County Clinics Turn Away 1,650 : Prenatal Horror Tales Just ‘Tip of the Iceberg’

When she was eight months pregnant, Denise Weaver, a homeless young woman of 20, was turned away from an Orange County prenatal clinic for lack of $40.

Anna Silva of Fullerton could not find care in a free clinic for her sixth pregnancy because of her Rh-negative blood factor.

Even with money or insurance, Anna Ramos said, it is hard to find a doctor who will provide prenatal care without a guarantee of delivering the baby as well.

And in a videotape presentation, a woman named Juanita said she did not even realize she was going to have a child until she was five months pregnant.

‘Scared’ of the Clinic

A 14-year-old girl said she delayed seeking prenatal care until she was six months pregnant because she was “scared” and did not have a ride to a clinic.

These and other stories were told Monday to a panel of health-care professionals, philanthropic and civic leaders and policy-makers. The committee met in Garden Grove to hear a report on the growing demand for--and inadequate supply of--public health-care services for Orange County’s pregnant women.

Moderated by state Sen. Marian Bergeson (R-Newport Beach), the public forum was held in response to data showing that the county’s Health Care Agency is increasingly turning away pregnant women.

The picture painted by the report and the panel’s witnesses was bleak.

Last year, 1,650 pregnant women were turned away from Health Care Agency clinics in Orange County because of overcrowding. The same year, 2,312 pregnant women received late prenatal care or no prenatal care, a 40% increase over 1983, according to the report, which was prepared by Professionals and Agencies for Prenatal Access, a broad-based committee of health and social welfare professionals.

Many of those women are Latina, poor and uninsured, the study found.

Moreover, the number of obstetrician/gynecologists who accept Medi-Cal patients has dropped from 64 to 45, the report said.

“The actual problem of adequate prenatal care may be, in fact, more of a problem than any of us even expected and is, in fact, just the tip of the iceberg,” the report said.

Crucial Early Care

In testimony before the panel, physicians said that early prenatal care--education about nutrition, examinations and counseling to detect problems such as toxemia and anemia--can be crucial to the health of newborns and their mothers.

Babies born to mothers without prenatal care are five times more likely to die in their first year of life than those whose mothers received adequate care, said Dr. Louis Gluck, a world-renowned neonatologist at UCI Medical Center.

In 1986, 38% of babies born at UCI Medical Center to mothers with inadequate prenatal care were children with low birth weights--under 5 1/2 pounds, Gluck told the panel. Despite the development of sophisticated machines and substances to help tiny babies, low-birth-weight infants continue to be at high risk for mental and physical disabilities, Gluck said.

Among them, 42% will have some neurological handicap or congenital anomaly, contrasted with 19% of normal-term babies, Gluck said.

Orange County, along with the state, has lost ground in the most important measures of infant health care, Wendy Lazarus, director of Southern California Child Health Network, told the panel.

She cited these examples:

- California dropped from 10th-best to 31st best in the nation on the percentage of pregnant women receiving prenatal care in the most important first trimester of pregnancy.

- In low birth weight, the state declined from 12th-best to 15th-best.

- In infant mortality, the state dropped from seventh to ninth.

Lazarus also said that in 1984 and 1985, California’s infant mortality rates rose for the first time in 20 years. In Los Angeles County, infant mortality, after dropping for seven years, increased to 10.4 deaths for every 1,000 live births largely because of county agencies’ inability to meet the growing demand for prenatal services.

In Orange County, infant mortality rates also rose in 1985, after having dropped to 7.9% in 1984.

Orange County ranked 23rd of 38 reporting counties in the state regarding children born to mothers who received late or no prenatal care, and 12th of 22 reporting counties in deaths of newborns (up to 28 days old). “It’s sobering knowing what a county like this is capable of,” Lazarus said.

The report presented to the panel showed that, beyond the emotional and psychological costs to the family, it costs $2,300 a day for a baby to receive care in a neonatal intensive care unit.

“When future costs are taken into account, it costs nine times as much to provide remedial services to these children as to provide adequate prenatal care to their mothers in the first place,” the report said.

Nine clinics, including the four operated by the Health Care Agency, offer prenatal care in Orange County.

The report by the committee of health professionals recommended that the county provide more funds to the Health Care Agency to improve and expand its existing prenatal services, create an information and referral service to help women find care, form a blue-ribbon task force on access to prenatal care to develop public and private partnerships and seek more money from state and federal sources.

Bergeson said she plans to propose a budget item this year that would augment prenatal services in the state. Her bill to raise $10 million in cigarette taxes for prenatal care in counties with inadequate services died this year in the Senate Appropriations Committee.

Bergeson said the chances of the budget item being adopted eventually are “excellent.” Orange County’s proposed budget includes funding for 500 more prenatal patients than in the current year.

“While this will not solve the problem, it is certainly an important and significant step,” said Len Foster, a deputy director of public health for the county’s Health Care Agency.