Special Delivery : A Group of Doctors Provide Care for Pregnant Women--Even If They Can’t Afford It

Bridget Bo was afraid of giving birth to her child.

She was not afraid of the pain but of the hospital. She had heard nightmare stories about the county facilities where an uninsured, 23-year-old single mother like Bo would usually deliver. Delivery in a private hospital was out of the question because of the thousands of dollars it would cost.

But because of the efforts of some obstetricians at St. John’s Hospital in Santa Monica, Bo’s story has a happy ending. Henry K. Hasserjian and the other doctors who believe that “every pregnant woman in our society deserves good health care, whether she can afford it or not,” put their actions behind the words.

They founded the Small Step program that provides some of the best health care available on the Westside. Care is provided at Westside Women’s Health Center, a private, nonprofit agency in Santa Monica, and St. John’s Hospital.

The program has two phases. Prenatal care is provided at the women’s center at a reduced fee--$600 to $800--said Holly Richards, coordinator of prenatal care at the center. Care can also be covered by Medi-Cal.

The clinic then refers eligible patients to St. John’s. Although the hospital does not accept Medi-Cal patients, each month it provides free care for 10 low-income women from the Westside with low-risk pregnancies.

They are assigned an obstetrician at St. John’s whom they meet weeks before the birth. The program provides a free delivery, a pediatrician to examine the infant while still in the hospital, and postpartum care at the women’s center, Richards said.

Viveca Cole is one of the patients who has benefited from the Small Step program. Her first child was born five years ago when she was employed as a supervisor at an answering service and had insurance. She said she got top-rate care for that birth.

But shortly after that child was killed in a car accident, Cole found herself pregnant, single, unemployed and uneasy about her health care choices.

She was accepted into the Small Step program and, by coincidence, was matched up with the same doctor who delivered her first child.

Richards emphasizes the professional quality care that these doctors donate and often refers to Cole’s situation.

“These are professional doctors, who do professional work--it is not an assembly-line atmosphere,” she said.

Along with the 13 doctors giving quality, individual care to patients, Richards said the program offers a personal prenatal program, where a woman is more than “just a body carrying a child.”

The prenatal program includes psychosocial counseling, nutrition counseling, vitamin supplements, childbirth preparation classes and referrals to low-cost ultrasound exams.

Most important, however, is the personal touch, she said. The walls of the clinic are covered with photos of small children, and patients and staff exchange pregnancy stories.

“It’s wonderful to see these girls come in as scared girls and leave to St. John’s as women ready to become mothers,” Richards said.

Program administrators have made a deliberate attempt to recruit Spanish-speaking workers to better serve the large Latina population in Santa Monica. Richards said 90% of the program’s patients come from working-class Latino families.

Maria Villa Grana, 35, was another patient who said she feared the county facilities because of the stories she had heard. Friends had told her that the mothers were often treated as a number, that she would be treated by a doctor she’d never met before and that her partner would not be allowed to be with her during the birth.

Villa Grana never had to see if all that was true. She was accepted to the Small Step program and delivered her child at St. John’s.

Sometimes, the program goes even further than promised. Hasserjian, who was chief of obstetrics and gynecology at St. John’s when the program was founded, recalls one child he delivered that was born with a cleft palate.

The parents were a young Mexican couple who spoke very little English and had no idea where to go for help.

Hasserjian said that he raised a small volunteer army, complete with a plastic surgeon, and that the child was provided with full care--at no charge--and left with only a small scar.

Gene Parks, an obstetrician at St. John’s and the medical director for the Westside Women’s Health Center, said that once the doctors take on a patient, they usually take full care of that woman through the delivery, even if it’s a Cesarean section, and as in Hasserjian’s case, care for the child as well.

Parks’ current Small Step patient is a 12-year-old girl whose boyfriend moved back to Mexico.

Richards said one of the hurdles she has had to overcome with many of her Latina patients is their fear of the U.S. health care system itself.

“Many of the women who are here illegally think they won’t qualify for Medi-Cal,” she said.

The women’s center’s prenatal program is buttressed by the small payments they receive from Medi-Cal. But the system has few fans among the Small Step doctors.

Hasserjian said the Medi-Cal system is so inefficient and burdensome that he would rather give out free care than deal with the state program.

James Moran, an obstetrician who volunteers for the program, echoed Hasserjian’s sentiments, and said he has even ended up in the red when dealing with Medi-Cal, producing a mountain of paperwork to get reimbursed less than the actual process was worth.

Moran said he finds the Small Step program an ideal way to provide volunteer health care while avoiding bureaucracy.

Hasserjian said the program is a small step in solving a big problem. He hopes that other communities will follow suit.

“If every obstetrician does his or her part, we may resolve one of our many problems,” he said.

“For me, the patients’ reaction is worth a lot more than the money from someone who can pay me for my services.”

Westside Women’s Health Center is located at 1705 Ocean Park Blvd., Santa Monica. (310) 450-2191.