Incarcerated & Pregnant | Promoting the Health of Mothers and Babies

At a state prison, a parenting group
facilitator asks a room full of new and expecting incarcerated mothers: “What is
your biggest fear about being a parent?” And one mother said, “My biggest fear about
being a parent is that I am going to be no better to my baby then my mama was to me.” And the group faciliator said “Well tell me more about that. How are you doing with that?” and she said, “Honestly, I truly
don’t know. I’m not beating my baby, but I’m sitting here in prison pregnant. So what am I
supposed to do?” What we know is that between 1991 and mid your 2007 the
number of parents who were held in state and federal prison increased by 79 percent. And
it is estimated that 52 percent of state inmates, and 63 percent of
federal inmates are parents of minor children. We know there are over 200,000
women in jails and state and federal prisons, and there are over 14,000 girls
in juvenile detention centers. An estimated 12 to 21 thousand
pregnant women are incarcerated every year. The majority of incarcerated people are more likely to have mental health problems to have substance abuse problems, to use
alcohol, tobacco, to have violence exposure, to have experienced
homelessness or poverty. And all of these social and medical risks are associated
with poor maternal, fetal and infant outcomes. Mental health and stress are
known to be related to pregnancy outcomes and maternal health. High stress, anxiety, or depression is associated with risk for low birth
weight, preterm risk, some birth defects, and it can also affect maternal behavior:
willingness to eat, ability to sleep. Actually stress can have even longer-term
effects on offspring. There’s sort of a transgenerational risk to offspring of
incarcerated people. One of the things that can buffer stress is social support.
Traditionally pregnant women in prisons receive limited social support and
prenatal education during pregnancy and delivery. Women who are incarcerated must give birth under supervision from a corrections officer without support from
family or friends, and in some states women are shackled
during active labor creating additional stress during the birth process. In
Minnesota, the Minnesota Prison Doula Project is working to change the birth
experience for pregnant incarcerated women. A prison doula is a very important
person in the life of an incarcerated pregnant women because she becomes the
primary source for prenatal education, emotional support during
pregnancy, and physical comfort during labor and delivery. So she gets 2 one-on-one
prenatal appointment. That includes prenatal education, emotional support
assistance with preparing a birth plan. The doula also provides labor and
delivery support. She meets the woman at the hospital after she is transferred
from the prison, and she provides emotional support, physical comfort, and
assists the mother with making informed decisions in this context. A big part of our
role, which is what a lot of the women say is the most important part, is that
they go at the day the baby is taken away from the mother, and they stay and sit with her that whole day. This is a really intense emotional experience for
the mom, and the doulas can be there to support them through that. The doula plays this critical role of providing emotional support in that setting. We have very
healthy babies in the context of this program. We’ve had 35
spontaneous vaginal deliveries, and 4 C-sections. Average 7.41 pounds, and
again none of the babies have been born low birth weight. Gestational age is right
where it should be: 39 weeks and 3 days, and none of the babies have been
born preterm. We also want them to be born healthy because premature babies are very very expensive. The cost difference for a mom and baby in the first two or three
days in the hospital is $50,000. At the 12 week follow up women are reporting
significantly fewer depressive symptoms, more confidence as parents, more support from other
women in the prison, more support from prison staff. One mom said: “Having a doula
there made my experience the good one. It helped a lot!! You have to find something positive
about your birth experience while you’re in prison, and my doula helped me achieve that.” We can offer
women all kinds of great programming, and I think we do, but one of the primary
things we do is we just let people grieve. Women are absolutely broken
hearted about being away from their children. Like pregnant women in prisons, pregnant women in jails are vulnerable to the stresses of incarceration. However, women in jails
serve much shorter sentences and face unique challenges that make intervention
more complex. Particularly in jail environments, it’s a pre-sentence, pre-trial facility, the
average length of stay is seven days. However, most women are gone within 72
hours, so that opportunity to make that connection with a woman to find out
where she’s at with her health, with her pregnancy is really limited. The CDC estimates anywhere from 6-10 percent. You look at jails
reporting from large urban areas you see rates between 20-30 percent of
women who are testing positive for pregnancy. Pregnancy is a time when many many women, incarcerated or not, are open to making lifestyle changes. They want to take better
care of their bodies not only for themselves, but also for the baby that’s developing
inside them. We’re really surprised to see that longer stays of incarceration were actually associated with healthier birth weights. And there could be any number of reasons
for that: the safety of the of the jail environment, removing from other life
stresses. But what this really said is the group that we need to intervene with are the
group that’s not incarcerated for a very long time. This group might really be in
need of services. We see incarceration as an opportunity to identify pregnant
women for a key part of intervention to start services. I think there’s a
challenge in terms of access to care out in the community. Inherently those connections with public
health aren’t there. Upon re-entering society, former offenders often struggle with
substance abuse, lack of adequate education and job skills, limiting
housing options, and mental health issues. Many pregnant women and new moms need
additional support to ensure they provide a safe environment for their
child. But I would say folks are dedicated and they’re committed and we want to do this, and we want to
do this better. I think there’s opportunities with every correctional health agency to make a connection with
local public health. I’d like to see every pregnant woman have a referral to their local
public health agency upon discharge. I would love to be able to have my staff
connect with every pregnant woman in custody. For more on pregnant
incarcerated women and their children, visit these links.

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