The number of Orange County doctors willing to accept Medi-Cal coverage of expectant mothers has decreased at a time when concern is growing over infant mortality, according to a new study.
Warnings about the need to reverse that trend were included in the March of Dimes study, which area health specialists said offers perhaps the most comprehensive assessment to date of the increasingly visible problem of prenatal care.
Despite clear evidence that medical attention in the early stages of pregnancy reduces the risk of low birth weight and unhealthy infants, the study found that about 12% of Latino mothers and 15% of teen-agers get little or no prenatal care, making them the two highest-risk groups.
Overall, about 7% of the 38,730 county women who gave birth in 1987 received inadequate prenatal care, the study found.
"We're seeing a wider schism than ever before between those who are able to receive care and those who aren't, and the message is that we need to get the community excited about making mothers and babies a priority," said Dorothy Andrews of the Orange County branch of the March of Dimes Birth Defects Foundation.
She oversaw the study, completed last month.
The lack of prenatal care among poor women was highlighted by UCI Medical Center's policy of diverting to other medical facilities women in labor who have not been treated previously at UCI. The diversion policy goes into effect only when the emergency room and maternity ward are full.
The study's findings on the increasing strain created by indigent women on the health system "vindicates us," said Dr. Thomas Garite, head of the medical center's obstetrics and gynecology department.
"When we first implemented our policy, we were looked upon as the perpetrator," he said. "But more and more lately--and this study shows it--we're being seen as the victim of a system that concentrates its indigent care on one hospital. We are not a county hospital."
The study, several months in the making, concluded that public and private campaigns against infant mortality and health problems should focus on the poor, minorities, youths and substance abusers--groups that have received inadequate care consistently in the past.
Research has shown that babies born to mothers with no prenatal care are four times more likely to die at birth than those who received first-trimester care.
Compounding the problem locally, health experts said, is the increasing strain on the state's public health insurance program and government-sponsored programs for poor mothers.
The March of Dimes study found that since 1985 the number of private doctors in the perinatal field--those providing service about the time of delivery--who accepted Medi-Cal coverage--decreased from 64 to 52.
The decrease portends "an especially critical situation," the study said, because recent income changes in the state plan mean that more women can get public aid.
But the change "will make no difference" if a woman eligible for Medi-Cal "cannot find a provider who will accept her insurance," the report said.
While the county provides prenatal care for poor women at four locations and offers additional referrals, it has no system to provide for actual delivery services, so women must make their own arrangements, the report noted.
"Because most of these women are low income, speak only Spanish and face severe financial and cultural barriers, arrangements for delivery prior to the onset of labor are rarely made," the report found.
"Women usually wait until they go into labor and then proceed to a hospital emergency room, with the hope of finding one that will accept laboring patients for delivery."
The study found that although Latino women account for just 35% of total births in the county, they make up 61% of the births to mothers who received inadequate prenatal care.
Marianne Maxwell, who heads the county's newly formed task force on perinatal care, said: "This is the first full report we have at this point and the most current, and it's certainly going to be vital information for us in our studies."