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The Atlantic Publishes Article on Pregnant Women in Custody and Reentry

Doulas at the County Jail

Women in jail typically have limited prenatal support and return to custody soon after giving birth. One Chicago program is testing a different approach.

Sarah Conway - 12/20/19

Inside a tier reserved for pregnant women in Chicago’s Cook County Jail, a doula said to a group of six round-bellied women sitting at a metal table, “Tell me, who has had an epidural before?” A few hands darted into the air. The doula, Lanise Washington, asked what has to happen before someone can receive an epidural. “There’s an IV,” someone offered. “Don’t move when they do it!” a second woman added. A third young woman, clearly confused, said, “It’s like a spinal tap, right?” Finally, a mother in her sixth pregnancy jumped in to tackle the question. (An epidural, like a spinal tap, involves an injection into the spinal area, but it’s otherwise different.) Washington and a colleague also leading the prenatal class nodded approvingly. Both have spent years working as doulas with at-risk pregnant women on Chicago’s South and West Sides. Nowadays, they also serve women behind bars at Cook County Jail.

The women were here as part of Healthy Moms and Babies, a unique program that offers doula services to women in jail and tries to get them released before they deliver. Afterward, women who have been released receive home visits from a community health worker for the first five years of a child’s life. The program, led by the Cook County Sheriff’s Justice Institute, an advocacy wing of the sheriff’s office, along with a coalition of seven nonprofits, aims to improve mothers’ birth experiences—and, in turn, better the lives of their children in the critical first few years of life.

The program is part of a wave of legislation and programs across the country that advocate for providing higher-quality care for those who are behind bars and their children, whether through building prison nurseries, ending shackling during labor, or considering children during sentencing. The trend aligns with growing research demonstrating that the incarceration of mothers often has a lifelong detrimental and traumatic impact on their children.

While doula care has been shown to help mothers have a positive birth experience, it is not widespread in jails and prisons. A program like Healthy Moms and Babies, combining case advocacy, birth planning, delivery, and postnatal visits, is especially unusual, said Mark Valentine, the director of the Illinois Birth to Three Institute at the Ounce of Prevention Fund, an organization focused on early-childhood development that helps lead the initiative.

“As birth workers, we want to end the incarceration of pregnant women, but in the meantime it’s critical that we go inside jails and prisons to do this work,” said Erica Gerrity, the executive director of the Minnesota Prison Doula Project, which provides pregnancy and parenting support to incarcerated parents in Minnesota and Alabama prisons and jails.

The population of incarcerated men is declining nationwide, but the same is not true for women. More than 200,000 women are currently incarcerated, an increase of nearly 800 percent since 1980. Yet the correctional system hasn’t adapted to their unique needs. An estimated 12,000 pregnant women are being held in U.S. jails or prisons each year, according to the American Civil Liberties Union, but there is no established federal standard of medical care for them. More than 20 states still allow the shackling of inmates during childbirth. Many women are forced to say goodbye to their newborns and return to jail after 24 hours.

This summer, one mother, Diana Sanchez, gave birth alone, with no medical supervision or treatment, in her cell at Denver County Jail. She filed a federal lawsuit against Denver, Denver Health Medical Center, and several nurses and deputies, on behalf of herself and her infant, saying her cries for help were ignored during about five hours of labor. (The city and county referred a request for comment to the Denver Sheriff Department, which said it has changed its policies to ensure that pregnant inmates who are in any stage of labor are now transported immediately to the hospital. The Denver Health Medical Center did not reply to a request for comment.)

In the summer of 2017, Karen Padilla-Garcia, a Chicago mother who was seven and a half months pregnant at the time, was pulled over while driving with a broken headlight. During the stop, the Chicago Police Department arrested her on an outstanding warrant for violating probation. The judge that oversaw her case, former Cook County Judge Nicholas Ford, ordered no bond and set a court date for two months later, essentially sentencing Padilla-Garcia to give birth in custody. While awaiting her next court date, she delivered a baby girl.

Cook County Sheriff Tom Dart, spurred to action by the incident, asked his office to propose language for a state bill that he hoped would make childbirth behind bars much less common, in the hope of improving outcomes for mothers and children and lowering costs for the jail. “It makes no sense to keep someone facing a nonviolent, low-level charge in custody to give birth,” he said. The bill called for pretrial pregnant detainees who don’t pose a physical threat to victims or their communities, and are expected to give birth while incarcerated, to be released before giving birth. A version of that bill was signed by the Illinois governor and took effect at the beginning of 2019. (Separately, the Illinois Senate added parenthood and caregiving to the list of mitigating factors that judges should consider during sentencing.)

Cook County Jail is one of the largest single-site jails in the United States. Fifty percent of women self-report as mothers during intake, a number that is on par with national data for incarcerated women. Under the Healthy Moms and Babies program, established when the Illinois law took effect, the sheriff’s staff prepares a case study for each pregnant woman in custody, including a mental- and physical-health profile, details about what was going on in her life at the time of arrest, and her criminal history. The staff then contacts the offices of the state’s attorney (Illinois’s equivalent to a district attorney) and public defender to find out if any woman who is being held in jail until her trial qualifies to be released under the new law. If so, they advocate for her release.

Some aspects of the jail’s offerings for pregnant women and new mothers predate the Healthy Moms and Babies program. Since 2010, all pregnant women have been housed together on a dormitory-style tier with medical and nursing staff nearby, and occasional educational visits from health-care professionals. There are a few special amenities, like an extra mattress and additional food. But the Healthy Moms and Babies program introduced weekly group classes led by doulas, focused on prenatal care, pregnancy, childbirth, and parenting. Staff members also now pair each pregnant woman with a doula, who might provide extra emotional support, for example, or information about staying healthy while addicted to opioids.

If a release isn’t possible, the Healthy Moms and Babies program helps women plan their birth and determine who will get custody of their newborn. For years, women held at the jail have given birth at John H. Stroger Jr. Hospital, a Cook County–run public hospital. Since February 2019, they have been allowed one support person of their choice to be present in the hospital room during labor and delivery, along with a doula. (The doulas “get out of bed at 2 a.m. and give you a back rub and some ice chips during your labor,” Valentine, of the Ounce of Prevention Fund, said.) After delivery, if a woman hasn’t been released from jail altogether, she is separated from her child and returns to the tier for pregnant women for a period of time determined by her physician.

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