A Tale of Two Births: Differences in Prenatal Care

Because my conversation with U-Dubb's Professor Gavin had piqued my curiosity as to whether it really is true that Hispanic women tend to have healthier births than do African American women, I thought I'd look into the care given both communities of women in Los Angeles.

I made a list of clinics to call in Lynwood as well as those I should try in Compton. Hispanics comprise roughly 80 percent of Lynwood, African Americans about the same percentage in Compton. These two south L.A. cities lie adjacent to one another.

I started cold-calling pages worth of clinics, trying the county hospitals but expecting such institutions to require many, many more attempts before getting through to the PR and then eventually the prenatal care untis (if).

Finally, I reached We Care More Family Clinic 2. Though it's located in Compton, it serves primarily Hispanic. Nevertheless, the two nurse practitioners manning the phones and attending to patients, Coco Dominquez and Cynthia Lidy, both said the only clinic-visiting-women they'd seen give premature births are African American.

Prescribing standard prenatal care and monthly visits, prenatal vitamins, ultrasounds, etc., they said those who tended to have premature births also tended to have them at the end of "noncompliant pregnancies."

Lidy described the many women who did not know they were pregnant or who were substance abusers.

But most concluding adverse pregnancies did so, she said, because of their nutrition.

"They want fast food: french fries, hamburgers," Dominguez said of the women who had had preterm births. "They said 'I don't like this, I don't like that.'"

Sometimes drug addicts, she said they feared coming into the clinic--which serves a majority of Medi-Cal subscribers--because they did not want their infants taken away from them.

So these nurses would say the effort to extend standard prenatal care is there, and they're trying their best, but those who have premature births have them because they do not come in to receive the prenatal care they should, ignoring visits, doctor warnings, eating unhealthily, often abusing substance.

I would like to know what kind of care women receive in county hospitals here. No hospital could refuse care to a woman in labor--even should she have no insurance. So theoretically, a woman living in Watts could take a bus to Cedars-Sinai, and if she's in labor, the hospital will not turn her away.

But when I visited Clinica Monsenor Oscar Romero, a federally qualified health center (FQHC) based out of Alvarado and twice in East L.A. (across the street from Marengo St.-bound L.A. County-USC), Prenatal Case Manager Sandra Rivera explained that the clinic sends pregnant women to county long before labor, so the women could acquaint themselves with those who will give them care during their baby's birth.

Such women, she said, will, by labor time, have developed a rapport with the hospital's staff and would want to go where they felt comfortable. And even were they not to have done so, she added, many of these women, uninsured and in the case of the Hispanic women, often undocumented, would not wish to go to a hospital that did not tend to serve their community--on the comfort level.

But that brings me back to county hospitals. I've been trying to reach:

-UCLA Harbor

-L.A. County

-CA

-...and what used to be MLK.

Looks like I will be able to speak to L.A. County's PR, Rosa Saca, tomorrow--which would be excellent. I think the county hospitals hold the key to the differences in prenatal care visible throughout the city.

And the hospitals may be able to answer Kim's question: how much do premies cost for the insured? How much do they cost for the uninsured?

L.A. County's prenatal care unit is robust, or so I have heard. And small wonder. Growing out of Marengo street like a Noir monolith dedicated to the memory of The Shadow, the hospital is, to say the least, imposing.

But does it provide quality prenatal care (for the uninsured? For Medi-Cal holders)? I don't know.

I will be returning to Clinica Monsenor Oscar Romero--whose mission it is to provide that quality care to those who would not otherwise be able to afford it. But those with whom I spoke, Sandra Rivera, Women & Children Program Director maria Valdez and Development Director James Hoyne, were adamant that the 15,000 people (mostly undocumented) they serve receive that quality care.

Nine or so doctors see patients at that branch of the clinic, three of them staff members. All, said Hoyne and Valdez, followed stringent medical methods.

Though women do not give birth at the clinic--tending, instead to cross the street to county--the clinic's representatives follow the progress of their 400 or so former pregnant patients.

Hoyne said this clinic, along with Venice Free Clinic or the Sabon Free Clinic and the 60-odd clinics serving Medi-Cal and Medicaid users or the uninsured, is very serious in its attempt to prevent preterm births. Medi-Cal only requires 10 prenatal visits, both he and Valdez said, but the women "patronizing" such places receive "many, many, more."

So I need to find out how big the difference in pregnancy and birth health is among women who use these clinics and receive what appears to be very decent-to-good care and those who are non-compliant, are scared to come to these places or do not know of their acceptance (or do come, receive sub-standard care compared with that of doula-using and/or afluently-targeted prenatal care-having women).

West side mom, Sarah Tuttle-Singer is a blogger. She writes the Crazy Baby Mama blog about her adventures in toddler mothering and those involving her current pregnancy. She was kind enough to give me the names of her doctors (and I was able to reach St. John Hospital OBGYN Dr. Laura Reynard, whose premature birth-delivering mothers tended to do so because of in vitro, among other non-care related causes) as well as offer me the chance to come along on her next doctor visit, Wednesday the 5th ("remember, remember, the fifth of November...").

If I could compare such a visit and the care it implies to that visible in a South L.A. clinic and/or hospital, I could, perhaps, gain some real insight into the potential care differences.

Clinica Monsenor Oscar Romero's employees pointed me to L.A.'s Best Babies Network, which, with its stated goals of improving prenatal care in the city, could be a very good source.

Going back to the erstwhile MLK hospital:

Yes, it's closed. But I believe it's line is still functional, its records still "available." It would be interesting to see what kind of premature birth numbers they had, "serving" a very poor African American community based in Watts. The care was so low in quality, the city had to shut the place down.

But I feel it would be valuable to know whether they saw more premature births than other hospitals and clinics and areas, and if they did, whether the causes of those births hinged on the sub-standard care, the diets of the mothers, that background stress or other factors.

No one I have spoken to has yet mentioned obesity--yes imbalanced nutrition, yes, pollution, yes, care, yes, substance abuse, yes, childhood stress and racial discrimination, and yes, race/genetics--as an element of the adverse pregnancy outcome equation.

Of course, bad nutrition and obesity make good bedfellows, but malnutrition and obesity fall just as often in diametric (and physical) opposition. Given the latter relationship, or lack thereof, then, it would likely be imperative to find out how obesity affects pregnancy and birth outcome as well as to find out how many of the women of lower means have premature births as a result of obesity (and diabetes?).

I'll be trying King Drew and clinics located in Watts tomorrow.