Pregnant Behind Bars: The Prison Doula Project

Amie Newman

At least 7 percent of incarcerated women are pregnant when they are sent to prison, with little access to health care or pregnancy resources. A group of Washington state doulas are there for them though.

When I was six weeks pregnant with my first child, my husband and I took a tour of the birth center where I hoped to give birth. The staff laughed at us (six weeks pregnant?!) but took us on a thorough tour, gave us booklets of information and connected us with their "most popular" CNM (certified nurse midwife). I bought books on how to write the most perfect birth plan, what it takes to be a "hip" mama and grilled women on the rhapsody and disaster of their own birth stories. After the birth of my son, my mother and mother-in-law provided endless fountains of patience, love and understanding as I cried when my son wouldn't eat or fretted when he wouldn't sleep. With the birth of my second child, I was lucky enough to have a close friend – a midwife by trade – act as my doula during the labor and delivery. Tracy fed me strawberries in between contractions, placed my husband's hands gently on my back when I needed support, and facilitated effortlessly my last-minute decision to birth standing up.

These were the memories flooding my brain during my phone conversation with Christy Hall, co-founder and Development Coordinator for The Birth Attendants – a non-profit organization that runs The Prison Doula Project, providing incarcerated women in the Washington Correction Center for Women (WCCW) with desperately needed pregnancy, labor and post-partum doula services. Christy's stories of the incarcerated women for whom The Birth Attendants provide these services are depressing, inspiring and unendingly educational. Where pregnancy is a time to share excitement, anxiety, information and hopes for the future for many women, for imprisoned women it is most often isolating and terrifying with a disturbing lack of resources and information.

Christy, a 27 year-old mother of a now 11-month old daughter, helped found The Birth Attendants in December 2002 when a friend of hers, Joanna – then a student at Evergreen State College in Olympia, WA – was doing a report for a class. Joanna called a local prison to inquire about what services the prison provided for pregnant prisoners. It just so happened that the woman on the other end of the phone had recently given birth with the help of a doula who had made it a "wonderful, empowering experience" and asked if Joanna would act as a doula at the prison for some of the female prisoners. Immediately, Joanna put a call out to her community and The Birth Attendants was born.

My phone interview with Christy – as her young daughter, who clearly inherited her mother's strong and proud voice, assertively protested sleep in the background – follows:

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First of all, what is a doula?

A doula is a woman who provides physical, emotional and psychological support to pregnant women before, during and after the birth of the baby.

And can I just say that I think it's important to note that The Birth Attendants are a collective and we identify as a feminist, pro-choice, reproductive justice organization because of the nature of the work that we do and the population we serve.

You can say that! So, what do you hope to accomplish with The Prison Doula Project?

Our long-term vision is that all women have access to doula services. We are also really interested in helping other prison doula projects get started in other states. But in terms of what we hope to accomplish with the women we work with, we think that through having a supportive pregnancy and childbirth, by helping women have positive pregnancy experiences, we are also helping women to learn how to parent more successfully, how to find their own voice, how to be a positive force in the world. Most times it's really the first time that these women learn they have a voice and that people will listen to them. A large part of what we do is bear witness to these women's stories and we hope that their pregnancy and childbirth can be an empowering experience. The other part for us is that a lot of times, for many women, they become politically active as a result of personal experiences – they find their voice that way. The theory is that when you are able to understand your experience as part of a larger system, it can bring you to a certain level of political awareness. So we really provide the resources for people to have those empowering experiences that may lead to a sense of how your experience is connected with others – simple things like learning that you deserve more, that a positive birth experience is a human right for all women.

How are you received by the women in prison?

It tends to ebb and flow. A lot of times we have women that we've already worked with who are advocates for us on the inside. They'll tell other women, "You need to meet the doulas!" A lot of times those women will bring the new women to us. But sometimes when we're not there as often, there is a certain amount of explaining we need to do and sense of distrust among the women. Our doulas then will come in and define what a doula is and let them know, "We're here to provide you with resources because we understand the serious lack of resources available to you. If you have questions, come to a Friday discussion group. We're here to help you figure out what you want and help you get it." We say it over and over again with an emphasis on what the women want. We have no agenda. Some women say "I'm having an epidural and that's the end of the conversation." So we'll tell that woman that we want to figure out how she wants that to happen: "Alright. When do you want it? Do you have a childbirth plan? Do you know what a childbirth plan is? Let's talk to your doctor."

I have read that it is common for female prisoners to be shackled during childbirth. There are only two states that forbid the shackling of female prisoners during labor and delivery (California and Illinois). Have you seen that with the births you've attended and does Washington state have a similar law?

In Washington and Oregon there are not laws about women being shackled but the Department of Corrections (DOC) in both states have policies in place that allow for it. Oftentimes when you approach a legislator about creating a law that forbids this practice, they tell you that there is already a policy in place through the DOC that they feel good about – that the policy does that job that a law would do. But I've seen lots of women shackled during labor and deliver and ultimately it's up to the discretion of the officer present. I talked to a woman incarcerated in Oregon for eleven years and she told me she could tell me the names of plenty of women in Oregon that were shackled during childbirth as well. It's a huge issue that still needs to be dealt with. There aren't many women who would agree that it's an acceptable practice knowing what it's like to give birth. I believe The Rebecca Project for Human Rights is working on federal legislation that would do away with the piecemeal of state legislation on this issue. [Editor's Note: The Rebecca Project is working with Senators Richard Durbin (D-IL) and Tom Coburn (R-OK) to end the practice of shackling and restraining pregnant women, especially during labor and delivery, in all state and federal correctional facilities.]

How does labor and deliver for an incarcerated woman differ from that for a woman "on the outside"?

A lot of the issues that are the general issues for pregnant women are magnified in prison. For instance, which provider will you choose for pregnancy and childbirth? In prison, you don't get to choose your provider – not being able to choose who attends your birth is a big deal. Up until recently, in the prison we work in, there was only a male doctor available for labor and delivery. But for many women in prison – a huge number of whom have experienced sexual and domestic violence – having a male provider between your legs is not exactly ideal. Another issue is lack of informed consent – the lack of information and resources around having a healthy pregnancy for these women is huge. They just aren't given any information on pregnancy, their health, their bodies. The lack of access to proper nutrition during pregnancy is a big problem – the pregnant women in the prison we work with get "extra canteen" which means they get like an extra pack of Fritos. Also, the lack of access to health care in prison means that, in general, a health issue is not dealt with until it turns into a huge problem. It's a high-risk population anyway because, for the most part, these women lacked proper health care before coming to prison and being pregnant in prison doesn't change that. Also, there is a much higher rate of cesarean sections for women in prison as compared to women on the outside – mostly for the convenience of medical and prison staff.

What does the post-partum doula support you provide look like?

We go to the prison once a week and facilitate a two-hour class that women can attend both before and after they've given birth. But we do "one-on-ones" as well – pre-natal visits and post-partum support. We have provided some women with post partum support for a long time after they've given birth. As long as they keep asking we'll work with them – whether it's on custody issues with children or navigating the complex web you find yourself in once you've given birth in prison. And as I mentioned earlier, the importance of bearing witness to a woman's struggle to maintain a relationship with her kids, to help them figure out how best to go about that, how to stay in contact, acknowledging that they are having an emotional experience. You meet so many strong women but they stifle their feelings because there is no way or room to process them but it's essential to process all of what they are going through.

Do you connect the women with other resources once they give birth?

Yes, in so far as there are resources that exist. A lot of the resources are just addresses and phone numbers for treatment centers for when they get out. Sadly, there is a ridiculous lack of resources for keeping families together after a woman has a child in jail. There is a woman in Alabama, an incredible woman, who provides resources for women parenting from prisons – she helps bring kids in to the prisons. Her program picks up kids from foster care families or grandparents homes and brings them to visit their mothers. It's an amazing amount of work though and I kind of wish every prison had an organization to service it like hers. But, aside from that, there are very few resources for women wishing to keep their families together after they've given birth in prison.

Why do you do it?

I'm glad you asked me. I get asked that a lot and people tell me how amazing it is that I do this for the women.

But the truth is I get a lot out of it. I feel deeply inspired by the women. It amazes me what human beings go through and yet still remain warm and amazing. At the end of the day the gift to me is that I get to know a lot of people that most people never get the chance to know. I get to be with them at the most important time in their lives. It's why I'm a doula. You end up being a very important person to them. And their stories so desperately need to be told.

When I speak on a panel or at a conference, people ask – what can we do to address the harm that's being done to these women? There are a million different organizations you can join or give money to. My answer? Find a way to go inside. If you find a way to go inside and get to know these women you'll never stop going inside and you'll find your own way to make an impact. It hurts in a lot of ways but you'll find that you just can't let people stay inside and not go in to help them.

For more on The Birth Attendants:

Lockdown on Life: Stories from Women Behind Bars, a program of the National Radio Project.

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

Commentary Sexuality

Black Trans Liberation Tuesday Must Become an Annual Observance

Raquel Willis

As long as trans people—many of them Black trans women—continue to be murdered, there will be a need to commemorate their lives, work to prevent more deaths, and uplift Black trans activism.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

This week marks one year since Black transgender activists in the United States organized Black Trans Liberation Tuesday. Held on Tuesday, August 25, the national day of action publicized Black trans experiences and memorialized 18 trans women, predominantly trans women of color, who had been murdered by this time last year.

In conjunction with the Black Lives Matter network, the effort built upon an earlier Trans Liberation Tuesday observance created by Bay Area organizations TGI Justice Project and Taja’s Coalition to recognize the fatal stabbing of 36-year-old trans Latina woman Taja DeJesus in February 2015.

Black Trans Liberation Tuesday should become an annual observance because transphobic violence and discrimination aren’t going to dissipate with one-off occurrences. I propose that Black Trans Liberation Tuesday fall on the fourth Tuesday of August to coincide with the first observance and also the August 24 birthday of the late Black trans activist Marsha P. Johnson.

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There is a continuing need to pay specific attention to Black transgender issues, and the larger Black community must be pushed to stand in solidarity with us. Last year, Black trans activists, the Black Lives Matter network, and GetEQUAL collaborated on a blueprint of what collective support looks like, discussions that led to Black Trans Liberation Tuesday.

“Patrisse Cullors [a co-founder of Black Lives Matter] had been in talks on ways to support Black trans women who had been organizing around various murders,” said Black Lives Matter Organizing Coordinator Elle Hearns of Washington, D.C. “At that time, Black trans folks had been experiencing erasure from the movement and a lack of support from cis people that we’d been in solidarity with who hadn’t reciprocated that support.”

This erasure speaks to a long history of Black LGBTQ activism going underrecognized in both the civil rights and early LGBTQ liberation movements. Many civil rights leaders bought into the idea that influential Black gay activist Bayard Rustin was unfit to be a leader simply because he had relationships with men, though he organized the 1963 March on Washington for Jobs and Freedom. Johnson, who is often credited with kicking off the 1969 Stonewall riots with other trans and gender-nonconforming people of color, fought tirelessly for LGBTQ rights. She and other trans activists of color lived in poverty and danger (Johnson was found dead under suspicious circumstances in July 1992), while the white mainstream gay elite were able to demand acceptance from society. Just last year, Stonewall, a movie chronicling the riots, was released with a whitewashed retelling that centered a white, cisgender gay male protagonist.

The Black Lives Matter network has made an intentional effort to avoid the pitfalls of those earlier movements.

“Our movement has been intersectional in ways that help all people gain liberation whether they see it or not. It became a major element of the network vision and how it was seeing itself in the Black liberation movement,” Hearns said. “There was no way to discuss police brutality without discussing structural violence affecting Black lives, in general”—and that includes Black trans lives.

Despite a greater mainstream visibility for LGBTQ issues in general, Black LGBTQ issues have not taken the forefront in Black freedom struggles. When a Black cisgender heterosexual man is killed, his name trends on social media feeds and is in the headlines, but Black trans women don’t see the same importance placed on their lives.

According to a 2015 report by the Anti-Violence Project, a group dedicated to ending anti-LGBTQ and HIV-affected community violence, trans women of color account for 54 percent of all anti-LGBTQ homicides. Despite increased awareness, with at least 20 transgender people murdered since the beginning of this year, it seems things haven’t really changed at all since Black Trans Liberation Tuesday.

“There are many issues at hand when talking about Black trans issues, particularly in the South. There’s a lack of infrastructure and support in the nonprofit sector, but also within health care and other systems. Staffs at LGBTQ organizations are underfunded when it comes to explicitly reaching the trans community,” said Micky Bradford, the Atlanta-based regional organizer for TLC@SONG. “The space between towns can harbor isolation from each other, making it more difficult to build up community organizing, coalitions, and culture.”

The marginalization that Black trans people face comes from both the broader society and the Black community. Fighting white supremacy is a full-time job, and some activists within the Black Lives Matter movement see homophobia and transphobia as muddying the fight for Black liberation.

“I think we have a very special relationship with gender and gender violence to all Black people,” said Aaryn Lang, a New York City-based Black trans activist. “There’s a special type of trauma that Black people inflict on Black trans people because of how strict the box of gender and space of gender expression has been to move in for Black people. In the future of the movement, I see more people trusting that trans folks have a vision that’s as diverse as blackness is.”

But even within that diversity, Black trans people are often overlooked in movement spaces due to anti-Blackness in mainstream LGBTQ circles and transphobia in Black circles. Further, many Black trans people aren’t in the position to put energy into movement work because they are simply trying to survive and find basic resources. This can create a disconnect between various sections of the Black trans community.

Janetta Johnson, executive director of TGI Justice Project in San Francisco, thinks the solution is twofold: increased Black trans involvement and leadership in activism spaces, and more facilitated conversations between Black cis and trans people.

“I think a certain part of the transgender community kind of blocks all of this stuff out. We are saying we need you to come through this process and see how we can create strength in numbers. We need to bring in other trans people not involved in the movement,” she said. “We need to create a space where we can share views and strategies and experiences.”

Those conversations must be an ongoing process until the killings of Black trans women like Rae’Lynn Thomas, Dee Whigham, and Skye Mockabee stop.

“As we commemorate this year, we remember who and why we organized Black Trans Liberation Tuesday last year. It’s important we realize that Black trans lives are still being affected in ways that everyday people don’t realize,” Hearns said. “We must understand why movements exist and why people take extreme action to continuously interrupt the system that will gladly forget them.”


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