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Pregnant in Prison? Some States Deliver Doulas

In a small but growing number of states, expectant inmates are getting help dealing with the trauma of giving birth and then having to say goodbye.

Serving time in prison is, obviously, unpleasant. But being pregnant behind bars is immeasurably more traumatic. While physical stress can take a toll, the emotional impact can be even worse. Many facilities use restraints during delivery, and in most cases female inmates are forced to say goodbye to their newborns shortly after giving birth.

But a couple of states are working to ease that trauma through an unconventional new approach: bringing in doulas to assist pregnant inmates. Unlike a midwife, who typically helps only during childbirth, a doula assists a woman throughout her entire pregnancy, attending to her physical and emotional well-being before, during and after giving birth.

Alabama this spring launched the Prison Birth Project, with the goal of assigning doulas to support about 30 female inmates in the first year. The effort was launched thanks to the help of Wendy D. Williams, the state’s first deputy commissioner for women’s services in the Department of Corrections. Williams’ position was created in response to a scathing report from the U.S. Department of Justice in 2014, which detailed deplorable conditions for inmates at Alabama’s Julia Tutwiler Prison for Women. That report highlighted a number of troubling prison practices, including systemic sexual abuse of inmates by guards as well as other prisoners. While Williams has been working to address that and other issues at the facility, the report also got her thinking about childbirth in prison, and the role that plays in determining a woman’s future once she leaves incarceration.

Williams turned to the Minnesota Prison Doula Project, which launched in 2011. That program currently serves women in 81 county jails and has supported around 100 incarcerated women over the past five years. It’s entirely voluntary. “Women will hear about another woman who got a doula during her pregnancy and will be interested and come to one of our support meetings,” says Erica Gerrity, the project’s program director. “This is one opportunity for women in these situations to feel empowered.”

The Minnesota project has seen impressive results, including a much higher rate of healthy pregnancies and healthy babies than average prison births. But for Gerrity, the most encouraging signs aren’t measurable. She points to one inmate who was terrified of speaking to child protective services but grew more confident after working with a doula. “A doula helps advocate on behalf of the woman, but we also give her language to advocate for herself,” Gerrity says.

Thanks in part to the success of the project, Minnesota passed a law in 2014 that bans shackling pregnant women in most instances and requires that pregnant inmates have mental health assessments. “We are starting a growing conversation” on issues surrounding health care for pregnant women who are incarcerated, says Rebecca Shlafer, an assistant professor of pediatrics at the University of Minnesota and the project’s research director.

It’s easy to villainize a pregnant woman who ends up in jail, says Ashley Lovell, the Alabama project’s executive director. But motherhood can help shape an inmate’s success in the future. If, despite her incarceration, “you can convince her she’s capable of being a good mother, you’re giving her tools to change the course of her life,” Lovell says.

In addition to Alabama, Minnesota has been contacted by 10 other states interested in implementing something similar. This is promising, Gerrity says, because there is currently a real dearth of research around the health of incarcerated women. “For women in this system,” she says, “this is beyond just crime. It’s about mental health, trauma and gender inequality. There has been so much progress around women’s issues, but none of it really touches on incarceration.” 

Mattie covers all things health for Governing.

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