September 1997 Vol. 24.3

Sheila Kitzinger's Letter from Europe

How Can We Help Pregnant Women and Mothers in Prison?

Pregnant women prisoners in British hospitals, those in labor, and mothers during their postpartum stay were held in handcuffs and chained to prison officers until January 1996. The chains were finally taken off because of vigorous protest by a small group of activists in the childbirth and prison reform movements. Our determination to put a stop to this barbaric practice, introduced by a repressive Home Secretary, Michael Howard, as part of a Conservative promise to be “tough on crime”, was taken up by the media. “Mothers in chains” became front page news and made lead stories on TV. We briefed researchers in opposition political parties and as a result there were questions in Parliament. After 3 weeks of intense publicity it was announced that in future no woman would be chained in a prenatal clinic, during labor and birth, or while in hospital after the birth of her baby.

But it is not enough to strike at the chains. The question is whether pregnant women and mothers and babies should be in prison at all. These are issues that will have to be addressed by the new Labour Government. And if they are to be in prison, can they be cared for in a humane way? Under the Conservative Government the number of women prisoners rose by 37% over two years, compared with a rise of 16% in the total prison population over the same period.¹

Wythenshawe Hospital in Manchester gained unwelcome publicity when a woman was shackled during childbirth and when she was trying to hold her newborn baby, and it hit the head-lines. I wrote about the case in my Letter of September 1994, page 21, and it set feathers flying.

Now a project initiated by midwives at this hospital has set new standards of care and support for women prisoners. Their aim is to “provide midwifery care which is woman centred, recognises and is sensitive to the needs of each individual woman with the emphasis on choice, continuity and control throughout the pregnancy continuum, at the same time ensuring accessibility of all services”.³

The team consists of 6 midwives, with back-up from midwives who focus on the care of women with special needs, a bereavement midwife and a parentcraft specialist. They see the women at a prenatal clinic in the prison every week. There are meetings at the hospital, too, the initial one to work out a care plan with the obstetrician as well as the midwife, at which the woman's birth partner is encouraged to be present, then again at 18 weeks for a normality scan, at 36 weeks to meet with the obstetrician again and to tour the maternity unit, (and partners are invited to this meeting, too) and, if a woman has not by then given birth, at 41 weeks.

Each woman is helped to write a birth plan and to choose a birth partner. She carries her own maternity records if she wishes. All examinations are done in private rooms and prison officers are not present.

Those of us who are working to improve the treatment of prisoners during childbirth are concerned that women often have a male prisoner officer with them during and after birth, and that this officer stays in the room right through delivery, while all the immediate post-partum care is given, and while a new mother first meets with and breastfeeds her baby. In this project women are escorted by female officers unless, on rare occasions, this proves impossible. In fact, with the Governor's permission, some prisoners attend the hospital alone, going to and from it like any other women.

Study days on breastfeeding, on problems facing families with special needs, substance abuse and child protection, are arranged for prison officers, and there are “Open Forum” sessions at the hospital to discuss issues with all midwives there. A survey of the views of women prisoners, not only those of midwives and prison officers, is planned.

It is significant that this is a midwives' initiative. It is midwives who are doing this work, bringing skills in communication and understanding to women who have no voice. Many women prisoners have been sexually abused, come from families in which violence is the norm, and suffer multiple social and educational handicaps. I believe that prison perpetuates injustice instead of solving problems and helping these women adjust to society. Yet the Manchester project holds hope for the future.

Another new initiative is the Doula Project for women in Holloway Prison. When we had succeeded in freeing women from their chains in 1996, I asked National Childbirth Trust teachers in London whether they would be

interested in training to offer a doula service to women prisoners, and there was an immediate response. The result is a small group of teachers and student teachers who get to know a woman during her pregnancy, one of whom will meet her at the hospital if she wants support during prenatal visits, and one or more of whom will be with her throughout her labor and birth and visit her after the birth.

Thirty-three per cent of women are first-time offenders, compared with 11% of men prisoners.² Few women are convicted of violent crime. In fact, some are on remand and will never be convicted of anything. Most are inside for non-payment of fines and TV licences, minor theft, for prostitution and for drugs-related offences.

Some women, however, are suspected of being involved in or are convicted of violent crime. They then become category A prisoners. When a woman is in category A, even if she is only on remand, her treatment is especially repressive. On May 26th Roisin McAliskey, the daughter of Bernadette Devlin, gave birth to a daughter who has been named Loinnir (“Light through cloud”). From the hospital she was moved to a mother and baby unit in a psychiatric hospital, suffering from depression. She had been on remand in Holloway Prison as a category A prisoner from November 1996, while German authorities sought her extradition on grounds of IRA terrorism on a British army base there. Roisin suffers from asthma and has a gastric ulcer. She is a vegetarian and since the prison does not cater for vegetarian diets, she was nutritionally at risk. In 4 months she was strip-searched 75 times. For much of that period she was kept in virtual solitary confinement and allowed out of her cell for exercise for only one hour out of the 24. A light was permanently on in her cell and all reading material was removed at 8 pm until the morning. When she had to attend the hospital because of concern about possible thrombosis and fetal growth retardation, she was surrounded by armed guards at the prison entrance and even inside the ambulance. She was told that her baby might be taken away from her at birth and learned that she would be able to keep her baby only during the seventh month of her pregnancy. It is hardly surprising that she was under stress, had bouts of vomiting, smoked up to 30 cigarettes a day, and had panic attacks. Whether or not Roisin is ever found guilty, I believe that this is an obscene way in which to treat a pregnant woman.

In many, perhaps most, countries, there is little public awareness of conditions in prisons in which pregnant women and new mothers are held, or of how they are treated during childbirth. In the United States women in labor are often chained until they have an epidural. In Massachusetts, for example, only when it is clear that a woman cannot walk are the cuffs unlocked. If she does not have an epidural, shackles stay on. The epidural is employed as another way of incapacitating women prisoners.

In France, the Inspector General of Social Affairs, described how a woman prisoner in Marseilles had given birth doubly immobilised by shackles and an intravenous drip. One newspaper asked whether this practice represented a new European norm.¹

When the debate about mothers in chains was at its height in Britain I spoke with a governor of a Swedish prison who was deeply shocked by what I told her. She said such a thing could not happen in Sweden, where pregnant women are imprisoned only under exceptional circumstances, and where each woman has a personal psychologist who is an advocate for her welfare.

Do you know what is happening to women prisoners in jails near you? If you work in a hospital to which prisoners come to give birth or belong to a childbirth organisation in a city where there is a women's prison, would you be willing to do research into the policies and practices that are in force? In Nazi Germany ordinary citizens protested that they knew nothing of what was going on in concentration camps. Today it is easy to remain ignorant of conditions in prisons and in detention centres for asylum seekers. I believe that our concern must be for pregnant women everywhere, and especially for those who suffer most deprivation and who are denied their liberty. I invite readers of Birth to send information to me either directly by email (sheila@sheilakitzinger.com) or fax (00 44 1865 300 438) or through the editor.

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