Commentary : A Pregnancy Here Is a Far Cry From Paradise

My fiance and I were living on the small South Pacific island of Efate, 300 miles west of Fiji, when I learned that I was pregnant.

We were living in a thatched-roof hut we had built at the edge of the jungle, and were trying to earn enough money to repair the broken mast on our sailboat. We carried our drinking water; we slept on mats on the floor; we ate by candlelight; we bathed in the sea. We had no electricity, no phone, no plumbing or furniture. The hut had open doorways with no screening, and the long mosquito season was approaching.

But the island had a hospital and a general practitioner, and it cost only $30 to deliver a baby. The doctor had a crude ultrasound machine in his office, where I saw a blur of my baby at 11 weeks old.

My blood tests had to be sent a thousand miles away to Australia, the island’s nearest modern neighbor. Fortunately, the results of the first tests were good.

But, at four months pregnant, I felt a growing responsibility for this new life, and I didn’t want to take unnecessary risks. I wanted to give my baby the best chance in a modern world. So I bought a one-way ticket home and arrived in San Diego with $20 to spare.

I moved in with my parents, but I didn’t know the first thing about where to go for medical care or what it would cost to have a baby here. In the following months, I became acquainted with the demanding and fickle nature of the social welfare system in San Diego County. I felt like the good girl in a fairy tale, trying my best to win the approval of a hostile stepmother.

At the social welfare office, I waited in a long, slow-moving line to request a Medi-Cal application, waited in another line to turn it in, and I waited again to be given an initial screening. I attended a required orientation session, where I was read the rights and responsibilities of an aid recipient.

I completed countless forms; I sent an urgent request for supporting documents to my fiance overseas; and I met with a caseworker who gave me her first initial and last name and a phone number. (How are you supposed to phone someone at a busy office with only an initial? May I speak with R. Smith? L. Wilson?) Clearly, my stepmother hadn’t warmed up to me. I was told that a decision on my eligibility would be sent in the mail.

Meanwhile, I looked into the options for prenatal care and delivery that are available in North County. As I had expected, visits to private doctors are costly--about $2,000 for an uncomplicated pregnancy.

But what sent me reeling were the hospital costs: one day in the hospital for a normal delivery at a minimum of $1,800! That would pay for delivering 60 babies on my island. I began to think that I should have never come back. And I couldn’t reduce hospital costs by buying a health-insurance policy, because my pregnancy was a pre-existing condition and would not be covered.

My mother and I scanned the Yellow Pages and made inquiries about clinics that offered low-cost prenatal care. There didn’t seem to be much available. One program affiliated with UC San Diego Medical Center does only four deliveries a month and was booked.

Planned Parenthood in Escondido takes 10 new patients a month on a first-come, first-served basis. Luckily, there were still two openings available. I hustled over there, not exactly sure what I was signing up for but knowing it was important. Once accepted in the program, I realized how anxious I had become about finding good care that wouldn’t cost a fortune, and I began to relax for the first time since coming home.

I liked the friendly and professional staff at Planned Parenthood. I would get regular checkups and tests; I’d get lots of information; complete records of my health history would be kept on file. I would see a nurse practitioner several times and a doctor twice before delivery. The charges are on a sliding scale, but substantially lower than visits to a private doctor--mine will be about $630. Still, there are the hospital costs to pay.

My caseworker’s telephone was busy for two days. I finally spoke to someone in the social welfare office who handles problem cases, who promised that my caseworker would call me. She never called. Instead, I got a notice in the mail: application denied--not a California resident.

During the course of this uncertain, and sometimes demoralizing, pursuit of finding prenatal care in San Diego County, I came to appreciate three areas in which I am fortunate:

First, my pregnancy is progressing well and I have had no real problems.

Second, I’ve had the full support of my parents, both financially and emotionally. They are lending me the money for the medical bills and have bolstered my morale as I sought my way through the tangled web of bureaucratic procedure.

Third, I am one of the lucky women who is getting good care in the Planned Parenthood Prenatal Program. I’m not one of the 5,000 women in the county who are turned away from overcrowded clinics each year, and are left to wonder what options remain and what will happen to their babies.