Late one night during my first months as a physician, I was helping a woman deliver her baby.  I was a first year resident in obstetrics and gynecology, training at a hospital in Pennsylvania. It was already a familiar scene to me: the mix of excited anticipation for the beautiful and messy arrival of new life, and of nervous anticipation for the possible complications which any doctor-in-training fears.  It was, by all accounts, a typical delivery room scene. Except by one account: the mother-to-be was shackled to the bed.

She was incarcerated at a nearby prison, and though I had no idea what alleged offense got her there, I had some idea that the pangs of labor and the numbing effects of her epidural seemed to override the need for any kind of restraints; how could she possibly flee in between painful contractions?  I watched the baby’s heart rate on the monitor dip with each contraction, hoping desperately the mother would push her little one out soon.  What if we needed to do an emergency cesarean section, I thought? How would we quickly transfer her from the labor room into the operating room with metal chains attaching her to the bed?  As it turns out, she did push her baby out, and we welcomed new life into the world. I handed mom her baby, which she cradled in her one unshackled arm.

That moment in the delivery room troubled me so deeply that it has started me on a path to caring for incarcerated women in California.  I now practice as an OB-Gyn at the San Francisco County Jail and at San Francisco General Hospital, the county hospital where jailed pregnant women deliver their babies.

Thankfully, despite working at the jail and delivering the babies of the women held there, I rarely have to attend to women in shackles anymore.  I have a weekly clinic at the jail where the women receive their prenatal care, uneventfully.  When they are transported to SF General to give birth, they are never shackled, and are never shackled during labor, delivery or during their post-partum recovery.  My colleagues and I have never felt threatened; after all, deputy sheriffs stand outside these women’s doors at all times.  And so I safely deliver their babies, place them on their mothers’ bellies, into the warmth of motherly arms—both arms. Just like all my patients. Why is this news? Because despite medical opinion and a 2005 law passed preventing the shackling of women in labor in CA, shackling pregnant women and women in labor is still common around the state.

AB1900, authored by Assemblymember Skinner, just passed the California State Senate unanimously, and is headed for the Governor’s desk.  This bill would ensure that incarcerated women around the state are afforded the same basic rights we give all women in San Francisco.  AB900 requires that pregnant inmates be restrained in the least restrictive way possible, consistent with the legitimate security needs of each inmate. 

Medical opinion supports this move: the American College of Obstetricians and Gynecologists (a sponsor of the bill) opposes the use of shackles on pregnant women in all but the most extreme circumstances, and earlier this year, the American Medical Association issued a resolution calling the practice barbaric and medically hazardous.   

Labor, we often say, is a retrospective diagnosis.  Because it is a process, we typically need information over time to tell if a woman is in active labor.  Nonetheless, many non-medical personnel—including some correctional officers I have spoken with– incorrectly presume labor to be the moment of delivery. Since the practice of shackling women during pregnancy is not banned, the de facto deciders of when labor begins are the people holding the keys: correctional officers.  The result is often women held too long, too often, and too late in highly restrictive and dangerous shackles.

Labor is not the only crucial moment.  Placing chains around a pregnant woman’s ankles, belly, or wrists is unsafe at any time.  The pregnant uterus shifts a woman’s center of gravity and obscures her full view of her feet.  Anything that throws her further off balance or makes walking more difficult—such as shackles—can increase her risk of falling, and make it harder to break her fall.  A fall in pregnancy is no small matter, as it can potentially harm the baby as well as the mother, and in serious cases, can cause stillbirth.

Some people may worry that these women could pose a danger—a flight risk, or a physical threat, or that they deserved to be punished. After all, they must have landed in jail for a reason, right?  Actually, 70 percent of women in California’s prisons are non-violent offenders. Most are fighting addiction, poverty, bad relationships, or depression, often precipitated by all of these things. Their focus during labor is the same as mothers outside of jail: giving birth and meeting their baby.

Let’s pass and enforce a law that protects the safety and dignity of these women at the time they need it the most, and enable each new mother in California to cradle her baby with both hands free.