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HEALTHWATCH : Early Is Better : With the expansion of county public health services, the number of pregnant women receiving prenatal care has increased.

February 18, 1993|LEO SMITH | TIMES STAFF WRITER

Ventura County's pediatric community recently received a $1.5-million federal grant from the Maternal and Child Health Bureau to study and reduce infant mortality and child abuse in the area.

One way, local officials say, to significantly lower the risk of infant mortality is to get to the baby before he or she is born, through prenatal health care.

"There have been lots and lots of studies on women who get prenatal care and women who don't get prenatal care. The difference is outstanding," said Dr. Bob Lefkowitz, director of Obstetric/Gynecological Services at the Ventura County Medical Center.

"Incidence of premature labor is less (with prenatal care). Growth-retarded babies are less," he said. "A lot of problems that need to be taken care of, such as toxemia (toxic substances in the blood), can be detected. A lot of health screening goes on. A mother with diabetes, heart disease, hepatitis, sexually transmitted diseases, can be detected and treated."

Over the last three years, Ventura County has made strides in providing affordable prenatal care to local residents.

Two public health clinics have opened in Oxnard--the Las Islas Family Medical Group and the Las Flores Women's Health Center, the latter having opened earlier this month at the Centerpoint Mall. The Santa Paula Family Practice Clinic was significantly expanded 1 1/2 years ago and there are now plans to expand a clinic in Simi Valley.

Yet, many women still don't get that care.

Lefkowitz estimated that about 5% of pregnant women in the county receive no prenatal care, about 5% to 10% get inadequate care and about 25% to 30% get late care (starting after the 20-week mark).

Lefkowitz said that because most pregnancies and deliveries go smoothly, it's hard to convince the mass population that prenatal care can be critical.

"It also depends on upbringing and economic status. They might not be used to having health care available," Lefkowitz said. "Even assuming access is equal, poor patients just don't tend to insist on health care the way private patients do. They have enough difficulty with rent and food, and making sure the kids are taken care of. When it comes to a healthy patient getting prenatal care, that gets put on the back burner."

Care has improved over the past three years, he said, due to a simplification of the MediCal process, shorter waiting periods for doctor visits, and the placement of clinics in neighborhoods with the greatest need.

"The problem is trying to put services where patients are," said Lefkowitz, "rather than telling the patients, 'you get in your car or get in your bus and you come to me.' "

The expansion of the Santa Paula clinic served that purpose. Dr. Michael Stone, one of three physicians there, said that when he came to Ventura County in 1987 "there were very few options for patients without insurance. We've added to the access."

Stone said that about 15% of the Santa Paula clinic's practice is prenatal. There are 20 to 25 deliveries each month.

When the clinic opened, he said, most women coming in for their first prenatal visit were already 20 to 30 weeks pregnant. Now, he said, pregnant women are getting to the clinic much sooner.

"Less than 16 weeks is good. Less than 12 weeks is ideal," said Stone. "That way you can take advantage of prenatal vitamins and early neurological development of the child."

Stone said if a mother visits before 20 weeks of pregnancy, screening can be done for Down's Syndrome and spinal defects. After 20 weeks, he said, the testing is not as effective. He said early care can detect diabetes, nutritional anemias, poor weight gain, chronic urinary infections, tuberculosis and other medical problems.

There are also non-medical aspects of prenatal care. The new federally funded project, a component of which will be prenatal, will have a more socioeconomic focus.

"When families show up for their prenatal visit they will be interviewed and assessed," said Dr. Paul Russell, director of the project. "We will talk to the mother about what sort of support system she has at home, is she socially isolated, is there domestic violence in the home, has there been a problem with substance abuse."

Russell said that once certain problems are identified, public health nurses will follow up with the patients regularly--either at a clinic or in the home.

"Having someone go into your home to act as your ally and advocate, to begin educating with respect to the problems of certain behaviors, we might be able to change those behaviors," he said. "If we are able to have someone stop snorting cocaine during pregnancy we might be able to prevent a premature birth."

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