Infant Mortality Rate Falls Sharply Despite Drop in Prenatal Care

A steadily increasing number of Orange County mothers are going without any prenatal care, yet despite this growing health problem, infant mortality dropped significantly from 1985 to 1986, according to recently compiled statistics from the Orange County Health Care Agency.

County health officials said they were surprised by these apparently contradictory findings. Since women who receive no prenatal care usually have very small babies with serious health problems, that usually means a rising infant mortality rate, they said.

No Computer ‘Blip’

Health officials added, however, that it is too early to tell if the one-year drop in the county’s infant mortality rate would become a trend. Still, Len Foster, deputy director of public health, called the drop--from an infant death rate of 8.4 babies per 1,000 live births in 1985 to a death rate of 6.59 per 1,000 live births in 1986--significant.

“It’s not a blip on the (computer) screen,” said Foster, who directs adult and child health services in Orange County. “It’s significant, I believe, because the infant death rate and the neonatal death rate (the death rate for babies in the first 28 days after birth) is down across the board--and down across the board for all the ethnic groups.”

Foster and other health experts around the county attributed the recent decline in infant mortality to more sophisticated technology and improved care at neonatal intensive care wards--for instance, new respirators and more aggressive surgeries for these tiniest of babies. In Orange County, as around the country, doctors and nurses in neonatal intensive care nurseries have gotten better at keeping sick babies alive, they said.

But, although more newborns appear to have survived last year, too many of their mothers received little or no prenatal care, Foster and other experts in maternal and child health said.

“The care is obviously getting better and more sophisticated for babies who have problems, but it still doesn’t excuse the rate going up of women who get no prenatal care,” said Denise Gimbel, project director for the Orange County Perinatal Council. “You just can’t excuse the fact that some mothers get no prenatal care.”

In Orange County, the number of babies born to mothers who received no prenatal care before delivery rose from 437 babies, or 1.3% of all births, in 1983 to 905 babies or 2.4% of all births by 1986, according to the latest Health Care Agency figures.

In addition, the number of babies whose mothers never saw a doctor until the third trimester of pregnancy was 4.5% of all births (or 1,479 babies in 1983) but accounted for 5.3% of all births (or 1,102 babies) by 1986.

Based on those figures, Wendy Lazarus, director of the Southern California Child Health Network in Los Angeles, said she believes that Orange County’s overburdened public health clinics last year turned away at least 2,000 women who needed prenatal care.

The rise in mothers who received no prenatal care has come even though the county, over the last four years, has steadily increased its prenatal services, Foster said. In 1983, the Health Care Agency provided that care to only 900 women, but the agency is expected to serve about 2,350 pregnant women in the current 1987-88 fiscal year.

Complex Reasons

Even so, many Orange County women--possibly an additional 2,000 in 1987--will continue to go without prenatal care, Lazarus and others predicted.

The reasons are complex, and include the rising cost of prenatal care, a declining number of obstetricians who will take Medi-Cal patients, and--among Latino women--fear, Lazarus said.

Latinas who are not legal aliens fear that they may be deported if they receive prenatal care under Medi-Cal, health experts said. “You don’t want to see a doctor because you may be exposed to immigration and you may be sent back,” said Dr. Manuel Porto, an assistant professor of obstetrics and gynecology at the UCI School of Medicine who also directs perinatal services for the Orange County region.

Of 905 new mothers who received no prenatal care in 1986, 710 or 78% were Latinas, according to the latest county figures.

Yet inexplicably, Latino babies appear to have a relatively high survival rate. In 1986, infant mortality for these infants was among the lowest in the county--a rate of 5.4 deaths per 1,000 live births vs. 7.8 deaths per 1,000 births for whites; 9 deaths per 1,000 births for blacks; 5.6 deaths per 1,000 births for Southeast Asians, and 1.2 deaths per 1,000 births for other Asians.

Latino Rate

Gimbel and others said they still did not know why Latino babies did so well, but she theorized that a stable family support system during pregnancy might have something to do with this. However, that is only a theory, she said.

But for most babies, lack of prenatal care is linked to low birth weights and poor outcomes for babies, said Foster, Porto and other health experts. Low-weight newborns require intensive neonatal care, typically at a cost of about $2,000 a day, to keep them alive, those experts said.

Although such care is expensive, Orange County’s ability to provide it has improved in the last seven years, Porto and others said.

For in that period, the county has established a network of hospitals that, under Porto’s direction, work together to provide perinatal care.

Two hospitals, Childrens Hospital of Orange County and UC Irvine Medical Center, have been designated by the state to provide the most sophisticated care and to receive the most ill infants.

Five other hospitals--Martin Luther Hospital Medical Center in Anaheim, St. Joseph Hospital in Orange, Western Medical Center-Santa Ana, Fountain Valley Regional Medical Center and Hoag Memorial Hospital Presbyterian in Newport Beach--have been designated as “Level 2” perinatal centers that also can provide some sophisticated care.

Three more hospitals--St. Jude in Fullerton, Mission Community in Mission Viejo and FHP in Fountain Valley are now seeking the Level 2 designation. In addition, 15 other Orange County hospitals have been designated to provide a lower level of perinatal care.

Porto was cautious about giving the perinatal network credit for the decline in the infant mortality rate in 1986. But he said the lowered rate may indicate that the new system is finally working well.

In addition to transporting sick babies to the best-equipped neonatal units, Porto and his team of 20 obstetricians and neo-natologists visit member hospitals once a month to lecture their staffs on neonatal techniques--better ways to resuscitate an infant, new surgeries that can save babies’ lives.

“A few years ago, a baby less than 1,000 grams (about 2.2 pounds) was considered to have a very little chance of survival. So heroic or aggressive obstetrical management was not offered to these patients,” Porto said.

Doctors were concerned, he said, that a baby born too soon would “look a little funnier. . . . People were concerned about cerebral palsy and retardation” and so might not have worked aggressively to save these tiny babies, he said.

But in the monthly seminars, his team has been “getting the message out” that many of these babies can survive without permanent impairment. “Studies show that if we do a good job with prenatal care and then transfer the baby to the appropriate (neonatal) center when delivery is imminent, the outcome is not so bad,” Porto said.

Still, improved prenatal care to expectant mothers should reduce the number of babies who would need “heroic” medical care, said state Sen. Marian Bergeson (R-Newport Beach), who is trying to persuade the Deukmejian administration to include a $10-million appropriation for prenatal services in the 1988-89 state budget.

Based on figures from testimony before a Bergeson committee last August and from Lazarus’ Child Health Network, Bergeson said a $10-million expenditure could provide prenatal care for 10,000 women and, in just one year, would save $17 million in state funds that would otherwise be spent on maintaining babies in intensive care.

“There’s no question in my mind, from a cost perspective, getting care to these mothers would avoid the tremendous cost of taking care of low-weight babies, and, as a result of brain damage (in such infants), a lifetime of social services for that individual,” Bergeson said.

It is an issue, said Bergeson aide Julie Froeberg, that is both a taxpayer issue and “a pro-life issue.”