Your Children, Our Children; Life & Death

<v TV Announcer>Your Children, Our Children: Life and Death. <v TV Announcer>Length 28 48. Twin Cities Public TV Incorporated. <v TV Narrator>Your Children, Our Children is made possible by major grants from the Dayton <v TV Narrator>Hudson Foundation, Target stores, <v TV Narrator>Mervyn's, with additional funding provided by Carnegie <v TV Narrator>Corporation of New York, Lane Bryant Malsin Foundation, <v TV Narrator>and the Lilly Endowment. <v Doctor 1>You can do it. <v Doctor 2>Come on! <v Doctor 1>Come on, push to 10! 2, 3, 4, <v Doctor 1>5, 6. <v Doctor 1>Good. Don't stop, 8, 9, 10. <v Doctor 1>Deep breath in! <v Doctor 2>Push again, come on!

<v Doctor 1>Push 10, push 10 hard. <v Doctor 2>Push hard! Hard! <v Doctor 1>Don't stop now. Keep pushing. <v Doctor 2>Push hard! <v Doctor 1>Don't stop, Annie! Keep pushing. Don't stop. Come on, Annie. Keep on, Annie! <v Doctor 1>Keep going, Annie! <v Doctor 1>Push, push. <v Doctor 1>Push. Keep pushing. [Annie screams] <v Doctor 2>Okay, okay. <v Doctor 1>You've got another boy. <v John Merrow>A baby is born. This happens 3 and a half million times a year in the United <v John Merrow>States. <v John Merrow>We have the best medical facilities in the world. <v John Merrow>No question. But 45 thousand of these babies will die before their first birthday. <v John Merrow>Many die because our medical system is out of kilter. <v John Merrow>Inadequate prenatal care is the greatest single cause of birth problems. <v John Merrow>We know that. But 3 out of 10 pregnant women get little or none. <v John Merrow>Almost routinely, our medical system spends a hundred thousand dollars or more to save a <v John Merrow>baby with problems, but then allows that baby to drop out of sight. <v John Merrow>We're good in a crisis, but at least 15 other countries are better at keeping <v John Merrow>babies alive and healthy.

<v John Merrow>I'm John Merrow for Your Children, Our Children. <v John Merrow>[music plays] <v Dr. Jay Goldsmith>I haven't heard back from Cliff yet, and I don't know what kind of situation he was in. <v Dr. Jay Goldsmith>He says he's going to be back within a half an hour. <v Dr. Jay Goldsmith>Then we can proceed with the first team, just turning around and getting this other baby. <v Dr. Jay Goldsmith>OK. OK. Right. Buh bye. <v Dr. Jay Goldsmith>OK. Notify everybody else and Earl will call you back and let you know whether the first <v Dr. Jay Goldsmith>team or second team is gonna go. [ambulace sirens] <v John Merrow>1 October morning, a baby weighing less than 1 and a half pounds was rushed to the <v John Merrow>neonatal intensive care unit at Ochsner Hospital in New Orleans, 1 of the finest <v John Merrow>medical facilities in the region.

<v John Merrow>[background chatter] Babies with problems are brought here from Louisiana, Mississippi <v John Merrow>and Texas, an area with 1 of the nation's highest infant death rates. <v John Merrow>Baby Dana had been born the day before, nearly 4 months prematurely in a rural <v John Merrow>Louisiana hospital 40 miles away. <v John Merrow>It would take 114 days and almost 100 thousand dollars to save <v John Merrow>her life. <v Dr. Jay Goldsmith>This is a little baby who is very similar to Dana ?Schmals? <v Dr. Jay Goldsmith>and that uh Dana was a very premature baby, a little <v Dr. Jay Goldsmith>less than 1 and a half pounds who was born across the lake and the <v Dr. Jay Goldsmith>baby was transported here and had severe problems. <v Dr. Jay Goldsmith>Daryl was uh a single, had no prenatal care and had a baby <v Dr. Jay Goldsmith>about a year previously. And she wasn't prepared for this- this baby, <v Dr. Jay Goldsmith>she certainly wasn't prepared for a premature baby. <v Daryl>I was scared now and- and besides, she <v Daryl>had um tubes all up in her head and stuff, and <v Daryl>she just didn't look good. She was- she look like a little miniature long Barbie doll.

<v Daryl>That's what she looked like. Litte long Barbie doll. <v John Merrow>Daryl lives in rural Louisiana, a world away from the complicated <v John Merrow>technology that saved her baby's life. <v John Merrow>Going from no care at all to the best there is overnight was bewildering. <v John Merrow>Daryl wouldn't have made it without the help of her neighbor, Loretta Everitt. <v Loretta>Daryl? <v Loretta>I think that was a problem for her all the time. <v Loretta>The shock. <v Loretta>You know, that's hard to think that she got a baby that little. <v Loretta>And, you know, I guess you have to think realistically she might die. <v Willie Haight>Loretta often would make arrangements to bring Daryl here. <v Willie Haight>Uh the 2 or 3 times he should get here. <v Willie Haight>It was Loretta who drove her, stayed with her while she was here visiting with the child <v Willie Haight>in intensive care, piece her back together, because Daryl was often <v Willie Haight>during- during those visits was often overwhelmed by the technology,

<v Willie Haight>by the sight of the child who really did not look very good. <v Willie Haight>I don't know if we could have gotten as far in the case as we did without her. <v Dr. Jay Goldsmith>Certainly, the equipment, the bells, things going on are overwhelming. <v Dr. Jay Goldsmith>And what you expect when you think about having a baby is a plump fat baby <v Dr. Jay Goldsmith>in your arms cooing and having a bottle, and that's not what you see here. <v Daryl>It made me sick. Whenever you look at all that stuff, you know, I couldn't take seeing <v Daryl>her that way because she- she was just covered with tubes and stuff. <v Daryl>I couldn't understand all the medical terms. <v John Merrow>What do you do when you saw her? <v Daryl>I was- I had- I had to go back out. <v Daryl>I stayed in for a sec- couple minutes or so and then I went right back out. <v Loretta>It's about an hour and 15-minute drive from the hospital, we talked a little bit and she <v Loretta>said her first thought was that could she <v Loretta>had done something, you know, while she was pregnant, that would have prevented that.

<v Loretta>And I sa- you know, she said instantly, that's what she thought about. <v Loretta>Maybe she did or didn't do something. <v Loretta>You know, she didn't know she was pregnant. She didn't take vitamins. <v Loretta>She didn't watch what she eat. <v John Merrow>She had no prenatal care. <v Loretta>None. So she, you know, thought, yeah, well, if I <v Loretta>took vitamins or something like that or done something to take care of myself, maybe the <v Loretta>baby would have been born healthier. <v John Merrow>And she's right. Half of premature births are a direct result of inadequate <v John Merrow>prenatal care. No regular checkups. <v John Merrow>Poor nutrition and overuse of alcohol, caffeine and cigarettes. <v John Merrow>We've known that for years. <v John Merrow>[background chatter] But the medical profession has concentrated its energy on saving <v John Merrow>premature babies rather than on preventing premature births. <v Dr. Jay Goldsmith>We consider about 24 weeks of pregnancy of gestation <v Dr. Jay Goldsmith>as the cutoff. <v Dr. Jay Goldsmith>Below that, the lungs are not developed enough where oxygen can come into the lungs <v Dr. Jay Goldsmith>and be exchanged into the blood. The lungs just haven't developed.

<v Dr. Jay Goldsmith>And that's a conflict that we've talked about. <v Dr. Jay Goldsmith>1 end of the hospital, they were aborting babies at 20 weeks and the other end we're <v Dr. Jay Goldsmith>saving them at 24 using thousands of dollars to do it. <v Dr. Jay Goldsmith>And I don't have an easy answer for that. <v Dr. Jay Goldsmith>It's- it's something that has to do, I think, with the environment, the society <v Dr. Jay Goldsmith>in which we live. My job is when a parent comes to me with a baby and <v Dr. Jay Goldsmith>they want everything done for that baby. <v Dr. Jay Goldsmith>I try to do that. <v John Merrow>What do the X-rays look like on these 2 new kids? <v John Merrow>[background chatter] <v Dr. Jay Goldsmith>Boy, he's got bad hyaline membrane disease. <v Dr. Jay Goldsmith>Where's the other 1, Anderson? <v Dr. Jay Goldsmith>I think there was a real historical event 20 years ago, and that is that the Kennedy's <v Dr. Jay Goldsmith>had a baby with membrane disease. And this really turned the public's <v Dr. Jay Goldsmith>attention to prematurity. <v Dr. Jay Goldsmith>There also was a feeling, a probably an erroneous feeling in the public <v Dr. Jay Goldsmith>that prematures either died or they grew up to be stupid and they wouldn't

<v Dr. Jay Goldsmith>develop as well as other children. <v Speaker>[background chatter] <v Speaker> <v Dr. Jay Goldsmith>What we have found is that the babies under 2 pounds is where we get into <v Dr. Jay Goldsmith>some ethical eh moral considerations. <v Dr. Jay Goldsmith>Should we resuscitate? How aggressive should we be? <v Dr. Jay Goldsmith>And if we- if the baby does survive, what will be the quality of life for <v Dr. Jay Goldsmith>that baby? The highest rate of problems in terms of mental retardation, <v Dr. Jay Goldsmith>cerebral palsy, and other kinds of problems come with babies under 2 <v Dr. Jay Goldsmith>pounds. <v Daryl>Give her her medicine this time. <v Daryl>OK. <v Loretta>Give her that ?inaudible? <v Daryl>Yeah. <v Loretta>That's the breathing medicine? <v Daryl>Yeah, the aqua one. <v Daryl>They can't tell yet whether or not they have any permanent brain damage. <v Daryl>[baby cries] [background chatter] She had a brain hemorrhage <v Daryl>which caused some clotting behind the eyes and they don't know how extensive <v Daryl>it's been. You know, they're almost- they're not positive.

<v Daryl>So I've got a lot of hope now. <v Daryl>With the right care and attention that you know, she's going to be perfectly <v Daryl>fine. <v Speaker>[background chatter]. <v Daryl>I was scared to death to bring her home. I just didn't think I could take care of her and <v Daryl>I'm you know, I didn't have any transportation or whatever in <v Daryl>case she got sick. I was thinking a lot about that. <v Daryl>And the fact that there is no one here around to take me, you <v Daryl>know, even when I don't have a car. <v Daryl>So everybody's workin' so I didn't know how I'd get <v Daryl>her to the doctors and stuff. That's what I was worried about really. <v Daryl>In case she got sick or me or something, I couldn't take her to the doctor. <v Daryl>I was scared to bring her home. <v Willie Haight>Awful lot of the caseload really disappears after the hospitalization, after <v Willie Haight>the intensive care stay. There's more than hundreds of thousands of dollars per case <v Willie Haight>for seeing to it that these children do survive. <v Willie Haight>I think we have a responsibility as a society to see that they do more than just

<v Willie Haight>survive. <v John Merrow>What if baby Dana doesn't get the kind of care she should have? <v Willie Haight>She may easily die. <v Willie Haight>She may not develop. She may be very, very retarded. <v Willie Haight>She may need continuous care all of her life. <v Willie Haight>She may need institutionalization at some point. <v Willie Haight>I hate to paint a very black picture because you can never tell what's going to happen <v Willie Haight>down the line, but that's a likely possibility. <v John Merrow>The system that saved Dana seems to have abandoned her. <v John Merrow>She has not gotten the care she has to have. <v Daryl>I'm gonna lay down with her. I think she's getting tired. <v John Merrow>She needed a brain scan, a pneumogram, and other tests when she was 6 months old. <v John Merrow>She's almost a year now and she still hasn't had them. <v Daryl>Give Mama sugar. [background chatter] <v John Merrow>Her mother can't afford the tests. <v John Merrow>The system won't pay until Dana is labeled handicapped. <v John Merrow>The longer they wait, the more certain it is that she will be. <v John Merrow>Ironically, if Dana's mother had happened to live in the next county, Dana might have <v John Merrow>been born on time and healthy.

<v John Merrow>A model program here has reduced the number of premature births and cut the infant <v John Merrow>death rate in half. Success doesn't depend on neonatal intensive <v John Merrow>care. The key is prevention. <v John Merrow>Getting pregnant women into health care early and educating them. <v John Merrow>That's the job of health worker Rachel Stewart. <v Rachel Stewart>I know the community, white, black, any color, from <v Rachel Stewart>the court house on back to the jail house. <v Rachel Stewart>And I know about raising kids. <v Rachel Stewart>I know about- I've been a housekeeper 40 some years. <v Rachel Stewart>And I can tell if that house ain't like it supposed to. <v Rachel Stewart>Been to the health clinic for your visit? <v Expecting Mother>Not yet. <v Rachel Stewart>When are you supposed to go back? [fades into background] <v Rachel Stewart>Purpose of the program is for the health [background chatter] and wellbeing of the kids. <v Rachel Stewart>[background chatter] And the purpose of the program is for the mothers that need and <v Rachel Stewart>want you to support them with their children. <v Rachel Stewart>Is it the first part or the last part of the week? <v Expecting Mother>The last.

<v Rachel Stewart>Well, I'll be by the first part [fade out]. <v John Merrow>Rachel, you're sort of like an extra mother. <v Rachel Stewart>That's what I'm supposed to be. That's what my job is supposed to be about. <v Rachel Stewart>What the program all about. <v Rachel Stewart>Okay, I'll get on back, ?tow? my car. <v Rachel Stewart>You see, times have changed, and they don't believe in the old ways, <v Rachel Stewart>but old way was most cheaper. <v Rachel Stewart>There was less money too, but it was much cheaper. But money ain't all of it all the time <v Rachel Stewart>when raising a family. If you got a healthy family, you've got money in your pocket. <v Rachel Stewart>But if you got sick family, I don't care how much money you got, your pocket is going out <v Rachel Stewart>for the doctor fee. Either way, you want to take it, it's 6 in one hand and half a dozen <v Rachel Stewart>in other hand. <v Rachel Stewart>My experience about raising the family was taught that charity begins at home. <v Rachel Stewart>If you knew how to raise a family, you know how to keep a house, well you do it routine. <v Rachel Stewart>But some of them really don't do it because the parents didn't teach it. <v Rachel Stewart>If I'm not interested in my kids, then my kids get their kid, <v Rachel Stewart>they're not interested in their kids, then they gonna be doing just like Mama did me. <v Rachel Stewart>Now that's the way I see it.

<v John Merrow>So without this program? <v Rachel Stewart>It would be sad. Because it's natural facts <v Rachel Stewart>that has happened. <v Rachel Stewart>You got you a baby girl now? See it ain't cryin', don't cha? <v Rachel Stewart>You got to watch for ?inaudible?, 'cause when that baby's wet, it's gonna cry. <v Rachel Stewart>That's the only way a baby can get your attention. <v Rachel Stewart>He can't tell you he's wet. <v Expecting Mother 2>You had much help with him? <v Mother>Mhm mhm. Nobody but me by myself. And I bring him down here, my grandmother help me. <v Expecting Mother 2>Hey Rachel, can I ask you something about a premature baby? What makes you have a <v Expecting Mother 2>premature baby? <v Rachel Stewart>What makes you have a premature baby? <v Expecting Mother 2>Uh huh. <v Rachel Stewart>Sometimes it's you neglecting your own self. <v Rachel Stewart>Sometimes your body's weak, because you didn't get the right vitamin and nourishment for <v Rachel Stewart>your body to feed that baby. You feed yours on cigarettes. <v Expecting Mother 2>[laughs] Oh, Rachel. <v Rachel Stewart>Yeah. I'm tellin' you the truth. <v Rachel Stewart>Keep yours on cigarettes, and yours might come here on the week. <v Expecting Mother 2>A pack of cigarettes lasts me 2 days and a half. <v Rachel Stewart>I don't care how many days it lasts, you still smokin'. <v Rachel Stewart>You- you might be harmin' that baby by smokin' that cigarette.

<v Rachel Stewart>?inaudible? born with birth defect. See the risk? <v Rachel Stewart>Drinkin'... <v Rachel Stewart>That's got a lot to do with it. <v Expecting Mother>Miss Rachel, I don't drink. <v Rachel Stewart>That's 6 in one hand and half a dozen in another. <v Rachel Stewart>Whatever you feed in your mouth is going in that baby's bloodstream. <v Rachel Stewart>It don't get nothin', but what you put in your mouth. <v Rachel Stewart>You feed the baby through you. <v Rachel Stewart>You puttin' that cigarette in your mouth, ain't you? <v Rachel Stewart>So you try to lay off the cigarettes. <v Rachel Stewart>It is gettin' late, it is gettin' cold, is gettin' my eatin' time, now 'cause I ain't- <v Rachel Stewart>this- this is my time of day <v Rachel Stewart>to eat. [mothers group laughs] 'Cause y'all have been eatin' and smokin' all day, and I haven't. [laughs] <v John Merrow>Rachel Stewart is paid 4000 dollars a year for helping ensure that 25 <v John Merrow>women have healthy babies. 4000 dollars. <v John Merrow>That's the cost of 4 days in the neonatal intensive care unit. <v John Merrow>The model program she's a part of provides continuous care throughout pregnancy and the <v John Merrow>child's first year. In this program, the different pieces of the medical system, <v John Merrow>this public hospital, 8 public health units, and 2 medical schools are required

<v John Merrow>to work together, something they've never done before. <v John Merrow>Just a few years ago, any woman who couldn't afford private care had to come to Lallie <v John Merrow>Kemp Charity Hospital for all her prenatal care, for some a 120-mile <v John Merrow>round trip. [background chatter in waiting room] Then this waiting room was 3 times as <v John Merrow>crowded and a woman might wait 8 hours to see a doctor. <v John Merrow>All these women will be seen by noon. <v Nurse Practitioner>I'm going to have to do a pelvic exam and I'll do a pap smear and I'll also do a culture <v Nurse Practitioner>to be sure that you don't have an infection that may hurt the baby when you deliver. Okay? <v Patient>Okay. <v John Merrow>Many of them will be seen by a nurse practitioner. <v Nurse Practitioner>I just want you to relax as much as you can. <v John Merrow>That's a big change. In most places, everyone waits to see the doctor, even for <v John Merrow>routine procedures. <v John Merrow>The medical profession resists the use of nurse practitioners. <v John Merrow>The program director, Dr. Hyrum Batson, fought for the change. <v John Merrow>As a result, the program is more efficient.

<v Nurse Practitioner>4 weeks ago and she's 39 weeks, it's the estimated gestational age. <v Nurse Practitioner>Now, this is her first visit. <v Nurse Practitioner>Her final height [fade out] <v John Merrow>There are other obstacles, though, to seeing every woman as early as possible in her <v John Merrow>pregnancy. <v Doctor 3>This is your first visit to the doctor? <v Patient 2>Yes, it is. <v Doctor 3>Why? <v Patient 2>Well, I didn't know about the place and we didn't have any insurance and didn't know who <v Patient 2>to go to. <v Doctor 3>You have not seen a doctor at all? <v Patient 2>Not at all. <v Doctor 3>50 years ago, prenatal care consisted of an infrequent visit <v Doctor 3>of takin' the blood pressure, a urinalysis, and the weight. <v Doctor 3>The death rate from childbirth was stupendous. <v Doctor 3>Little has changed. <v Doctor 3>The only thing that's lowered the mortality rate is antibiotics and blood transfusions. <v Doctor 3>And it's a matter of custom. <v Doctor 3>It's a matter of faulty beliefs, through lack of proper <v Doctor 3>education or through traditional means. <v Doctor 3>They don't go to a doctor until they need one. <v John Merrow>When should a pregnant woman go to the doctor?

<v Doctor 3>As soon as she feels like she's pregnant, or more ideally, before she gets <v Doctor 3>pregnant for a good checkup and be sure she has no contraindications to being pregnant. <v Doctor 3>Maybe something, maybe a little better nutrition could be ensued before <v Doctor 3>she gets pregnant. <v Doctor 3>1 week we'll have a report of all your lab percentages. <v Doctor 3>Just keep doing you've been doing. <v Doctor 3>You're taking your vitamins? <v Doctor 3>The problem is an individual who's not quite so poor yet poor enough not <v Doctor 3>to be able to go to private means. <v Receptionist>Jennifer Ducrey? <v Doctor 3>You're not impressed with patients' ignorance as sometimes stating <v Doctor 3>as being a real barrier to access. <v Doctor 3>They say, well, she didn't come to clinic. Well, she doesn't have the mental capabilities <v Doctor 3>or she's just plain ignorant. That's why she didn't go to a doctor. <v Doctor 3>That isn't the usual case. <v Doctor 3>Usual case is lack transportation, lack of somebody to keep the kids. <v Doctor 3>And the blood pressure is recorded here,

<v Doctor 3>I think that she should be following any high-risk type clinic here <v Doctor 3>and a Lallie Kemp, rather than being triaged to the <v Doctor 3>low-risk clinic which [fade out]. <v John Merrow>Most pregnancies are low risk. <v John Merrow>For routine prenatal checkups, Lallie Kemp Hospital sends women to 1 of 8 <v John Merrow>public health units in the region. <v John Merrow>These are in local neighborhoods, easier to get to and less crowded. <v John Merrow>Cooperation is the heart of the model program. <v John Merrow>Traditionally, hospitals and doctors disregard public health and preventive medicine. <v Joy Castell>How does it feel to be pregnant today? <v Patient 3>Just fine. <v Joy Castell>Just fine. <v John Merrow>Joy Castell, a nurse at one of the public health units, has been part of the change. <v Joy Castell>Chair up on my table. <v Joy Castell>Up until just recently, people didn't realize that anybody <v Joy Castell>can come to a parish health unit. <v Joy Castell>It should be no reflection on their ability or inability to pay.

<v Joy Castell>The normal pregnancy, I can see in this health unit. <v Joy Castell>They get more 1 to 1 care. <v Joy Castell>Normal looking belly. <v Joy Castell>It also helps Lallie Kemp, because they- because I am taking care <v Joy Castell>of patients that would- really don't need intensive <v Joy Castell>nursing and doctoring, then they have more time to give to the patients that do <v Joy Castell>require extensive or- or more concentrated efforts. <v Joy Castell>As you grow, once you get past the umbilicus, which is the bellybutton, <v Joy Castell>you want to grow 1 sonometer for every week that you are. <v Joy Castell>You are exactly where you ought to be. <v Joy Castell>So listen. <v Joy Castell>Baby's been turning a lot? <v Patient 3>Yeah. <v Joy Castell>Real active? 'Kay. <v Patient 3>Sometimes I wish it would give me a break. <v Joy Castell>When I was pregnant with 1 of mine, I could've swore, I'd wake up in the middle of night, <v Joy Castell>I could swear, he was layin' there goin'. <v Joy Castell>[patient laughs] You will feel a lot of things in your pregnancy down here.

<v Joy Castell>Like um, you can tell when a baby has hiccups, sometimes a baby will have hiccups in <v Joy Castell>utero, and it feels like this. <v Joy Castell>That's the beauty, really, of having a nurse do a maternity visit a lot <v Joy Castell>of times, because you'll find that the uh the patient will open up and say <v Joy Castell>something to a woman, especially a woman who has been pregnant before, that she will not <v Joy Castell>say to a physician. <v Joy Castell>Sometimes, for instance, one of the things that I hear most often. <v Joy Castell>A patient will say at night, I wake up and I <v Joy Castell>have this terrific pain in my side. <v Joy Castell>Well, I have felt that pain. <v Joy Castell>I know what she's talking about. So I can tell her, well, just draw <v Joy Castell>your knee up into your abdomen and gently turn over. <v Joy Castell>Can you hear it? <v Patient 3>I can hear it now.

<v Joy Castell>Yeah, he's moving, he's flip flopping. <v Joy Castell>It was this appointment and then 1 other and you'll be sent back Lallie Kemp. <v Joy Castell>We need some specific blood tests and things that need to be done on you today. <v Joy Castell>There's nobody that could bring you? Because we really do need to check [fade out]. <v John Merrow>The first 2 years of this program, there was money for a bus to get women to the clinics. <v John Merrow>Those funds have been cut. <v John Merrow>Without the simple things, someone to watch the kids and a way of getting to the clinic, <v John Merrow>even the best health care goes unused. <v Nurse Practitioner 2>Hold it real tight. <v John Merrow>Once there, women get the care they need. <v Joy Castell>Hopefully, because the mother has been kept in good health, <v Joy Castell>we get a healthy baby. <v Joy Castell>'Kay your blood pressure's very good. <v Joy Castell>And even if there is perchance, something wrong with that baby at birth, the baby <v Joy Castell>has a better chance of making it because of the mother's condition at birth. <v Joy Castell>You're following the curve pretty good. We'd kinda like to see you come up, you know, and

<v Joy Castell>follow this curve as close as possible, which you're doing. <v Joy Castell>You were a little underweight [fade out]. <v John Merrow>The model program here in rural Louisiana is a success. <v John Merrow>Because of Joy Castell, Hyrum Batson, Rachel Stewart, and others, the infant death <v John Merrow>rate has been cut in half. <v John Merrow>But we've already proved this can be done in other model programs in the 1920s, <v John Merrow>the '40s, and the '60s. <v John Merrow>Those model programs were funded, made their point, and then disappeared. <v John Merrow>The same thing may happen here. <v John Merrow>If it does, then, as usual, black and poor children will suffer the most. <v John Merrow>More children will be born with serious problems and more babies will die. <v Nurse>Just have all your meds ready, because y'all gonna have to crash as soon as you get into <v Nurse>the office. So just be ready for anything and everything. <v Interviewee>The best care in this country is better than any care in the world, no doubt about it. <v Interviewee>But the care is very uneven and certain segments of the population get very little, if <v Interviewee>any care. And that's why our country does not rate the number 1

<v Interviewee>in infant mortality, but 15th or 16th or 18th. <v Dr. Jay Goldsmith>They'll be arriving around 5:30, we need elevators ready and they're doing CPR en route. <v Dr. Jay Goldsmith>They feel that they cannot stabilize the baby any further. <v Dr. Jay Goldsmith>[ambulance parks] He's got a venous line in- an umbilical venous line and he's intubated <v Dr. Jay Goldsmith>and they'll be doing cardiac massage on the way home. <v Nurse>Give us a call Cliff when you get there. <v Dr. Jay Goldsmith>So it's not going to be a good situation. I will try to have Dr. ?inaudible? <v Dr. Jay Goldsmith>here to help us get down to [fade out] <v Interviewee>75 percent of infant mortality is caused by prematurity <v Interviewee>and we've shown that we can- model systems have been done again and <v Interviewee>again and again, and I'm almost tired of the models, that show we can get to the mom's <v Interviewee>early and we get them good prenatal care, we can cut down significantly on infant <v Interviewee>mortality. <v Interviewee>But we have used the last 2 decades to reduce infant mortality, <v Interviewee>not by improving prenatal care, but by taking better care

<v Interviewee>of the premature infant after the baby's born. <v John Merrow>In other words, after the damage has been done. <v John Merrow>That doesn't make any sense. We all want healthy babies. <v John Merrow>We all pay for unhealthy ones. <v John Merrow>We don't have to choose between advanced technology and basic health care. <v John Merrow>We need both. And we need to guarantee access to care for all <v John Merrow>pregnant women and babies. <v John Merrow>That's a matter of life and death. <v Dr. Jay Goldsmith>A week old, mother had a urinary tract infection 3 days prior to delivery. <v Dr. Jay Goldsmith>She had a fever, 102, 103 for 5 days and culture from UCSF <v Dr. Jay Goldsmith>told the [fade out] [background chatter from emergency room, doctors and nurses talking over each other] [EKG machine flat lines] [music plays] <v TV Announcer>Your children, Our children, is made possible by major grants from the Dayton Hudson

<v TV Announcer>Foundation, Target stores, <v TV Announcer>Mervyns, with additional funding provided by Carnegie <v TV Announcer>Cooperation of New York, Lane Bryant Malsin Foundation, <v TV Announcer>and the Lilly Endowment. <v TV Narrator>For more information and a guide to action, send 1 dollar <v TV Narrator>to Life and Death, box 1 7 9 7 <v TV Narrator>1, Denver, Colorado, 8 0 2 1 7.