WHEN HER LABOR STARTED in the middle of the night, Benidalys Rivera’s contractions were painful and regularly three minutes apart. Correctional officers clamped on handcuffs for her ride from the Western Massachusetts Regional Women’s Correctional Center in Chicopee to a local hospital. Her contractions had done nothing to dilate her cervix. In her hospital room, Rivera was shackled by one ankle to the bed; the restraints would be removed only when she reached “active labor.” After awhile, Rivera was given morphine to rest, and Vicki Elson, a volunteer doula, or woman’s delivery coach, massaged her feet and back.
Rivera, who’s serving 2½ years for trafficking cocaine, says the restraints hurt her ability to progress with her labor because she could not relax. When she and Elson walked the halls of the hospital, she was handcuffed in front, and she felt embarrassed as nurses and other patients looked on, as if judging her. “Being in shackles, that make you be in stress,” says the Puerto Rico native. “I about to have this baby, and I’m going to go back to jail. So it’s too much.” Rivera asked to have the handcuffs removed but the correctional officer refused. “I remember it bothered me, and I probably should have said something,” says Elson. “[The officer] was just kind of going by the book.”
Were it not for Elson, Rivera says she would have been alone during the more than two days she labored. Her ex-boyfriend’s sister was approved to be at the delivery, but because Rivera never advanced to active labor — a cervix dilated to 5 or 6 centimeters — the sister was allowed in only once the caesarean section was being performed and her handcuffs came off. E.J. was born January 3, 2013, weighing 6 pounds, 12 ounces. In the postpartum recovery room, a correctional officer again shackled Rivera to the bed by her ankle.
Rivera, now 35, is one of seven women at the Chicopee jail who gave birth since January 2013; hundreds of other prisoners across the country did as well. Many of them were handcuffed during labor and delivery, in some cases with abdominal chains added for good measure. For 10 years, some lawmakers and activists in Massachusetts attempted to ban this practice, calling it inhumane and unnecessary — but only this year did they meet with success. In late February, when an antishackling bill came out of a state Senate committee and started getting media attention, Governor Deval Patrick implemented a 90-day emergency regulation that halted the practice. By late March, the state House and Senate both had passed bills that would allow restraints only if the prisoner poses a safety or flight risk, and set minimum requirements for prenatal and postpartum care. If the two bills can be reconciled, the legislation will land on Patrick’s desk to sign, something he has said he will do. Massachusetts would join Rhode Island and Vermont — 18 states in all — that outlaw or restrict the shackling of pregnant prisoners. Many federal law enforcement agencies, including Immigration and Customs Enforcement and the Marshals Service, have adopted policies against the practice. The American College of Obstetricians and Gynecologists says restraints may be harmful and are “rarely necessary.”
Freeing incarcerated pregnant and postpartum women from restraints is just one piece of a complicated story when it comes to prison birth. Slowly, correctional facilities in Massachusetts and elsewhere have been examining other ways they treat these inmates, trying to distinguish between appropriate punishment and unduly harsh conditions. In some places, prisoners are being encouraged to pump breast milk; women can have extra support, including family members, during births; midwives are an option for medical care; and doulas are available before, during, and after deliveries teaching weekly childbirth classes, coaching, and leading support groups. Thanks to these efforts, for some incarcerated women, their pregnancy experiences behind bars are more positive than what they might have gone through on the outside. Jail and prison officials say that socioeconomic status, history of sexual abuse, and substance abuse problems often distract women from seeking prenatal care in their communities.
These changes don’t just have the inmates in mind. Correctional officials and advocates are hoping the efforts will bring real benefits for the rest of us, too, producing better mothers less likely to re-commit crimes and healthier babies, and potentially reducing the need for caesarean sections and other birth interventions that are costly for taxpayers. State Senator Karen Spilka, the Ashland Democrat who sponsored the antishackling bill in the Massachusetts Senate, says improved prenatal and postpartum care “will increase the likelihood, when the woman gets out, of her bonding with her baby and child and continuing to have a strong bond. It’s about healthy relationships, healthy families, which in turn, we all know, foster healthy communities, a healthy Commonwealth, less recidivism.”
Experience has shown that prenatal and postnatal programs can vary widely. In Pennsylvania in 2007, one incarcerated woman gave birth alone in her prison cell, wrote Rachel Roth, an Arlington, Massachusetts-based expert on female inmates’ health issues, in a 2012 Center for Women Policy Studies paper. In Maryland in 2005, Rebecca Swope gave birth while imprisoned at the Jessup Correctional Institution. She says she could not “move through” contractions due to restraints over her stomach, chest, and legs during the ambulance trip to the hospital. Swope says her right ankle was shackled to a stirrup and her right arm was handcuffed to the bed during the delivery of her daughter. During pregnancy, prenatal vitamins were not regularly available, says Swope, who is now director of the advocacy group CURE-Women Incarcerated. Though her stay at Jessup was just 10 months, Swope says her back molars started chipping, cracking, and crumbling toward the end of her pregnancy, which she attributes to poor prenatal nutrition. Pennsylvania banned shackling in 2010, and Maryland is on track to do the same. Yet the majority of states still don’t have antishackling laws on their books.
IT WASN’T UNTIL last summer, while studying to become a childbirth educator, that I first contemplated women giving birth behind bars. My mentor had posted a note on Facebook looking for a volunteer doula for a birth at a local jail, and in no time a volunteer had stepped forward. Many people, like me, focus on men when considering imprisonment. The US prison system was built around men, who still make up the bulk of the 2.2 million incarcerated people. The Netflix series Orange Is the New Black, a comedy-drama based on a true story, recently shed light on what it’s like for women in prison, but even this show glossed over a minor character’s pregnancy and postpartum.
Roughly 200,000 women are in prison or jail nationwide, and from 6 to 10 percent of those women are pregnant at any one time. Many of these expecting women, experts say, have substance abuse problems. At the jail in Chicopee, 92 percent of the up to 192 women housed there are grappling with an addiction, according to superintendent Patricia Murphy. Over half have mental health issues, and about a third are violent offenders. Typical inmates there have sentences no longer than 2½ years, with the average stay lasting about four months. The one-year recidivism rate hovers around 20 percent.
Officials at Chicopee counsel pregnant women on options like adoption. Plan B, the morning-after pill, is offered to all incoming inmates, and women there have access to abortions via Planned Parenthood, which they must pay for themselves or by accepting funds via private agencies. Most women decide to keep their babies and hope to place them with a family member.
All women who carry to term experience “a catalyst moment,” according to Marianne Bullock, cofounder of a Western Massachusetts-based reproductive justice organization called The Prison Birth Project. Just as on the outside, the arrival of a child can spur an incarcerated woman, once freed, to get and keep a job, set up a home, and reestablish strong ties with her family. Of the more than 50 women who have given birth since the Chicopee jail opened in 2007, the superintendent says, only one or two have come back.
Bullock founded The Prison Birth Project just as the Chicopee jail opened; the organization provides doulas and support groups organized by a handful of paid part-time staff and assisted by about 25 volunteers. Bullock says that giving birth while incarcerated, even with the beneficial services offered at the jail, is still far from alluring. Similar doula organizations that cater to incarcerated women operate elsewhere, such as in Minneapolis; Olympia, Washington; and San Francisco. Some volunteer doula services help the general public as well, such as the Birth Sisters Program at Boston Medical Center and similar programs at other area hospitals.
Doulas, as dedicated support for women in labor and their families, are linked to lower incidences of potentially costly birth interventions like caesarean sections, as well as the sometimes risky use of forceps and vacuum extractions in vaginal deliveries. The doulas “have a set of skills that the majority of our staff don’t have,” says Murphy, the Chicopee superintendent. Doulas, and particularly Vicki Elson, are also consumed with making sure mothers-to-be understand birth doesn’t have to be traumatic. In fact, Elson says, it can be “transformational.”
“I want to help make [birth] an opportunity for women to discover that they’re awesome,” says Elson, who is also a childbirth educator and volunteers with The Prison Birth Project. “If a woman is losing access to her child, it’s still a really important thing for her to bond. Even if she never has access to her child, she will always be the mom.”
At the Chicopee jail, typically three to eight women are pregnant at any one time, says Tracey Burton, who until March was the family service counselor, a position she held for 12 years. Staying at the jail while pregnant is usually the last resort. Burton says she tried to transfer these inmates before delivery into less restrictive housing if space was available and the women qualified for the lowest levels of security. According to Murphy, judges don’t have to approve these transfers.
Prison is for many incarcerated women the safest place they’ve ever lived. Many come from broken homes, abusive relationships, and even prostitution. They’ve often lacked regular health care. “They are used to being treated poorly by everyone in their lives,” says Roberta Richman, now retired from the Rhode Island Department of Corrections and a onetime warden at the state’s women’s facilities. Richman says some women may even seek out prison because they can get better care. Dr. Fred Vohr, medical programs director at the Rhode Island Department of Corrections, based in Cranston, agrees: “They’re more comfortable that their pregnancy is being managed here than outside. They feel safer and better cared for while they’re here.”
In Cranston, up to 200 women are housed at any one time, and only a handful may be pregnant. Nurses and medical staff have encouraged and facilitated pumping breast milk, correctional officers are trained in women’s care, and pregnant women receive nutritional counseling. Rhode Island banned shackling in 2011.
After serving 12 months of a 21-month sentence in Cranston, Brittney Mills now lives in Woonsocket, Rhode Island, with her daughter and works in a thrift store. The 24-year-old says she did not take childbirth classes at the prison but had two family members, her cousin and her aunt, at daughter Naomi’s birth on March 18, 2012. Mills says she was so close to one correctional officer that she allowed her to cut Naomi’s umbilical cord.
Yet even a seemingly somewhat positive experience like this doesn’t always create a happy near-term future. Mills says seeing her daughter during prison visiting hours was initially too painful. “Don’t even bring her up here,” she told her aunt after the first visit. “I don’t want to see her.” Mills changed her mind after a few weeks, and Naomi then visited at least once a week.
CHYNNA CARTER’S undoing began in 2005, when she was 14 and injured in a car accident. Her resulting addiction to opiates like Percocet and OxyContin had a deep hold on her by early spring 2012, when she stole computer equipment from her mother’s workplace to pawn. She admitted to the charges and received an 18-month suspended sentence in exchange for probation. Due to an issue involving a hernia, Carter says she was not medically stable enough to fulfill the requirements of her probation and that her probation officer seemed unwilling to advocate for her. She stopped attending her court dates, knowing she would be in violation. As a result, 11 warrants were issued for her arrest.
That fall, Carter, who is originally from Worcester, decided to get clean and entered a detox program. Then Carter learned she was pregnant. At first, she hesitated to keep the baby, but in the end she decided to go ahead. “If I wasn’t pregnant, it would have been easier to turn myself in,” she says. “I guess I was trying to have the baby outside of jail.”
Once the pregnancy was discovered, Carter was not allowed to stay in the detox program. On the advice of her obstetrician, she started that October on methadone, a synthetic opioid used to treat dependence. Her baby would have to detox from the drug following birth. The police picked Carter up in late January 2013 on the outstanding warrants and soon after brought her to the women’s prison in Framingham.
MCI-Framingham, a medium-security institution run by the Massachusetts Department of Correction, houses more than 650 pretrial and sentenced women, with between six and eight pregnant at any one time. Many find out they are expecting only following a post-admittance health evaluation. A health professional explains a woman’s options, and the Department of Correction covers the cost of termination if that’s what an inmate chooses.
MCI-Framingham does not allow family members to be present during births. But as in Chicopee, Framingham officials attempt to explore less restrictive options for pregnant women, especially in programs that focus on substance abuse if necessary, but that’s not always possible. Those who stay in the Framingham prison have access to a prenatal program called Catch the Hope, run by nurse Geraldine Keefe; they’re offered unlimited meetings with Keefe, regular visits from a Boston Medical Center obstetrician, and a weekly prenatal class.
“I think they actually do get better prenatal care than they would out in the community,” Keefe says of Catch the Hope participants. “If you’re an addict, you’re very selfish. You’re not really thinking of anybody but yourself, so you’re not going to do the right things always.”
Carter participated in Catch the Hope for about a month. In February 2013, then seven months pregnant, she was found guilty, sentenced to 18 months, and sent to the Women’s Correctional Center in Chicopee. Every pregnant woman at the jail is offered a doula, and most accept once they understand the role. Carter started working with Vicki Elson, who convinced Carter that she was physically able to give birth. “When I first got pregnant, I was like ‘I’m having a C-section.’ Apparently when I got to jail, that’s no longer an option,” Carter says, referring to her initial desire to avoid a vaginal birth.
Donna Jackson-Kohlin has been a certified nurse midwife for 20 years and has worked with the Hampden County Sheriff’s Department for 10 years through her employer, Baystate Midwifery and Women’s Health, which has a contract with the jail. A typical woman in an outside community sees her midwife or obstetrician about once a month for the first 28 to 30 weeks, but pregnant women at Chicopee, according to Jackson-Kohlin, are seen more frequently, thanks to three midwives who take turns spending two afternoons a week at the jail.
WHEN CARTER went into labor at the Chicopee jail in May 2013, fellow inmate Benidalys Rivera, along with a correctional officer, came to her aid. Rivera helped Carter count contractions and phoned the doula. She also got Carter fresh clothing when she started to bleed.
“I know it’s hard,” Rivera told her. “Trust me, I know. But you need to be calm. Calm down.”
Carter ended up at Baystate Medical Center and, after 36 hours of labor, delivered a 7-pound, 13-ounce boy, Jacob. The jail had granted her a medical furlough, easing her situation greatly: She wasn’t shackled to her hospital bed and didn’t have a correctional officer keeping vigil. She was allowed to have her doula, parents, and ex-boyfriend by her side.
But then she had to say goodbye. With her jail sentence not even half completed, Carter left the hospital 48 hours after she entered and returned to the Chicopee facility. Two weeks later, after a stay in the neonatal intensive care unit to withdraw from methadone, Jacob went home with Carter’s parents, who live in Brookfield. Carter, now 23, says she’d suffer through more labor and delivery just to hold Jacob, smell him, and be with him. “I’d do it again, every single day for the rest of my life.”
That sentiment is not uncommon. Pregnant incarcerated women can simultaneously look forward to their baby’s impending birth and dread the significant separation ahead. For most of these women, postpartum is simply grief. Rivera was especially rocked separating from E.J., whose arrival in January 2013 made her the mother of four boys (the others are 4, 15, and 17 and are living with their grandmother in Puerto Rico). Rivera pleaded guilty to a charge of trafficking cocaine in 2012 to get a lighter sentence than her codefendant and ex-boyfriend’s 17-year punishment. She maintains her innocence, saying her ex-boyfriend, who is her youngest son’s father, is to blame for storing drugs at her Springfield rental house.
Of her postpartum experience, Rivera says, “the day before I know for sure I’m going to be going back, I was feeling mad and then the baby was crying. I think he feel it.” Due to her C-section, she spent five days in the hospital. This extra time together made it harder when E.J. was taken from her. The day of her return to jail, she says, the correctional officer heard her crying.
“Everything’s going to be OK,” the officer told her.
“He gave me my time. He step away. He leave me alone. He stayed at the door,” she says, as her ex-boyfriend’s mother, who is caring for the baby, picked up E.J. “I never want to let the baby go.” She says she was so heartbroken she took postpartum depression medication for seven months. Proudly, Rivera says she’s off it now. She should be released no later than October.
Back at the jail, Elson and other doulas visit postpartum moms within days. “In some ways, that’s the most important part of our job, when they go back to jail without their baby,” says Elson. “We just sit with them . . . .We just sit with them.” What more is there to do?
The Chicopee jail holds mother-child visits every Saturday. Not every woman will get a meeting due to sometimes unpredictable caregivers and, at times, the distance children live from the jail. “Babies are part of the healing. When you’re only seeing your baby once a week . . . I don’t think [the moms] heal emotionally,” says nurse midwife Jackson-Kohlin. That’s part of why the doulas encourage pumping breast milk. “I don’t think there’s any danger in falling in love with your baby, no matter what the future holds,” says Elson. “They’re loving that baby that way, several times a day, giving their milk.”
The jail allows women to pump milk up to seven times a day, and the record is held by a mother who pumped for eight months. When one woman had trouble producing enough breast milk, Rivera says she donated a month’s worth of her own milk after her own son stopped consuming it. Rivera had not breast-fed her three older children.
Breast pumping isn’t allowed at MCI-Framingham, says Keefe, the nurse; one of her main goals is to place women in outside programs before delivery. “The women are lucky that they have this [Catch the Hope] program,” she says. “You know, is it 100 percent the best? Probably not. But it’s what we have, and hopefully I can make it better.”
As for Carter, she pumped breast milk for about two months. She received fairly regular twice-a-month visits from her parents and Jacob, and she tried to speak on the phone daily with them. But she says her parents struggled financially and felt the exhaustion of raising her son, who only started sleeping though the night at 9 months and, around the same time, began showing an interest in walking.
She knew adjustment to life after jail could be overwhelming. But she was ready — off methadone, nine months sober, excited to be with Jacob, finally. “I’m not gonna lie. I don’t know how to feel what it is to be a mom,” Carter told other pregnant women during a late January childbirth class at the jail. “I feel like half of me is a mom and half of me isn’t.”
Still, Carter counts her son’s delivery as one of the most empowering experiences she’s gone through. “If I were to do it over again, I wouldn’t mind being in jail. I would never have met [my doula] Vicki,” she says. “It just wouldn’t have been the same. I felt so lucky.” She was released earlier this month from the Western Massachusetts Correctional Alcohol Center, which is part of the jail. Carter says she’s channeling a newfound self-esteem into dreams about going for walks, visiting parks, listening to music, and building a new life, all with her son. “I’ve been through a lot, and I’m still going to come out on top,” Carter says. “That’s a good feeling.”
Meredith Derby Berg is a freelance journalist and certified childbirth educator from Newton. Send comments to firstname.lastname@example.org.