Can County Deliver Enough Maternity Beds? : Health care: Severe overcrowding at Medi-Cal hospitals could cause rise in infant mortality rate for all, a researcher warns.

Predicting a shortage of maternity beds in the near future, a March of Dimes researcher warned Friday that pregnant women in Orange County--rich and poor alike--could face crowded delivery rooms and a rise in infant mortality.

“If you plan to get pregnant in 1990 and deliver in 1991, I’d be concerned,” said UCLA public health researcher Dr. Gary Richwald.

“I would suggest women seek obstetrical care early and be certain a physician is delivering at a hospital with adequate (obstetrical) capacity.”

The worst crowding is occurring at Orange County’s nine Medi-Cal contract hospitals, facilities with state contracts to care for low-income patients, Richwald concluded after a six-month study of Orange County’s obstetrical capacity.

In 1989, those hospitals ran 123% over their capacity for deliveries, he said, handling 6,038 births when they were designed for only 4,625.

But Richwald warned that crowding may spill into non-Medi-Cal hospitals around the county, causing “severe disruption” at the other hospitals. Already, two hospitals that do not participate in Medi-Cal are experiencing crowding.

“Although the current crisis principally impacts lower-income women who have Medi-Cal as their health insurance, without immediate intervention, this problem will spread to most if not all of the perinatal facilities in the county and impact women from all economic backgrounds,” the 34-page report by Richwald and UCLA researcher Dianna M. DeVane concluded.

Also, a new baby boom may bring deliveries this year beyond the county’s capacity for maternity services, Richwald said. The county’s birth rate has been rising unusually sharply, he noted, from 43,948 births in 1988 to 49,239 last year, a 12% increase.

If that rate continues--and Richwald said it might--there could be 55,000 births here this year, nearly 4,000 deliveries above an estimated capacity for 51,575 births a year.

Crowding on maternity wards could lead to increased infant mortality rates because doctors “may not be as sharp” as they should be or have enough space to operate advanced equipment, Richwald said. He noted that Los Angeles County last year had a 7% increase in infant mortality, possibly due to severe crowding on maternity wards.

To avert a “public health crisis,” Richwald said, Orange County needs more obstetrical beds. Beyond that, he and the March of Dimes executive board also offered a list of recommendations to ease crowding on maternity wards. Among the suggestions:

State officials should permit hospitals to have partial Medi-Cal contracts for obstetrical and neonatal services. They should also improve Medi-Cal reimbursement rates for pediatricians, anesthesiologists, and hospitals providing birthing services.

County officials should ensure that clinics offering prenatal care have links with a hospital so women have a planned birth site.

Doctors should accept a minimum number of Medi-Cal patients.

Volunteer organizations should start pilot projects in perinatal care.

The March of Dimes commissioned Richwald’s study last September after its directors were shocked by a new policy at UCI Medical Center in Orange. Saying it was handling 500 deliveries a month on a ward designed for 250, the medical center in June instituted a procedure called “obstetrical diversion.”

Under that policy, when both the maternity and emergency rooms are full, hospital security guards have met women in labor at curbside, asking them to try another hospital. That policy has reportedly reduced deliveries, but the maternity ward is still too crowded, hospital officials have said.

Early reaction to the March of Dimes report was positive. Russ Inglish, director for the Hospital Council of Southern California’s Orange County region, called the recommendations “sound” and said he knew of five local hospitals interested Medi-Cal obstetrics contracts.

Dr. Lawrence Wellikson, chairman of an Orange County Medical Assn. committee on health care access, vowed that doctors would take Medi-Cal patients if reimbursement improved. “Docs in the county are willing to do their part,” he said. “They just don’t want to be taken advantage of.”

And Marianne Maxwell, director of Orange County’s Perinatal Task Force, called Richwald’s statistics on overcrowding “compelling.”

“The state’s going to have to answer whether there’s a solution. They have to present alternatives on contracting,” Maxwell said.

That could happen in Irvine Thursday when March of Dimes officials will present this report again, before a special hearing on obstetrical care by the California Medical Assistance Commission, the state panel that handles Medi-Cal contracts. Up to now, however, commission staff have claimed there was no problem in Orange County and their figures show sufficient maternity capacity.