Our research finds pregnant prisoners are giving birth without midwifery support
Newly published research by Dr. Laura Abbott, specialist midwife and senior lecturer at the University of Hertfordshire, has highlighted significant risks to the safety and wellbeing of pregnant mothers and their babies in UK prisons; including women giving birth in cells without midwifery care.
The UK has the highest incarceration rate in Western Europe, with pregnant women making up around 6% of the female prison population but there are limited qualitative studies published that document the experiences of pregnancy whilst serving a prison sentence.
A key finding from Dr. Abbott's research is that breaches of pregnant women's rights and entitlements are being experienced in some English prisons on multiple levels. The study took place during 2015-2016 and involved semi-structured interviews with 28 female prisoners in England who were pregnant, or had recently given birth whilst imprisoned, ten members of staff, and ten months of non-participant observation. Follow-up interviews with five women were undertaken as their pregnancies progressed to birth and the post-natal phase.
Layla's story
During her research Dr. Abbott encountered a number of stories of births happening in prison, including speaking to one woman named as "Layla' who had a potentially life-threatening premature footling breech birth (feet first) in her cell. A member of the prison healthcare team had dismissed Layla's concerns she might be in labour earlier in the evening, telling her she had weeks left until her due date. The baby was born a few hours later, amid what was described as 'absolute panic' among staff.
Dr. Laura Abbott says: "Women should not be giving birth in prison cells and appropriate midwife assessments, and sensitivity to a woman's situation, should make this highly unlikely. In Layla's case, despite her repeated concerns, the nurses did not contact the hospital to speak to a midwife. Prison staff are making assessments and taking decisions they are not qualified to make, and indeed are forbidden from making according to the Nursing and Midwifery Council code.
"Of course, on rare occasions sudden births may be unavoidable. Yet despite the significant threat such situations pose to the lives of both mother and baby, there are no specific guidelines for emergency births in prison—not even basic instructions—and hardly any staff have been given training in this area."
Recommendations
Dr. Abbott made clear recommendations from her research for the Ministry of Justice, the prison inspectorate and for the healthcare, midwife and maternity services; including the recommendation that, if there is no alternative to a custodial sentence for a pregnant woman, the development of clear, explicit and tailored guidance in the form of a Prison Service Instruction / Order (PSI /PSO) specific to the perinatal woman in prison is required with some urgency. To ensure that guidance is evidence-based, it is imperative that there is midwifery input.
Responding to the research, Naomi Delap, Director of Birth Companions, says:
"Dr. Abbott's work shines a vital and long overdue spotlight on the risks mothers and babies currently face within the prison system. It appears, based on this research and our own conversations, that births may be happening in cells or during transfer to hospital in greater numbers than the prisons service or government are aware of, often as a result of slow staff responses, unqualified assessments or incorrect advice. Such situations are not only dangerous for mothers and babies, but are also highly stressful for prison staff.
"Any pregnancy and birth carries risks, and complications can happen for many reasons. We don't want to blame prisons for incidents beyond their control, but there seems to be a good deal of evidence suggesting that prisons are failing to minimise and manage these risks, not only in terms of physical safety, but women's mental health too.
"It's vital that these issues, and others affecting pregnant women and new mothers in prison, are fully addressed in the new framework for women offenders due to be published by the Ministry of Justice before the end of the year. Without urgent changes, the lives of babies and mothers will continue to be put at risk in the prison system."
