Evidence-based Policies Needed in Prison Populations

by Donna Jackson-Köhlin, CNM

One reality of midwifery practice in these times is that all of us will—if we haven’t already—care for women who are affected by the criminal justice system, whether they are incarcerated themselves, or the child, parent, or partner of someone who has been in the U.S. prison system. Thanks to the relationship between the community health centers where I practice with Baystate Midwifery and Women’s Health in Springfield, MA, along with the Hampden County Correctional Center, I have been able to provide obstetric and gynecologic care to incarcerated women inside a regional women’s jail for the past six years.

Caring for incarcerated pregnant women is demanding. Standards of care must be meshed with jail concerns around security, planning for the baby at/after birth, confidentiality concerns, and trying to facilitate normalcy in what is not a “normal” setting.

Shackling of pregnant women has received media attention, and for good reason. Few states have legislation in place regarding standards for prenatal care or restraints for labor/birth. Prison nursery programs that help foster bonds between mothers and infants are uncommon. The current practices at my facility in Massachusetts have been put into place due to a commitment to proactive policies, and good graces of the correctional medical and administrative staff. However, they are not part of state policy, and as such, they can be reduced or discontinued at any time.

It was with great interest that I received the report from The Rebecca Project for Human Rights/National Women’s Law Center, “Mothers Behind Bars: a state-by-state report card." I recommend that you read this document, consider what your past experience has been with this population where you practice, and think about what you can do to advocate for more humane, evidence-based beneficial policies and legislation that influence the family, community, and society long after a woman’s time in the prison system has passed.

Empowering Incarcerated Women during Pregnancy, Birth, and Motherhood

by Cheryl Hanna-Truscott, CNM

Mandi and Gabriel (3 days old)

Photo by Cheryl Hanna-Truscott, CNM: www.protectivecustody.org

"I’ve gone through a lot being here in prison. Early on when I first got here, I worried about a lot of things. One of them was, ‘Am I going to get to keep my baby?’"

In the mid-1990s, I first heard about a new program at our state women’s prison that would allow non-violent, incarcerated pregnant women to maintain custody of their infants while serving short prison sentences. I was intrigued, never having given much thought to women convicts, let alone pregnant ones. Healthy maternal-infant attachment could be promoted during this critical time in a protective, supportive, and safe environment.

“Being in the Residential Parenting Program has just given me a second chance, you know? I didn’t really have a place to send my baby to. I was blessed to be able to keep my baby here and it just shows me that I have a second chance.”

The program began in 1999, and in 2003, I asked if I could do a portrait photography project about the prison nursery. Even with my professional background as a nurse-midwife and expertise in child sexual abuse evaluations, I was surprised that administrators and mothers welcomed me. Prison is a closed, off-limits, censored, and locked-up environment. Prisoners are unseen, disenfranchised, and voiceless.

“Nobody I knew was with me when I gave birth. Nobody. But, gosh, the one officer was so great. I can’t think of her name…but, she, my gosh! I was leaning over the officer. I was slobbering, crying, and she didn’t care about her uniform. I wish I could think of her name so I could thank her.”

When I began this work, I expected to find the unit crawling with researchers interested in promoting maternal-infant health in such a vulnerable population and was aghast at the paucity of available information. Today, my photography project continues; although it is anecdotal and personal, it validates conclusions of current research efforts made by: Dr. Mary Byrne, Marie-Celeste Weisenburg (PhD candidate from UW with pending participatory action research), Chandra Villaneuva with the Women’s Prison Association, and the National Women’s Law Center with the Rebecca Project for human rights.

There is a great need to focus more attention and resources to maternal-infant health issues among this growing population. Both prison-based nursery and community-based programs have a place in our public health and safety system. We midwives like to say that we change the world one baby at a time. Through my work, I know that midwives are also the best-qualified providers that can make a huge impact on empowering incarcerated women.