Many Poor Women Still Forgo Prenatal Care : Obstetrics: Benefits have improved. But ignorance and shame, among other factors, deter patients. Babies pay the price.

Despite improvements in Medi-Cal benefits and improved services at satellite health clinics in Ventura County, many low-income women are still getting inadequate prenatal care, doctors and other health officials say.

Of the 2,882 babies born last year at Ventura County Medical Center, where most of the county’s low-income women deliver, 40.7% did not receive prenatal care in the first trimester, according to hospital records. More than 10% of the mothers were not examined by a doctor until the third trimester.

Dr. David Kasting, director of the hospital’s neonatal intensive care unit, estimates that as many as a quarter of the infants in the unit--most of whom were born prematurely--would be healthy if their mothers had received adequate treatment during pregnancy.

“There’s no question that infant mortality climbs significantly when women have no prenatal care,” Kasting said. The 20-bed neonatal unit is nearly always full, and will expand to 30 beds next year, he said.

The county’s infant mortality rate was 6.6 in 1988, the most recent year for which figures are available. That means that for every 1,000 babies born, 6.6 did not survive to age 1.

The county’s rate is below the statewide average of 8.6 and is lower than 30 of the 38 urban counties ranked by the state Department of Health Services.

But the Ventura County rate was significantly higher--7.4 deaths per 1,000 births--among Latinos, who make up most of the clientele in the county system.

Latinos also have a higher percentage of babies weighing less than 5 1/2 pounds, a key predictor of mortality and disability. Among Latinos, 5% of the 4,014 babies born in 1988 weighed less than 5 1/2 pounds; of the 10,167 Anglo babies, 4.7% had low birth weights.

“Most middle-class women miss a period and see a doctor,” said Dr. Robert Lefkowitz, the county hospital’s director of gynecology and obstetrics. “There’s a certain amount of education and sophistication” about the importance of prenatal examinations and tests.

But ignorance is only one of many reasons that low-income women often fail to get prenatal care, officials say. Language and cultural differences, lack of transportation, frustration with bureaucracy, embarrassment about being a single mother and long waits to see a doctor also discourage women from getting care early in pregnancy.

“Usually within our culture, women take care of themselves last,” said Petra Luna, associate director of health education for Clinicas del Camino Real, which operates three clinics serving the Latino communities in Oxnard, Saticoy and Fillmore. “As long as they feel fine, they think there’s no need to go.”

Many low-income couples think they cannot afford prenatal care, at least in the early stages of pregnancy. But a 1987 change in state law made it much easier for low-income women, even illegal aliens, to qualify for Medi-Cal obstetric benefits.

Some women are taking advantage of the change--660 were receiving Medi-Cal obstetric benefits in Ventura County last month, compared to 259 in July, 1989. But many more don’t know they qualify, officials said.

“People don’t know it’s easy to qualify for Medi-Cal,” Lefkowitz said. “There are very few who wouldn’t qualify.”

Low-income mothers also qualify for the federal Women, Infants and Children program, which provides food for pregnant and nursing mothers. But Antonia Lopez, who helps mothers sign up for the program at the county hospital’s women’s clinic, said many women are not aware of it.

Socorro Torres, a patient at the county’s satellite clinic in west Ventura, said she delayed getting prenatal care because she still owed the clinic money from a previous operation and didn’t know that Medi-Cal might cover her pregnancy.

Now in her fourth month, she had her first visit with a doctor on Friday. Her physician, Dr. Brian Prestwich, said it is difficult at this stage to predict Torres’ delivery date, which may become significant if she eventually needs a Cesarean section.

Torres, 29, said her husband abandoned her when he learned she was pregnant. She works at a Ventura glass company and is raising her 6-year-old daughter by herself.

She said most of her friends know the importance of prenatal care but think they cannot afford it. She said one friend, an illegal alien, did not realize that she qualified for Medi-Cal pregnancy benefits. The friend did not get prenatal care, Torres said, and delivered a baby with facial deformities.

Lefkowitz and other physicians said prenatal exams can detect kidney disease, diabetes and hypertension, which complicates fetal growth and can provoke premature delivery. Mothers also are counseled about nutrition, smoking, drinking and drugs. Sonograms and other tests can detect problems early that otherwise might threaten pregnancy.

Early prenatal care should keep Romie Pina and her unborn child healthy. She has come to the Ventura clinic every month since learning she was pregnant. After she told Prestwich about occasional bleeding, he found that her placenta was turned around and was bumping against the cervix.

Now Pina, 26, must stay off her feet as much as possible and avoid strenuous activity.

“She really has to take it easy,” Prestwich said. “The placenta could break and cause life-threatening bleeding.”

If she had not seen the doctor early, Pina said, she probably would have continued her job as a janitor, which often involved heavy lifting.

“He has helped me a lot to understand the problem. I was in a panic,” said Pina, who had been told at age 20 that she could not conceive and is eager to have the baby.

Another patient at the clinic, Elida Mendoza of Santa Paula, was diagnosed with a pregnancy-related condition that causes her immune system to destroy blood platelets, the cells that cause clotting. She must avoid bruises and cuts, she said.

Mendoza, 21, said she learned about prenatal care in her sex-education and home-economics classes at Santa Paula High School.

“I believe it’s important for the baby to be healthy. I want to know that everything is all right,” said Mendoza, who has been coming to the clinic since the first month of her pregnancy.

Most of her acquaintances know the importance of prenatal care and are aware of the programs that provide it, Mendoza said. “A lot of girls don’t go because they are embarrassed. They live with their parents and want to keep it quiet as long as possible. Sometimes they want to put off facing it.

“There’s a lot of help available,” she said. “I don’t think that’s the problem.”

Lefkowitz agreed. “If everyone asked for prenatal care, we’d have difficulty providing it. But at this point it’s not a problem of availability. There is some wait to get in, but there are many who just aren’t calling for care.”

Prestwich said the county’s mission is “not only making care available, but getting people to take advantage of it.”

The county’s satellite clinics in Ventura, Santa Paula, Moorpark, Simi Valley, the Colonia neighborhood of Oxnard and South Oxnard encourage people to use the system for prenatal care and other treatments.

Among other things, the clinics provide continuity, which is unavailable at the county medical center’s clinic, where a woman is likely to see a different doctor each visit.

The clinics also make prenatal care more accessible to people with transportation, child-care and financial problems. Every Wednesday, for example, a Medi-Cal worker visits the west Ventura clinic to answer questions and help patients with paperwork.

Jonette Duchai, associate administrator of the county’s Health Care Agency who is in charge of the clinics, said the county has placed more emphasis on the clinics in recent years. The result has been a steady increase in patients, she said.

Next year, physicians will be added at the Santa Paula and south Oxnard locations.

Prestwich said the clinics’ outreach is crucial to providing effective prenatal care.

“If I can get a mom in here and develop a relationship with her, I have a much better chance of keeping her . . . out of pre-term labor,” said Prestwich of the west Ventura clinic. “Patients are much more likely to call when they develop a problem.

“If we have an attitude that ‘here we are, come and get us’ instead of reaching out, we’ll fail, there’s no question,” Prestwich said.