County Scrapes for Funds to Deliver Prenatal Care to Pregnant Women

Everybody knows that Orange County’s population is booming. There are more than 2.2 million residents now, and by the year 2000, the experts say, that number will be 2.6 million.

That’s the equivalent, roughly, of absorbing the entire population of St. Louis, Mo.

But before you go out and slap another one of those bumper stickers on your car (“Welcome to Orange County. Now go home.”), consider this: Most of those newcomers won’t be people from back East, nor will they be immigrants from foreign countries.

They will be Orange County natives.

They will be our children.

“Newborn babies already make up the largest proportion of our growth,” says Orange County 3rd District Supervisor Gaddi H. Vasquez. “In the next year, 60% of our annual growth rate will be newborns.”

The county’s figures are in keeping with a national trend. The National Center for Health Statistics reported this week that 3.9 million babies were born in the United States last year, up 2% from 1987 and the highest number since 1964.

Orange County already has the second highest child population in the state, Vasquez says, even though it is third in general population.

Vasquez is concerned that the county isn’t doing as much as it should to welcome those new arrivals. More attention should be paid to all the services the county provides for children, he says. But in particular, he wants to put more resources into prenatal care, helping women--especially poor women--go through their pregnancies in as healthy a state as possible.

Problem is, his fellow Republican, Gov. George Deukmejian, is trying to cut back the amount of state money available for those services, even as the demand increases.

“We’re scraping for dollars,” Vasquez says. “We’re trying to at least retain the amount of money we’re already getting.”

As medical expenses go, prenatal care is one of the biggest bargains around. The woman goes in to see the doctor once a month or so, gets her blood pressure and urine checked for signs of trouble and has a routine examination. She gets vitamins and guidance on diet and exercise, and a few blood tests along the way. The doctor gets to listen to the baby’s heartbeat, and so does she. Most of the time, nothing goes wrong, but if it does, doctors can intervene right away to minimize the problem.

The county will spend about $1.7 million for its public prenatal care services this year, about $460,000 of which is county money. About 2,500 patients are served by the program, according to Dr. L. Rex Ehling, director of public health. That works out to less than 5% of the approximately 45,000 births expected in the county this year, he says.

So Orange County is spending about $680 per patient, which is pocket change compared to the thousands--or more--we have to spend if a child is born prematurely, underweight or with other problems that might have been prevented with good prenatal care.

“It isn’t so expensive to take care of babies before they are born,” Ehling says. “It’s terribly expensive to take care of them after. We’ve spent more than $1 million on some babies, and it’s not at all uncommon to have a child cost $400,000 to $500,000.

“It’s a uniquely American phenomenon,” he says. “We have a great capacity to care for these babies that result from poor pregnancy outcome. But we haven’t really made prenatal care a priority.”

But, no matter how much is spent, some of those babies just don’t make it. In Orange County, 7.6 of every 1,000 infants born in 1987 died before they were a year old, according to Ehling. Orange County’s infant mortality rate is better as a whole that the national rate of 10.4 (the figure for 1986, the most recent year for which numbers were available). The state infant mortality rate for that same year was 8.9. Ehling credits the county’s overall affluence as a factor.

On the national level, Sen. Bill Bradley (D-N.J.) has introduced the “Healthy Birth Act of 1989” in an attempt to improve both the infant mortality rate and prenatal care in general. The bill includes provisions for prenatal handbooks and home visits by nurses.

Some women simply don’t seek prenatal care. “Sometimes it’s a cultural situation,” Vasquez says. “We have some women who come from areas where prenatal care is unheard of.”

In other cases, the mother may be a drug addict for whom the baby’s health is not a priority, says Lawrence Leaman, the county’s director of social services. “Many of the kids who come to us at birth via Orangewood (Children’s Home) are the byproducts of inadequate prenatal care.”

“A couple of years ago, we thought the biggest problem would be babies born AIDS-positive. But now we are overwhelmed with drug babies, babies that are born addicted. We get seven or eight of them every week.

“When we planned and built the Orangewood shelter (in 1985), this (drug) problem didn’t really exist,” Leaman says. “But now our ability to care for infants is stretched.”

Orangewood was intended to house as many as 12 infants at one time, with the overflow, if any, being sent to foster homes. But drug babies need closer medical supervision than foster parents can provide, so they must stay either at the hospital or in Orangewood, he says.

“We’ve had as many as six or seven babies in the hospital ready for discharge with no place to put them. That’s expensive. And frustrating.”

Other expectant mothers may try to find treatment, but without success. Many pregnant women--no one can say exactly how many--are turned away, either by private physicians or the county’s own clinics.

Ehling says that even when the county does have to turn a patient away, the public health nurses try to offer the woman some help by doing blood and urine screenings and “teaching her things to look for during pregnancy that are signs of a complication. We don’t want to give the impression that that’s any substitute for complete medical care, but it’s better than nothing.”

Ehling advises pregnant women, or women who think they might be pregnant, to seek treatment with a private physician first, someone close to their home. The state provides reimbursement to those doctors in many cases, through Medi-Cal or other programs, although many doctors are reluctant to participate. A new program even provides reimbursement for doctors who provide prenatal care to illegal immigrants, he says.

If that doesn’t work, he suggests trying another local doctor or clinic. Only as a last resort, he says, should a woman come to the county’s clinic because it is already so far over capacity.

“I can’t guarantee her care in any particular sector,” Ehling says. “There may be no place for her to turn.”