Pregnant Behind Bars

The shameful lack of prenatal care in U.S. prisons and jails 

by Victoria Law

Reprinted with permission from In These Times magazine http://inthesetimes.com/article/18410/u.s.-prisons-are-threatening-the-lives-of-pregnant-mothers-and-newborns.

At 5 a.m. on June 12, 2012, lying on a mat in a locked jail cell, without a doctor, Nicole Guerrero gave birth.

Guerrero was eight-and-a half months pregnant when she arrived 10 days earlier at Texas’ Wichita County Jail. The medical malpractice lawsuit Guerrero has filed—against the county, the jail’s healthcare contractor, Correctional Healthcare Management, and one of the jail’s nurses, LaDonna Anderson—claims she began experiencing lower back pain, cramps, heavy vaginal discharge and bleeding on June 11. The nurse on duty told her there was no cause for concern until she had bled through two sanitary napkins. Several painful hours later, Guerrero pushed the medical emergency button in her cell.

At 3:30 a.m., more than four hours later, Guerrero was finally taken to the nurse’s station. Guerrero says she showed Anderson her used sanitary pads filled with blood and fluids, but was not examined. Instead, she was taken to a one-person holding cell with no toilet, sink or emergency call button, known as the “cage.” At 5 a.m., her water broke. She called out to Anderson, but, Guerrero says, Anderson refused to check on her. Shortly after, Guerrero felt her daughter’s head breach. A passing guard stopped to assist her, and Guerrero, unable to keep from pushing, gave birth on a blood and pus-covered mattress.

The baby was dark purple and unresponsive, with the umbilical cord wrapped around her neck. When Anderson arrived minutes later, she did not attempt to revive the baby, Guerrero says. The EMTs got there after 20 minutes and rushed the baby to the hospital. Guerrero remained in the cage, where she delivered the placenta. At 6:30 a.m., the baby was pronounced dead.

No data, no problem

The number of women who cycle through U.S. jails is increasing by approximately 1.6 percent each year, to 109,100 in 2014, while the number of women in prisons has risen nearly tenfold in the past 40 years, to 111,300 in 2013. Though the United States accounts for only 5 percent of the world’s women, it has 33 percent of the world’s women prisoners.

There is no current data on how many of those women are pregnant. In 2004, a Bureau of Justice Statistics survey found that 3 percent of women in federal prisons and 4 percent of those in state prisons were pregnant upon arrival. The statistics on pregnancy in local jails is older—a 2002 survey found that 5 percent of women entered local jails pregnant. At those rates, approximately 9,430 pregnant women are incarcerated annually.

There is even less data on what kind of care pregnant prisoners receive: their nutrition, prenatal check-ups and medical attention, which can be a matter of infant life or death in cases like Guerrero’s. Nor do we hear much about the trauma of pregnancy and childbirth under prison conditions, or the heartbreak of having an infant taken away hours after birth.

In a six-month investigation, In These Times reached out to dozens of incarcerated women, activists and advocates, seeking to reach women who had been pregnant behind bars. Twelve came forward to share their stories.

In These Times then requested information about pregnancy care and policies from the prisons and jails where the women were incarcerated. Only four of eight complied. Correct Care Solutions, a contractor that provides healthcare at Nashville’s Davidson County Jail, refused, declaring that private companies do not need to open their records to public scrutiny. Those that did provide records typically took months to do so, and the data was often poor. Phoenix’s Maricopa County Jail records live births, miscarriages and abortions, but not stillbirths. Washington’s Clark County Jail keeps track of the number of medical visits by pregnant women (42 in 2014), but not the number of pregnant women incarcerated.

However, from the 12 individual women’s accounts, a picture began to emerge. Many received no medical care or experienced long waits. Most were constantly hungry. Others were restrained during labor, delivery or postpartum recovery, even in states that ban the practice. The majority of those who gave birth in custody had their infants taken away within 48 hours.

Care and loathing

Medical neglect can endanger the lives of pregnant women as well as fetuses.

Diana Claitor, executive director of the Jail Project of Texas, says she interviewed a young woman whose complaints of extreme pain were dismissed by a jail doctor as morning sickness. But “it was because her fetus had been dead for some time,” says Claitor, who also examined the woman’s medical records. “She was very ill and could have died.” The woman was finally taken to the emergency room, where she delivered the dead fetus.

Bridgette Gibbs says that, despite telling staff of her history of miscarriages, she received no medical attention in two months of pregnancy at the Westchester County, N.Y., jail. She still hadn’t been examined when, early in her second trimester, she went into labor. Before being taken to the hospital, she was strip-searched and shackled at the hands, waist and ankles. She gave birth to twins handcuffed to the bed, and was still handcuffed there hours later when she learned that her premature newborns had died. The hospital told her that the early labor was the result of a treatable infection. (The Westchester County Department of Correction could not confirm or deny her story, saying that it no longer has Gibbs’ records.)

In Arizona, complaints about prison medical care prompted the ACLU and the Prison Law Office to file a class-action suit in 2012. An accompanying investigation uncovered two incidents in the summer of 2013 when officials at the state prison in Perryville dismissed women’s claims that they were going into labor. One woman said that it took two hours to convince the guards to transport her to the hospital. She gave birth 20 minutes after arrival. The other said nurses refused to believe her water had broken even after it tested positive for amniotic fluid. Officers sent her to the hospital only when she began screaming.

‘It hurts to be hungry like that’

Pregnant women especially need nutrient-rich food. It’s typically recommended that they eat three or more servings of fresh fruits, vegetables, dairy and protein each day, as well as several servings of whole grain breads or other complex carbohydrates. Nutritional deficits can, for example, increase the risk of gestational diabetes, which can cause a fetus’s trunk and shoulders to become too big for vaginal birth.

“Withholding healthy food from a pregnant woman is withholding medical care,” says Tess Timoney, a certified nurse-midwife and director of women’s HIV services at New York’s Bronx-Lebanon Hospital.

In jails and prisons, meal times, foods and portions are limited. More than half of the dozen women interviewed by In These Times recalled an overwhelming, unrelenting hunger.

Some jails and prisons specify a special pregnancy diet and an additional snack. But women report that these foods are often inadequate.

Twenty-three-year-old Minna Long was pregnant with twins when she entered the Clark County jail in Washington state in 2010. She received an extra 8-ounce carton of milk with all three meals, but, she recalls, “There were countless times the milk was expired and sour and I couldn’t drink it.” Her pregnancy also caused her to feel revulsion toward many of the foods served. During her four months in jail, she subsisted on milk, fruit and cold cereal, as well as commissary purchases of donuts, candy, trail mix, meat and cheese sticks, and flavored popcorn.

Kandyce (who is still incarcerated, and asked that her last name not be used and her prison not be specified, for fear of retaliation) says that when she was pregnant in prison in 2014, between breakfast and dinner was a 12-hour wait. “It hurts to be hungry like that,” she says.

‘I don’t ever want to be pregnant again’

Even when medical care is adequate, the restrictions and confinement inherent in prisons can make pregnancy and birthing traumatic. It is standard policy in U.S. prisons and jails to strip search prisoners upon entering and exiting, including a squat and cough, with no exceptions for pregnant or postpartum women.

A five-year study by the nonprofit Correctional Association of New York found that while there were delays in pregnancy care upon arrival, most women in state prisons then received prenatal care at roughly the frequency recommended by the U.S. Department of Health. Waiting for those visits, however, was often painful. Women were seated for up to five hours on a narrow wooden bench with no food or water. Though pregnant women are supposed to move around frequently to ease muscle tension and prevent fluid build-up, the women were not allowed to stand, and were often threatened with disciplinary tickets if they leaned back.

Kandyce saw a doctor regularly during her pregnancy, but the nurses, she says, strictly enforced the prison’s policies and often refused her doctor’s requests. For instance, her doctor asked for a wedge pillow and an extra mattress to supplement the thin prison mattress. “As you get bigger, they get thinner,” Kandyce recalls. “I’m already heavyset and being pregnant was even worse—I couldn’t really breathe if I wasn’t propped up.” The nurses denied her the pillow but allowed extra blankets. Those were confiscated by officers in the monthly room search, however, and each time, Kandyce had to go to the sergeant to get them back. “By the time I was eight months pregnant, I was really frustrated,” she said.

Medical staff told Kandyce that she needed a caesarean section. The night before, she was placed in the prison’s Inpatient Unit. “You’re in a room by yourself—no TV, no book, no nothing,” she recalls. “All you do is sit in this room by yourself. You know that you’re about to have your baby [and] that you’re going to have to give your daughter up. All you have time to do is think about it.” By 11 a.m., when officers arrived to transport her to the hospital, she no longer wanted to go through with it. “I just wanted to keep my baby with me.”

Normally, caesarean sections require only regional anesthesia, but when Kandyce arrived at the hospital, she was so stressed and anxious that the doctor—a man she had never met—decided to put her to sleep. “My daughter was going to be here and everything was wrong,” she recalls thinking. Her daughter was born healthy, but the entire experience was so devastating that Kandyce says, “I don’t ever want to be pregnant again.”

Each time Minna Long went to court, jail staff placed her in handcuffs, ankle cuffs and a waist chain, a practice known as shackling. Then, they stopped. Washington had become the seventh state to pass legislation restricting the shackling of pregnant women. That was in 2010; fourteen states have followed suit.

But advocacy groups in California, Massachusetts, New York, Pennsylvania and Texas have found that the practice persists despite bans. Sierra Watts, 37, incarcerated in Washington state just after the law went into effect, learned this firsthand. While she was allowed to give birth without restraints, she was then cuffed to the bed. Her son was placed in a cradle next to her. “I just had to lean over to get him out, but it’s harder when you can’t move that far,” she says.

The Washington State Department of Corrections says that “a post-incident review determined she was not supposed to be cuffed.”

Sierra’s choice

For Sierra Watts, the worst part wasn’t the shackling, but what followed. Although she had granted her mother temporary guardianship, child welfare workers told her that they would not send her son to live with his grandmother. After spending 24 hours with her newborn, Watts was taken back to prison without knowing her son’s fate. Because he was born on a Friday, he was to remain in the hospital until child welfare offices opened on Monday.

As Watts tells this story, her eyes fill with tears.“He was going to stay in the hospital with nobody holding him, nobody knows where he’s going, nobody’s even going to tell me where he’s going,” she says. “Nobody said [to me], ‘It’s going to be okay. We’re going to watch him. We won’t let anything happen to him.’ ” She did not learn where he was placed until the following Tuesday. The next—and last—time she saw him in person was during a prison visit one year later, shortly before he was adopted.

Under the 1997 Adoption and Safe Families Act, if a child is in foster care for 15 of 22 months, the state must begin proceedings to terminate parental rights. Watts says that she initially fought to maintain custody, but finally signed away her rights. “They told me that if I was to take it to trial and lose, then I wouldn’t be able to get photos or hear how he’s doing or send him cards or anything,” she says. She receives photos of her son, age 3, several times a year, but never sees or speaks to him.

That’s relatively common for incarcerated women who give birth; two other women interviewed by In These Times arranged for their babies to be adopted.

By contrast, when Michelle Barton, 37, gave birth in an Oklahoma prison in 2013, she knew that her baby would be safe with her sister-in-law, who was already taking care of Barton’s 3-year-old son until her release from prison. But she still cried when it was time to leave the hospital. Upon her return to prison, she was reminded how little motherhood means there. A nurse had given her a piece of paper with her daughter’s footprint. The officer who strip-searched her upon arrival threw it away. “Getting strip searched is nothing,” Barton says, but watching her daughter’s footprint tossed into the garbage “just tore my heart out.”

Another way

Michelle Barton’s daughter was 18 months old when Barton was released from prison in August. She boarded a bus to Oklahoma City with only the clothes on her back. Although she has a job lined up at Church’s Chicken, she is homeless and cannot reclaim her two young children from her sister-in-law until she finds affordable housing.

The Mabel Bassett Correctional Center spends $14,800 per year to incarcerate each woman. Barton was there for nearly two years. What if that $29,600 had been spent directly on resources for her and her family?

Oklahoma’s incarceration cost is dramatically low. At the Washington Corrections Center for Women, incarcerating each woman costs $44,400 per year. Sierra Watts was sentenced to 40 months. What if the $148,000 spent to imprison her had instead been spent to help her stay out of the prison system?

The UN Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders, known as the Bangkok Rules, recommend that for a pregnant woman or a child’s primary caregiver, “non-custodial measures should be preferred where possible and appropriate.” But pregnancy and parenting are rarely taken into consideration in the U.S. legal system. Across the nation, more than 120,000 mothers and 1.1 million fathers of children under 18 are behind bars. Approximately 10 million children have had a parent incarcerated at some point in their lives.

Recognizing that maternal incarceration can devastate children, some states are exploring alternatives. In November 2014, the Delaware Department of Correction created New Expectations, a group home for pregnant women with drug addictions who would otherwise be imprisoned. The home provides meals, prenatal vitamins, clothing, toys, intensive substance abuse counseling, and classes on infant care, parenting, breastfeeding, nutrition and budgeting. But the facility is run by the Department of Corrections and its healthcare provider, Connections Community Support Programs, and the doors are locked and alarmed.

By contrast, New York City’s Drew House and JusticeHome operate independently of the prison system. To be eligible, mothers must plead guilty to felony charges—but the charges are dismissed once they complete the program. In the meantime, they avoid prison, and their children avoid foster care.

Olgita Blackwood’s youngest child was barely a week old when she was arrested. “I was so worried about my kids,” she told the Associated Press. “They depend on me. They asked for me every day.” The 24-year-old was sent to Drew House instead of prison, enabling her to stay with her three children. Nearly two years later, as she prepared to take her GED, she said that the program made her independent. “I can make decisions on my own, raise my kids. I can’t imagine it any other way now.”

What if such alternatives to incarceration were available everywhere?

The Bangkok Rules recognize that women’s needs are unmet in a prison model designed for men and that women’s incarceration is often a result of layers of gender discrimination. In addition to recommending non-custodial measures for pregnant women, the UN urges countries to establish alternatives to imprisonment for all women.

If the United States took these ideas seriously—or at least took seriously its basic healthcare responsibilities in its prisons and jails—today, Nicole Guerrero might be watching her 3-year-old daughter, Myrah Arianna, scamper around the playground. 

This investigation was supported by the Fund for Investigative Journalism and the Leonard C. Goodman Institute for Investigative Reporting.