A steadily increasing number of Orange County mothers are going without any prenatal care, yet despite this growing health problem, infant mortality dropped significantly from 1985 to 1986, according to recently compiled statistics from the Orange County Health Care Agency.
County health officials said they were surprised by these apparently contradictory findings. Since women who receive no prenatal care usually have very small babies with serious health problems, that usually means a rising infant mortality rate, they said.
No Computer 'Blip'
Health officials added, however, that it is too early to tell if the one-year drop in the county's infant mortality rate would become a trend. Still, Len Foster, deputy director of public health, called the drop--from an infant death rate of 8.4 babies per 1,000 live births in 1985 to a death rate of 6.59 per 1,000 live births in 1986--significant.
"It's not a blip on the (computer) screen," said Foster, who directs adult and child health services in Orange County. "It's significant, I believe, because the infant death rate and the neonatal death rate (the death rate for babies in the first 28 days after birth) is down across the board--and down across the board for all the ethnic groups."
Foster and other health experts around the county attributed the recent decline in infant mortality to more sophisticated technology and improved care at neonatal intensive care wards--for instance, new respirators and more aggressive surgeries for these tiniest of babies. In Orange County, as around the country, doctors and nurses in neonatal intensive care nurseries have gotten better at keeping sick babies alive, they said.
But, although more newborns appear to have survived last year, too many of their mothers received little or no prenatal care, Foster and other experts in maternal and child health said.
"The care is obviously getting better and more sophisticated for babies who have problems, but it still doesn't excuse the rate going up of women who get no prenatal care," said Denise Gimbel, project director for the Orange County Perinatal Council. "You just can't excuse the fact that some mothers get no prenatal care."
In Orange County, the number of babies born to mothers who received no prenatal care before delivery rose from 437 babies, or 1.3% of all births, in 1983 to 905 babies or 2.4% of all births by 1986, according to the latest Health Care Agency figures.
In addition, the number of babies whose mothers never saw a doctor until the third trimester of pregnancy was 4.5% of all births (or 1,479 babies in 1983) but accounted for 5.3% of all births (or 1,102 babies) by 1986.
Based on those figures, Wendy Lazarus, director of the Southern California Child Health Network in Los Angeles, said she believes that Orange County's overburdened public health clinics last year turned away at least 2,000 women who needed prenatal care.
The rise in mothers who received no prenatal care has come even though the county, over the last four years, has steadily increased its prenatal services, Foster said. In 1983, the Health Care Agency provided that care to only 900 women, but the agency is expected to serve about 2,350 pregnant women in the current 1987-88 fiscal year.
Even so, many Orange County women--possibly an additional 2,000 in 1987--will continue to go without prenatal care, Lazarus and others predicted.
The reasons are complex, and include the rising cost of prenatal care, a declining number of obstetricians who will take Medi-Cal patients, and--among Latino women--fear, Lazarus said.
Latinas who are not legal aliens fear that they may be deported if they receive prenatal care under Medi-Cal, health experts said. "You don't want to see a doctor because you may be exposed to immigration and you may be sent back," said Dr. Manuel Porto, an assistant professor of obstetrics and gynecology at the UCI School of Medicine who also directs perinatal services for the Orange County region.
Of 905 new mothers who received no prenatal care in 1986, 710 or 78% were Latinas, according to the latest county figures.
Yet inexplicably, Latino babies appear to have a relatively high survival rate. In 1986, infant mortality for these infants was among the lowest in the county--a rate of 5.4 deaths per 1,000 live births vs. 7.8 deaths per 1,000 births for whites; 9 deaths per 1,000 births for blacks; 5.6 deaths per 1,000 births for Southeast Asians, and 1.2 deaths per 1,000 births for other Asians.
Gimbel and others said they still did not know why Latino babies did so well, but she theorized that a stable family support system during pregnancy might have something to do with this. However, that is only a theory, she said.