Grimacing from contractions, expectant mother Castuca Marino had more on her mind than birth pangs. She was nervous about whether she and her newborn child would make it out of the hospital alive.

Interviewed as she stood in the emergency room of Concepcion Palacios Maternity Hospital here last week, Marino had heard news reports of six infant deaths there over a 24-hour period late last month. She knew that since the beginning of February, six mothers had died in the hospital during or after childbirth.

"What are poor people going to do?" said Marino, 20, as she was being admitted to this sprawling complex where, on average, 60 babies are born a day. "I'm just hoping that there are no complications and that everything goes well."

Palacios, Venezuela's largest public maternity hospital and once the nation's beacon of neonatal care, has fallen on hard times. Half of the anesthesiologists and pediatricians on staff two years ago have quit. Basic equipment such as respirators, ultrasound monitors and incubators are either broken or scarce. Six of 12 birth rooms have been shut.

On one day last month, five newborns were crowded into one incubator, said Dr. Jesus Mendez Quijada, a psychiatrist and Palacios staff member who is a past president of the Venezuelan Medical Federation.

The deaths of the six infants "were not a case of bad luck, but the consequence of an accumulation of circumstances that have created this alarming situation," Mendez said.

Cases of malaria nearly doubled between 1998, the year before Chavez took office, and 2007. Incidents of dengue fever more than doubled over the same period.

Chavez is building a parallel health program called Barrio Adentro, which features 11,000 neighborhood clinics staffed mainly by Cuban doctors.

Inaugurated nationwide in 2003, Barrio Adentro initially was so popular with the poor that it helped Chavez win a crucial 2004 referendum and hold on to power. It has brought basic healthcare to the barrios, providing free exams and medicine as well as eye operations that have saved the sight of thousands.

But the system siphons resources and equipment away from the public hospitals, which have four-fifths of the nation's 45,000 hospital beds and where the public still goes for emergency and maternity care, as well as for most major and elective surgeries.

Since the mid-1990s, the death rate of women giving birth has risen 18%, to 59 in every 100,000 deliveries, according to UNICEF. That's four times the rate in Chile. Venezuela's infant mortality rate of 18 deaths for every 1,000 live births in 2007 was down from 20.5 in 1998, but still double the rate of Chile and higher than other Latin American countries such as Colombia, Uruguay and Costa Rica.

Gonzalez, the university professor, fears that the situation could get worse because maternity hospitals such as Concepcion Palacios are having increasing difficulty finding young pediatricians to pursue neonatal specialty training due to low pay and lack of resources.

"It's not that before Chavez things were great," he said. "It's that things have deteriorated."