The incarcerated pregnancy: what is the experience of being pregnant in an English prison?

It is thought that roughly 6% of the UK’s female prison population are pregnant at any one time. Many women learn of their pregnancy on reception to prison. The population is slight but there is limited research globally looking at women’s experiences of pregnancy, birth and becoming a mother as a prisoner.

My interest in researching the experiences of pregnant women in prisons has been sparked by my professional curiosity as a midwife, as well as having an interest in marginalized and disenfranchised groups of women who often do not have their voices heard. (See Albertson, O’Keeffe, Burke, Lessing-Turner, & Renfrew, 2014; Kennedy, Marshall, Parkinson, Delap, & Abbott, 2016; O’Keefe & Dixon, 2015)

My doctorate study has been looking at the experience of what it is like to be a pregnant woman in an English prison. I was able to interview a number of women who were pregnant or who had babies in prison. Initial findings show that women feel stressed and some wish to be invisible due to the perceived threat to their unborn baby (whether or not this threat is justified). Many women talked about feeling hungry and exhausted. Women do have some good access to midwifery care in prison. Some women who have chaotic lives outside of prison may even have better healthcare and greater continuity of midwifery antenatal care in prison, due to being able to keep appointments more easily. However, there is inconsistency when it comes to having being able to attend pregnancy groups. For first-time mothers this was particularly difficult with women gaining most of their information about labour, birth and feeding choices from other women prisoners. A number of women were unclear about their rights to apply for a place in ‘mother and baby units’. Women who did apply often did not find out about a place until late on in pregnancy. This was especially stressful, leaving women feeling fearful and sometimes blocking out emotions of love for their unborn child due to anticipating potential separation.

Some women have talked about how they are working until almost their due date and occasionally beyond. Although the prison system in England does have guidance with regards to maternity leave, women are concerned with regards to the reduction in pay once a woman is not able to work. The biology of the pregnant woman is different to women who are not pregnant. Feeling hungry, having cravings and feeling nauseous are all difficult to manage in prison. Pregnancy packs of extra food are available in some prisons but the quality varies. Women often rely on the support and kindness of other prisoners and staff in order to get extra provisions.

The UN Bangkok Rules on women prisoners give guidance on the treatment of pregnant women and mothers with young children, including that they should receive advice on health, diet and receive adequate and timely food. This is not about a pregnant woman receiving special treatment but about humanity and the rights that every pregnant woman is entitled to. Evidence from a number of research studies shows that stress has a direct effect on the unborn baby. This in turn leads to high cortisol levels crossing the placenta, potentially leading to behavioural problems as the child grows up. I would argue that it is essential to consider the effect that the deprivation of entitlements, leading to fear and stress in some women in prison, may have on the unborn baby.

Some women find the support, care and shelter of prison a safe place for them, away from abuse, violence and the cycle of addiction they may be experiencing. For these women, prison may offer a better experience than on the outside. However, more provisions need to be available outside of prison to prevent this revolving door. In Scotland, where small community units for women are an alternative to traditional prison, the results are already demonstrating a reduced reoffending rate. Reducing the revolving door effect will have an impact on society, economically and upon the women and her children.

During the lead-up to my time in the field, I trained as and volunteered with the charity Birth Companions (and continue to do so) which provides support for women who are pregnant in prison and those becoming mothers. The support is unconditional, non-judgemental and provided whether women are being separated from their babies or remaining with their child. Birth Companions led the development of the ‘Birth Charter’, which is a set of recommendations for the care of pregnant women and new mothers in prison, developed in consultation with service users and with guidance from the Royal College of Midwives and UNICEF UK Baby Friendly Initiative. The Birth Charter seeks to inform the Government’s review of the treatment of pregnant women in prison and their babies, and to improve current practice nationally.

The initial findings from my research echoes much of what Birth Companions have found over the years. Early outcomes demonstrate that there is a need for pregnant women in prison to feel less stressed and to have their pregnancy needs met regardless of their crime, and whether or not they are being separated from their babies or joining a Mother and Baby Unit. There are some examples of good practice in some of our prisons, such as one prison where women have 24-hour phone access to a midwife, food packs and pregnancy and early parenting groups run by charities. There are also examples of staff compassion and kindness, with some going out of their way to make women feel safe, secure and supported, especially when going on escort when a woman is in labour. Nevertheless, we do need consistency in all of our prisons and to benchmark the very best practice. The Birth Charter is an excellent place to start.

More information

• Birth Companions UK
• Born Inside Project
• For guidance on relevant provisions in the UN Bangkok Rules, see PRI’s Guidance Document, Chapter 8

Notes

Albertson, K., O’Keeffe, C., Burke, C., Lessing-Turner, G., & Renfrew, M. (2014). Addressing Health Inequalities for Mothers and Babies in Prison. Health and Inequality: Applying Public Health Research to Policy and Practice, 39.

Kennedy, A., Marshall, D., Parkinson, D., Delap, N., & Abbott, L. (2016). Birth Charter for women in prison in England and Wales.

O’Keefe, C., & Dixon, L. (2015). Enhancing Care for Childbearing Women and their Babies in Prison.

Photo: by Karla Nur, prisoners knitting baby clothes, Kazakhstan.