Restraining women while they're giving birth is "demeaning and unnecessary." Some institutions still don't care.
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Tonier Cain-Muldrow, an author and trauma survivor, knows all too well what it feels like to be incarcerated and pregnant. Having struggled with addiction for years—an addiction that led to many of her 83 arrests—she was pregnant or already a parent during much of her time in correctional facilities.
During one of her stints in jail, she claims, she found out just how unprepared correctional officers were to deal with the often physically and emotionally traumatic aspects of pregnancy. “While I was incarcerated I miscarried at five months pregnant,” she says. “They shackled me to the bed and left me to lay there for several hours with my deceased baby stuck between my legs. My lifeless baby was unable to fully abort and I was left lying there hopeless and helpless. I will never be able to erase that memory.”
Cain-Muldrow’s nightmare didn’t end there. After her miscarriage, she says, “They continued the inhumane treatment keeping me shackled the whole time I was transported and treated at the hospital. I could feel them yanking and pulling, and still hear the sound of my deceased baby dropping into a metal bucket. Still shackled, I was returned to the jail, put back into my cell, not the infirmary."
When I contacted The Anne Arundel County Department of Detention Facilities—where Cain-Muldrow says the incident happened—they confirmed that she was incarcerated at their Jennifer Road Detention Center several times in the late 1980s and early 1990s. They said they don't, however, have any paper records from those incarceration periods and "are unable to confirm the incident described." Cain-Muldrow says she didn't report the incident when she was locked up because "when you're incarcerated, you try not to make waves."
Cain-Muldrow’s allegations are far from uncommon, given the rapidly increasing number of pregnancies, births, and miscarriages that are now occurring under the control of prison industrial compex. Due to the War on Drugs and the expansion of US police forces, along with other legislative and social factors, the number of incarcerated women in the United States has exploded over the past several decades, increasing by 700 percent between 1980 and 2014.
The most recent estimates indicate that there are over 200,000 currently incarcerated women—and 6 to 10 percent of them are pregnant. This exponential increase in the number of incarcerated women has posed both moral and medical dilemmas, including how to deal with pregnancy and childbirth in correctional facility settings.
The practice of restraining, or shackling, pregnant or laboring women—particularly during childbirth and in the postpartum period—has been widely criticized for over a decade, especially after reports of women giving birth in solitary confinement or while handcuffed to prison beds. In response to these reports, the American College of Obstetricians and Gynecologists issued a specific set of medical guidelines for correctional facilities, calling the practice of restraint “demeaning” and unnecessary, as no incarcerated women have been reported to have attempted escape during childbirth. Apparently, some jails aren’t exactly adhering.
ACOG guidelines, which are voluntary (not mandatory), suggest that women not be restrained at all during pregnancy, childbirth, or the postpartum recovery period if at all possible in order to protect their own physical and mental health and the health of the fetus. They also suggest that all women be tested for pregnancy upon entering a correctional facility, that correctional officers and all prison staff members be trained specifically in the unique medical and emotional needs of pregnant and laboring women, and that women be able to move unrestricted during labor for the purpose of healthy birth and pain management.
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Yet a 2017 study in Maternal and Child Health Journal indicates that, despite the many federal and medical guidelines indicating the practice’s barbarism and inefficacy, the practice of shackling continues in many regional jails, particularly in the immediate postpartum recovery period. And though the practice of shackling pregnant and laboring women was banned in all federal facilities by the Federal Bureau of Prisons in 2008, regional and state prisons can still decide whether or not to implement these guidelines.
Facility staff members were questioned about their implementation of ACOG guidelines for the study. The results were startling: Only 37.7 percent of facilities tested women for pregnancy upon entry, and the majority of facilities—56.7 percent—report that they restrain women using handcuffs or other methods just hours after they give birth.
Gail Saltz, psychiatrist, author, and associate professor of psychiatry at the NY Presbyterian Hospital Weill-Cornell School of Medicine, echoes what we can assume: that this kind of treatment is not only physically painful and potentially dangerous, but also psychologically traumatizing to postpartum mothers. “Being restrained would likely amplify distress and fear that may already accompany childbirth, especially in a prison setting. Childbirth is already experienced as a loss of control over one’s body; restraints would add to that dramatically,” she says, “This would increase the likelihood of symptoms of acute stress reaction including anxiety and depression following the event.”
The trauma of Cain-Muldrow’s own post-miscarriage recovery was compounded by her alleged treatment by facility staff. She says, “I became very depressed, unable to eat, and then heavily medicated with psychotropic drugs.” Like Cain-Muldrow, many previously incarcerated women who claim they were handcuffed during or immediately following childbirth are now fighting back against the degradation and trauma they say they experienced. Some are organizing activist groups to raise awareness and fight for harsher consequences for staff who violate medical guidelines, while others are suing the facilities where they allege they were abused.
Lawmakers, too, have taken notice of this unjust practice. Senators Cory Booker, Elizabeth Warren, Kamala Harris, and Dick Durbin introduced the Dignity for Incarcerated Women Act to the Senate in July 2017. The bill would federally prohibit shackling, along with providing for free electronic contact between incarcerated women and family members, free menstrual products, and greater attention to placing a child near the facility where a woman is incarcerated. Most importantly, ACOG’s current guidelines suggest that those who do restrain women during or immediately following childbirth should have to file reports with the Department of Corrections and face consequences, and ideally, this bill would make those policies more immediately enforceable.
Trauma-informed education for prison staff is a key first step to changing the way incarcerated women are treated, Cain-Muldrow says, adding that “expert recommendations don’t change mindsets.” She herself spent years working with the Florida Department of Juvenile Justice, teaching staff about trauma-informed approaches to juvenile corrections. This is especially important in women’s prisons, because the majority of incarcerated women have previously experienced sexual, physical, or emotional trauma. Many more incarcerated women than men, moreover, suffer from mental health issues, which exacerbates trauma reactions and requires more expertise from staff members when approaching medical care.
Saltz adds that these attitudes might be influenced not only by staff members’ relationship to inmates in general, but also by ingrained societal biases against all pregnant and laboring women as “out of control” and therefore requiring containment. “Childbirth evokes a host of feelings in observers...from awe to fear because it is a reminder of power,” she says, “because women in the throes of the pain and extremes of childbirth may seem to be out of control or primitive in their vocalizations and body movements. To an observer this may stir enough extreme emotion that they wish to restrain or control the woman, even though it is against the rules and is wrong.”
A trauma-informed approach and an emphasis on informed consent and physical autonomy would improve not only birth behind bars, but would potentially reduce the incidence of birth trauma and negative psychological consequences in births everywhere.
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