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Political, economic, and demographic changes have had a detrimental effect on access to and quality of health care in California. What once started as moderate health care for minor illnesses and infant care has snowballed into expensive technological care for major illnesses and chronic conditions. A growing class of poor, uninsured, and underinsured people whose benefits are being reduced is developing, compounding the problem of a lack of preventive and promotional health care. High-risk populations - teens, HIV+, the undocumented and premature infants - also present new challenges to affordable, accessible quality care. No end to this trend is in sight.

Perinatal medicine has not been immune to the changes occurring in health care. In the past, the health care delivery system has fallen short in providing accessible, risk-appropriate care for all pregnant women. With the failure to address poverty as a whole and discrepant services in health care, there is an increasing number of women considered to be at risk - socially, medically, or both - for adverse pregnancy outcomes. This, of course, leads to more intensive and expensive care for the mother and/or neonate. Those at greatest risk for receiving inadequate prenatal care are ethnic minorities, teens, women who are poor, lack a high school education, or live in inner cities. Health care for these high-risk mothers, as currently delivered, is resource-intensive and results in little or no improvement in outcomes.

Health care in California is further complicated by the diversity of the population and a lack of health care providers. Costly duplication of high-tech services, coupled with inequities in distribution of resources for prenatal care, prompted the legislature to mandate regionalization throughout the state and to allocate funding for the Regional Perinatal Programs of California (RPPC). The programs are partially funded by federal Title V funds to the Maternal and Child Branch of the California Department of Health Services. The intent of the legislation includes identification of unmet needs, as well as collection and analysis of local and statewide data to assure that appropriate perinatal care is available, accessible and acceptable for all pregnant women and their newborns through their first year of life. The goal of the RPPC is to coordinate perinatal services so that they will meet the needs of the population. Initially, in the early 1980s, the programs focused on matching the needs of high-risk patients with appropriate levels of care. More recently, RPPC has concentrated on building coordinated networks of perinatal services, providers and related agencies to promote optimal care for patients, families and the community. The programs continuously monitor, evaluate and address regional needs.

The Orange County Perinatal Council (OCPC) is the community advisory council of the Region 8 RPPC (Orange County). The purpose of the OCPC is to promote access to quality health services for pregnant women and their infants, develop linkages between health professionals and organizations throughout Orange County, and foster risk-appropriate prenatal care. In carrying out this purpose, the mission of OCPC is to improve perinatal care and birth outcomes.

Activities of OCPC are directed at improving access to care and quality of care so as to reduce the risk of neonatal complications as well as the risk of maternal deaths from obstetric complications. These activities include: performing perinatal assessments of regional and statewide significance; developing communication networks among providers, organizations and agencies; providing education on current perinatal issues and services; providing resource directories and referral services; and disseminating quality assurance standards and protocols.

An increasingly important activity of OCPC is to develop recommendations based on regional assessments, to assure appropriate levels of care for all perinatal patients and to assist in the quality improvement of regional maternal and neonatal care as OCPC strives to reduce morbidity and mortality in Orange County.

OCPC has developed and distributed perinatal clinical practice guidelines countywide. Current practice focus issues include access to care, diabetes and pregnancy, teen pregnancy, breastfeeding support, and delivery of preterm/high-risk infants in appropriate settings.

The Orange County Perinatal Council works to improve perinatal care and birth outcomes through education, enhanced communications and cooperation among providers, agencies and the community. For more information on how to become involved in the Orange County Perinatal Council, please email Lucy VanOtterloo at Lvanotte@uci.edu or contact OCPC's office at ( 714) 456-6706.

Treason by Ann Coulter (Crown Forum: $26.95) has just hit the bookstores. It is a virulent and an unprecedented attack on liberals, whom the author assails as people who detest America. Her hero is the disgraced and discredited demagogue Senator Joseph McCarthy of the infamous House Un-American Activities Committee (HUAC), and her diatribe accuses liberals of siding with "Third World savages" against the United States.

The shrillness of this attack is unprecedented, since the extreme right wing of the Republican Party, until now, has only gone so far as to wrap itself in the flag, and to label those who dissent from their views as unpatriotic. Coulter goes further. In her heated imagination, liberal Americans are traitors, "fellow travelers" during the Cold War, who defended Alger Hiss and the Rosenbergs, and who are (secretly?) in support of Osama Bin Laden, in the same way they were in support of Stalin and his Communists!

A student of American history may well take an opposing position. Liberals have provided much that is fine and of lasting value to American political life, and to the society as a whole. The Bill of Rights was drafted by liberal thinkers and has been defended by liberals ever since. We owe our civil rights to liberals, including those heroic, non-violent civil rights workers who died in Mississippi and Alabama. Liberals empowered women and minorities to achieve the gains they have made to date, and this task is far from complete.

On the other hand, what do we, the American people, owe to ultra-conservatives? Why don't we begin with the "robber barons" who initiated the rape of the environment, while waging war on their own workers? The student of American history may consider the dreadful story of the long and bloody fights of the unions in this country, from the Wobblies to Cesar Chavez. The battle has always been between the might of the wealthy right-wingers, and the suffering and endurance of the exploited workers, supported by compassionate liberals.

Historians who study the causes of the Second World War often cite the Treaty of Versailles and the failure of the League of Nations among the pivotal starting points leading to the rise of totalitarianism. In this country, one may regard the right-wing politicians' rejection of Woodrow Wilson's eminently reasonable foreign policy, and refusal to join or support the League of Nations as another root cause of World War II, and another "debt" we owe the ultra-conservatives. Lindberg's Silver Shirts and the Bund helped to lull Americans to sleep while nazism and fascism metastasized in Europe. Certainly a case could be made that these ultra-conservative isolationists helped to make the rise of Hitler, Mussolini, and Stalin possible, leading to World War II and the Holocaust.

Then, consider the greedy and rapacious speculators who helped to bring on the Depression. We can say, with at least as much validity as Coulter's assertions, that the history of Wall Street, the crash and its aftermath, the Dust Bowl and the world-wide misery that followed, were certainly not the results of liberal actions or policies.

Today we are learning that about a million Hispanic men, women and children, many of them American citizens, were deported or forcibly "repatriated" to Mexico in the 1920s and 30s. Like the Japanese-Americans who were interned during World War II, many, at least 50 percent, were American citizens. It wasn't the liberals who carried out these outrages.

Having personally sniffed Ronald Reagan's tear gas at Berkeley during the Free Speech movement, this student of American history feels particularly strongly about innocent students who were gunned down at Kent State, liberal students who were brutalized by the Oakland Police Department, the student who was permanently blinded at People's Park in Berkeley, and the continuing oppression of liberal students (and faculties) by rightist politicians and administrators.

What else have the anti-liberals done for us? A disgraced Vice President, Spiro Agnew, followed by Watergate and Nixon's resignation; the agonizing escalations of the Vietnam war; the war crimes against unresisting Cambodia; the murder of Salvador Allende; the Reagans seeking guidance from an astrologer; the Iran-Contra scandal; trillions of debt; tax breaks for the wealthy and failing, inadequate, inequitable health care and social services.

Finally, the Bush dynasty - the father who was "out of the loop" when Iran-Contra was going on; the son, America's first appointed president; our Social Security and Medicare threatened; a war in Afghanistan that produced huge increases in the world's opium and heroin trade; a gang in the White House that only serves to enrich its cronies, despoil the environment, outrage the rest of the world and dismantle our Constitution. Coulter finds fault in none of these. Only liberals are treasonous in her book.

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