Total of Sick Newborns in State Rises as Prenatal Care Shrinks

More and more babies are being born sick or premature in California, as pregnant women face increasing difficulty in getting adequate medical attention, according to a private study released Tuesday.

A record $104 million in public funds was spent last year on hospitalization costs for these tiny infants, while many of their medical problems could have been prevented if their mothers had received adequate--and relatively inexpensive--medical care during pregnancy, the Southern California Child Health Network reported.

One promising sign, the group noted, is that the state’s infant mortality rate resumed its downward trend in 1986, after a well-publicized increase during the previous year. However, director Wendy Lazarous pointed out that the gap in death rates for black and white babies in 1986 was wider than at any time in the last 16 years. Nearly twice as many black babies as white babies died during their first year of life.

Experts have concluded that prenatal care--consisting of between nine and 13 medical checkups of the mother beginning early in her pregnancy--significantly improves a baby’s chances of being born healthy and surviving its first few months of life.

Yet access to this care has gotten worse. About one in 13 women in California get no prenatal care or get it too late, the report stated.

In 15 counties, the group reported, there were no obstetricians willing to provide prenatal care to pregnant women whose bills are reimbursed through Medi-Cal, the state’s health insurance program for the poor. In Los Angeles County, as elsewhere, many obstetricians have discontinued treating Medi-Cal mothers, leaving one doctor for every 707 Medi-Cal mothers in Los Angeles County in 1986, according to the report.

Increasingly, women throughout the state are turning to overburdened public clinics for prenatal care, encountering long waits for appointments and being refused by the thousands in clinics in San Diego and Orange counties.

It was not uncommon for women to wait a month for appointments in San Bernardino, Alameda and Santa Cruz counties, the report noted. But lines were the longest last year in Los Angeles County, where women in some cases were forced to wait 16 weeks for appointments.

“I see firsthand the consequences of this,” said Dr. Ezra Davidson, chief of obstetrics at Martin Luther King Jr./Drew Medical Center in Watts.

He said his statistics show that 28% of the 8,000 women who delivered babies at King last year had received no prenatal care, up from 20% the year before. Their babies, he said, accounted for half the newborn deaths.

Dr. Irv Silberman, director of maternal health and family planning programs for Los Angeles County, said he has no countywide data for 1987. But 1986 statistics “are markedly improved over 1985 and close to an all-time good record,” he said.

Countywide, Silberman said, the number of women receiving inadequate prenatal care has dropped from 8.8% to 8.3%. Another good sign, he said, is that fewer babies in Los Angeles County are being born dangerously underweight.

Many Small Babies

However, across the state, 28,782 babies were born in 1986 weighing less than 5 1/2 pounds, compared to 28,389 in 1985 and 26,538 in 1984.

The study prepared by the Child Health Network pointed out that for every $1 spent on prenatal care, the state could save at least $1.70 in hospitalization costs of children during their first year of life. Spending $43.2 million to provide prenatal care to the 36,000 women who each year go without it would yield a net savings of $30 million--and up to $345 million when future costs of caring for disabled children are taken into account.

Davidson illustrated the cost-savings potential by pointing to the case of 3-year-old Corina Guzman.

The toddler, who suffers from cerebral palsy, was born prematurely and weighing less than three pounds. Since birth, she has run up bills of about $200,000, which have been paid with public health dollars. But her premature birth might well have been avoided, doctors said, if her mother had received prenatal care. Her mother, Cinde Guzman, a free lance graphics artist, said she did not get prenatal care because she had no health insurance, could not qualify for Medi-Cal, and could not afford to pay $900 for doctors’ care.

State Has Two Choices

Leon Schwartz, director of the EC Irvine Medical Center, said the “Back to Basics” report by the Child Health Network makes clear that the state has two choices: “Either we can provide pregnant women with the preventive care they need, or we can pay a lot more later to treat babies whose problems could have been avoided.”

Lazarus pointed out that some counties and community groups have taken steps to ease the prenatal care crisis but said that it will be up to the legislature and the governor to provide meaningful relief.

The County Supervisors Assn. of California has called for increased state funding of prenatal care programs.

RANKING CALIFORNIA’S NEWBORN DEATHS HOW CALIFORNIA RANKS AMONG 50 STATES

1970 1984 1985 Infant Mortality 7th 9th 14th Newborn Deaths* 5th 15th 17th Low Birthweight 12th 15th 17th Late or No Prenatal Care 16th 34th 36th

* Deaths within 28 days of birth

RACE AND NEWBORN DEATHS (1985) Newborn Deaths (Per 1,000 Births)

All Californians: 6.0

White: 5.3

Black: 10.6

Latino: 5.6

Asian: 4.2

Late/No Prenatal Care (Per 1,000 Births)

All Californians: 7.6

White: 4.8

Black: 10.8

Latino: 9.3

Asian: 6.2

Source: Back to Basics