Obstetrics

Lynda had tried to become pregnant for almost a year. But, discouraged by months of infertility, she was not taking the best care of herself. She had a few drinks at a party. She used a hot tub. She took antihistamines for a cold. Ordinarily, none of these things would be considered unhealthy. But they happened in the first few weeks of Lynda's pregnancy--before she realized she was pregnant.

A rebirth of sorts is under way in the old maternity quarters at Daniel Freeman Memorial Hospital. The walls and trim have turned a rose pink; the rooms are quickly filling up with fetal monitors, high-tech incubators and bottles of baby formula. Next week the unit will reopen, the result of a partnership between the 365-bed nonprofit Catholic hospital and Los Angeles County aimed at providing care for hundreds of poor women who would otherwise bear their babies in crowded county hospitals.

Mary Lievanos, 31, is eight months pregnant, but for her, Orange County's sophisticated network of health care is in another world. Most obstetricians see the heroin tracks on women like Mary and turn them away. Drug-addicted mothers can deliver drug-addicted babies, many with birth defects that lawyers might blame on physicians five, 10 or 15 years later.

A Panorama City doctor has been suspended from practicing medicine for 30 days for not recognizing medical complications in a pregnant woman whose baby was born dead in a hospital hallway. The Medical Board of California also placed Dr. Lee S. Brilliant on five years probation and ordered him to undergo additional classes in obstetrics and gynecology in connection with the 1988 stillbirth.

Esther Zorn 10 years ago took a lonely journey from the familiar landscape of medical technology to the uncertain terrain of trust in her own body. She had a VBAC--a vaginal-birth-after-Cesarean. And it changed the course of her life. "I felt, after I had given birth to my daughter, that I had regained the blueprint for birthing that I could now pass on," said Zorn, whose own birth in 1952 was by Cesarean delivery. "It was a feeling that I had regained something I had lost, way back."

Six-and-a-half weeks before she was due to deliver her first baby, Lynn Dasteel felt that something was very wrong. By the time she reached the hospital, she was 90% along into delivery, and she had not felt a single contraction. Her newborn had to spend a month in intensive care. Today, Alex Dasteel is 4 1/2 years old and healthy, but because he was born so early, his chances of severe mental retardation were great. Now Dasteel is pregnant with a second child.

The concept of birthing centers--a less expensive alternative to hospital maternity wards--is catching on in Southern California. But no one knows for sure how rapidly, or how well, the centers take care of mothers and babies. That is because there is no state licensing or inspection of the centers, and no agency regularly keeps track of them.

Private hospitals have helped reduce the waiting period for pregnant women seeking initial prenatal care from the county to 1.6 weeks from a high of three weeks, an official said Monday. Los Angeles County officials last year joined with the private sector in a plan to divert thousands of pregnant women to private hospitals to ease tremendous overcrowding in the county's obstetrical system.

Breathing techniques central to the Lamaze method have been substantially altered since they were introduced in the United States in the 1950s, says Flora Hommel, one of the first Lamaze instructors in this country. Hommel says the techniques have been so distorted that they are no longer effective. More important, she says, the emphasis on controlling pain has been lost. "The Lamaze philosophy says that the huge majority of pain comes from your head, from conditioned responses," she says.