On many matters, Sue Vicchrilli is very decisive.
She likes cherry pie better than rhubarb, picks sophisticated over funky attire, prefers bubble baths to showers and would rather listen to Randy Travis than Michael Jackson.If the baby's life isn't threatened, she'd opt to deliver vaginally rather than by Caesarean.
"It's far more intimate to have just the doctor, nurse, my husband and me in the delivery room, rather than 16 (medical) people," she said.
Eleven years ago, a tell-all ultrasound revealed a double whammy: The 2 1-year-old was carrying two fetuses and one was in a breach position.
Well-informed of the possible threat a vaginal delivery posed to her unborn sons, Vicchrilli readily agreed to a Caesarean birth in which the baby is delivered through a surgical incision made in the mother's abdomen and uterus.
Vicchrilli delivered two red-headed, 6 1/2 pound boys - Adam Joseph and Jonathan Jerome. Although there were no complications, the new mother had other problems with which to cope. First, a difficult recovery from a large abdominal incision. Then came the comments, such as: "The twins weren't really born," and "It's a shame you couldn't experience the joy of labor."
That "joy" was hers five years later when son Sam was born. At the urging of her obstetrician, Dr. Kent Rasmussen, her third son was delivered vaginally.
Rasmussen, in practice at Salt Lake Clinic, encourages women to deliver vaginally whenever possible to alleviate the mental and physical strains associated with a Caesarean.
With Sam's birth, Vichrilli joined the ranks of women throughout the United States who are beating the myth: "Once a section, always a section."
The soaring rate of Caesarean deliveries is being reduced throughout the United States and Utah - thanks to aggressive nudging from insurance companies, physicians and mothers who have proven it's possible for women who have delivered Caesarean to give birth vaginally in subsequent pregnancies.
But the trend has been slow in turning.
Since 1984, Caesareans have ranked as the most frequently performed surgery in the nation.
Statistics released from the College of Obstetricians and Gynecologists show that 24 percent of the 3.7 million babies born annually in the United States are delivered by Caesarean. That represents a dramatic increase from the 1970s, when rates averaged 5 to 10 percent. And researchers estimate that rate could hit 40 percent by the year 2000.
But, according to the college's studies, 70 percent of women who underwent a Caesarean because of abnormal labor were subsequently able to have normal deliveries.
For years obstetricians have been urged by women's advocacy groups and insurance agencies to limit the number of Caesareans they perform, primarily because these surgeries are more dangerous and costly than vaginal deliveries. A woman's stay in the hospital is likely to be shorter after a vaginal delivery, and recovery at home is usually much faster.
But financial gain and convenience have motivated some physicians to perform an increasing number of C-sections, critics report.
"When you look at hospitals that have high C-section rates - 30 percent - you have to wonder if that's true," said Dr. Greggory De Vore, director of maternal-fetal medicine for Intermountain Health Care.
Insurers and other third-party payers have pressed for fewer Caesareans because of the cost involved: about $4,300 vs. about $2,500 for a normal delivery.
"Some insurance companies have mandated that patients have to try to have a vaginal labor or they will not pay for the care," said De Vore, director of the Intermountain Fetal Diagnostic and Treatment Center at LDS Hospital.
According to De Vore, there are three primary reasons for a physician to perform a C-section: the baby is in a breach position or is undergoing fetal distress, or the mother is failing to progress in labor.
"The biggest problem with a lot of these primary C-sections is that doctors do not monitor labor properly. It's also to the physician's benefit to California, however, than in Utah," said De Vore.
The College of Obstetricians and Gynecologists guidelines say each hospital should develop its own protocol for maternity patients but that the concept of routine repeat C-sections should be replaced with encouragement of normal labor. However, the doctor and hospital "must have the capacity to respond to acute . . . obstetric emergencies," including an emergency C-section should it become necessary.
De Vore believes that many of these "emergencies" can be eliminated if more hospitals will begin treating the fetus as well as the mother as a "patient."
The specialist said the best news for pregnant women isn't that they are given options for delivery. It's that, with sophisticated new technology, their unborn child can be monitored and problems diagnosed early.
"Instead of treating the problem - a woman in labor with a baby who has fetal distress - we have tried in the last 18 months since I have been at LDS Hospital to identify the baby who could have a problem."
By changing a woman's lifestyle during the pregnancy, such as putting her on bed rest, specialists have been able to avoid many cases of fetal distress.
***** (chart) Percentage of
Hospital Total Births By Total
Caesarean Section Births
Brigham City Comm. Hosp. 21.2% 457
Alta View Hospital 20.1% 1024
American Fork Hospital 17.0% 1034
Dixie Medical Center 21.4% 1035
Lakeview Hospital 24.2% 1118
University Medical Ctr. 26.0% 1572
Logan Reginal hospital 10.3% 1737
St. Marks Hospital 25.3% 1887
Cottonwood Hospital 21.2% 2822
Holy Cross Hospital 18.5% 3050
McKay-Dee Hospital 17.7% 3148
Utah VAlley Reg. Med. Ctr. 16.4% 4033
LDS Hospital 16.6% 4464
United States 24.0% 3,700,000
Utah 18.0% 36.196