Taxpayers bear burden of moms without prenatal care

Friday, March 9, 2001 | 3:57 a.m.

More than 1,000 women gave birth last year in Clark County hospitals without receiving adequate prenatal care despite the availability of low-cost medical assistance.

Health care experts say one consequence is that Nevada taxpayers are spending tens of millions of dollars annually to assist low-birthweight babies, most of whom were born to mothers who lacked adequate care during pregnancy.

The problem is most acute at University Medical Center, which recorded 615 births last year involving women with little or no prenatal care. Dr. Donald Roberts is a UMC specialist in maternal fetal medicine who delivers their babies.

"There are people who don't want to get prenatal care," Roberts said. "It could be that they are illegal aliens or that they have no money, so they think they can't get a doctor."

The percentage of births to Nevada mothers with little or no prenatal care dropped from 8.1 percent in 1990 to 7 percent in 1998, according to a study released in February by the nonprofit Child Trends of Washington and Annie E. Casey Foundation of Baltimore. But Nevada's 1998 percentage ranked it 48th of the 50 states and was nearly twice the 3.9 percent recorded nationally.

Some women, such as Cassandra Stewart, an 18-year-old Las Vegan, use a midwife instead of standard medical care because their mothers did. Stewart was resting comfortably at UMC last week with her newborn daughter, Elizabeth. The infant is a healthy 7 pounds, 2 ounces, but Stewart said she had second thoughts about using a midwife.

"I probably would have gone to a doctor a lot sooner," Stewart said. "It would have been a lot less painful for me."

Cheryl Sonnenberg, health services administrator for the nonprofit Economic Opportunity Board of Clark County, which offers low-income prenatal care at two clinics, said Nevada's ranking as a state with a high percentage of uninsured residents contributes to the lack of prenatal care.

Many uninsured women do not feel they can afford to pay for prenatal care and therefore do not see doctors. The state funds health care programs such as Nevada Check-Up for children from low-income families. But Sonnenberg said she wants the state to develop a low-cost insurance program that includes prenatal coverage.

"The state has taken giant steps to help children, but they need a healthy start, and I think we're missing the boat," Sonnenberg said. "There should be low-cost health insurance because there's a stigma in asking for a handout as opposed to being able to purchase a health care policy for your family."

Another problem is that Southern Nevada has a large number of illegal aliens who do not seek prenatal care because they fear that medical professionals will turn them over to immigration authorities. But Darlene McQueen, director of maternal child services at Lake Mead Hospital, which had 76 drop-in births last year, said illegal aliens who seek medical attention are not reported to authorities.

"We let them know that no one will turn them in," she said.

There also are those women who do not seek prenatal care because their culture promotes natural childbirth without prior medical assistance, according to Ann Lynch, spokeswoman for Sunrise Hospital and Medical Center.

"A lot of it is also ignorance on the part of the mother," Lynch said. "Some mothers don't even know they're pregnant. We've had women complain about a bellyache, and they're actually delivering."

Inadequate prenatal care often leads to low-birthweight babies, who are defined as infants who weigh less than 5.5 pounds at birth. Using a federal Centers for Disease Control and Prevention estimate that it costs taxpayers $14,755 on average to cover the birth-related expenses of an underweight baby, Nevada taxpayers paid at least $32.2 million in 1998 to care for 2,181 underweight babies.

But Roberts said many underweight babies are in the hospital for up to three months, which further escalates costs. Those costs can run $2,000 to $3,000 a day, he said.

"That cost ultimately gets passed to the taxpayer," he said.

"The better start the baby can get, the better off our community will be," Roberts said.

Normal prenatal care includes a comprehensive checkup by a physician once a woman discovers she is pregnant. Her medical history is reviewed, and she is warned about the dangers of smoking, alcoholic beverages and drugs. Monthly checkups are then scheduled up to about the seventh month, when visits with the doctor become more frequent.

The lack of prenatal care often means that health problems developed by the mother during pregnancy go unchecked. Those problems affect fetal development. The umbilical cords of twins, for instance, can become entangled, causing one to develop faster than another.

"We see babies that don't want to feed or move," Roberts said. "They just want to lie there."

The fact that so many local women give birth without adequate prenatal care does not mean there are not enough medical services available. To the contrary, health care professionals rave about the success of programs such as Baby Your Baby, Baby Steps and Baby Find that are supported by local hospitals and the state and county.

These programs assist low-income women by setting them up with affordable prenatal plans based on their ability to pay. Baby Steps sponsored by UMC, for instance, serves 200 pregnant women a month and includes free educational classes on childbirth and parenting.

"What a lot of patients don't understand is that the earlier they can get prenatal care, the better off they will be," said Linda Yi, UMC's director of maternal child support services.

Although these programs advertise on billboards and in brochures available at Medicaid and other welfare offices, hundreds of local women each year either fail to learn of their existence or don't care.

"We need to do a better job letting them know about Baby Your Baby," said Lynch, whose hospital sponsors that program. "A lot of people are indifferent. A lot of people are new to town, and they don't know about Baby Your Baby. They're too busy looking for a job or a new home."

Cynthia Huth, a perinatal nurse consultant in the State Health Division, said Southern Nevada's rapid growth contributes to the high number of drop-in pregnancies.

"A lot of pregnant women moving into the community don't know the language or don't know where they can get care," Huth said.

The Economic Opportunity Board was forced to close one of its three low-income prenatal clinics about three years ago because of inadequate funding, Sonnenberg said. The number of pregnant women served by the board dropped from 486 in 1997 to about 350 last year.

"Lab costs go up, medical supplies go up and salaries go up," Sonnenberg said. "Let's face it. Unless your funding goes up, you have to be creative with your operations."

Some of that slack was picked up by the federally funded Nevada Health Centers, which operates three prenatal clinics in the Las Vegas Valley. That organization, which began offering prenatal care in Southern Nevada last year, has enough capacity to serve all local women who give birth without adequate medical care.

But Michelle Wilson, Southern Nevada director of operations for the nonprofit organization, said there is not enough money to advertise its services.

"We don't have money to let people know we are here," she said. "We are getting some help from Spanish-language radio and TV, but we don't have city or county support, and we could use more of that."

Dr. Carl Heard, chief medical officer of Nevada Health Centers, said another dilemma is that there are at least six local health maintenance organizations that have refused to include his clinics on their lists of eligible health care providers.

"The impact on us is that we are taking care of patients who cannot afford to pay us, but we cannot offset that cost with patients who can afford to pay through their insurance," said Heard, who supports a bill before the Legislature that would require HMOs and other insurers to include nonprofit clinics in their coverage.

"We are trying to provide access to as many patients as possible."

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