Options for Pregnant Inmates

One of my colleagues recently tipped me off to a great article in the Journal of the American Medical Association by Dr. Jennifer G. Clarke entitled Perinatal Care for Incarcerated Patients: A 25-Year-Old Woman Pregnant in Jail. 305 JAMA 923 (2011). I wish I could share the full article but it does not appear to be available without a subscription. The abstract, at least, is available here. The article uses the case of a Rhode Island woman sentenced to a 1-year jail term during the second trimester of her pregnancy as a springboard for discussing the issues, benefits, and challenges of caring for an incarcerated pregnant woman. Though its target audience is health care providers the article offers plenty of food for thought for people in the criminal justice system—as well as an opportunity to summarize some related points of North Carolina law. The article begins with a moving first-person account of the woman’s jail stay. She describes a range of emotions, going from being “glad I came to jail to get cleaned up so my child could be born clean” to “getting really sad because I’m gonna have my baby in jail.” When it came time for her to deliver she was moved to a community hospital where, aside from some minor complications on account of her prior heroin use, everything went smoothly. She was discharged after 36 hours and returned to the jail. Shortly thereafter she was granted some type of parole to a community-based residential parenting program. The article highlights the many challenges of being pregnant or having a baby while serving an active sentence. Many such pregnancies are complicated even before any imprisonment beings; they are, according to the article, often unplanned and compromised by “variable prenatal care, poor nutrition, domestic violence, illicit drug and alcohol abuse, [and] sexually and parentally transmitted infections.” Once the woman is imprisoned, institutional security requirements impede optimal care. For example, shackling and handcuffs create a hazard due to imbalance and the risk of falls, and officer escort requirements reduce the likelihood of successful breastfeeding after delivery. Faulty assumptions about state and federal privacy laws, such as the Health Insurance Portability and Accountability Act (HIPAA), can frustrate communication at every stage in the process. In spite of these challenges, though, many studies have paradoxically shown “better outcomes for pregnancies managed behind bars than for women of similar socioeconomic status whose pregnancies are managed in the community.” Some outcome measures actually improve with increasing lengths of incarceration—which is not so much an endorsement of inmate medical care as it is an indictment of a “preincarceration environment . . . characterized by poverty, drugs, chaos, and danger.” North Carolina law doesn’t say much about pregnant inmates, but there are a few important provisions to note. Jail regulations require jails to have a written medical plan that addresses the handling of emergency medical problems, specifically including emergencies involving pregnancy. 10A NCAC 14J. 1001(b)(5). The regulations also provide that pregnant women must receive four servings from the “milk group” each day instead of the usual two afforded to jail inmates. 10A NCAC 14J .0903(c). For pregnant prison inmates, G.S. 148-4(7) authorizes the Secretary of Correction to put a prisoner on maternity leave for a period not to exceed 60 days. The law says that county departments of social services are “expected to cooperate” with DOC officials to coordinate “prenatal care, financial services, and placement of the child.” DOC’s policy on Inmate Maternity Leave is available here. Finally, there is a special sentencing option available for certain pregnant women. When a pregnant woman is convicted of a “nonviolent crime,” the court may, under G.S. 15A-1353(a), specify in the order that the date of service of the sentence is not to begin until at least six weeks after the birth of the child or other termination of the pregnancy, unless the defendant requests otherwise (which, given some of the research cited in the JAMA article, a woman might reasonably do). The court is authorized to impose reasonable conditions upon the defendant during the “waiting period” to ensure that the defendant will return to begin serving the sentence. The issue of inmates with children obviously goes beyond pregnant women. Thousands of inmates—both men and women—are separated from their families while serving time in prison. Some states have programs allowing very young children to live with their mothers in prison (Washington’s program is described in this article). There is no such program in North Carolina, although the N.C. Correctional Institution for Women has long had a program called Mothers and Their Children (MATCH) that provides a home-like space to facilitate enhanced visitation. A nonprofit group called Our Children’s Place has worked to establish a full-time housing unit where women could actually live with their babies or preschoolers, but it is not yet operational. (Several times the General Assembly has asked for information about the program, most recently in section 19.15 of S.L. 2009-451, the 2009 appropriations act.) For defendants eligible for probation, the court might want to consider a residential program like Summit House, which describes itself as a “residential alternative-to-prison program for mothers convicted of a non-violent crime and their minor children.”