Analysis Law and Policy

Murder by Nursing?

Emily Horowitz

Stephanie Greene is being charged with murder. Her crime? Breastfeeding her newborn.

Stephanie Greene is being charged with murder. Her crime? Breastfeeding her newborn.

The unexpected death of a 5 ½ – week-old infant is a mind-numbing tragedy. Facing murder charges in the face of that death is an inconceivable horror. Yet this is happening to Stephanie Greene, 37, a woman currently facing homicide by child abuse charges.

Stephanie lives in Campobello, South Carolina. Prosecutors allege that Stephanie took so much prescription medication that her daughter Alexis died of a morphine overdose ingested via breast milk. The coroner’s report shows the cause of death as drug overdose, because the infant had an elevated blood level of morphine. The case is complicated; because there is no question that Stephanie takes a significant amount of prescription medication for documented physical ailments (i.e. fibromyalgia, chronic pain, high blood pressure) resulting from a near-fatal car accident a few years ago, including MS Contin (a drug that metabolizes as morphine).

In the hospital, Stephanie did not reveal that she was taking any medications at all, even though she was asked multiple times by multiple people. Stephanie was sheepish when asked about this. Stephanie says she knew that her medication use would open her up to suspicion. South Carolina is the state, after all, notorious for shackling new mothers to their hospital beds if they (or their infants) tested positive for illegal drugs – and removing infants to foster care and the mothers to jail. Although the Supreme Court ruled this practice illegal, Stephanie had been a nurse in South Carolina long enough to know she was in a state where mothers and pregnant women who use or abuse drugs are viewed with special contempt.

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Stephanie was aware that her use of strong opioids (especially morphine) would raise suspicion. South Carolina has aggressively (and, according to legal advocates, illegally) prosecuted women who unintentionally miscarry a fetus after illegal drug use. Although the state has come under fire from advocates for these racist (although Stephanie is white, almost all the women convicted of this charge have been African-American and poor) and problematic policies, a woman like Stephanie knew it was not a good idea to openly discuss her painkiller use while in the hospital.

Stephanie’s lawyer, C. Rauch Wise (known as “Rock”), a noted local defense attorney, has represented a number of women facing similar charges, although he is unaware of others charged with homicide by child abuse as a result of breastfeeding. “What’s scary to me,” Rock explains, “is that the state thinks enough of a drug can be distributed through breast milk to kill a baby.” Wise says that South Carolina takes advantage of their Whitner decision, a ruling that allows the state to use child neglect and homicide laws to punish pregnant women who use drugs. Organizations like National Advocates for Pregnant Women (NAPW), a group devoted to defending the civil and human rights of pregnant women, recognizes the peculiar harshness of South Carolina, noting that: “Every state court of last resort and all intermediate appellate courts that have addressed this issue have rejected the approach taken by the South Carolina Supreme Court in the Whitner case.”

Wise views Stephanie’s case as something even more ominous than Whitner, and thinks if Stephanie goes to prison, women will be scared to breastfeed and will think they have the power to kill their infants – a power that is a point of significant scientific debate and controversy.

After arriving home, Stephanie says a lactation consultant from the hospital called to see how she was doing with her breastfeeding. Stephanie revealed her medications to the consultant – including the MS Contin. The consultant referred her to a website run by NIH with a comprehensive list of drugs and their compatibility with breastfeeding. The consultant told Stephanie she got all of her information from the site, and Stephanie accessed it and found the that morphine is relatively safe for nursing mothers, with breast milk levels ranging from “trivial” to “quite low.”

After being discharged from the hospital, nothing unusual was noted by the doctors or nurses, nor was anything unusual noted with either Stephanie or Alexis during their 4-week pediatric visit or by a visit to a pediatric ophthalmologist (recommended because of an eye cyst). In the days just before Alexis died, she had a cold and stuffy nose. Stephanie called the pediatrician who told her to use a vaporizer and vapor rub to help the baby breathe (which Stephanie did), which she did, but to only bring her to the office if fever was present (which Stephanie didn’t, because it wasn’t).

Stephanie spent all her time with newborn Alexis, caring for her like any new mother, and family photos show her older siblings and extended family doting on the new baby. Randy, Stephanie’s husband, strongly asserts that he would have noticed if Stephanie was under the influence or impaired in any way, and Homer, Stephanie’s father, stopped by the house almost every day after Alexis was born, and he too forcefully says that Stephanie was doing all she possibly could for the new baby and was not neglectful in any way.

At 12:30am, on November 13, 2010, Alexis awoke and Stephanie fed her – and then fell back to sleep next to Stephanie and Randy in bed. At 3:30am, Randy awoke and noticed something was wrong with the baby (“she felt cold,” he says). Stephanie realized Alexis was not breathing, and immediately began infant CPR. Randy called 911 and paramedics arrived, but they were unable to resuscitate Alexis and she was pronounced dead.

Stephanie doesn’t remember what happened next. The coroner says he has a video of Stephanie when he arrived at the house that same morning where she appears “under the influence”. Another report claims that Stephanie smoked when they arrived and appeared unconcerned. Stephanie and Randy say none of this is true, except for the fact that she was smoking (she and Randy are both smokers). Obviously, they were in shock, and it seems pointless and cruel to critique the behavior of any parents in the hours after learning of the death of a child.

Stephanie and Randy tried to move on with their lives and mourn Alexis. They were totally shocked when on June 7, 2011, 9 months after Alexis died, Stephanie was arrested. Initial reports say Stephanie used fraudulent prescriptions morphine and was “doctor-shopping.” National and international outlets picked up the story about the “morphine mom” who nursed her baby to death.

A spokesperson for the county sheriff, Tony Ivey, was quoted in these reports saying that that toxicology proves that the infant died directly from medication ingested from Stephanie’s breast milk, and that Stephanie is fully responsible for the death of the infant, noting “Taking care of children and raising children is very serious business, and if you’re taking medication or whatever, follow the doctor’s guidelines, consult your doctor, because this is something that should never have happened to an infant child like that. It had no control over this whatsoever and the mother should’ve known better.”

In spite of what Ivey says, official records show that Stephanie was taking medication prescribed by the same doctors she had seen regularly over the past few years for her various ailments, and that she received all her prescriptions from the same pharmacy. Her doctors continued to prescribe medication after the death of Alexis and only stopped following Stephanie’s arrest.

In a similar Canadian case, a woman was charged with murder after her baby allegedly died after ingesting morphine-tainted breast milk. It turned out the woman was a “rapid metabolizer” of morphine, and extremely high levels of morphine were transferred to her breast milk. In that case, the woman was prescribed morphine for postpartum pain, and doctors regularly prescribe morphine to postpartum women because of its relative safety and few side effects. The La Leche League has even issued a statement saying that morphine is safe to take while nursing.

Did Stephanie try to hurt her baby? No. Was Stephanie neglectful because she breastfed her infant while taking prescription drugs? No. Any mother will tell you that breastfeeding can be more difficult than formula feeding. Mothers who can’t nurse for physical reasons often suffer tremendous guilt – particularly when they see research about the often-hyped benefits of breastfeeding.

The notion that one would nurse a baby to death makes as much sense as cuddling or snuggling someone to death. Stephanie nursed her baby out of love and affection, and this is not something that can be questioned – by definition, nursing can never be an act of violence or harm.

After 4 weeks in jail, Stephanie was released on a $100,000 bond in July 2011. Stephanie was under house arrest and had to wear a 24-hour-monitoring bracelet for 6 months. The family struggled to pay the $136.50 weekly fees for the bracelet. Stephanie was relived when it was finally removed on January 20, but she still can’t be alone with her 3 minor children (ages 5, 12, and 14). Her attorney is baffled by the extreme restrictions, noting that Stephanie is clearly not a flight risk because she has lived her entire life in the area, has 4 other children, and put the home of her mother-in-law up for her bond.

Why prosecute Stephanie? Breastfeeding while taking medication is almost always safe. There is little funding for research about the safety of medication and breastfeeding, and women are mostly left on their own to learn about what medications are compatible with breastfeeding. It is an open secret, now documented widely on websites and blogs, that doctors will recommend weaning and will always say medications are unsafe for breastfeeding to avoid lawsuits.

Dr. Sears, a Harvard-trained expert on child health, advises that there are risks involved with weaning and exclusive formula-feeding that can be as significant as the effects of medication transmitted via breast milk. He notes that physicians often advise women to wean when they aren’t sure about the effects of medication in breast milk, and that it is “impossible” for physicians to always keep up with the latest research about drugs in breast milk. He writes: “The risks of exposing a baby to a drug in breast milk should be weighed against the known risks of exposing a baby to infant formula while depriving him of breast milk…. Be aware that often what a mother is told about taking a medication about breastfeeding is based more on legal considerations than scientific knowledge. The information available from pharmaceutical companies about a drug…. often advises mothers not to breastfeed while taking a drug, but this advice reflects the company’s desire to protect itself from lawsuits and to avoid having to do expensive research that would allow it to say a certain drug is safe.” Women know not to ask their doctors if they should breastfeed if they are taking medication, because they know the answer – so they don’t ask.

When every single drug has a warning that breastfeeding mothers should consult their physician before ingesting, it numbs women to the reality that some drugs might actually be harmful to their babies. Add to that a medical profession that puts forth contradictory messages about breastfeeding, and with a legitimate paranoia about lawsuits, and women are not going to feel comfortable being honest with their healthcare providers about their medication. Further, when mothers read about the myriad benefits of breastfeeding, many desperately want to breastfeed at any cost (for example, in a recent Harper’s article, the French feminist Elizabeth Badinter points out that there are actually dangers to the extreme hype about breastfeeding, and argues that the interpretations of the existing studies about the benefits of breastfeeding are often exaggerated. Badinter notes that women who don’t breastfeed are now considered “bad” mothers – and there is little or no hype about the many alternate studies that show that formula-feeding does not necessarily doom a child to disease, a low IQ, and psychological disorders).

Dr. Steven Karch, an expert witness for the defense, is a leading expert in the field of drug related death and author of the authoritative textbook in the field, Karch’s Pathology of Drug Abuse. Karch believes that that there is no chance that a baby can die from morphine absorbed solely through breast-milk when the mother does not have a genetic defect.  Stephanie took morphine for many years and it is highly unlikely that she has this defect because she always tolerated morphine without a problem. According to Dr. Karch this genetic defect is exceedingly rare (and requires an expensive and difficult test), so it is still routinely prescribed for nursing mothers.

Most significantly, the coroner’s office says that Alexis had levels of morphine that exceeded 500 ng/ML. This is absurd, says Dr. Karch, and there is “zero possibility” that Alexis could have morphine levels this high after ingesting breastmilk from a mother taking any amount of prescribed morphine. By contrast, the infant in the Canadian case had levels of only 70 ng/ML. In the latest version of his textbook, Karch explains that it one cannot determine breast milk drug transmission without testing the mother’s milk, writing, “the only really accurate way to measure breast milk drug transmission is to collect the entire volume of milk from both breasts over 24 hours, then measure both the volume of milk and the amount of drug contained in it. This is difficult to do, and has not been done either for morphine or heroin in humans. However, when studies have been done on other drugs, such as prednisolone, fentanyl, and propofol and, more recently hydrocodone and hydromorphone, the amount of drug actually transmitted has been such a small percentage of the amount given to the mother that most experts see little need to discontinue breast feeding (normally, a nursing mother having elective surgery is advised to discard her milk for 24 hours).” According to Karch, in order to establish that drug-tainted breast-milk is the cause of infant death, one has to test the breast-milk from the mother and not only the blood levels of the infant – something that did not happen in Stephanie’s case.

In California, a woman is currently facing manslaughter charges for breastfeeding after taking methamphetamine, and women have been prosecuted for the same crime since the early 1990s. Dr. Karch points out that the science behind these cases is also flimsy, noting methamphetamine has been used for many years as a treatment for various conditions, including narcolepsy, and earlier research saw limited negative effects in nursing infants. He explains that infants absorb drugs in different ways than adults, and that drugs needs to bind to certain receptors in order to bind and do damage. “Babies,” says Dr. Karch, “don’t have a lot of those receptors, and newborns therefore don’t have even places for drugs to bind.” In most of the other documented cases of breastfeeding-related deaths, women plead guilty to lesser charges so they didn’t have to face trial. In one case, a breastfeeding infant was found to have a tiny amount (.266 micrograms) of methamphetamine in her blood, and the coroner concluded that the infant died of methamphetamine poisoning. The mother pled guilty to child endangerment and spent six years in prison, even though the coroner admitted that they weren’t sure what exact amount of methamphetamine could cause an infant death.

Why are women being prosecuted for murdering infants via breastfeeding when the science is so questionable? Clearly, prosecutors are deciding that women who use drugs are easy targets for public outrage and deserve punishment. On some level, it doesn’t matter if the drugs actually caused the death in the eyes of the prosecution. The idea of a mother taking drugs and breastfeeding causes outrage, and if a baby with a drug-using mother dies this only increases moral panic and demands for justice.

Are women who use drugs and get pregnant and/or breastfeed criminals? While the medical community overwhelmingly sees drug addiction as a public health problem, our social welfare system contradicts this when they seek to punish or intervene in punitive ways when pregnant and breastfeeding women use drugs. These policies, that appear well meaning and obvious – after all, no one thinks it is good if a pregnant or nursing mother abuses drugs – effectively and subtly undermine efforts to promote public health and welfare and, in turn, expand the war on drugs and abortion rights. Women can’t be prosecuted for having abortions or seeking birth control, but they can be punished for behaviors that supposedly end pregnancies or harm newborns – even though there is little scientific basis behind these charges. As NAPW points out, the women who are most harmed by these laws are overwhelming poor and lack access to health care and drug treatment. NAPW lawyers argue that are actually no laws that authorize prosecuting pregnant or nursing women for drug use, yet they are continuing to happen –and this is what needs to be questioned and challenged by lawyers, advocates for women’s rights, and well as the public health community.

In 1998, an impoverished woman named Tina Rodriguez was convicted in Texas for intentionally killing her son by starvation. The baby had milk in his stomach when he died, something that doesn’t happen when someone is starved, and she breastfed him (and bottle-fed) him regularly, but nevertheless Rodriguez was convicted of murder. Her post-conviction lawyer presented testimony of a nutrition specialist and a pediatric expert in malnutrition who studied the autopsy report and concluded that he may have died from a rare genetic defect that prevented him from metabolizing the milk he drank. Rodriguez lost her appeal and, despite reasonable doubts, and is serving 38 years in a Texas prison, in spite of substantial scientific evidence that she did nothing wrong.

Why is so easy to believe that women like Tina Rodriquez and Stephanie Greene want to harm their babies by neglect or intention? The moral panic about adults deliberately harming children in their care is an unfortunate reality of modern times. From hysteria about sex rings at day care centers to myths about poisoned Halloween candy, our culture is transfixed and obsessed with the idea that adults want to deliberately harm children. Adults in playgrounds without children are breaking the law, as are parents who allow their children to ride bikes without helmets. If a child is hurt in a playground, it is because their parents weren’t watching them and they should be arrested or because the playground equipment is dangerous and the designers should be sued. It is not possible that sometimes kids get hurt when they play – that is what scares us. The police state we live in makes everything a crime, especially when children are harmed. An adult must have caused this – accidents don’t happen in a society where everyone is either a victim or a perpetrator.

Mothers like Stephanie Greene and Tina Rodriguez are easy targets in this social context, because they make us feel good about ourselves. Her baby dies, but it couldn’t happen to us because we are different – we would never breastfeed after taking morphine and we would notice if our baby wasn’t metabolizing milk properly. It is too horrible to think that babies die for no reason, or that we can’t always protect our children, or that parents make mistakes. We are scared to allow our children to walk to school even in the “safest” suburbs or ride bikes without helmets – if we can afford it, we send our children to private schools when we live in neighborhoods with the very best public to have more control over their lives. Children in poor neighborhoods are on the path to being criminals, because their poverty itself is a crime, so we justify searching them with metal detectors when they go to school. If they die, we jump to their defense and arrest the parents, but, if they live, we treat them like potential criminals in the same way that we treat their parents like potential criminals. In Florida, the recent effort to drug test adults who receive welfare benefits because they are getting money from taxpayers highlights our contempt, distrust, and hatred of the poor.

If a healthy infant dies, there must be a reason – and the reason must someone who is different than us. Stephanie Greene is a monster, mocked on websites “Bad Breeders,” a place where horrible parents (mostly poor and drug-addicted) are ridiculed and targeted.

Medical associations and drug companies don’t establish hard and solid rules about pregnancy and breastfeeding and drug use because the science just isn’t there. Smoking and alcohol can contribute to miscarriages and hurt babies, and there are numerous public awareness campaigns preaching the negative effects of these behaviors, yet women still smoke and drink while pregnant and while nursing –women are not prosecuted for these behaviors. NAPW also points out that women who use drugs and pregnant and breastfeed are not being punished for using drugs but are actually being punished for being pregnant and not terminating the pregnancy. If they used drugs and terminated the pregnancy, there would not be a prosecution – the state is thus prosecuting women for being pregnant or nursing, and not for using drugs, and this is unlawful because it is essentially punishing women for having babies in spite of having a drug or health problem (like Stephanie).

Making efforts to prosecute women for killing their infants with tainted breast milk is similar to the crack-baby hysteria. In the 1980s, the media reported an epidemic of birth defects and brain damage resulting from pregnant women using crack. Yet, in 2005, University of Florida researchers Dr. Fonda Eyler, PhD, a developmental psychologist, and Dr. Marylou Behnke, MD, a neonatologist found that babies exposed to cocaine during pregnancy were no more likely to have birth defects than other babies. Interestingly, the mothers in the study were offered help but few accepted because of a state policy that often removed children from mothers in drug rehab centers. It is policies like these that discourage drug treatment and increase the likelihood that women with drug problems won’t seek help.

The effort to prosecute Stephanie Greene is a witch-hunt. Stephanie breastfed because she believed she was doing the best for her baby, and because she depended on prescribed medication to manage her medically-documented chronic pain. Women who use illegal drugs are not much different – they are drug-dependent but they want to love and nurse their infants.  The idea of a drug using pregnant or breastfeeding mother is shocking and upsetting, but there isn’t enough scientific evidence that it is the sole or primary cause of infant.  Women who use drugs and are pregnant or nursing need help and objective sources of information – not prison. Women have legal and civil rights even if they get pregnant and nurse babies, these cases violate their constitutional rights because they are not about drug use but about pregnancy. Pregnant and nursing women have human rights, and punishing their behaviors puts them in a special category that violates the reality that we all have equal protection under the law. Stephanie Greene might have been dependent on prescription drugs, but she didn’t kill her baby.

Stephanie and Randy and the rest of their family are still mourning the loss of their baby. They also have to prepare for an expensive legal battle as well as the nightmare of waiting for a criminal trial that could result in a prison sentence. After Alexis died they put up a memorial webpage for her, and Stephanie posted this on the day of her funeral: “Lexi was born “sunny side up”, and she was so sunny, such a good baby, such an angel in life, really the sunshine of our lives. We miss her beyond words…”

Analysis Politics

The 2016 Republican Platform Is Riddled With Conservative Abortion Myths

Ally Boguhn

Anti-choice activists and leaders have embraced the Republican platform, which relies on a series of falsehoods about reproductive health care.

Republicans voted to ratify their 2016 platform this week, codifying what many deem one of the most extreme platforms ever accepted by the party.

“Platforms are traditionally written by and for the party faithful and largely ignored by everyone else,” wrote the New York Times‘ editorial board Monday. “But this year, the Republicans are putting out an agenda that demands notice.”

“It is as though, rather than trying to reconcile Mr. Trump’s heretical views with conservative orthodoxy, the writers of the platform simply opted to go with the most extreme version of every position,” it continued. “Tailored to Mr. Trump’s impulsive bluster, this document lays bare just how much the G.O.P. is driven by a regressive, extremist inner core.”

Tucked away in the 66-page document accepted by Republicans as their official guide to “the Party’s principles and policies” are countless resolutions that seem to back up the Times‘ assertion that the platform is “the most extreme” ever put forth by the party, including: rolling back marriage equalitydeclaring pornography a “public health crisis”; and codifying the Hyde Amendment to permanently block federal funding for abortion.

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Anti-choice activists and leaders have embraced the platform, which the Susan B. Anthony List deemed the “Most Pro-life Platform Ever” in a press release upon the GOP’s Monday vote at the convention. “The Republican platform has always been strong when it comes to protecting unborn children, their mothers, and the conscience rights of pro-life Americans,” said the organization’s president, Marjorie Dannenfelser, in a statement. “The platform ratified today takes that stand from good to great.”  

Operation Rescue, an organization known for its radical tactics and links to violence, similarly declared the platform a “victory,” noting its inclusion of so-called personhood language, which could ban abortion and many forms of contraception. “We are celebrating today on the streets of Cleveland. We got everything we have asked for in the party platform,” said Troy Newman, president of Operation Rescue, in a statement posted to the group’s website.

But what stands out most in the Republicans’ document is the series of falsehoods and myths relied upon to push their conservative agenda. Here are just a few of the most egregious pieces of misinformation about abortion to be found within the pages of the 2016 platform:

Myth #1: Planned Parenthood Profits From Fetal Tissue Donations

Featured in multiple sections of the Republican platform is the tired and repeatedly debunked claim that Planned Parenthood profits from fetal tissue donations. In the subsection on “protecting human life,” the platform says:

We oppose the use of public funds to perform or promote abortion or to fund organizations, like Planned Parenthood, so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare. We urge all states and Congress to make it a crime to acquire, transfer, or sell fetal tissues from elective abortions for research, and we call on Congress to enact a ban on any sale of fetal body parts. In the meantime, we call on Congress to ban the practice of misleading women on so-called fetal harvesting consent forms, a fact revealed by a 2015 investigation. We will not fund or subsidize healthcare that includes abortion coverage.

Later in the document, under a section titled “Preserving Medicare and Medicaid,” the platform again asserts that abortion providers are selling “the body parts of aborted children”—presumably again referring to the controversy surrounding Planned Parenthood:

We respect the states’ authority and flexibility to exclude abortion providers from federal programs such as Medicaid and other healthcare and family planning programs so long as they continue to perform or refer for elective abortions or sell the body parts of aborted children.

The platform appears to reference the widely discredited videos produced by anti-choice organization Center for Medical Progress (CMP) as part of its smear campaign against Planned Parenthood. The videos were deceptively edited, as Rewire has extensively reported. CMP’s leader David Daleiden is currently under federal indictment for tampering with government documents in connection with obtaining the footage. Republicans have nonetheless steadfastly clung to the group’s claims in an effort to block access to reproductive health care.

Since CMP began releasing its videos last year, 13 state and three congressional inquiries into allegations based on the videos have turned up no evidence of wrongdoing on behalf of Planned Parenthood.

Dawn Laguens, executive vice president of Planned Parenthood Action Fund—which has endorsed Hillary Clinton—called the Republicans’ inclusion of CMP’s allegation in their platform “despicable” in a statement to the Huffington Post. “This isn’t just an attack on Planned Parenthood health centers,” said Laguens. “It’s an attack on the millions of patients who rely on Planned Parenthood each year for basic health care. It’s an attack on the brave doctors and nurses who have been facing down violent rhetoric and threats just to provide people with cancer screenings, birth control, and well-woman exams.”

Myth #2: The Supreme Court Struck Down “Commonsense” Laws About “Basic Health and Safety” in Whole Woman’s Health v. Hellerstedt

In the section focusing on the party’s opposition to abortion, the GOP’s platform also reaffirms their commitment to targeted regulation of abortion providers (TRAP) laws. According to the platform:

We salute the many states that now protect women and girls through laws requiring informed consent, parental consent, waiting periods, and clinic regulation. We condemn the Supreme Court’s activist decision in Whole Woman’s Health v. Hellerstedt striking down commonsense Texas laws providing for basic health and safety standards in abortion clinics.

The idea that TRAP laws, such as those struck down by the recent Supreme Court decision in Whole Woman’s Health, are solely for protecting women and keeping them safe is just as common among conservatives as it is false. However, as Rewire explained when Paul Ryan agreed with a nearly identical claim last week about Texas’ clinic regulations, “the provisions of the law in question were not about keeping anybody safe”:

As Justice Stephen Breyer noted in the opinion declaring them unconstitutional, “When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

All the provisions actually did, according to Breyer on behalf of the Court majority, was put “a substantial obstacle in the path of women seeking a previability abortion,” and “constitute an undue burden on abortion access.”

Myth #3: 20-Week Abortion Bans Are Justified By “Current Medical Research” Suggesting That Is When a Fetus Can Feel Pain

The platform went on to point to Republicans’ Pain-Capable Unborn Child Protection Act, a piece of anti-choice legislation already passed in several states that, if approved in Congress, would create a federal ban on abortion after 20 weeks based on junk science claiming fetuses can feel pain at that point in pregnancy:

Over a dozen states have passed Pain-Capable Unborn Child Protection Acts prohibiting abortion after twenty weeks, the point at which current medical research shows that unborn babies can feel excruciating pain during abortions, and we call on Congress to enact the federal version.

Major medical groups and experts, however, agree that a fetus has not developed to the point where it can feel pain until the third trimester. According to a 2013 letter from the American Congress of Obstetricians and Gynecologists, “A rigorous 2005 scientific review of evidence published in the Journal of the American Medical Association (JAMA) concluded that fetal perception of pain is unlikely before the third trimester,” which begins around the 28th week of pregnancy. A 2010 review of the scientific evidence on the issue conducted by the British Royal College of Obstetricians and Gynaecologists similarly found “that the fetus cannot experience pain in any sense prior” to 24 weeks’ gestation.

Doctors who testify otherwise often have a history of anti-choice activism. For example, a letter read aloud during a debate over West Virginia’s ultimately failed 20-week abortion ban was drafted by Dr. Byron Calhoun, who was caught lying about the number of abortion-related complications he saw in Charleston.

Myth #4: Abortion “Endangers the Health and Well-being of Women”

In an apparent effort to criticize the Affordable Care Act for promoting “the notion of abortion as healthcare,” the platform baselessly claimed that abortion “endangers the health and well-being” of those who receive care:

Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.

Scientific evidence overwhelmingly supports the conclusion that abortion is safe. Research shows that a first-trimester abortion carries less than 0.05 percent risk of major complications, according to the Guttmacher Institute, and “pose[s] virtually no long-term risk of problems such as infertility, ectopic pregnancy, spontaneous abortion (miscarriage) or birth defect, and little or no risk of preterm or low-birth-weight deliveries.”

There is similarly no evidence to back up the GOP’s claim that abortion endangers the well-being of women. A 2008 study from the American Psychological Association’s Task Force on Mental Health and Abortion, an expansive analysis on current research regarding the issue, found that while those who have an abortion may experience a variety of feelings, “no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.”

As is the case for many of the anti-abortion myths perpetuated within the platform, many of the so-called experts who claim there is a link between abortion and mental illness are discredited anti-choice activists.

Myth #5: Mifepristone, a Drug Used for Medical Abortions, Is “Dangerous”

Both anti-choice activists and conservative Republicans have been vocal opponents of the Food and Drug Administration (FDA’s) March update to the regulations for mifepristone, a drug also known as Mifeprex and RU-486 that is used in medication abortions. However, in this year’s platform, the GOP goes a step further to claim that both the drug and its general approval by the FDA are “dangerous”:

We believe the FDA’s approval of Mifeprex, a dangerous abortifacient formerly known as RU-486, threatens women’s health, as does the agency’s endorsement of over-the-counter sales of powerful contraceptives without a physician’s recommendation. We support cutting federal and state funding for entities that endanger women’s health by performing abortions in a manner inconsistent with federal or state law.

Studies, however, have overwhelmingly found mifepristone to be safe. In fact, the Association of Reproductive Health Professionals says mifepristone “is safer than acetaminophen,” aspirin, and Viagra. When the FDA conducted a 2011 post-market study of those who have used the drug since it was approved by the agency, they found that more than 1.5 million women in the U.S. had used it to end a pregnancy, only 2,200 of whom had experienced an “adverse event” after.

The platform also appears to reference the FDA’s approval of making emergency contraception such as Plan B available over the counter, claiming that it too is a threat to women’s health. However, studies show that emergency contraception is safe and effective at preventing pregnancy. According to the World Health Organization, side effects are “uncommon and generally mild.”

Analysis Maternity and Birthing

Pregnant Women Are Being Shackled in Massachusetts—Even Though It’s Been Illegal for Years

Victoria Law

According to a new report, not a single jail or prison facility in the state has written policies that are fully compliant with the law against restraining pregnant women behind bars.

Korianne Gamble was six months pregnant in November 2014 when she arrived at the Bristol County Sheriff’s Office Women’s Center, a jail in North Dartmouth, Massachusetts. Six months prior, the state had passed “An Act to Prevent Shackling and Promote Safe Pregnancies for Female Inmates.”

According to the new law, the jail should have been prohibited from using any type of restraint on Gamble during labor, and using of leg and waist restraints on her during and immediately after her pregnancy. It also guaranteed her minimum standards of pregnancy care and required—as with everyone incarcerated while in their second or third trimesters—that she be transported in the jail’s vehicles with seat belts whenever she was taken to court, medical appointments, or anywhere outside the jail.

But that wasn’t the case for Gamble. Instead, she says, when it came time for her to give birth, she was left to labor in a cell for eight hours before finally being handcuffed, placed in the back of a police cruiser without a seatbelt, and driven to a hospital, where she was shackled to the bed with a leg iron after delivering.

According to a new report, Gamble isn’t alone. Advocates have been monitoring pregnancy-related care since the law’s passage. After obtaining and analyzing the policies of the state’s prison and jail system, they found that no facility has policies that are fully compliant with the 2014 law. They issued their findings in a new report, Breaking Promises: Violations of the Massachusetts Pregnancy Standards and Anti-Shackling Lawco-authored by Marianne Bullock of the Prison Birth Project, Lauren Petit of Prisoners’ Legal Services of Massachusetts, and Rachel Roth, a reproductive-justice expert.

In addition to analyzing policies, they spoke with women who were pregnant while in custody and learned that women continue to be handcuffed during labor, restrained to the bed postpartum, and placed in full restraints—including leg irons and waist chains—after giving birth.

“The promise to respect the human rights of pregnant women in prison and jail has been broken,” the report’s authors concluded.

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Medical experts, including the American Congress of Obstetricians and Gynecologists, the American Medical Association and the American College of Nurse-Midwives, have all agreed that shackling during pregnancy is unnecessary, inhumane, and dangerous. Shackling increases the risk of falling and injury to both mother and fetus while also preventing medical staff from assessing and assisting during labor and delivery. In 2014, both the Massachusetts legislature and then-Gov. Deval Patrick (D) agreed, passing the law against it.

“The Massachusetts law is part of a national trend and is one of the most comprehensive in protecting pregnant and postpartum women from the risks of restraints,” said Roth in an interview with Rewire. “However, like most other states, the Massachusetts law doesn’t have any oversight built in. This report clearly shows the need for staff training and enforcement so that women who are incarcerated will be treated the way the legislature intended.”

Gamble learned all of this firsthand. In the month before her arrest, Gamble had undergone a cervical cerclage, in which a doctor temporarily stitches up the cervix to prevent premature labor. She had weekly visits to a gynecologist to monitor the development of her fetus. The cerclage was scheduled to be removed at 37 weeks. But then she was arrested and sent to jail.

Gamble told jail medical staff that hers was a high-risk pregnancy, that she had had a cerclage, and that her first child had been born six weeks prematurely. Still, she says she waited two months before seeing an obstetrician.

As her due date drew closer, the doctor, concerned about the lack of amniotic fluid, scheduled Gamble for an induction on Feb. 19, 2015. But, she says, jail staff cancelled her induction without telling her why.

That same evening, around 5 p.m., Gamble went into labor. Jail staff took her to the medical unit. There, according to Gamble, the jail’s nurses took her blood pressure and did a quick exam, but did not send her to the hospital. “They [the nurses] thought I was ‘acting up’ because my induction was canceled,” she told Rewire.

She was placed in a see-through cell where, as the hours progressed, her labor pains grew worse. “I kept calling to get the [correctional officers] to get the nurse,” Gamble recalled. By the time a nurse came, Gamble was bleeding. “The nurse made me pull down my pants to show her the blood—in front of a male [correctional officer]!” Gamble stated. Still, she says, no one called for an ambulance or made arrangements to drive her to the hospital.

At 1:45 in the morning, over eight hours after she first went into labor, the jail’s captain learned that Gamble was in labor. “[He] must have heard all the commotion, and he called to find out what was going on,” she said. He ordered his staff to call an ambulance and bring her to the hospital.

But instead of calling an ambulance, Gamble says jail staff handcuffed her, placed her in the back of a police cruiser without a seatbelt—in violation of the law—and drove her to Charlton Memorial Hospital. “My body was already starting to push the baby out,” she said. She recalled that the officers driving the car worried that they would have to pull over and she would give birth by the side of the road.

Gamble made it to the hospital, but just barely. Nine minutes after arriving, she gave birth: “I didn’t even make it to Labor and Delivery,” she remembered.

But her ordeal wasn’t over. Gamble’s mother, who had contacted Prisoners’ Legal Services and Prison Birth Project weeks earlier, knew that the law prohibited postpartum restraints. So did Gamble, who had received a packet in jail outlining the law and her rights from Prisoners’ Legal Services. When an officer approached her bed with a leg iron and chain, she told him that, by law, she should not be restrained and asked him to call the jail to confirm. He called, then told her that she was indeed supposed to be shackled. Gamble says she spent the night with her left leg shackled to the bed.

When the female officer working the morning shift arrived, she was outraged. “Why is she shackled to the bed?” Gamble recalled the officer demanding. “Every day in roll call they go over the fact that a pregnant woman is not to be shackled to anything after having a baby.” The officer removed the restraint, allowing Gamble to move around.

According to advocates, it’s not unusual for staff at the same jail to have different understandings of the law. For Gamble, that meant that when the shift changed, so did her ability to move. When the morning shift was over, she says, the next officer once again shackled Gamble’s leg to the bed. “I was so tired, I just went along with it,” Gamble recounted.

Two days after she had given birth, it was time for Gamble to return to the jail. Despite Massachusetts’ prohibition on leg and waist restraints for women postpartum, Gamble says she was fully shackled. That meant handcuffs around her wrists, leg irons around her ankles, a chain around her waist,g and a black box that pulled her handcuffs tightly to the waist chain. That was how she endured the 20-minute drive back to the jail.

Gamble’s jail records do not discuss restraints. According to Petit, who reviewed the records, that’s not unusual. “Because correctional officers don’t see it as out of the ordinary to [shackle], they do not record it,” she explained. “It’s not so much a misapplication of the extraordinary circumstances requirement as failure to apply it at all, whether because they don’t know or they intentionally ignore it.”

While Bristol County Sheriff’s Office Women’s Center’s policies ban shackling during labor, they currently do not prohibit restraints during postpartum recovery in the hospital or on the drive back to the jail. They also do not ban leg and waist restraints during pregnancy. Jonathan Darling, the public information officer for the Bristol County Sheriff’s Office, told Rewire that the jail is currently reviewing and updating policies to reflect the 2014 law. Meanwhile, administrators provide updates and new information about policy and law changes at its daily roll call. For staff not present during roll call, the jail makes these updates, including hospital details, available on its east post. (Roll call announcements are not available to the public.)

“Part of the problem is the difference in interpretation between us and the jurisdictions, particularly in postpartum coverage,” explained Petit to Rewire. Massachusetts has 14 county jails, but only four (and the state prison at Framingham) hold women awaiting trial. As Breaking Promises noted: “Whether or not counties incarcerate women in their jails, every county sheriff is, at minimum, responsible for driving women who were arrested in their county to court and medical appointments. Because of this responsibility, they are all required to have a written policy that spells out how employees should comply with the 2014 law’s restrictions on the use of restraints.”

Four jurisdictions, including the state Department of Correction, have policies that expressly prohibit leg and waist restraints during the postpartum period, but limit that postpartum period to the time before a woman is taken from the hospital back to the jail or prison, rather than the medical standard of six weeks following birth. Jails in 11 other counties, however, have written policies that violate the prohibition on leg and waist shackles during pregnancy, and the postpartum prohibition on restraints when being driven back to the jail or prison.

Even institutions with policies that correctly reflected the law in this regard sometimes failed to follow them: Advocates found that in some counties, women reported being restrained to the bed after giving birth in conflict with the jail’s own policies.

“When the nurse left, the officer stood up and said that since I was not confirmed to be in ‘active labor,’ she would need to restrain me and that she was sorry, but those were the rules,” one woman reported, even though the law prohibits restraining women in any stage of labor.

But shackling pregnant women during and after labor is only one part of the law that falls short. The law requires that pregnant women be provided with regular prenatal and postpartum medical care, including periodic monitoring and evaluation; a diet with the nutrients necessary to maintain a healthy pregnancy; written information about prenatal nutrition; appropriate clothing; and a postpartum screening for depression. Long waits before transporting women in labor to the hospital are another recurring complaint. So are routinely being given meals without fruits and vegetables, not receiving a postpartum obstetrician visit, and waiting long stretches for postpartum care.

That was also the case with Gamble. It was the middle of the night one week after her son’s birth when Gamble felt as if a rock was coming through her brain. That was all she remembered. One hour later, she woke to find herself back at the hospital, this time in the Critical Care Unit, where staff told her she had suffered a seizure. She later learned that her cellmate, a certified nursing assistant, immediately got help when Gamble’s seizure began. (The cell doors at the jail are not locked.)

Hospital staff told her that she had preeclampsia, a pregnancy complication characterized by high blood pressure. Postpartum preeclampsia is rare, but can occur when a woman has high blood pressure and excess protein in her urine soon after childbirth. She was prescribed medications for preeclampsia; she never had another seizure, but continued to suffer multiple headaches each day.

Dr. Carolyn Sufrin is an assistant professor of gynecology and obstetrics at Johns Hopkins Medicine. She has also provided pregnancy-related care for women at the San Francisco County Jail. “Preeclampsia is a leading cause of maternal mortality,” she told Rewire. Delayed preeclampsia, or postpartum preeclampsia, which develops within one to two weeks after labor and delivery, is a very rare condition. The patient suffering seizures as a result of the postpartum preeclampsia is even more rare.

Postpartum preeclampsia not only needs to be treated immediately, Sufrin said, but follow-up care within a week at most is urgent. If no follow-up is provided, the patient risks having uncontrolled high blood pressure, stroke, and heart failure. Another risk, though much rarer, is the development of abnormal kidney functions.

While Sufrin has never had to treat postpartum preeclampsia in a jail setting, she stated that “the protocol if someone needs obstetrical follow-up, is to give them that follow-up. Follow through. Have continuity with the hospital. Follow their instructions.”

But that didn’t happen for Gamble, who was scheduled for a two-week follow-up visit. She says she was not brought to that appointment. It was only two months later that she finally saw a doctor, shortly before she was paroled.

As they gathered stories like Gamble’s and information for their report, advocates with the Prison Birth Project and Prisoners’ Legal Services of Massachusetts met with Rep. Kay Khan (D-Newton), to bring her attention to the lack of compliance by both county jails and the state prison system. In June 2015, Khan introduced An Act to Ensure Compliance With the Anti-Shackling Law for Pregnant Incarcerated Women (Bill H 3679) to address the concerns raised by both organizations.

The act defines the postpartum period in which a woman cannot be restrained as six weeks. It also requires annual staff trainings about the law and that, if restraints are used, that the jail or prison administration report it to the Secretary of Public Safety and Security within 48 hours. To monitor compliance, the act also includes the requirement that an annual report about all use of restraints be made to the legislature; the report will be public record. Like other statutes and bills across the country, the act does not have specific penalties for noncompliance.

In December 2015, Gamble’s son was 9 months old and Gamble had been out of jail for several months. Nonetheless, both Gamble and her mother drove to Boston to testify at a Public Safety Committee hearing, urging them to pass the bill. “I am angered, appalled, and saddened that they shackled her,” Gamble’s mother told legislators. “What my daughter faced is cruel and unusual punishment. It endangered my daughter’s life, as well as her baby.”

Since then, both the Public Safety Committee and Health Care Financing Committee approved the bill. It is now before the House Committee for Bills in the Third Reading, which means it is now at the stage where it can be taken up by the House for a vote.

Though she has left the jail behind, Gamble wants to ensure that the law is followed. “Because of the pain I went through, I don’t ever want anyone to go through what I did,” she explained to Rewire. “Even though you’re in jail and you’re being punished, you still have rights. You’re a human being.”