Taking prevention to the womb, Ventura County's Health Care Agency is working to beef up prenatal services for low-income women.
A smoking-cessation program launched this week is seeking out expectant mothers to help them kick the habit. And the Women, Infants and Children program is expanding to provide food and nutrition education to more needy people.
"We want to reach women with a dual message," said Steve Lehman, coordinator of the county's Comprehensive Perinatal Outreach program, which runs the smoking-cessation effort. "Get into prenatal care early, and quit smoking now for your own future health and the health of your baby."
David Kasting, director of the county hospital's neonatal intensive-care unit, estimated that at least 20% of the 500 babies he sees each year are born to women who smoke.
"If we could get pregnant women to quit smoking, we'd do a lot toward reducing the number of unhealthy babies born," Kasting said. "I can't underscore to moms enough the dangers of smoking during pregnancy."
Mothers who smoke risk giving birth to babies that weigh less than 5 1/2 pounds, have underdeveloped organs and a tendency toward sickliness, Kasting said. The mortality rate also is higher for babies born to smokers, he said.
Although separate figures for women who smoke are not available, the county's overall infant-mortality rate in 1990 was 7.6 deaths per 1,000 babies before age 1. The state rate was 7.9.
Causes of infant mortality are not entirely understood, but health officials agree that women who receive early prenatal care are less likely to smoke during pregnancy, more likely to follow a proper diet and more likely to give birth to healthy babies.
At Ventura County Medical Center, 37% of the 3,795 babies born last year did not receive prenatal care in the first trimester, according to county records. Eight percent did not have a doctor's care until the third trimester.
Many of those babies ended up requiring long, expensive stays in the intensive-care unit, Kasting said. "It's been said over and over, but it's worth saying again," he said. "Prevention saves money."
In 1987, California spent about $130 million caring for low-birth-weight babies, according to the state Department of Health Services. "If we can prevent just a fraction of low-weight births, we're looking at a substantial savings," Kasting said.
Quality and duration of prenatal care also affect births, Kasting said. By county standards, a woman with an adequate level of care sees a physician at least once during the first trimester and continues going to the doctor at regular intervals for the rest of her pregnancy. Countywide, 19% of women who gave birth in 1992 received less than adequate prenatal care, according to the county's Department of Public Health. That number jumps to 29% for Latina women.
"Women who get little or no prenatal care are a special concern for us," said Bita Holakouee, who manages the smoking-cessation program. "If we can find them early, we can be that much more effective."
To address the need among Latina women, outreach workers are posting bilingual flyers at laundries, grocery stores and community centers. An upcoming ad campaign will run on billboards and radio stations in both Spanish and English.
"We are just getting started," Holakouee said of the $50,000, yearlong program. "We are trying to be creative in getting the word out."
Kim Galbraith, 20, who works in an Oxnard day-care center, was one of Holakouee's first clients.
Five months pregnant, she smokes about nine cigarettes a day, down from a three-year, three-pack-a-day habit. Recently, with the help of the smoking-cessation program, Galbraith was in Holakouee's office near the county hospital, learning how to quit.
"Sometimes when I'm smoking I realize there's a being in there," Galbraith said. "There's something else that's a part of me and I start thinking, 'Maybe I shouldn't be doing this.' "
Holakouee handed Galbraith a "quit kit," loaded with stickers, candy, balloons, colored toothpicks, a water bottle and relaxation tape. She told Galbraith that if she quit for a month, she would be rewarded with a mall gift certificate worth $50.
Galbraith nodded and said she would like to use the money to buy a maternity swimsuit. Holakouee suggested that Galbraith start by signing a contract promising not to smoke for two days.
"I don't know," Galbraith said, hesitating for a moment. "I need to stop, but it feels impossible at times.
"But I don't want to be big and puffing on a cigarette," she said as she picked up a pen to sign the contract. "That would be terrible."
The cessation program, which is financed by state tobacco tax grants, joins a corps of programs offering care to pregnant women throughout the county.