ORANGE COUNTY VOICES : More Thought and Money Must Go Into Prenatal Care : Health: Up to 10% of women having babies in the county have not seen a doctor during pregnancy. Recent attention to the problem is only a first step.

The birth of a newborn baby is one of the most important events in any family, an event to be desired, planned and carried out in the safest environment possible. Ideally, this should happen with family members present, in a hospital of choice close to your home, with a physician of your choice, all planned ahead of time.

But many women in Orange County do not have a choice of physicians or hospitals and thus cannot effectively plan and carry out such a safe delivery. These limitations result from factors such as poverty, language, ignorance and transportation.

One of the major limiting factors has been the lack of available maternity beds that will accept women who are funded under the state Medi-Cal system. Many Orange County hospitals and physicians, because of multiple problems with Medi-Cal, discontinued their participation in the program in 1988-89. The result was that in Orange County, one of the nation’s most affluent areas, a large number of women were not able to safely plan their deliveries. Many of our women ready to deliver were being forced to go to a single large, central hospital, the UCI Medical Center, where they were either not known or arrived too late to experience a safe, well-monitored labor and delivery. This resulted in the institution of the “Obstetric Diversion” policy that the medical center announced in June, 1989.

There are many key participants involved in providing quality maternal care, including hospitals, physicians, clinics, government funding agencies (Medi-Cal), county government and the Hospital Council. These people gathered at a March of Dimes Forum in July, 1989, to discuss this issue. Medi-Cal intransigence, the need for data, access issues, the seriousness of the situation and public awareness were all identified as major problems. The conclusions were that much could be accomplished if everyone worked together. Subsequently, the March of Dimes commissioned a major hospital capacity report from the UCLA School of Public Health, which showed that the birthrate in Orange County was increasing at a 12% annual rate, and that the county was in danger of an absolute deficiency in maternity beds.

The Board of Supervisors founded the Perinatal Task Force and state Sen. Marian Bergeson and Supervisor Gaddi Vasquez formed the Coalition for Health Care Solutions to look at this problem. California Medical Assistance Commission (Medi-Cal) officials were contacted about the capacity needs, and public hearings were held in the county.

The results over the past year have been impressive. CMAC has worked with one central Orange County hospital on a limited-service contract to lighten the load on UCI Medical Center’s obstetrical service. A pair of hospitals under the same corporate leadership have contracted for general Medi-Cal services at one hospital and obstetrical services at another (others are reviewing a similar contract), and Medi-Cal and Proposition 99 monies are committed to support two birthing centers within the next year.

These changes, which have been a direct result of a sudden awareness of this “crisis” last summer, are gratifying. But much remains to be done.

The birthrate in Orange County remains very high and the projected safe delivery capacity for the entire county is expected to be surpassed this year. One of our major Medi-Cal contract hospitals has just canceled its contract, leaving up to 1,500 Medi-Cal mothers per year to find someplace else to deliver their babies. New delivery facilities must be recruited, and soon, to avert the situation where no bed will be available for a woman in labor.

The number of women going into labor with no prenatal care is sharply rising. Preliminary data indicates that 5% to 10% of deliveries involve women with no prenatal care who drop in at the emergency room in the final stages of labor. This could result in as many as 5,200 babies delivered in 1990 whose mothers received no prenatal care--babies who are subjected to a much higher risk of newborn illness, injury and death.

It has been estimated that the average cost of an ill newborn, many of whom can be prevented with early prenatal care, is enough to pay for the entire prenatal care of more than 100 women. That is certainly a much wiser use of our limited funds. But Orange County, judging from a recent public hearing before the Board of Supervisors, certainly does not intend to place health care at the top of its budgetary agenda.

There are many problems in providing adequate prenatal care. To realize our goal of a safe delivery for every Orange County mother and child, all the individuals and agencies must work together. We have come a long way in a single year, but we must continue to seek more innovative approaches that fully use existing resources if we expect such progress to continue.