Guest blog: A new position statement for perinatal women in the criminal justice system
By Laura Abbott on 12 November 2019 Maternity Services
It is understood that around 600 pregnant women are held in one of the UKs 12 female prisons every year with approximately 100 babies born. Numbers and outcomes are not currently collated – something the RCM’s new position statement is calling for alongside parliamentary select committees, politicians, campaign groups, midwives, academics and charities. We know that women in prison often suffer extreme disadvantage such as being victims of violence, childhood sexual abuse, homelessness, mental illness and drug / alcohol addiction (Baldwin and Epstein, 2017). Consequently, perinatal women in prison need expert midwifery care and the new RCM position paper highlights the issues and provides the solutions to how we can work together to ensure this happens. Working with charities (Birth Companions, Women in Prison), campaign groups (Prison Reform Trust), women with lived experience and academics – the RCM have produced an expert statement so that midwives, policy makers, health care providers and the prison service have a blueprint for maternity care provision.
My research explored the experiences of perinatal women in prison and involved the narratives of 28 women and 10 prison staff members. I found that women often had basic needs unmet – they were often hungry, exhausted and suffering from toxic stress. All women talked of the shame they experienced, especially when on visits to antenatal departments. Considering that 82% women are in prison for non-violent crimes (Corston, 2007; Baldwin & Epstein; 2017) – it was especially hard for the pregnant women to be viewed by the public, feeling judged and exposed:
“You've got all the Mums and the Dads, husbands and wives and sitting there holding their precious little bump, and there I am walking in and they just looked at me like I was filth. And it's like, I've just made a mistake, I was stupid; I haven't hurt anybody, I'm a good Mum” (Sammy)*.
In one of the prisons I researched midwifery care was provided by one midwife who had a community caseload as well as her prison caseload. Therefore, when she went on annual leave or off sick, there was no cover for her. The security processes to deliver care in our prisons is understandably and necessarily complex, however an over reliance on one staff member means that no contingency plans are in place for women. More alarmingly, when the midwife retired, no plans were in place for her immediate replacement. The prison had approximately 10 pregnant women housed there at that time with no direct access to a midwife. With no direct access to a midwife, I found that women in prison were not receiving equivalence of healthcare – a right for all prisoners:
“I asked the officer could I have an extra pillow for my belly, because of the way the baby's lying. And they asked the nurses, so then I asked the nurses, and the nurses were like, whoa, you've got to ask the officers” (Kayleigh)*.
The links between infant and maternal health and the long-term health and social consequences of separation are well documented. The principle of equivalence of care (having the same health care inside as outside of prison) needs to be adhered to and data on the number of perinatal women experiencing contact with the criminal justice system must be recorded and published, along with data on the outcomes for pregnant women in prisons. At present we do not collect data on perinatal women in our prisons and this is being called for by parliamentarians and our Royal College. We need to know how we can appropriately plan and deliver the care for our perinatal women and ensure that small teams of midwives are trained and able to deliver that care. The newspapers recently reported the case of a new-born baby dying in an English prison - this is why now more than ever we need robust support from the RCM in terms of this position paper. We do not know the circumstances and need to await the full investigative reports, yet from my research I can tell you that women are frightened of labouring at night and indeed one participant did give birth to her baby in a prison cell without a midwife in attendance.
“Well, apparently, you get two extra pillows, which I haven't got; you get extra milk, which I don't get; you get extra fruit, which I don't get; you get night snacks, which I don't get; and you get use of a toaster at dinnertime, which I don't get. So, loads of good things that you just don't get” (Jolene)*.
Midwives do need to get political when it comes to issues effecting the safety and care of women. Giving evidence at the recent joint human rights committee chaired by Harriet Harman meant that pregnant women and their unborn babies had a voice. Working with the RCM and Birth Companions means that this responsibility is shared. It is also essential to know that we are not misrepresenting those who have lived experience – one participant from my research contacted me after seeing the evidence given at The Human Rights committee: “keep going... It’s long overdue that women’s voices get heard”. The response from the government on 05/11/2019 to the JCHR report “The right to family life: children whose mothers are in prison” https://www.gov.uk/government/publications/government-response-to-the-joint-committee-on-human-rights-22nd-report stated that
“A perinatal pathway is currently being developed and applied across the entire estate, building on the excellent maternity service that HMP Low Newton has developed in conjunction with County Durham and Darlington NHS Foundation Trust. We are expecting full roll out across the women’s estate from 2020 onwards”.
“We aim to establish more accurate metrics to measure the number of pregnant women in custody and the number of prisoners with primary carer responsibilities. We will collect data on the number of women in prison who are pregnant at an agreed date, and also plan to collect data on those in prison with primary caring responsibilities. In the interim, we have taken steps to improve our understanding of the number of pregnant women in custody”.
This is a positive step forward but we need to ensure that the midwifery care is measurable and sustained. The RCM position paper will add to the body of evidence to ensure that perinatal women in prison do get the best care. I am meeting with the prison service and ministry of justice next week and will ensure the midwifery voice is represented. One of the areas I feel strongly about is that we need midwifery representation at the prison inspectorate. Otherwise, we cannot appropriately assess and effectively monitor the needs of incarcerated perinatal women. Where perinatal women are institutionalised, albeit prison, detention centres or psychiatric units, we need to be there, ensuring needs are met and calling out inappropriate practice. We need to see a written presence about perinatal women in every inspectorate report – this must be undertaken by a Registered Midwife. Until we shine a light on what is going on, and indeed on the positive practices we encounter too, perinatal women who are locked up and powerless will remain invisible. Presently, as a society, we care so little for these women, that until 2019, we have not even counted how many exist, or indeed what the outcomes are for the women and / or their babies - we, as midwives, must keep calling this out.
Abbott, L. (2018). The Incarcerated Pregnancy: An Ethnographic Study of Perinatal Women in English Prisons. Thesis. University of Hertfordshire.
Baldwin, L. and Epstein, R. (2017). Short but not Sweet: A Study of the Imposition of Short Custodial Sentences on Women, and in Particular, on Mothers. De Montfort University.
Corston, J. (2007). The Corston Report: A Report by Baroness Jean Corston of a Review of Women with Particular Vulnerabilities in the Criminal Justice System: The Need for a Distinct, Radically Different, Visibly-led, Strategic, Proportionate, Holistic, Woman-centred, Integrated approach. Home Office.