Ep 68 PIPPI - Navigating Pregnancy in Prison: Spotlight on Midwifery Practice and Maternal Incarceration

Ep 68 http://ibit.ly/Re5V PIPPI - Navigating Pregnancy in Prison: Spotlight on Midwifery Practice and Maternal Incarceration with Laura Abbott, Tanya Capper and Rebecca Shlafer

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new book-  Pregnancy and New Motherhood in Prison t.ly/t1RC0

Can you imagine the anxiety of being pregnant while incarcerated, navigating a system that wasn't designed with your unique needs in mind? Welcome to a heart-stirring episode of Thru the Pinard, where we shine a spotlight on the complex world of midwifery practice for pregnant women in prisons. We're fortunate to have the formidable Pregnancy in Prison Partnership International (PIPPI) at our table – a collective of dedicated experts who've turned this overlooked aspect of maternity care into their mission.

Together, we dissect the complicated dynamics of maternal incarceration, focusing on alarming rates of imprisonment for indigenous and black women. We pull back the curtain on the harsh realities within correctional facilities, from the separation of mothers and newborns to the woefully inadequate support offered to mothers upon their release. And amidst these stark truths, there are glimmers of hope. We talk about the recently passed Healthy Start Act in Minnesota, a promising step towards improving incarcerated maternal and baby care.

Our conversation takes us through troubled waters and towards potential solutions. We tackle the implications of monumental policies like the overturning of Roe v Wade and the criminalization of substance use during pregnancy. We echo our collective outrage at the power imbalances, the lack of autonomy for these women, and the insufficient support structures. Yet, despite these daunting challenges, we believe in the power of unity and collaboration. We invite you to join us in this vital journey to mend a broken system, to fight for better healthcare, and to stand up for the rights of incarcerated mothers and their babies.

Transcript

Speaker 1: 0:15

And welcome to Through the Pinard, your conversational podcast, talking to midwives around the world about the research they are doing to improve midwifery practice. This research can range from small quality improvement programs and projects to those starting part way through or just finishing their postgraduate studies, and to those that have been there, done that and got the t-shirt. So settle back and enjoy the conversation and remember you can continue the conversation on Twitter after you finish listening. Thank you very much for joining us. Now we have a special episode, so we're going to actually do an extension.

Speaker 1: 0:54

So in episode 61, we had the pleasure of speaking to Laura about her PhD and looking at pregnant women in prisons, and we talked a little bit about PIPI in the formation of that. So what we thought we'd do is we'd actually get some of the people that are involved in PIPI and we're going to refresh your memory. Laura's going to tell you a little bit about how the group came about and we're going to talk about the situation in different countries, about why it's important that we have a group that focuses on pregnant women in prisons and also looking about what's the future and how possibly people can be involved. So, laura, do you want to just kind of give us a recap on your background into this whole area. Yeah, brilliant.

Speaker 2: 1:38

Also, my background, my research, was looking specifically at pregnant women's experiences of prison through their own experience, rather than looking at. I thought it was a qualitative piece of work and through that work, obviously, when you start off looking at doing your literature of you starting to find where the gaps in the evidence are, you read a lot of papers and a lot of the papers that I read were, in fact, people that we're now sitting around the table with this evening, this morning. So, for example, rebecca and Tanya, who we're with tonight, real seminal, amazing research which forms a lot of my thinking and, with the research that I did, was building on some of the work that they'd already done in different countries. So my work, specifically looking at experiences of women, and it was an ethnographic study, so looking at the whole picture of what prison was and how that impacted on women in prison who were pregnant or who were just having babies, newborn babies. And as this work progressed and as to cut a long story short, we're through the doctorate, get the doctorate and deciding that it's really important that, thinking about the collaborations and the experts around the world, because it's quite a small, unique area and there's not a lot of work that's done. So the people that have done the work are particularly special.

Speaker 2: 3:18

So Pippi is a way of getting us all together, so it stands for pregnancy in prison, partnership international, and we're all part of thinking of what should we call ourselves. So, right in the beginning, when I think we started I can't remember, it's probably not that long ago, maybe a couple of years ago that was the acronym that we came up with. I remember it quite vividly us talking about, you know, talking as you do and thinking about the acronym. And really since then we've kind of grown as a group. We meet every third Tuesday, pretty much the issues that we have, obviously around time zones which are quite difficult because we're in the world, but we're growing. We've got a paper under review at the moment and another paper in progress we presented together. So, yes, we're doing really well. So, yeah, that's in a nutshell what Pippi is, and it's really about bringing best practice together and thinking about funding opportunities internationally together and just sharing knowledge and expertise, because it's not an area that is going to go away.

Speaker 1: 4:33

We know it's an area that has increased, and especially in some countries, when looking at the differences between public and private correctional systems and legal systems and also governments that control correctional systems as well. And we're just going to make life easy, so we're just going to kind of go round in the rotation that I've got here. So that means that, tanya, would you like to introduce yourself and provide some of the background?

Speaker 4: 5:00

Yes, thank you Liz. So my name is Tanya Kappa. I am an associate professor of Midwifery at Australian Catholic University in Brisbane, australia, and I guess my interest in this area has come from two unique angles really. First of all, as you'll call those helping my accent, I am originally from the UK and I practice as a midwife in an area where we provided care to women that were incarcerated in a large local prison. So I worked day to day with women in that environment and I became aware of the issues they face and, I guess, got a bit of a feel for the additional support needs that they had. And then, when I came to Australia, I began teaching in a Bachelor of Midwifery program here and I became aware that we don't really provide students midwifery students with any education around care for this group of women. And this was how our project came about, which I'll probably talk more about later on.

Speaker 4: 6:07

But we, as part of our continuity of care requirements that the students have here in Australia, they have to follow 10 women during pregnancy, birth and postpartum.

Speaker 4: 6:17

We came up with the idea of connecting our students with women who were incarcerated, who were often unsupported, had very little contact with the outside world.

Speaker 4: 6:29

So when I say that, I mean when they went to appointments or, you know, pregnancy care or when they presented in labour, they were often alone and that really we saw an opportunity to obviously provide our students with a wonderful opportunity to develop, you know, meaningful professional relationships with women and provide that support. But also the women yeah, they ultimately were, you know had someone by their side who they knew they'd built a relationship with and that provided them with an element of comfort, of course, but also, I think, advocacy in some way that they hadn't had in the past. And so we've had several students that went through our program and the feedback we had from both students and the women was very, very positive, and we ended up extending the project to providing education to incarcerated men and it really really grew and as part of PIPI coming back to PIPI we are now looking at the educational provision for students that are undertaking different programs around caring for women in prison.

Speaker 1: 7:38

And if you want to hear more about 10 years' own PhD journey, then you can kind of scroll back to episode 16 and listen to you. Her, jenny, one of the early people to jump on board and support the podcast Excellent, okay, so we've got a non-midwife, but that makes her no less important in this circle. She's a very qualified child psychologist. I got that right. Yeah, one of your caps. And so this is Rebecca Schaffer. So, rebecca, would you like to introduce yourself and your background please?

Speaker 3: 8:11

Yeah, thanks so much, liz. Thanks so much for having me. So my name is Rebecca Schaffer. I am a developmental child psychologist by training, so my PhD is in developmental child psych and I have a master's degree in maternal and child public health, and my work in this area started back in 2009.

Speaker 3: 8:31

I knew I was going to be staying in Minnesota, so I am currently in at the University of Minnesota in the United States so sort of middle of the country, a Midwest state on the northern half of the country and I knew I was going to be staying here professionally and started doing some outreach to our local prisons, because much of my work as a graduate student was related to children and families broadly affected by incarceration, and so I reached out to our women's prison.

Speaker 3: 9:03

Our state has only one.

Speaker 3: 9:04

Our country, of course, has many as the leading incarcerator in the world, but our state has one women's prison about 30 minutes from where I live, and so I had reached out to that group to say sort of what's happening for incarcerated women there and in I think you know what I have since described as a lot of serendipity I got connected with a nonprofit organization really at that point just a grassroots couple of people who are starting to do group-based prenatal education and one-on-one birth support to pregnant and postpartum women at the prison, and that really was the start of what we now call the Minnesota Prison Dula Project. So I have had the privilege over the last 13 years of serving as the research director for the Minnesota Prison Dula Project. We have supported nearly every birth of a pregnant person who has entered our prison pregnant and given birth in custody, as well as expanded to county jails all across our state, and the organization now also has contracts with the Bureau of Prisons, which is in control of our federal prison system, and a sister organization in Alabama, the Alabama Prison Birth Project, and really, as a result of this, have been connected to birth work and thinking about moms and babies and the developmental implications of incarceration for more than a decade now all across the country and continue to do this work, and I think for me, being a part of PIPI has really helped me feel like some of the challenges that I'm encountering in our country are. Some of them are unique, but so many of them are not.

Speaker 1: 10:46

And.

Speaker 3: 10:46

I think that's been actually really helpful to hear some of the struggles that other people are navigating, particularly as it relates to, maybe, abortion care or nutrition or depression Some of these things that are common problems that we're trying to tackle here and hearing best practices and lessons learned from others that are doing work in this similar space and other parts of the world has been amazing.

Speaker 1: 11:11

And please feel free to correct me if I've got my information and stats wrong, because you are the expert since field Women who are incarcerated tend to be of a higher proportion of lower socioeconomic lower or higher racial proportion and therefore, when we're looking at women in birthing statistics who were already at high risk, they actually eat. This is even a greater proportion of them that are going to be incarcerated without the support network that you will actually have when you're actually on the outside and again, a lot of them wouldn't have that support network on the outside as well.

Speaker 3: 11:49

Yeah, that's exactly right. I mean, in some of our research, one of the things that we have seen is that women who come to prison pregnant are younger, more racially and ethnically diverse and have fewer years of education than women in prison who aren't pregnant. So when we think about, and then we think about all of the socioeconomic disadvantages that people who are in prison generally have, this is really just compounded for people who come to prison who are pregnant. So really really high rates of past trauma, mental health issues, substance use issues and really intergenerational patterns often of trauma that are coming through our prison system.

Speaker 1: 12:31

One of the things that when we're talking about your journey, laura, it was also kind of quite an emotional time because there was a recent report that had been released in the UK around death in both. Now was it just a? Well, I'm not going to say just because that sounds wrong, but there was a couple of baby deaths, but was there also a woman's death as well? That was in that report.

Speaker 2: 13:01

There have been two baby deaths 2019 and 2020, and there has been. I mean, we have quite a high I understand for you, quite high self-harm and suicide rate in our prisons. I think that's the same for globally, actually, but when I was doing my research, there was a death of a woman who died by suicide and that was following her baby being removed, so being separated from her baby. So you know, it is a very difficult, challenging, traumatic time for women. But what's really caught the headlines here in the UK have been these terrible deaths of these babies.

Speaker 2: 13:51

One woman who was very young she was an 18-year-old care leaver who was on remand in prison and she was known to sort of be a care leaver. She'd had a very difficult life, followed the trajectory of a lot of women in prison and when she called for help, when she went into labour, she had her core bell ignored and she ended up birthing in her cell on her own and her baby died. And the story I mean it's a really very harrowing, difficult story to even read about Leclo and imagine what the young woman went through herself. So that has been in the headlines a lot over here and, from her particular case, all prisons were announced as being high-risk. So the prison ombudsman declared that all pregnancies, all pregnancy in prison, is a high risk by the nature of being in prison.

Speaker 3: 14:59

Yeah.

Speaker 2: 15:00

Any barriers to health care. If you're in prison, you have got the structure of the prison as a barrier, especially at night time. So I think, with those situations, there's been a lot of campaigning over here about getting the laws changed, as having pregnancy as a potential mitigation against sentencing. We know that around one third of pregnant women held in our jails are actually on remand.

Speaker 2: 15:32

So we're at the moment we're going to hear fairly soon, I believe- the end of the month we're going to be hearing from the sentencing council to see whether the consultation that has gone through is successful. So that might set a bit of a precedent. We do know, because through working with Pippi we know that there are around 11 countries that won't imprison their pregnant women, so it can be done.

Speaker 1: 15:58

So can you give some examples of which countries?

Speaker 2: 16:02

We know Brazil, portugal, ghana, ukraine I can't think of everywhere, everywhere on the top of my head, but I think I believe it's 11 countries. So we do think that that's potentially. There are going to be situations where there isn't an option, but the majority of the time there are alternatives out there and, especially as Rebecca was just describing, the types of women that we do meet in prison are generally from very disadvantaged populations who may be served better in community settings where they can get the proper support and looking at the root causes of their incarceration in the first place.

Speaker 1: 16:48

So, yeah, and Tenya, have you found the same things within Australians correctional service?

Speaker 4: 16:56

Yes, yes, liz. So one of the things that we know about the Australian female prison population is that obviously, a large portion of the male mothers and a significant number have had a parent who have been incarcerated during their life at some point in their life, and often that they have partners that are also incarcerated. So it just really highlights, as Laura was saying, it's a little cycle which unfortunately often leads to them becoming involved in what is often a petty crime. I'm going back to my experience of working in the UK, but I'd often meet women who were pregnant and they were incarcerated because of having not paid their council tax or something that was relatively and we're not talking, like Laura said, in other African situations where it is unavoidable, incarceration is unavoidable, but often they were very minor matters that had led to their period of incarceration.

Speaker 4: 18:01

And so here in Australia it is very similar. You know women are sentenced to a period of imprisonment. There isn't a mitigating element around pregnancy as far as I'm aware, but the opportunity for them to remain with their babies are sure. We'll talk about more in a moment. You know they are limited to those opportunities. Not every woman in every prison will be provided with the support required to remain with her baby and obviously that creates another issue during both the pregnancy and beyond.

Speaker 1: 18:37

Really, and in Australia we have sadly a much higher incidence of incarceration of Aboriginal women as well. For similar things, very small things that kind of they can't pay the fine, therefore they get put in prison, which means they can't pay the fine. So yeah, once again you end up in the perpetual cycle that you can't pay the fine.

Speaker 4: 19:00

Yeah, I believe there's one in three. At the last sentences were Aboriginal Torres Strait Islander women that were incarcerated. So one in three, that's a really significant number.

Speaker 1: 19:11

Especially when you think that nationally, the percentage of Aboriginal and Torres Strait Islanders to the rest of the kind of non-Aboriginal Torres Strait Islanders is 3.3% of the population and yet you're talking about 30% of incarcerated rates. And I think that that's going to be similar from what I've read in America as well, that the black rates and incorrect term, I apologise is much higher and up to 50 to 80% in some places in relation to other ethnicities.

Speaker 3: 19:48

Yeah, and I mean I think in particular related to so we I'm from, my university is situated on indigenous land, stolen land, right in Minnesota and the Midwest.

Speaker 3: 19:59

We're certainly tremendous tribal lands that still exist here and we have, a relative to other states in the country, a high proportion of indigenous folks, but our state is made up of less than 1% around 1.5%, 2% of indigenous folks, native American indigenous individuals, but they make up 25% of the pregnant women in prison.

Speaker 3: 20:25

And, yeah, I mean in our country has a really horrific history, as I'm sure others do right, forced separation of indigenous mothers and their children across generations, stolen lands, stolen homes, stolen culture and many of the indigenous moms that we have in our program or who are moving through our prison system have very high rates of trauma, substance use that is untreated and really high rates of housing instability.

Speaker 3: 20:59

You know, I think that is one of the things that we are constantly trying to understand here in this, in this state, as it relates to to like where child welfare involvement or child protection involvement comes in, because there has been so much forced separation of mothers and children across generations. So that's true of indigenous and Native American folks. It is also true of Black or African American folks in terms of the disproportionate representation in our criminal legal system here and I think you know really hones in on just a historical all of the ways in which slavery has perpetuated. You know that our country was built on that and that sort of slavery is sort of the foundation of our current criminal legal system and mass incarceration in the United States.

Speaker 1: 21:53

And then when you look at the differences between the ways that the jails deal and the venues, between public and private, is very different as well in what they do and the support that they give. Laura, when you're looking at the same, the mixture, do the women have a chance to keep their babies with them after birth in the correctional services and I'll ask all of you the same question or are they separated straight away? Where does that separation occur within the UK system that you know of?

Speaker 2: 22:31

Well, we've got mother and baby units in our prisons. So we've got six mother, we've got 12 prisons and six mother and baby units and women are given an opportunity to apply for a place on the mother and baby unit and we understand around 50% are able to keep their babies with them on the mother and baby unit and the rest of the women are separated at or soon after birth. So what tends to happen is they will go into labor, go into hospital and they will very soon after having their babies, their babies will be removed and they will then return to the main population of the prison without their baby. There's sometimes facilities whereby the mother may be able to express breast milk for that baby, but again, it's very complicated geographically to get that milk to the baby if that's what she chooses to do. So separation usually happens pretty much soon after the birth. Sometimes the mum is able to stay with the baby for a few days before they're separated, but more often than not it's quite soon after birth.

Speaker 1: 23:53

So in their mother and babies' units. How long do they get to stay together before that baby is then kind of either taken into care or given to another family member, so on the mother and baby unit.

Speaker 2: 24:05

They are between 18 and 20 months. So yeah, so the and again, when we think about the majority of the women in prison there, on pretty short sentences, usually for six to 12 months. So it's unusual to have longer, really long sentences where there is a separation between a mother and a toddler. And when that does happen it's done quite carefully with the prison service planning. It's not done suddenly, because it needs to be done very gently and gradually for in the best interest of that child as well. So what would usually happen is the child would go out, maybe with family members, up to sort of three, four, six months before, sort of the weekends or for overnight visits. So it's not a sudden separation from the mother. And then obviously the child can be brought in for visits with the mother.

Speaker 2: 25:08

It is understandably extremely difficult, especially for the mother, who then has to go back into the general population after living on a mother and baby unit. But again, it's an area where there's not a huge amount of research. I think we do need to look more at the impacts, especially of that child and that bonding. When you've had that intensity of that relationship together for that 18 to 20 months. It can be very difficult for that separation. It has to be managed really carefully.

Speaker 1: 25:42

When we look at the importance of bonding and attachment and how that actually affects relationships for that child in the future and their own parenting skills and their own ways of incorporating. Has there been much research done in that, or is that one of the areas that's kind of like an extension to where Pippi could actually help lead as well?

Speaker 3: 26:00

Yeah, I mean I think we have so much more room to learn in terms of what does, what are the alternatives to incarceration and how can there be systems in place to support attachment. So Laura talked a bit about what happens in her country as it relates to separation or not. In the United States, the majority of women who give birth in custody will be separated from their babies within 48 to 72 hours. Very rare is the exception of a prison nursery program or a program like Laura described where there are nursery settings where moms and babies can co-reside. So those are really the exception to the norm and, as Laura described, only a proportion of the moms some of them will be eligible to stay. And for us, really, the research that's there is actually really limited to essentially one prison.

Speaker 3: 26:53

It was Mary Byrne's work on the Bedford Hills Correctional Facility in New York and I think it's really interesting because, while there is some data to show that that as an intervention improves maternal and child attachment relationships, we also know that there's some really important selection effects to consider, because the moms who got to participate in the program were already.

Speaker 3: 27:18

They had shorter sentences, had lower risks, they were in a different position potentially to be able to be engaging in the program and might have been different than the moms who didn't get to participate, and I think we need to know a lot more about prison nursery programs across the world and these alternatives. In Minnesota in 2021, we were able to pass what we call the Healthy Start Act, which allows our commissioner of corrections to release pregnant and postpartum women into community-based alternatives, Rather than bringing babies in. The idea here was to get moms out. Still issues around selection effects, but the idea would be we want to try to minimize the disruption that happens from that separation and the real insult to the parent-child attachment relationships and to trying to think about alternatives in general, whether that is preadjudication or on the sentencing side, or post adjudication, and what settings moms and babies can stay together in so lots of the same things that we're wrestling with here too.

Speaker 1: 28:27

And Tanya, my understanding is we've got a mixed base in Australia with some states that support and some states that don't.

Speaker 4: 28:34

Correct, liz, correct. I was just thinking about when Laura was talking about the uncertainty and I know, going back to having worked very closely with incarcerated pregnant women for several years, one of the biggest sources of anxiety to them was the unknown. And whenever I say how are you, immediately it would be I'm really worried. I still haven't heard whether I'm going to have a place on the mother and baby unit and I think without a doubt that impacted the woman's ability to bond with her unbeknown because she was aware that potentially she wouldn't have a place in the mother and baby unit and therefore there'd be separation. So there was always that wall there, I think, and a reluctance to bond and, like you say, that's very similar here in Australia we have some mother and baby units in some prisons and none others.

Speaker 4: 29:29

But we worked closely with a charity called the Companions that I know Laura's had a lot of involvement with in the UK to develop an Australian version of their birth chart, and the birth chart is a document that guides the care of incarcerated mothers and babies in the correctional setting and that document, I believe, talks about providing women with at least some indication of when they will know what they have a place in a mother and baby unit. So that is something that we have brought into our Australian version, and our recommendations were that women should know by at the latest 24 weeks gestation whether they will have a place and if they are incarcerated at that stage of pregnancy or beyond that, within two weeks, they should at least have an idea of what will be allocated to them in the postpartum period, because that, without a doubt, that lack of certainty has a significant impact on the ability to bond during pregnancy and obviously that delays that process then as well, once they have their baby and then their care is in the postpartum period.

Speaker 3: 30:41

So, yeah, I was just thinking about something that Tenya was saying with regard to the anxiety and the uncertainty, and I hear in our work a tremendous amount of anxiety and uncertainty as it relates to not knowing when women will be transported to the hospital.

Speaker 3: 30:57

So our system won't allow moms to know even if it's a scheduled induction or when they're having an appointment, and I think this breeds a lot of fear and uncertainty and worry that I have to imagine has a lot of stress hormones related to it that are not good for baby.

Speaker 3: 31:15

And then we have a lot of moms who have a lot of uncertainty about the caregiving placement. So because most moms won't be able to stay with their babies or be released with their babies, they have to identify a caregiver to come and pick that baby up from the hospital. And there's often a lot of precarity in the family system that may lead that mom to be worried about is my sister going to come? Can my sister get here in the snow? My mom's car is broken. She's supposed to come pick up the baby, and so a lot of fear and uncertainty. And even then, for so many moms that are placing babies with relatives, moms own concerns about the safety of that environment, knowing full well, perhaps, the environment she was raised in, and so a lot of these intergenerational concerns regarding safety and well-being of the relationship to something I think you know. Tanya, as you were talking, just made me think about that being a real theme of our work.

Speaker 1: 32:10

And I think Laura alluded to that earlier as well in about the actual climate of a correctional service and having done some I did some first aid courses in a youth detention center and all the security that you need to go through and that it takes time to open and shut a door and open and shut a door and you can't. The security is primary above everything else's security. Everything else comes underneath that. So that kind of fits in nicely with that situation Laura you were talking about. That adds that extra stress.

Speaker 2: 32:47

Absolutely, and I think you know wherever in the world we have pregnant women in prison, wherever they are, there's going to be that anxiety and stress. And it really resonated with me when Rebecca was just saying about that anxiety and that fear and coming out of prison not knowing when your scams are, not knowing when your appointments are and you know, all of us, you know for any appointment, we kind of want to be prepared. It's a universal thing, you know. You want to, you want to. So to get a knock on your, on your cell door and to know that you're going to be in a taxi with two prison officers without having a chance to really think about maybe questions or or, you know, have a wash or have something to eat. It's a very stressful time.

Speaker 2: 33:38

And something else that you know resonated a lot when I was doing my research is feeling ashamed. So I think we talked about that. We've talked about that a lot, about how you know the fact that you're pregnant. You're going in and out of prison and hospital more often than any other type of prisoner because you're going for your appointments. You're usually high risk, so you're having more, more appointments. So you'll be with prison officers, often in handcuffs and it's it's really shameful and it feels embarrassing and it feels uncomfortable, and you know what women have said to me in my research.

Speaker 2: 34:21

I know you know it's again a universal thing feeling that you know everybody's looking, everyone's staring, everyone's judging, feeling doubly judged and doubly punished in those situations. So, yeah, it's, it's, it's stress, and and another thing that Rebecca was saying is that how stress and we know how it, how it crosses over on the placenta and you know we're impacting that unborn baby and I think that's something that we don't know enough about the impact on that child going forward. We do know that stress and cortisol can cause problems and it can cross the placenta, but we don't follow up these children and it's something that perhaps I know. I know we're all really ambitious, but it would be great to be able to do some research and look at the actual impact that pregnancy had on that child, for that child's lifespan. You know, maybe, maybe one day we can do that together.

Speaker 1: 35:19

There's probably about 100 PhDs. That could come out of just the conversation we're having today. But that leads quite nicely onto one of the other questions have, which I know is kind of outside of the role of the midwife what preparation is actually within the correctional services to prepare them to actually have that child again when they get out and to actually reestablish those mothering skills and that role again? Like, is that part of the process or is that another missing link that we need to add on to actually ensure that they are safe when they're actually suddenly got this baby under their total control again?

Speaker 2: 36:00

I'll just come in quickly there and I'll let Tamia and Rebecca finish. That just reminds me of a woman I spoke to in my research and she was coming towards the end of her sentence when she was due to give birth. She gave birth, had her baby, came back to prison without her baby and was released three weeks later. It was her first child. So those three weeks that she said she was going to breastfeed but there was no point because she wasn't going to see the baby for three weeks. So it almost felt crazy that that situation was allowed to happen, that she wasn't given an opportunity to be on a mother and baby unit or be released. What difference was that three weeks going to make? But for that bonding it was huge. She accepted what was happening to her. I kind of remember feeling, as a midwife and as a researcher at the time, pretty outraged that that could happen and how ridiculous.

Speaker 1: 37:03

Just to make a sense, just for taking the box three weeks is not going to change a person's life in that context and after they've had that experience, but it could actually enhance another life kind of properly.

Speaker 4: 37:16

Tanya, I was just thinking this actually is a space that we jumped into. I know I alluded to this earlier when I spoke about the connection program between our students and the women, because, yes, they say they don't have any preparation. There's no childbirth preparation classes in that setting. So by connecting the students with the women, we're able to actually provide education around some of those basic elements of birth and the early days or hours, even beyond. And, as I mentioned, we extended that to the men, the partners that were in the male cuisine close by, because we felt that often they lacked that and they released and suddenly it's the case of well, here's the child and you have no preparation whatsoever. That's really confronting for anyone but somebody who has all those additional complexities that we've already talked about, maybe family support, so on, and so that was an element of our program that was really successful.

Speaker 4: 38:25

But what we also did, in addition to connecting with students, was providing education for the officers.

Speaker 4: 38:32

We gave them a little badge with champion on and they were, I guess, people who self-nominated to work particularly in this space and provide that support to women who were pregnant or in labour.

Speaker 4: 38:45

So, for example, if they were champions, they would be the person that would ideally accompany the woman to the hospital for appointments or if they go into labour, and they'd save them for the duration of labour and they would have some preparation for that role for us too. So they weren't. Just I think we'll probably talk about this a little bit, and I'll probably talk about it a bit more. One thing we have identified is that seldom are women who are incarcerated during pregnancy, treated any differently to the larger population in relation to the way that they're moved, the way that they are provided with healthcare in many ways, and, I'm interested, how their diet is provided to them during that period, and so we felt that, by having this project and providing support to the champions or the officers that were keen to get involved, it just provided the women with that additional layer of security and support that they really, really needed in that situation.

Speaker 3: 39:44

Rebecca, yeah, I mean, I think for us, our departments of corrections across the country as a system do nothing to prepare pregnant people for childbirth right, and so what is happening in our state and other states across the country is really mostly done by nonprofit organizations or NGOs that are coming in and providing some sort of support, often on a volunteer basis, to offer some emotional support, informational support, some physical support in terms of what can you expect when you'll go into labor, what will this be like? And I think so important.

Speaker 3: 40:25

You know, for our groups those are co-facilitated by doulas, but really mostly it's having the doulas be there to create a space where moms can share with one another about what they experienced with their last childbirth, what they felt like when they went into labor, how they handled their back pain, how they got comfortable, how this will compare to their last birth. Those are all things that I think are really the importance of creating a community in this space where there can be some shared empathy around how unbelievably difficult this will be, where the doulas really are there to provide information but mostly emotional support around the trauma associated with birthing inside.

Speaker 1: 41:09

Because, if you think about it with women that are not in correctional facilities. They just go on the internet and they will find a mothers group or they will find somewhere that they can chat. They can phone anyone at any night in the middle of the night. They're feeling concerned, they can log on to someone, they can phone someone. They don't have that control of their own communications. Everything is so regimented that that takes away that opportunity of timely assistance and need when they need it and then, depending on who they're working with, whether it gets kind of ignored it gets. Oh, that's not important enough. We haven't got the staff. We kind of can't facilitate that at the moment, or by the time you facilitate it. What could have been dealt with as a small situation has been escalated and therefore ends up being something that becomes quite traumatic.

Speaker 3: 42:02

I think that's exactly right, and I think it's not only just that they don't have access to the internet. They have no autonomy as it relates to scheduling their own appointments. They actually can't start an appointment without, at least here, a corrections officer being in the room, and so the idea of so little autonomy and privacy to ask questions or to be sort of in charge of a year-old pregnancy and birth is, I think, part of the carceral control that extends to this population.

Speaker 1: 42:32

And that kind of takes a whole pile of structural changes and organizational changes of is there a way that a woman can have her appointment and the prison officer being outside in the glass door or something like that, so you can still have eyes on but you actually have that privacy to have those conversations? Because if you don't feel trust and there is a power imbalance in prison, no matter what you do and no matter how much you may like that person, there is a power imbalance. That is very much. You play the game. You don't get out of line because it will be used again to you in a lot of places. So then what's the solution? Just a simple question, kind of so when you're looking at what you can do, you've got blue sky thinking with what you could do with endless money, with endless support, endless hours and endless people. You don't have that as a reality. So what are the next couple of things that you're focusing on as PIPI that are priorities nationally, internationally, but as well as in your own kind of like country areas?

Speaker 4: 43:38

We, as I alluded to, have been working at all the paper that looks at the provision of diet. So, you know, across the world, and we've identified, as I mentioned earlier, that there is really very little difference in the diet offered to those women that are pregnant, to the broader prison population, and in fact, I think how much we work at the per head food budget was it was, you know, really really small indeed. The other thing that we identified was that often women don't have access to additional snacks or even fluids. In some case there wasn't, you know, access really to water and the water that was available was unpalatable and they just felt, you know, really, I guess, that they were just being fed rather than nourished when they were being filled up with potatoes and pastas and things like that. So that, I think, is one area that we're really interested in looking at more.

Speaker 4: 44:32

We've completed a little review, as I say, of the literature pretty much across the world and we are interested in taking that one step further. But I also mentioned earlier on that we are exploring the education that's provided to midwifery students, so those that will be preparing for women in the setting, and there is very little content in those midwifery courses at this time. So we're looking at, really, you know, providing students with a better understanding of the social determinants of health and how they impact women in this environment, and you know that their needs and things that they need, I guess, additional consideration around, and one of the things that surprises a lot of people is that being incarcerated during pregnancy for some women is actually a really positive thing, but that's the time in their life where they have had, you know, a routine. They have three meals, such as a shower, a bed to lie on yeah.

Speaker 4: 45:24

Yeah, absolutely. They have access to healthcare and it provides a unique opportunity, a window of opportunity really, for health intervention. So the opportunity to talk about, you know, various health promotion issues and we have their drug addiction issues addressed or the opportunity at the very least. So, whilst there are absolutely issues that we've talked about, there are also opportunities that are created and that's why we feel it's important that those caring for women, such as the next generation of midwives, have that awareness of what we can do in that time. Or we have opportunities to spend, you know, whether it be half an hour or every other couple of weeks, with these women to improve their own health outcomes, but also those of their babies.

Speaker 2: 46:14

So, yeah, yeah, I agree. I mean you know the things that we're working on together. You know there seems to be more and more things of the more discussions we have of what we want to look at. I think, you know, thinking about what's going on in the UK and also education-wise is sort of training and making sure that there is greater awareness. And I think something that will come out of what we're doing together is that raising awareness so that, you know, I mean ideally, I think in an ideal world we would have far fewer pregnant women in prison, and I know that's something that we're campaigning for strongly in the UK.

Speaker 2: 46:59

But whilst we do have, you know, women who are pregnant, having their babies in prison, we do need to have more of an awareness of how we can best care for them, and in a compassionate way. And it includes not just sort of midwives, but also you know, those officers we have coming in our prisons. Now we have they have called PMBLOs it's like the Pippi acronym. I can never quite remember what we're saying, but it's pregnancy, mother and baby prison officers. So they're sort of like a conduit between the prison midwifery services. So they work sort of on an advocacy sort of basis with the women.

Speaker 2: 47:47

Although they're still guards, they're still prison officers. They have a special interest in pregnancy, so it means that they can be there as an additional support, which is quite a positive move, but it doesn't replace midwifery services and I do worry that sometimes, when you have these plans that have been put in place and additional personnel, that there might be a thought that they can take the place of midwives. It's always a little bit of a worry to us to think that those officers who are not midwives could you know from on paper, on policy and from sort of governments might think well, actually we don't need more midwives in our prisons, and here we have in our prisons. We do have specialist midwives, but not in every prison. So, as well as PPP, in the UK we have a support group for the Prison Midwives Action Group, which is something that I set up a little while ago so that we could have a supportive environment for prison midwives to meet up.

Speaker 1: 49:00

We have to care for ourselves and we're quite bad at caring for ourselves. We care for the women and the families, but we know that the resilience, we know that the levels of PTSD, of moral distress and injury is huge within midwifery. So we need to, especially in such a unique area. Absolutely well done.

Speaker 2: 49:21

Yeah, well, we meet once a month and the midwives are just incredible the work that they do and it is stressful, as you can imagine. And the thing is with Prison Midwifery they're very much working in a silo, so it's not like you're working on a unit where all your friends are on shift and you're pretty much on your own. And I think also it's a little bit like in the community people don't really quite understand what you're doing sometimes so it's a bit of a them and us and because the caseloads are quite challenging, complex people that the midwives are supporting, I think there's little understanding of how much time they can take to support when you might have somebody who is finding it difficult to engage with health care and health services and not wanting to go to appointments, for example.

Speaker 2: 50:17

the midwives will be working extremely hard to develop those supportive therapeutic measures. But also the rates of burnout are high, especially our prisons, especially at the moment. I'm aware that because I'm often talking about the cases that are happening, often asked to give comment in the media and in the newspapers. It's a stressful, yet under the spotlight as well, quite a lot being scrutinized and criticized, and I'm aware that must be quite difficult for the midwives to feel under that glare of the spotlight too.

Speaker 1: 50:53

When it comes back to the midwifery care is human rights, like every woman should have the right to access a midwife. We are the experts in physiological birth, but when you've got a change of environment we can still have, and it is the midwives with their clinical knowledge that can look at the previous pregnancies, can look at the clinical information and kind of go. This is a high risk. We need to increase monitoring, whereas somebody who's not trained doesn't have that information and background, which unfortunately leads to oh, she's just putting it on, she can't be real, she can't. There's no problems with that type situation.

Speaker 3: 51:35

Rebecca, you know it's really interesting. In most prison systems in the United States, incarcerated women don't have access to midwifery care. They have. We have really medicalized birth in this country and a horrific rate of maternal mortality.

Speaker 3: 51:49

I think, what one of the few countries in the world where maternal mortality is increasing and not decreasing, which is stunning, and I think for us just thinking about all of the ways in which incarcerated people can be get access to high quality healthcare, and not just pregnancy related care right, but just health in general.

Speaker 3: 52:13

I think one of the things that I'm really thinking about here locally is all of the ways in which our country's overturning of Roe v Wade and what we're referring to here as the post-dobs decision has impacted access to abortion care in our country.

Speaker 3: 52:30

What that will mean, where we have some states that are really criminalizing substance use during pregnancy in a way that is actually sweeping more women into the criminal legal system, and then in states where they can't access abortion care, what will happen to our population of pregnant incarcerated people in this country in the next five to 10 years and without some other major shift in policy in this country?

Speaker 3: 52:54

And so I think that's something that I'm very much thinking about, that it's sort of it eats at me to think about the fact that we have made such great strides in some pieces of this puzzle as it relates to getting doula care for pregnant incarcerated women, having prenatal groups doing advocacy around lactation, continuing to do anti-shackling legislation in different parts of the country. Yet there's this against the backdrop of broader policies that are going to likely lead to more people in prison and more women in prison and more birthing people in prison. So I'm doing a lot of thinking on that and just continuing to think here locally about the ways in which we can do ongoing community partner research and stay inside these facilities to keep collecting information while simultaneously battling these really broken, fundamentally flawed systems.

Speaker 1: 53:54

So if people are listening to this podcast episode and you have tickled an interest in them and they've got a strong social justice or whatever reason they want to get involved, how can they get involved with Pippi and how can they help work to change the system, even if it's one person at a time, because that's all it takes is one person to start and then others follow. Laura.

Speaker 2: 54:23

I think we're all really very accessible, and I think I don't know I'm sure I can speak for Daniel and Rebecca as well is when people reach out and they want to learn more. We're so excited. I mean, I'd certainly feel you know, when anyone any student or any midwife or anybody wants to know more about this area of research, I'm very happy to engage with that person. So I think you know that's the first step would be to get in contact with any of us. We're really happy to talk or discuss or you know, and also something we'd like is more countries on board. So we're very aware that we're sort of, you know, at the moment we're UK, usa, australia, japan, new Zealand, but we'd really like to have some more. You know, we'd like more diversity in the world and we'd like to be able to see what happens in all of our countries around the world. So I mean, that would be I can imagine the time zones trying to work out.

Speaker 2: 55:29

It's hard enough with us. So, but I think you know there's possibility. You know we can work across time zones and just working together and I think you know it's about collaboration really. So something that's quite strong with PIPI is that we don't have a hierarchy. It's we really that's part of our PIPI philosophy is that we're not hierarchical at all. You know we're all sort of equal partners in PIPI. There's, you know, we don't have people in charge which we don't like. We're almost like anti how the prisons are.

Speaker 1: 56:04

Well, when you're considering if you're working with a system that is extremely hierarchical and extremely powered, kind of to have to see the, I suppose, the negative effects of what that can cause. It's quite understandable that you don't you want to be something opposite, that as an almost like an antidote.

Speaker 2: 56:21

Yeah, not really liking authority.

Speaker 4: 56:27

Yeah, I think, as Laura said, you know, if you're interested in finding it more, get in touch and, in particular, it would be wonderful to have some additional members, maybe from our other disciplines, that would be keen to provide their input. You know, from the legal background or you know, there's lots of other elements that I'm sure that we probably haven't taken into consideration just yet because we are predominantly in a bit of a free or, in Rebecca's case, psychology background. So we would love to hear from anyone who thinks they have anything. You know they contribute to the group and, yeah, we all is.

Speaker 1: 57:07

I think you mentioned nutrition and so you got nutrition, dietetics, social work, even physiotherapist and occupational therapist looking at post birth as well. So absolutely nice for some interprofessional engagement which adds and makes things richer, Rebecca.

Speaker 3: 57:25

Yeah, I just want to echo what Laura and Tanya said. Like I think we're all incredibly accessible. I respond to every email. I get happy to collaborate, you know, within the United States or and beyond very much, so this has been a really fruitful group to be engaged with and, truthfully, I just find real appreciation for being connected with others who are in the struggle and trying to do the best we can in a fundamentally broken system, and so I would just, yeah, say reach out, stay connected and and really thinking about the diversity of disciplinary perspectives and diversity across the countries and really trying to get a better sense of how this is happening all across the world.

Speaker 1: 58:13

Thank you very much for your time, very much appreciated, that's a pleasure.

Speaker 4: 58:18

It's lovely to be here Thank you. Thank you for joining us today.

Speaker 1: 58:21

You'll find all the links on Twitter, instagram and on the podcast website. If you are a midwife and you would like to share your research, your postgraduate studies or even the quality improvement projects you are doing now, then email me at throughthepinardcom, send me a tweet or send me a DM.