Infant Death Rate Falls in L.A. County : Obstetrics: Officials report success in easing the load on the public health system. Inadequate prenatal care remains an area of concern.

Five years ago, Los Angeles County’s public health system was overwhelmed by huge numbers of poor women looking for a place to give birth, many of whom had received no prenatal care, and infant mortality figures were on the rise. Today, county health officials are rejoicing over a modest decline in infant mortality and the success of efforts to ease the county’s obstetrical crisis.

Infant mortality fell from 9.3 deaths per 1,000 babies in 1988 to 7.2 deaths in 1992, according to a report from the March of Dimes and the county Department of Health Services. The number of babies born too small has also dipped slightly, as has the overall number of births.

But problems remain. The infant death rate among African American women is disturbingly high. Huge numbers of teen-agers are giving birth. And babies born to Latinas face an abnormally high risk of neural tube defects such as spina bifida, officials noted Wednesday at a forum at Cedars-Sinai Medical Center.

“Overall, it’s a tremendous success story,” said Dr. Irwin Silberman, director of family health programs at the Department of Health Services. “But the population of the county is changing fast. There is a lot of poverty and cultural issues to deal with.”

Silberman credited the efforts of public and private agencies with easing the nightmarish scene in the county’s obstetrical units five years ago. In particular, an expansion in Medi-Cal services gave more women access to care, and more private health providers were persuaded to accept Medi-Cal patients.

Medi-Cal still pays for half of the births in the county, but county facilities serve only one-fifth of pregnant women today, compared to one-third in the late 1980s, Silberman said. The private sector lessened the burden on the county by absorbing more patients.

“We helped organize the nonprofit, community-based clinics to provide the care,” he said. “This has made a tremendous difference.”

Early prenatal care includes educating mothers to avoid tobacco, drugs and alcohol and is associated with a much brighter outlook for newborns, including healthier birth weights.

Although they are cautiously optimistic over the improved infant death rate, health officials said they worry about substance abuse among pregnant women, high birth rates among young teen-agers and the possibility that state budget cuts could dismantle some prenatal care programs that have sprung up in the past five years.

“Although we’ve made good progress since . . . 1990, there are serious questions on whether we can continue to maintain the current level of care and invest in improving the situation,” said Dr. Bruce Allen, chairman of the March of Dimes Health Professional Advisory Committee.

Of the 540 births each day in the county, 140 babies are born to mothers who received prenatal care only late in their pregnancies or not at all, the report said.

Ethnic variations also continue to frustrate medical professionals. For instance, the infant mortality rate for African Americans is double that of the rest of the population.

Substance abuse is also a problem among all races, with about 10% of all babies exposed prenatally to tobacco, drugs and alcohol (about 22,000 of the total 197,415 births in 1992). That statistic is based on urine tests at the time of delivery, health officials noted, and probably underrepresents the extent of the problem.

Overall, Latinas had the highest rate of substance abuse during pregnancy. African American women had a high rate of abusing illicit drugs, Latinas had a particularly high rate of alcohol abuse and whites had the highest rate of non-illicit drug and tobacco use.

Latino babies had a higher-than-normal rate of neural tube defects, for unknown reasons.