the often overly intense circumstances under which babies are born.

    "We are unnecessarily scaring our moms," Garite says. "When they see us looking at the [heart rate] monitor and becoming concerned and putting oxygen on their faces, they put two and two together. That kind of unnecessary intervention increases the whole anxiety level. As people begin to realize with this monitor that actual hypoxia is so much less frequent, the whole environment will improve."

    Kimberly Sanchez is a freelance writer in St. Louis and a frequent contributor to WebMD. She also has written for the Los Angeles Times, New York Newsday, the Chicago Sun-Times, and the Dallas Morning News.

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