Incarcerated pregnant people face grave issues part two

The conversation with  Carolyn Beth Sufrin, A.M., M.D., Ph.D. about her Pregnancy in Prison Statistics (PIPS) project continues this week on Our Milky Way. Find part one here

Q: In some cases, prison personnel have to inspect breast pumps for contraband, and it’s been reported that mothers get them back and they no longer work because they’ve been tampered with. Did you see this happen?

A: I did not see that where I worked. Part of my time there, women only had access to manual pumps; there are fewer parts with that and it had been around for enough time that people accepted it.  When we got a hospital grade pump, we worked it out over time that the pump would be stored in the clinic and women would come there to use it.

But it does happen other places. There’s a fundamental distrust of incarcerated people by the custody staff in a lot of cases. They assume that anything can be a weapon, and they don’t have any knowledge of how the instrument might work so they don’t really take care to put the pump back together. Perhaps they could work more closely with the medical staff. There are all kinds of medical devices that have to be brought into the prison or jail for patient safety, and they shouldn’t be non-functioning after whatever inspection might need to happen.

Q: In facilities that have a breastfeeding policy, are the breastfeeding rates higher than in facilities without a policy?

A: Yes, if there is a policy, more women are more likely to take advantage of that opportunity. If there’s no policy, it’s a signal that it’s not important or it’s not possible. If there’s no policy in prison or jail, it’s not going to happen.

Q: What can we do to help incarcerated women who want to breastfeed be successful?

A: Help jails and prisons devise policies; policies that fit within the logistics of jail and prison. Receive input from previously or currently incarcerated moms. Lactation care providers can make arrangements with local jails and prisons to provide support to women while they are in the hospital, but also perhaps arranging to get security clearance so that they can provide continued postpartum support.  

Not only do mothers who are incarcerated need motivation to pump, it can be really hard for caregivers picking up the milk. They’re taking care of a newborn that they weren’t planning to take care of in some cases. Often times the jail or prison that the women are in are far away from where a family lives.  

There are some jails I’ve seen where their policy is only to allow women to express breast milk for the sole purpose of maintaining their production so that when they get releases they can still breastfeed. They discard the milk because they fear the systems of getting the milk to the baby are too complicated.

Q: Can babies come to visit moms? Are there any programs or prisons where women are allowed to keep their babies with them while they breastfeed?

A: The answer again is it depends. Some jails and prisons have contact visits where they allow the newborn to visit their moms sometimes up to 3 or 4 times a week for 2 hours at a time. That’s considered a lot. They’re allowed to breastfeed.

There are some jails and prisons though where there are no visits allowed or they might be video visits which there’s obviously no opportunity for skin-to skin contact or to breastfeed. There are several states and Rikers Island Jail that do have prison nursery programs where moms and babies can be together and baby actually lives with mom in prison or jail for varying periods of time, in some places up to 2 years. There are special wings of the prison that are designed for moms and babies. They have a pediatrician who comes, cribs, toys, parenting classes. Although those programs are often celebrated, and it’s good to keep the mom and baby together, they’re not necessarily the solution. The mom is still in prison and the baby is starting its life in prison. A lot of effort could be spent on thinking about alternatives to incarceration especially for pregnant women and new moms, to think about ways to keep them under whatever supervision might be required but to have a more realistic environment where they can actually parent their babies and not be under the constant surveillance of prison.

Q: Shackling. It’s important for people to realize this is something that happens to women.

A: There are only 22 states in the country that have laws that prohibit the shackling of pregnant women in labor.  This means that it is perfectly legal in 28 states. Even in states that have laws, it doesn’t mean that it’s not happening. There are women in this country who are shackled while they are in childbirth, and they are restrained throughout the pregnancy. It’s inhumane.

It’s certainly hard to hear that this happens, but it’s also medically unsafe. I’m an OB and I can tell you this is unsafe. Obstetric emergencies arise unpredictably and when that happens we need to take care of the patients, not be negotiating with the guard to unlock the handcuffs.  I have also seen it lead to harm. Women have had direct abdominal trauma from tripping and falling.

It’s unnecessary. The chances that a woman in labor is going to run off is pretty slim, especially because some women choose an epidural and can’t really move their legs very well. It’s a really tragic practice that has been condemned by every major professional medical society and just should not happen, and yet it does. It’s an issue that is really, deeply, deeply troubling mostly of course for the women who have to experience it, but it’s only the tip of the iceberg of what pregnant incarcerated people experience.

Q: What advice do you have for lactation care providers working with incarcerated people?

A: If they’re taking care of incarcerated women, that’s great– just recognizing that this is a population in need and making efforts to reach out. They’re still mothers and they still need the support.  

Beyond that, being proactive about efforts to support them while they’re in the hospital and recognizing the realistic nature of things. It’s not the same as providing support to non-incarcerated moms. There are all of the logistical concerns.

On the one hand, treating these women as you would treat any woman, any new mom– with dignity and respect, and on the other hand, recognizing the unique circumstances that she’s in.

Sufrin’s book, Jailcare: Finding the Safety Net for Women behind Bars, can be found here.

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