Giving Birth In Jail

Giving Birth Jail

It is estimated that 6%-10% of women who are in prison are pregnant.1-3 Pregnant women in prisons or local jails are considered high-risk, and many of these women do not receive adequate care.2 Chronic illnesses such as drug addiction, alcohol abuse, and mental illness affect these high-risk pregnant women.1,4

Current Issues with Care of Pregnant Inmates

An article published in March 2017 in the New York Times shed light on the mistreatment of two pregnant women in a federal prison in Brooklyn. Both women detailed the neglect and lack of treatment provided to them by the prison’s correctional officers during their pregnancies. The officers failed to provide timely medical assistance, failed to follow doctor’s orders to have one pregnant women on bed rest, and failed to stop “intrusive” searches that contributed to bleeding in another woman. At least one woman’s pregnancy ended in miscarriage.5 Current federal efforts are re-evaluating the management of female prisoners in federal prisons.6

Recommendations for Providing Better Care

Prenatal care and counseling and support services are often neglected in managing pregnant female prisoners. The National Commission on Correctional Healthcare has identified several components of appropriate care for female prisoners such as gynecologic care, pregnancy care, family planning, postpartum care, physical and sexual abuse care, and parenting services. The organization encourages prisons to provide a broad array of pre-release and post-release services to women.7

The American College of Obstetricians and Gynecologists (ACOG) recommends specific care be provided to pregnant women who are imprisoned.1 This includes:

  • Assessing pregnancy risk upon entry (menstrual history, sexual history, contraceptive use, pregnancy testing)
  • Providing counseling and abortion services
  • Assessing women for substance abuse and start treatment
  • Testing and treat human immunodeficiency virus (HIV)
  • Providing perinatal care as outlined by the American Academy of Pediatrics and ACOG
  • Screening and treat mental illness
  • Providing dietary supplements during pregnancy and breastfeeding
  • Providing services in a licensed hospital that can provide care for high risk pregnancies
  • Providing postpartum contraception

ACOG also recommends limiting strenuous physical activity during pregnancy and during postpartum recovery, providing women privacy during examination or delivery, allowing breastfeeding of newborns, allowing pregnant women to sleep on a bottom bunk to avoid falls, providing infant care, and avoiding the use of physical restraints.1

How do U.S. Prisons Fare?

In 2010, 42% of states in the United States received failing grades due to poor care of women in prisons; the grades were based on provision of prenatal care, restraint use, and use of family-based treatment.8 A 2017 survey of 53 jails across the United States found that many of the recommendations set forth by organizations such ACOG are not followed. Among some of the surprising results, only 37.7% of jails tested women upon entry, 45.7% put women with opioid addictions through treatment programs, and only 56.7% of jails used physical restraints hours after birth.3 Another survey of 50 U.S. state prisons found similar issues including jails providing poor nutrition, inadequate rest, limited use of lower bunks, minimal support and education, and restraint use.9

Benefits of Providing Appropriate Pregnancy Care

Adequate care during pregnancy in female prisoners is linked to decreased preterm delivery and Cesarean delivery and better prenatal care.10 Interestingly, despite the inadequacies in the care of pregnant inmates, many studies find that pregnancy outcomes are generally better for imprisoned women compared to women in similar socioeconomic classes in the community.11

Ongoing State Improvements

Some states have made efforts to improve the care of pregnant inmates.Several birth and pregnancy programs supported by volunteers, grants, community organizations, churches, medical organizations, and colleges are providing services to pregnant inmates in Washington, Pennsylvania, New York, Indiana, Minnesota, Idaho, Illinois, Colorado, Texas, and Michigan.8,12,13 These programs include birth support, counseling and recreational activities, prison nurseries, residential drug treatment programs, and parenting support.12

References:

  1. https://www.acog.org/-/media/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/co511.pdf?dmc=1 HYPERLINK “https://www.acog.org/-/media/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/co511.pdf?dmc=1&ts=20170924T2052449842″& HYPERLINK “https://www.acog.org/-/media/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/co511.pdf?dmc=1&ts=20170924T2052449842″ts=20170924T2052449842
  2. https://www.ncbi.nlm.nih.gov/pubmed/24158132
  3. https://www.ncbi.nlm.nih.gov/pubmed/28236159
  4. https://www.ncbi.nlm.nih.gov/pubmed/25190332
  5. https://www.nytimes.com/2017/03/14/nyregion/pregnant-inmates-federal-jail-in-brooklyn.html?mcubz=3
  6. https://oig.justice.gov/ongoing/all.htm
  7. http://www.ncchc.org/women%E2%80%99s-health-care
  8. https://www.nwlc.org/sites/default/files/pdfs/mothersbehindbars2010.pdf
  9. https://www.ncbi.nlm.nih.gov/pubmed/22643607
  10. https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-1080-z
  11. https://www.ncbi.nlm.nih.gov/pubmed/21304069
  12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2409166/
  13. https://www.ncbi.nlm.nih.gov/pubmed/26548788
Lauren McMahan
Dr. Lauren McMahan has a Doctor of Pharmacy from Lipscomb University College of Pharmacy in Nashville, TN. She currently works for a large national healthcare company, where she provides her research and writing expertise to support evidence-based initiatives to improve patient care. She enjoys exercising, reading, and thrifting in her spare time.

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