Wednesday , 13 December 2017

Pregnant in Prison: Maternity Care for Incarcerated Women


myheadshotWhen thinking about maternal health access, one group of women are often forgotten, even silenced – incarcerated women.  According to the two part TV series “Babies Behind Bars,” the number of women in US prisons has climbed 400% over the past 30 years. It is estimated that the majority of these women are in jail for non-violent crimes. Each year, 6-10% of all incarcerated women are pregnant.

Adequate maternal care for inmates has multiple components. Do they have access to prenatal care? Are they allowed more food? If they sleep on a top bunk can they be moved to a bottom bunk? Is access to mental health services provided to help with post-partum issues that may arise as the result of separation from their infant? Can the women breastfeed? Is shackling used?

Restraining women during labor and delivery and post-labor poses potential harms to the health of the mother as well as the baby.  The National Commission on Correctional Health Care, Federal Bureau of Prisons, and American College of Obstetricians and Gynecologists, along with numerous other notable organizations advise against shackling pregnant women. However, it is up to state and local jurisdictions to decide. While some states and local leaders have made great strides to prohibit shackling of pregnant women, many still have not enacted laws to protect pregnant inmates against this inhumane treatment.

Furthermore, there have been reports of shackling occurring despite laws prohibiting it. In some cases, the minute the baby is born and the woman is considered no longer pregnant, she is restrained. According to Susan Buttenwieser in a March 10, 2015 article “Shackled and In Labor,” 29 states still allow pregnant women to be shackled. She explores how even in places where it is outlawed, women are still shackled. Reports often say that medical staff asks officers to take off the restraints but they often refuse.

birth behind bars

In exploring what is being done to provide support and help increase the health of both mother and infant, I came across Birth Behind Bars. Its mission statement is: “Helping birth professionals across America care for pregnant inmates and their newborn child.” I had the pleasure of speaking with Janice Banther, a doula who is the founder of both Birth Behind Bars- a 501C3 Non-profit and For the Love of Birth. Janice explained to me how she has been a childbirth educator and doula for decades working with diverse populations from millionaires to women living in poverty.

“Sixteen years ago I was going to lunch with a midwife friend. She said she was going to jail after lunch, and I asked her why, and it opened my eyes; it sat with me.

Something more needed to be done. I contacted a local jail and mind you, local means anything within one and a half hour reach, and asked for programs, called different people- chaplains, people from programs and asked if they have pregnant inmates. ‘Are there any classes? Would you be interested?’  I told them about myself and what I do and they said to come down and bring any information about who I was. They liked what I had to say and felt like they could trust what I was saying and did a background check on me. It was hard to schedule the start of my childbirth classes because so many hours of lock-down meant the program room was free for only a few hours; but we got in. I honestly thought I would be going to the jail twice a month; had no idea it would become national and international.”

From there it just seemed to take off and Janice was able to convince the jail to allow her to provide both labor and post-partum doulas for pregnant inmates. Having a doula present at childbirth not only increases the outcome of the health of the baby, decreases the risk for c-section, and helps with mother and infant bond, but doulas provide a wealth of support for the birthing mother. Doulas are allowed to offer comforting touches to the laboring inmate. This is especially helpful because most incarcerated women cannot have family at their birth, do not know the medical staff, and the only familiar face in the room is the prison guard who is not allowed to offer comfort.

When I asked Janice about shackling at the prison she worked at in Florida she said she felt like it was the presence of the doulas that seemed to stop that county from shackling. Janice mentioned that often, the reason officers did it was for fear of a random check from a higher-up deputy; if they saw someone coming to check on them they would quickly place the shackles back on. About three years ago Florida made shackling women during labor, delivery, and the immediate postpartum illegal. “There is a tiny percent of officers who just do it no matter what. Just like there is a tiny percent of nurses who treat inmates badly. The majority of nurses go out of their way to make the inmates just feel normal.”

I asked Janice to tell me about some of the challenges she has faced with regard to her work. Jails have been very good except for breastfeeding. They have been great about letting us make their library huge [with books on prenatal and child development, birthing, and parenting]. What it comes down to is we have to stop thinking in our world and think in their world. For example, she explained that a breastfeeding pump would be considered contraband. That designation is what is stopping many jails from allowing options for women to breastfeed. There is also the consideration that if the baby is living with a relative or in foster care, getting the milk to be stored and transported properly would be quite complicated. A second aspect of “their world” that Janice described to me is something as simple as pillows. Often in childbirth classes she taught outside of prison, the women bring multiple pillows with them. However, a woman in prison does not have that option. She is sleeping on a mattress that is almost as thin as a yoga mat. She tells me how some jails will say they give pregnant women a second mattress, but in reality there is such an overpopulation of women in prison that they don’t have extra mattresses to give.

The documentary series “Babies Behind Bars” explored the Wee Ones Nursery at the Indiana Women’s Prison in Indianapolis where a small number of pregnant women who have not committed violent crimes apply for a spot in the “baby wing” allowing them to keep their baby. Americans often debate this topic asking: does a mom, convicted as a criminal, deserve the right to parent? Is it fair for the baby to live in prison?  I had the honor of speaking with Dr. Mary Byrne, a Professor in Clinical Health for the Underserved at Columbia University who has conducted National Institute of Health (NIH) funded research for more than 10 years– her expertise: studying the outcomes of babies in prison nurseries.

I asked Dr. Byrne how she ended up getting involved in her research. She told me, “I got interested in criminal justice kind of accidentally; the school of nursing asked me to go the women’s prison in order to coordinate graduate student placements to provide nursing care in women’s health and midwifery. That was the first time I was exposed to a prison nursery and it took quite a while to get them to trust me and lo and behold they had never allowed anyone to evaluate their prisons.

Finally, I received approval to conduct the study. It was a cross-sectional analysis of 60 women and 58 babies; there were two sets of twins, and I saw each one a couple of times to get a complete set of data-interview, development assessment of baby, and parenting assessment. I thought that would be my contribution but I ended up getting funded by NIH to conduct a longitudinal study and had a new group of 97 women to follow. I followed each pair, mommy and baby while in the nursery- from the time they entered until they left and one year after the baby left. About half went home with babies and half did not and baby would go to a family member temporarily. Because it was a rolling process, the whole study took four years and then my team received additional funding to follow mothers, children, and alternate caregivers into the community. I interacted with some of the babies until they were nine or ten years old, but the majority were eight when the study was concluded. Very consistent findings reveal the mothers tend not to go back to prison and, importantly, the infants attach securely to their mothers in prison and achieve and maintain child development outcomes appropriate for age over the years in prison nursery and in the community.”

So what exactly should happen with pregnant women in prison? The likelihood of each woman’s prison having a nursery is slim. The chances that every pregnant inmate could have a doula by her side are also unlikely. However, positive change can start when more knowledge is spread about the inhumane treatment, lack of medical care, and trauma incarcerated pregnant women experience. Disruptive Women, such as Janice and Dr. Byrne, are bringing the necessary awareness to this topic.


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