Giving birth while imprisoned usually occurs under inhumane conditions, with women remaining shackled and not being permitted to hold newborns. This is a reminder that every patient deserves our compassionate and nonjudgmental care.
“Are they going to let me hold my baby?” Deija was pregnant and in jail when she asked this question, unsure what would happen to her and her baby if she was still in custody when she went into labor. Deija was a participant in my team’s research study about pregnancy care experiences and decision-making available to incarcerated individuals. Her simple, heartbreaking question is emblematic of the trauma and uncertainty endured by so many of the pregnant incarcerated patients I’ve cared for and learned from through research and advocacy efforts over the last 15 years.
While national estimates on number of births to incarcerated people are lacking, our team’s study reported that in one year, at all federal prisons and 22 state prisons, there were 813 births. The reasons for their incarceration are irrelevant to their right to medical care, and yet it’s also worth noting that most women are incarcerated for reasons that have more to do with structural racism and other negative social and structural determinants of health than them being a threat to public safety. Incarcerated people have a constitutional right to healthcare, yet because there are no required standards or systems of oversight that institutions of incarceration must follow, access to standard, comprehensive, and quality pregnancy care is inconsistent, and at many prisons and jails is absent or harmful.
These women are often denied access to abortion, even before the Dobbs decision. They may be shackled while in labor, for even in states where it’s prohibited by law, we know it still happens. During birth, women may or may not be allowed to have a support person with them in the hospital. And, to answer Deija’s question, despite no compelling public safety or medical reason, they may or may not be allowed to have their infant in their hospital room with them during their postpartum recovery.
Understanding the care experiences and needs of incarcerated pregnant and birthing people is important for all healthcare professionals to recognize the medical harm that carceral systems contribute to, and that we must provide dignified, equitable care for all patients.
What can we learn from Deija and others like her when caring for incarcerated patients, especially when treating them in hospital or community clinic settings?
1. Give compassionate, noncoercive, nonjudgmental, patient-centered care to all patients, including those that are hospitalized and incarcerated. Recognize that they’re isolated from their usual supports. Let them know they’re being cared for and treated like you would any patient.
2. Avoid making assumptions about their lives or why they’re incarcerated.
3. Be familiar with professional society recommendations, state laws, and hospital policies that pertain to care, especially shackling, of pregnant patients. Make sure that your hospital policy is aligned with state law, is patient-centered, and that providers and hospital security staff are aware not only of the law, but of ethical standards of care.
4. Consider giving medical care onsite or in consultation with a carceral facility.
5. Advocate for patients within your hospital or clinic, state and federal legislature, professional societies, and with community organizations that serve currently or previously incarcerated people, some of which are led by people with lived experience. Support efforts addressing the needs of incarcerated pregnant and postpartum patients or other incarcerated individuals.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.