Listen to Pamela White's interview on KGNU about this story by clicking here.
Tammy White lies back on the examination table and lifts her green smock and gold T-shirt to reveal a bulging belly. She is expecting her fifth child. The mother of three boys and one girl ranging in age from 9 to 19, she’ll give birth to this baby — a girl — sometime around May 23.
Pam Spry, a certified nurse midwife, measures White’s uterus by stretching a measuring tape from her pubic bone to her fundus — the top of her uterus — and finds that the baby’s growth is right where it should be for a fetus at 21 weeks and three days of gestation.
It’s good news, but not a surprise. White already had an ultrasound, as well as an alpha-fetoprotein test, and both tests showed that her baby is developing normally despite the fact that White, 36, is considered to be at higher risk for fetal defects because of her age.
Spry chats with White about how she’s feeling. The two listen to the baby’s heartbeat using a handheld Doppler ultrasound device, the steady rhythm making White smile.
Then her smile fades. She slowly sits up, pulls her shirt back into place, fiddles with the identification band on her wrist, clearly not anxious to get back to her unit.
“I just hope I’m out before I deliver,” she says. “I pray to God every night.”
White is pregnant, but she’s also in prison.
In the state’s hands
It didn’t have to be this way.
Arrested for possession of a controlled substance — a class 6 felony — White was originally sentenced to a year’s probation. She ended up in prison after blowing off her initial meeting with her probation officer.
“I thought I’d get away with reporting a week late,” she says.
The judge wasn’t impressed with that excuse and sentenced her to one year in prison.
“If I could do it again, I’d report on time,” she says.
White is one of 50 to 60 women who will give birth this year while in the custody of the Colorado Department of Corrections (DOC). Incarcerated at Denver Women’s Correctional Facility (DWCF), inmates arrive pregnant, their well-being and that of their unborn babies the responsibility of the state.
It’s not an ideal situation for anyone — certainly not for the inmates, who must endure the uncertainty and discomfort of pregnancy and childbirth in a world of cold steel, strip searches and strangers. Neither is it ideal for prison officials or correctional staff, who must meet the challenges of supervising offenders with special medical and emotional needs, as well as behavioral problems.
DWCF, which opened in 1998, was designed to address the special needs of female offenders, including pregnancy. The original program design was written by Dr. Mary West, who was a psychologist and who had extensive experience with corrections, both in Colorado and other states.
“She had a vision of what she thought we needed to be doing differently with offenders,” says Joanie Shoemaker, a registered nurse who once served as warden at DWCF and contributed to its design. Shoemaker is now the deputy director of corrections. “The concept plan for Denver Women’s was that it was supposed to be the high-needs, high-custody offenders for the department. We knew from inception that we would most likely have the pregnant women. By keeping them all in one facility, we could access some services like [Spry, the nurse midwife] to be doing prenatal services on site.”
There are advantages of doing prenatal care on site rather than transporting inmates to facilities outside the prison. DOC saves money and staff time, while also sparing offenders the humiliation of being brought, pregnant, wearing a prison uniform and in restraints, into a public area.
It’s clear that Spry, who has been a midwife for 43 years, has a rapport with the offenders. Having worked as a labor and delivery nurse for a time — many states didn’t allow for the practice of nurse-midwifery when she first graduated with her advanced nursing degree — she also cared for women at inner-city clinics in Detroit.
On the faculty of the University of Colorado’s Anschutz Medical Campus, Spry is contracted out to DOC, which pays on a per diem basis for her time. She provides all of the prenatal care inmates receive here, referring those with high-risk conditions — gestational diabetes, twins, high blood pressure — to DOC’s infirmary, where they can receive more intense medical supervision.
Inmates are transferred to Denver Health for labor and birth.
“The reason I love working here is that this is a vulnerable population that has high educational needs,” she says. “Basically, no one has paid much attention to them.”
As a result, caring for pregnant inmates means dealing with the range of health needs they present at the time they’re put in prison. Many have had no prenatal care, which statistically puts them and their babies at greater risk. Compared to the general population, they’re more likely to have serious health problems like hepatitis C from injection drug use, mental health issues from past physical and sexual abuse, and bad dental health from methamphetamine use.
A whopping 40 percent of female prison inmates have problems with mental illness, and many also suffer from drug or alcohol addiction, their attempt to self-medicate.
For Spry, helping inmates to connect with their own bodies is paramount. Many come from highly dysfunctional backgrounds and have never had that chance. If they can connect with their own bodies, perhaps they’ll learn to take care of themselves.
“These women want to learn,” she says.
Spry shows White a book of fetal photos, pointing out one showing a fetus at the same gestational stage as White’s, and helps her track the baby’s growth on a chart that she developed and printed for inmates. Then Spry asks her how this pregnancy compares to her other four.
“If it weren’t for my children, I could sit here forever,” White jokes.
She says she misses her children, and she hasn’t been able to communicate with her family since coming to prison. Her sons are living with her ex-husband, while her daughter is in her sister’s care.
But there’s more.
“I can’t eat as much food as I’d like,” she says, laughing.
From Spry’s point of view, that’s not necessarily a bad thing. If White weren’t gaining the right amount of weight or had other health problems, like anemia, Spry could order extra snacks, such as yogurt, for her to eat. But White’s pregnancy is on track, and additional calories might result in unnecessary weight gain.
Despite opportunities for exercise, including a gym, weight gain in prison can be a problem.
“The number of calories is excessive,” Spry says. “I just shudder whenever I see what they eat — Ramen noodles, white bread, white rice, potatoes.”
In addition, inmates with money in their inmate accounts — money they’ve earned or that relatives have deposited — can buy junk food from the commissary.
But White has only 58 cents on her “books,” as the accounts are called. No junk food for her.
“I love people with no money on their books,” Spry says, suggesting that White use her 58 cents to buy a stamp so she can send a letter to her kids.
Then the joking ends.
“If I have to deliver [before I get out], I think I’m going to give the baby up for adoption,” White says, looking down at the floor. “A mother is supposed to bond with her baby, and if I can’t bond with her …”
She doesn’t finish that sentence.
‘A restricted environment’
“The prenatal care we offer here is the standard of care they would get on the outside,” Spry says.
The same tests that a pregnant woman would receive on the outside — ultrasounds, blood work and tests to check for fetal abnormalities — are available to pregnant women in prison.
But there are differences. First off, there’s the food.
DWCF feeds offenders a six-week rotating menu that provides 2,500 calories a day.
“They’ve done a lot of work adding more fresh fruit and vegetables, and not just with the women but department-wide,” says Shoemaker, the deputy director of corrections. “Part of the reason the calories are high is that that’s what it takes to meet the recommended daily allowances of nutrients. When I started talking with our dieticians about it, I was shocked. But that is part of the challenge that they have. And we do have to operate within the dollars we’re allocated.”
But there are other differences as well. Spry has to supply breast pads — made to absorb milk that leaks from the breasts of lactating women — on her own. Otherwise, the pads are not available, leaving women who’ve just delivered leaking onto their clothes and bedding.
Further, pregnant inmates are expected to work and aren’t excused from their classes or prison jobs unless there’s a bona fide medical reason.
But the biggest difference might be in the area of simple comforts.
“There’s really not a lot of access to alternative comfort measures that women on the outside would have,” Spry says. “Extra pillows, extra blankets, extra mattresses are just not available.”
Often, inmates ask for things they want but don’t need. Their interaction with Spry is different from their interaction with prison staff, and they sometimes see her as the means to getting things they otherwise couldn’t have. This occasionally leads to problems.
“I think that the most conflict that there is [for me] is that women see me as their access to comfort, and I see myself as access to health care,” she says.
Shoemaker says that under certain medical circumstances, prison staff might supply an inmate with an extra pillow or two. But most women who develop medical complications are sent to the infirmary, she says.
“As clinical staff, there are times we would order something specific like that, and it would be provided by the department,” Shoemaker says. “Yes, it is a restricted environment, and we typically issue a certain number of pillows and a certain number of mattresses, but the woman who’s really having a difficult time — we’re all going to know that and we’re going to find a way to manage it.”
And then there’s the issue of reproductive freedom. State law prohibits the use of government money for abortions. So, although women in prison can opt to have an abortion, the fact that they must pay the wages of the guards who accompany them and the cost of transportation to and from the clinic, in addition to the expense of the abortion itself, means that few actually have that option. More often than not, being pregnant in prison means carrying a pregnancy to term, even if the fetus is fatally deformed.
But many female inmates come from such deprived and violent backgrounds that being in prison can be a good thing — especially if they’re pregnant.
“There truly is a positive aspect to it,” Spry says. “It’s much easier to stay clean here. They can’t drink, smoke or use drugs. They’re fed, clothed, given prenatal care and shelter here. There are no violent boyfriends to beat them up.”
Many are so poor that they never had access to regular health care until they were sent to prison.
“It’s the one population in the United States that has guaranteed health care,” Spry says. “It’s sad that you have to be in prison to get guaranteed health care.”
Spry has heard inmates say that they were grateful that they’d been arrested because it forced them to quit using drugs and gave them a chance to change their lives.
Veronica Rodriguez, 33, is 30 weeks and five days pregnant with a girl. She has a 12-year-old daughter and a 5-year-old son who live with her mother.
Rodriguez has been battling drug addiction for a long time. When she was pregnant with her first daughter, she used drugs both early and late in the pregnancy, something she says she couldn’t imagine doing now. Because of her drug problem, and her time in and out of the correctional system, she has had little to do with her kids, and her mother, who has custody, won’t allow her to spend time with them, a factor in her continued problems with addiction.
“I think, ‘What’s the use of me trying to do something different?’” she says.
But this time will be different. Rather than giving her new baby to her mother to raise, she’s signed up for the New Horizons program. Her baby will be cared for by a family of Mennonites, who will bring the infant in for visits and help Rodriguez stay connected with the child until she’s released from prison and ready to shoulder the responsibility of motherhood herself.
“I’ve given birth to my two kids, but I’ve never raised them, so I’m really looking forward to this,” she says, rubbing a hand over her swollen belly.
During her visit with Spry, she listens to her baby’s heartbeat, looks at fetal photographs and charts her baby’s growth.
“This baby is starting to kick a lot,” she tells Spry.
“They have a whole active life in there,” Spry says. “Do you read to her?”
“I talk to her,” Rodriguez answers. “I don’t read to her.”
Spry then asks Rodriguez to describe her baby’s personality. This makes Rodriguez smile.
“She’s stubborn — with a sense of humor,” Rodriguez says, describing the baby’s penchant for kicking when her mother wants to sleep.
When asked how this pregnancy compares with her other two, Rodriguez says this one is much better. For one thing, she’s never had prenatal care before. But also she feels very conscious of the baby growing inside her.
“When I was pregnant with my other two children, I allowed myself to be a part of too many dangerous things,” she says. “Here, it’s just me and my baby. I’m just so attached to her.”
And then the tears flow.
Rodriguez can’t imagine having to give up her baby after its birth, but it’s something she has to face. After the baby is born, Rodriguez will spend a couple of hours holding her, and then the baby will be taken from her. Rodriguez will then be locked in a special ward of Denver Health, then brought back to prison the next day.
Because she’s signed up for the New Horizons program, she’ll be able to see her baby once in a while, something that gives her hope.
“That’s the saddest part,” Spry says, handing Rodriguez a tissue. “In prison there’s a conflict over a woman’s desire for the pregnancy to end and knowing they won’t be with the baby.”
Most women feel anxiety over labor and birth. It’s one of the most amazing and also most overwhelming times in a woman’s life. Typically, women worry about the pain of labor. They worry about possible complications and the health of their babies.
In prison, they worry about all of these things, too.
But they also worry about being shackled during labor.
Six states in the United States have laws banning the use of restraints on women in labor. Illinois, New Mexico, New York, California, Texas and Vermont expressly forbid the practice. California’s law came about after a couple of high-profile lawsuits in which the use of restraints was found to have prolonged women’s labor and caused pain and humiliation. Other states and the District of Columbia have correctional policies that restrict shackling of pregnant and laboring women to varying degrees. In Oregon, for example, shackles are not used on laboring inmates unless requested by the attending physician.
The Federal Bureau of Prisons, which sets policy for all federal penitentiaries, has recently banned the use of restraints on laboring inmates, as well as the use of belly shackles. The U.S. Marshal Service recently changed its policy to follow suit.
And this past October, in Nelson v. Norris, a case out of Arkansas, the U.S. Court of Appeals for the Eight Circuit ruled that shackling an inmate in labor constitutes a violation of the 8th Amendment, which prohibits “cruel and unusual punishments.”
Past lawsuits have ruled that prolonging a woman’s labor qualifies as causing “bodily harm” because of the extreme pain involved.
Despite this, Colorado still permits the shackling of inmates in labor under the pretext of “security.”
Shoemaker says DOC does not permit the use of leg restraints on women late in pregnancy, and that in cases where a woman’s pregnant belly is too large, the use of a belly belt may also be waived. But during transport to and from medical facilities and while in the hospital, official DOC policy requires that women be kept within sight or sound of an armed guard and that they remain shackled to the hospital bed by one extremity.
“I’m sure you can’t imagine that someone would walk out in the middle of labor, but there are actually documented cases where that has happened,” Shoemaker says, though she later clarifyies that none of those were Colorado DOC cases. “We are responsible to keep in custody the offenders we are supposed to keep.”
Shoemaker says DOC officers are instructed to work with the medical staff and that Colorado has not had any “bad outcomes” from its use of restraints in labor. If the medical staff wanted the inmate to get out of bed and walk, she would still have to be cuffed by the wrist but could move about her room, she says.
But pressure is mounting across the nation to end this practice, and it has support not only from high levels of the criminal justice system but also from human-rights groups like Amnesty International and the medical community. What correction officials see as their duty to public safety, others view as the thoughtless application of prison rules to a medical environment.
The American College of Obstetricians and Gynecologists (ACOG) declared that “the practice of shackling an incarcerated woman in labor may not only compromise her health care but is demeaning and unnecessary” and that it puts “the health and lives of the women and their unborn children at risk.”
“Most women in correctional facilities are incarcerated for non-violent crimes and are accompanied by guards when they are in a medical facility,” states Dr. Ralph Hale, executive vice president of ACOG, in a letter dated June 12, 2007. “Testimonials from incarcerated women who went through labor with shackles confirm the emotional distress and physical pain caused by restraints. Women describe the inability to move to allay the pains of labor, the bruising caused by chain belts across the abdomen and the deeply felt loss of dignity.”
Hale’s letter goes on to state that banning restraints on women in labor has not led to escapes or violence against medical staff.
“This safety track record demonstrates the feasibility of preserving the dignity and providing compassionate care of incarcerated laboring women,” he writes.
At the moment, however, DOC is not reconsidering its policy, and no legislative efforts to change the policy are under way, though Shoemaker has heard discussions about the issue at both the state and national levels.
Of course, there’s DOC’s official policy, and there’s practice. Whether or not a DOC inmate is placed in restraints, and for how long, seems to depend on which officer guards her in the hospital and which nurses are on duty.
Stephanie Teague, 23, gave birth to her first baby, a seven-pound, 15-ounce boy, on Jan. 7. Arrested after she and her brother attempted to take a drunken joyride in someone else’s brand new convertible sports car, she became pregnant while in community corrections after having consensual sex with a man she said was a DOC employee. (The employee was reportedly fired.) When her pregnancy revealed that she’d broken the rules of community corrections by having sex, she was sent to prison.
During labor, Teague was transported to Denver Health in wrist restraints, but once she was in a hospital bed, the guard, a woman, removed her restraints.
“She said she’d given birth and she knew I wouldn’t be running anywhere,” Teague says.
At the change of shifts, a male guard came on duty and would have put her in restraints, but the nurse wouldn’t allow it, she says.
Inmate Nicole Smith, 23, gave birth to her third baby on Feb. 1. Smith, who is serving a sentence on drug charges, says she was kept in restraints for a short period of time.
“The only point I was shackled was during shift change,” she says in a written response delivered to Boulder Weekly by DOC staff. “Then it was up to the officers to decide if I needed it or not. After I got my epidural, they left it off until after delivery.”
When asked about this discrepancy between practice and policy, Shoemaker said that correctional officers try to be sensitive to some of the special nuances of labor and childbirth — such as an inmate’s desire for privacy during the birth — and that custody staff are “good at making sound decisions.”
Though most incarcerated women in Colorado are in DWCF, some are serving time or awaiting sentencing in county jails, and each jurisdiction seems to have its own policy. While DOC is free to change its policy without the state legislature’s involvement, legislation would be necessary if the shackling of laboring women is to be eliminated across the state.
William Lovingier, director of corrections and undersheriff for the Denver Sheriff’s Department, says pregnant inmates in labor are not placed in restraints during transport to the hospital because pregnant women often have problems balancing. Once they arrive at the hospital, however, they are restrained by a long chain and attached to the bed by one ankle. The long chain, or “long lead,” is long enough to allow them to get up and walk around the room, he says. Lovingier says the restraint is removed when the inmate is taken to the delivery room and then put back on when the delivery is finished.
Division Chief Larry Hank of the Boulder County Jail knows of two women who went into labor while in custody at the jail. Hank says inmates are transported to the hospital in wrist cuffs, but that they follow the lead of the medical team once they reach the hospital.
“They’re going to have IVs. They’re going to have other stuff going on. Trying to shackle someone to a bed during labor just doesn’t seem to be common sense at all,” Hank says.
“During labor we’re going to do the reasonable thing with the medical advice that we get.”
After the birth, however, the inmate will likely be placed in some kind of restraints, particularly if she’s a flight risk, he says.
Shoemaker says DOC tries to be as progressive as it can be with regard to its treatment of inmates. The vulnerability of pregnant inmates is something of which she and others at DOC are acutely aware. So although DOC isn’t considering changing its policy regarding the use of restraints on laboring women, that’s not to say that it won’t take up the issue.
“I’m not involved currently in any discussions about that, but that doesn’t mean that isn’t going to happen in the future,” Shoemaker says.