Adapting Childbirth Services for Incarcerated Mothers: Midwifery Today article

Adapting Birth Services for Incarcerated Mothers

[Article submitted to Midwifery Today Magazine, October 2011]

 By Marianne Bullock, CD, and Vicki Elson, MA, CCE, CD

Approximately 40,000 women who are incarcerated in the United States each year are pregnant.  85% of women in prison are mothers.  2/3 were their children’s primary caregivers prior to incarceration.

The number of women incarcerated in the U.S. has increased 832% in the past decade (that’s not a typo), in large part because of the “War on Drugs.”  More than 1% of U.S. adults are in jail or prison right now.  73% of incarcerated women are serving sentences for nonviolent crimes (property, drugs, prostitution), and many do not pose a flight risk.

When you go into a jail to serve mothers, you leave contraband items behind: sharp objects, glass, chewing gum, cellphones, notebooks with wire spirals, even plastic forks.  You cope with the security screenings, dress codes, and big metal doors.  And you leave behind whatever notions you once had about “good” and “bad,” or “teacher” and “learner.”

In many ways, working with incarcerated women is the same as working with any other population: it’s all about empowerment. In other ways, its vastly different, because incarcerated mothers lack autonomy and birth choices.

In our work with The Prison Birth Project (www.theprisonbirthproject.org), a reproductive justice organization working to provide support, education, and advocacy with women and girls at the intersection of the criminal justice system and motherhood in our regional women’s jail, empowerment takes the form of advocacy, friendship, peer mentoring, and leadership development.  We offer childbirth education, doula services, and mothers’ groups.  We organize with incarcerated people around policy change.

For all mothers, giving birth has the potential for being traumatic.  But for incarcerated mothers, giving birth is inherently traumatic.  Mothers give birth under the supervision of an armed corrections officer (CO).  They are not allowed to bring their own food, clothing, or belongings.  Even going for a walk in the hospital hallway is at the discretion of the CO.  Many are handcuffed or shackled before, after, and sometimes during active labor. Vaginal exams and monitoring are done with the CO present.  Without the presence of a doula or advocate, mothers don’t know if their rights will be respected.

Hardest of all, they have to surrender their newborns after only a day or two together, and go back to jail.

We assume that every single client has experienced trauma.  If they’ve been jailed, they’re traumatized.  But there’s more. 57% of incarcerated women have experienced sustained physical and/or sexual abuse.  (There may be many more that do not report such abuse.)  Not surprisingly, given that history of trauma and the lack of support services available, 84% of incarcerated women have histories of drug addiction.  Poverty and illiteracy are also disproportionately represented in jail.

16-20% also suffer from diagnosed mental illnesses.  A generation ago, there were ten times as many beds per citizen in facilities for the mentally ill.  Now, jails and prisons, the only places where health care is mandated, are functioning as de facto mental health centers — only lacking adequate mental health care resources.

Effective care requires a space of absolute nonjudgment, awareness of local resources, and a willingness to emphasize good listening skills over advice-giving.

In fact, the whole caregiver-client relationship shifts in the work that we do. We cultivate peer-to-peer relationships.  We offer training for incarcerated and newly released women to take up leadership positions in our grassroots collective organization. They are designing and running programs, and helping to set the course for the future of the organization.  After all, they have the best perspective on what is really needed. They are the experts!

We all reap the spiritual and educational benefits of being equals. It’s rewarding to share information and explore issues. Love is love, whether or not we share a similar ethnicity, age, or life history.  We try to keep the love flowing out, so the sadness doesn’t flow in as much.  We start having fun, just like any bunch of women.

When we were learning to be doulas, our training emphasized being a liaison between mothers and their care providers.  But in doula work with incarcerated mothers, advocacy is a primary role. We advocate as needed, plus we teach advocacy skills to clients during pregnancy and postpartum. We try to expand the small number of choices that mothers have left to them.  We offer space for mothers’ voices to be heard in a system that might not believe that they are capable of making good decisions for themselves.

Incarcerated mothers obviously don’t have the option of homebirth, or of laboring at home and choosing when to come in to the hospital.  They go when they have convinced a CO and a medical staffer that they really are in labor.  The common scenario of “you’re still in early labor, go home and come back when it picks up” is complicated by strip searches, the use of restraints during transport, and the whims of whoever is on call.  We try to be there for transitions to and from the hospital, but we never know if we will make it in time.  Also, we can’t just pick up the phone and ask our clients what’s up.  Communications go through complex channels and are sometimes delayed.

Luckily, we have two wonderful nurse-midwives providing prenatal care at the jail, but they are part of a large practice. So, when women are in labor, they may not know the midwife on call.  The hospital staff may or may not be comfortable working with incarcerated people. Our role then often becomes helping care providers see clients as “human”.

We try to help laboring moms feel more in control.  We try to create a “bubble” that consists of the mom, her family (if they’re present), and her doula.  We help CO’s and hospital staff create a friendly atmosphere, but we try to let the mom decide who gets to be in her bubble.  It feels odd that we doulas are allowed to touch her, but her close family members are not.  We try to channel their touch, and offer suggestions for how family can participate in ways that are allowed under Department of Corrections protocols.

Of all the women who have ever received PBP’s doula services and then been released, only one has returned to jail so far. We believe that doula care is stopping a cycle of violence and trauma to mother and baby during delivery, and helping women to have the tools to make healthier choices. Other prison birth programs report similar decreases in recidivism.

Having a baby is a time of transformation for all of us.  And for women on the inside, sometimes it’s an opportunity to re-think and re-invent oneself, a catalyst for hitting the cosmic re-set button and starting fresh.  It’s an honor to witness this, and a delight to help facilitate it.  It’s the ultimate teachable moment.

“I’m never coming back in here.  I’m gonna do right by my baby.”

For women experiencing homelessness, starvation, or abuse, jail may feel like the safest place they could be while birthing. We honor that, and we try to make distinctions between personal choices and societal oppression.

We are proactive.  We provide evidence-based information to those who have power over our clients’ lives.  For example, our Department of Corrections used to give postpartum women a one-size-too-small sports bra and a suggestion to take cold showers until their milk stopped flowing.  Now there is a breastpump at the jail, and one mother just broke our record: she pumped five times a day for seven months, breastfeeding her baby in person at weekly visits (until the baby decided the bottle was easier).  The baby’s guardian lives nearby, and drives to the jail to pick up the frozen milk regularly.

Another example: Mothers using heroin are put on methadone until after their babies are born, at which time the methadone is tapered off.  (It can be dangerous to mother and baby to stop using methadone during pregnancy.)  We sometimes help women to communicate with their doctors when their dosages are too high or too low as their blood volume changes during pregnancy.  We sometimes find ourselves in the role of educating staff and even pediatricians about the value to the baby of breastfeeding while the mother tapers off her methadone.  (It seems to make Neonatal Abstinence Syndrome less frequent and less severe, perhaps because the low concentration of methadone in mothers’ milk helps the newborn through withdrawal.)

Many of us may harshly judge a mother who puts her baby in such a situation, but part of our mission is to recognize the the ways in which perceptions of incarcerated people are shaped by those with power and not by incarcerated people themselves. We have come to know so many mothers who have barely survived their own lifelong difficulties, and we are try to be more compassionate without being naïve. Some of the women at the jail are there for violent crimes, but they are no less deserving of care than the vast majority who are incarcerated for nonviolent or victimless offenses, or those who may even be entirely innocent. We are in the business of harm reduction.

We usually have more contact with our clients than their midwives have, and, since we are not government funded, we sometimes have more freedom to advocate on behalf of our clients.  If a postpartum woman is tapering off methadone, she is typically placed in a segregation unit, a lonely place where we may be her only visitors.  Here she is, having just given birth, missing her baby, going through withdrawal, living in terrible uncertainty about when or even whether she will see her baby again.  Here, empowerment takes the simple form of witnessing and listening.  We say, as we did in labor, “I’m with you” or “This will be over.” One of the most useful things a doula can do is take pictures of the baby and bring them to the mother postpartum.

In addition to doula care, we offer full-spectrum reproductive care.  This might include pregnancy options counseling.  We serve as abortion doulas or adoption support.  We help women with custody issues and interactions with the Department of Children and Families.  We offer support in the courtroom.

We offer weekly childbirth classes, to which postpartum moms are also invited.  We bring in lunch: fresh fruits and vegetables, whole grains, and real meat, cheese, poultry, and fish.  For women who aren’t doing well on the jail diet (typically inexpensive foods, heavy on soy protein and white flour products), this is most welcome.  For women who prefer processed foods or do not have kitchen facilities outside the jail, it’s an opportunity for nutritional education.

Childbirth classes are a little tricky in jail because there are issues (like custody, or survival) that overshadow everything you ever thought was important to teach pregnant people.  Sometimes the best “classes” are just being together.

It’s also tricky because you never know for sure if you’re going to see a woman only once or if you’ll see her every week for her entire pregnancy. It doesn’t matter.  Any respect and kindness – and food – that you offer will not be wasted.  There’s a suggested class plan at: http://birth-media.com/the-prison-birth-project/  There are also some one-page handouts that you’re free to use.  One handout is what Vicki thinks pregnant women need to know if you only meet them once, and another is a postpartum guide specifically for incarcerated moms.

We also offer mothers’ groups for ALL mothers.  So far, more than 75 moms have participated in “Mothers Among Us,” PBP’s peer-led support group. MAU offers a safe place to be real and honest about the full spectrum of mothering experiences.  Both participants and facilitators are reclaiming their resiliency and strengthening their core selves.

“I have had an extremely difficult time in jail.  At this group I was comfortable for the first time.  The women of this group have brought me a long way.  They provide us with hope, faith, and compassion.  The group is open-minded and understanding. I am fortunate to have these women helping me to obtain the resources that I will need.  Also when I leave I will still be working with them.  Because of this group I know I have a chance to have a good, solid, nurturing bond with my children.”

We are building an empowered community that supports mothers through recovery and release.  We address issues of justice, oppression, healing, education, reunification with children, and leadership development.  We connect women with needed resources and information.

“Being incarcerated doesn’t make us bad people, and Mothers Among Us recognizes that.”

The average age of children with an incarcerated parent is 8 years old.  22% are under age 5.  In 2004 59% of parents in state facilities and 47% in federal facilities reported never having had a personal visit from their children.

“Then one of the girls in my ‘pod’ told me about this group.  My first reaction was doubt: ‘They won’t help me.  I won’t be welcomed.’  Wow, I arrived and they welcomed me.  The facilitators didn’t turn me away.  They actually listened to my story.  I shared about my daughter’s mental illness, her new diagnosis.  I didn’t understand it, and the PBP women offered to research this for me.”

Inside a jail, there is limited access to books, phones, or nature.  There is no access to the Internet.  We try to fill in the gaps.

“The great thing about this group is I’m able to share my feelings, my troubles, get feedback.  So I’m able to get better equipped to be a great mother when I return home and not bring all my guilt home to my children and my community.”

Most of us mothers make a straightforward transition, from person to pregnant person to parent.  Incarcerated mothers have many more stages to move through: moving between jail and the community, changes in access to their children, challenges with reunification with their families.  We try to ease those transitions, helping mothers to create not only birth plans but postpartum plans, safety plans, and relapse plans.

No matter what the custody situation ultimately becomes, we encourage bonding for both the mother’s sake and the baby’s.  We encourage the children’s caregivers to support mother-child connections.

As you can see, this is a time-intensive project.  Marianne Bullock and Lisa Andrews were 20-something moms nursing squirmy babies when they “envisioned a space for mothers to receive support and tell the truth about their experiences” during and after incarceration. They created a program based on their own experiences with the criminal justice system and reunification with family. They presented their program to the new women’s jail and it was accepted.  Within days they had their first client deliver.

Now they have expanded their volunteer partnership into a grassroots collective, supported mostly by private donations, plus a few grants.  PBP does not receive funding from any government sources.  In order to be sustainable, we have to put considerable energy into administration and fundraising as well as direct services and programming.

We can’t talk about PBP without talking about the context: the vast problems of mass incarceration, inadequate support systems, racial and economic disparities, domestic abuse, breakdown of communities.  But since we are doing something so concrete and so clearly effective, even for just a small sliver of the affected population, donors appreciate the opportunity to be part of it.  We have house parties and “Secret Cafes” and knit-a-thons.  Sometimes local musicians – from punk to classical — offer benefit events.  There is still a whole lot of volunteering going on, and food is donated.

Are you interested in helping incarcerated women in your community?  There are so many ways, large and small.  Ours is just one model.  Here are some ideas.

1.  Start a doula project in your local jail or prison. Organize incarcerated and formerly incarcerated mothers in guiding the project and providing services. Work with incarcerated folks, not on behalf of them.

2.  Tailor a childbirth class for incarcerated women. Movies are welcome, though many natural childbirth films need a little bit of cultural contextualization.  (“I know you might find it strange that this woman gives birth in her bathtub with her kids jumping in, but check out the way she moves in labor, and how she works with it when it gets hard.”)

3.  Raise money and volunteer for your local doula project — or PBP!

4.  Organize mothers’ groups (www.motherwoman.org is a GREAT resource). Learn how to run these groups from an anti-oppression framework, so everyone can be included.

5.  Be a mentor to mothers during incarceration and/or after release. Give your card to medical/jail staff and tell them you will offer free doula/midwifery services to women when they get out.

6.  Be a mentor to teens, pregnant or not.  Help them develop good decision-making and life planning skills.

7.  Network with programs that run outside the jail for people after release.  Hold an event to raise funds for people in transition.

8.  Research prison nutrition for pregnant mothers.

In the United States:

1.  See www.RebeccaProject.org or www.ACLU.org for current campaigns regarding shackling and treatment of pregnant inmates.

2.  Research the causes of mass incarceration (see www.leap.cc).

3.  Research the effects of disrupted bonding on families.  So far, it appears that when fathers are incarcerated, role models are lost, but when mothers are incarcerated, families just fall apart.

4.  Research the disparate effects of this disruption on communities:  70% of  U.S. women in prison are African American or Latina, and this is the fastest growing sector.  (Only 29% of all U.S. citizens are African American or Latina.)  African American children are 9 times more likely than white children to have a parent in prison.  Latino children are 3 times more likely than white children to have a parent in prison.

5.  Research community-based alternatives to incarceration.  Some states have prison nurseries, which are cost-effective and successful, but they tend to be small and serve only a small number of families.

Marianne Bullock founded the Prison Birth Project based on her own experience with the criminal justice system. She has been working as a doula for 10 years. She lectures on prison and reproductive justice issues.  She is an Ada Comstock Scholar at Smith College, and mother to a spirited young daughter.  www.theprisonbirthproject.org

Vicki Elson made the film “Laboring Under An Illusion: Mass Media Childbirth vs. The Real Thing.”  Her next film will be about what REALLY works for labor.  She has been a childbirth educator and doula for 28 years, and a grandma for 8.  She offers a workshop called “Childbirth Education Essentials” and a low-cost, grassroots, streamlined certification program for childbirth educators.  She is a volunteer childbirth educator and doula with PBP.  www.birth-media.com

Leave Your Comment

Your email will not be published or shared. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>

*