On the day after she was born, Elizabeth Kathleen Truman was baptized. Her parents were afraid she might die if they waited any longer.
The baby had come into the world on April 26, three-and-a-half months early, weighing less than 2 pounds, barely the bulk of a box of chocolates. Her mother remembers sitting next to her transparent Isolette day after day, hours at a time, impervious to the doctors and nurses bustling about the newborn intensive care unit. She was too captivated by the fragile nature of her first and only child.
"They tell you that premature babies are small, but you don't realize how small they are," said Marcy Truman. "They're like dolls, they're like little dolls."
That was 15 weeks ago. Today Elizabeth's weight has more than doubled to "an enormous 5 pounds, 2 ounces," her mother said, laughing at the Truman home in Mission Viejo. But that is still less than what most full-term babies--with about 36 weeks in the womb--weigh at birth. Her tiny eyes, a delicate blend of green and brown, continue to be threatened by a disease that could take her sight. But everyone is optimistic that this danger, like countless others she has encountered, eventually will pass.
So far, Elizabeth Truman has beaten the odds that say underweight babies are 40 times more likely to die in their first month than a normal infant. However, she remains five times more likely to die before the end of her first year. Her mother is convinced that the infant has made it this far because of Memorial Medical Center of Long Beach.
According to some recent state figures, she may be right. For the fifth year in a row--since researchers at the University of California, Santa Barbara, began compiling such data--Memorial has recorded the state's lowest so-called perinatal mortality rate. It is not a measure of how many babies die each year at Memorial or any of the state's 349 other active maternity hospitals. Rather, it is an intricate, and occasionally imperfect, statistic that balances a hospital's death rate for newborns against what might normally be expected given the severity of cases typically handled.
The perinatal period, stretching from the last 20 weeks of a mother's pregnancy through the first 28 days of her newborn's life, is the time in which "medical intervention" can carry the most impact, explains statistician Ciaran S. Phibbs, who works out of UC San Diego. The mortality rate for the perinatal period is the best available standard by which a hospital can judge the effectiveness of its newborn care.
Out of about 5,000 Memorial births last year, 94 newborns died--in cold numbers about double the average for the rest of California. But when you consider that 35% to 40% of those births came after problem pregnancies, medical experts agree, the hospital's success rate is almost astounding.
The fact that Memorial should fare so well is not really surprising, experts say. The giant $267-million complex, which towers over Atlantic Avenue at 28th Street, has both a women's hospital and a children's hospital widely recognized as among the most advanced in the state.
By its number of licensed beds, Memorial has the state's largest perinatal center and the largest newborn intensive care unit, treating up to 54 high-risk infants each day. It has the largest educational outreach program, where medical information is shared among doctors at 20 hospitals as close as four blocks and as far as 30 miles away. And it has the largest maternal transfer program, through which more than 30 surrounding hospitals refer problem cases. Its Life Flight helicopter ambulances were used 600 times last year to transport expectant mothers.
There are innovative programs from laser technology to in vitro fertilization, the process that produces what most people think of as test-tube babies. A few weeks before Marcy Truman had her daughter, for example, Memorial was the birthplace of the nation's first test-tube quadruplets, born to the Kuzmanic family of San Pedro. All weighed less than 2 pounds at birth and have been released in good condition, hospital officials said.
"I think we give very good care here," said Dr. Roger K. Freeman, medical director of the women's hospital at Memorial. "But a lot of places give very good care, in my opinion."
Abundance of Hospitals
The Long Beach area, as well as all of Los Angeles and Orange counties, enjoys an abundance of hospitals that are well-equipped and staffed. In the state perinatal mortality research, for example, high marks also were registered by Cedars-Sinai Medical Center and White Memorial Medical Center in Los Angeles, UC Irvine Medical Center and the Kaiser Permanente hospital in Bellflower. (The state figures combine data from 1978 to 1982, the most recent year in which certain statistics are available.)
The state's two poorest-performing hospitals, contrasting actual perinatal deaths against what researchers expected, were Los Angeles' Martin Luther King General Hospital and County-USC Medical Center. (One in 10 California births occurs in Los Angeles County.)
Nevertheless, researchers found that perinatal mortality continues to be a relatively rare event statewide, averaging 12.3 deaths for every 1,000 births, and remains generally on the decline. The rate of Caesarean sections, however, seems to be rising, particularly in hospitals that have lower mortality averages, such as Memorial.
But neither Memorial's high-tech image nor its relatively high Caesarean rate really accounts for its newborn delivery success, medical director Freeman argues. "I think we have a combination of perinatal (before the birth) and neonatal (after the birth) care and a coordination of care that probably exceeds other places."
Much of that coordination stems from Freeman's close working relationship with Dr. Houchang D. Modanlou, director of newborn services at Memorial's Miller Children's Hospital. The two physicians first met at County-USC Medical Center in the early 1970s, and only a few months after Freeman became medical director at Memorial Women's Hospital in 1975 he convinced pediatrician Modanlou to join him. Both are also professors at UC Irvine.
Freeman also acknowledges that Memorial enjoys an advantage not found in many comparable baby hospitals.
"Most regional centers like ours rely primarily on transferred units--that is, the babies are delivered in other hospitals and sent in (to regional centers) after they're born." In contrast, he said, "we have the opportunity to get the mothers (before they give birth) and begin the intensive perinatal care, with a continuum into the neonatal care, because of our high maternal transport rate.
"You can imagine," said Freeman, "if you get a 1 1/2-pound baby that's born in an institution that doesn't have everything immediately available, you lose ground on those."
Doctors at other hospitals waste no time referring touchy cases to Memorial because "of the 10 years of work we've done to establish these relationships," the physician said.
In fact, 34-year-old Marcy Truman ended up at Memorial through just such a hospital referral. Her drama began to unfold after a draining 12-hour day at the office where she works as a graphic artist. At 1:15 a.m., she suddenly awoke when her water broke--the sac of fluid surrounding her baby ruptured and began to leak.
Mother Was Worried
"I really didn't think the baby was viable at that time," she said. Ruptures usually occur just before a baby is born. Truman was worried because her pregnancy had only reached its 28th week--about two-thirds of a normal term.
She quickly woke her husband, Larry. They called the doctor, jumped into their clothes and gingerly crammed into their compact car and headed for Hoag Memorial Hospital in Newport Beach.
"I was scared and I was angry," she recalls. "On Friday night at 1 o'clock you're concerned about drunk drivers. It was no time to be on the freeway. Larry kept assuring me that things were going to be fine. He was wonderful."
At Hoag, they were taken to a labor room, and a nurse performed a test to make sure the leak was amniotic fluid. When the test proved positive, the nurse paused. "You could tell she was real sad. She just said, 'Go ahead and cry.' "
Truman's obstetrician, Dr. Richard S. Jonas of Newport Beach, decided to transfer her to Memorial the next morning.
'The Best Chance'
"I feel that Roger Freeman has created a women's hospital there that is as good as any in the world," Jonas said, "and that he and his staff are among the best in the world. We (at Hoag) are oriented toward (full) term deliveries." But in a case like Truman's, he said, "we would prefer to get the patient to Memorial so the baby has the best chance."
At Memorial, Truman spent the following week in bed with a fetal monitor strapped to her abdomen until the baby's heartbeat began to fade. On a Friday night at 7:15, she was wheeled into an operating room, a Caesarean section was performed and daughter Elizabeth was born.
But for a brief bout with pneumonia, the baby grew stronger each day and after 13 weeks was allowed to go home with her mother. Jonas said her prognosis is good.
"When I started my medical practice about 25 years ago, most infants under 34 weeks didn't survive, and they were virtually written off at 32 weeks," the doctor said. "But now, if we have an infant that's a pound or more, it probably has a pretty good chance of surviving."
Truman said she can't find the words to adequately thank the doctors and nurses at Memorial. "How do you ever thank somebody who saved your child's life?"