Maternal and neonatal outcomes among incarcerated women who gave birth in custody

Characteristics and Outcomes of Women and Infants Who Received Prenatal Care While Incarcerated in Arkansas State Prison System, 2014-2019

BACKGROUND

Prisons face challenges in meeting the unique health care needs of women, especially those who are pregnant. This retrospective chart review sought to describe the maternal and infant health outcomes of incarcerated women who received prenatal care while in an Arkansas prison.

METHODS

Using a hospital-based electronic medical records (EMR) system, we examined the maternal health history and current pregnancy characteristics of 219 pregnant women who received prenatal care while incarcerated from June 2014 to May 2019. We also examined labor and delivery characteristics and postpartum and infant birth outcomes for the 146 women from this cohort who delivered a living child while still incarcerated.

RESULTS

Most records indicated complex health histories with several chronic illnesses, mental health diagnoses, history of substance use, and lifetime medical complications. Despite comorbid illness, substance use disorder (SUD), trauma-history, and post-traumatic stress disorder (PTSD) prevalence was lower than expected. Previous and current obstetrical complications were common. Although the Neonatal Intensive Care Unit (NICU) admission rate (41%) was high, few infants required extensive treatment intervention. Postpartum complications were rare; however, a small portion of women who gave birth in custody experienced severe complications and were re-admitted to the hospital post-discharge.

CONCLUSIONS

Incarcerated pregnant women and their infants are a marginalized population in great need of health care advocacy. To optimize maternal-infant outcomes, carceral agencies must recognize the health needs of incarcerated pregnant women and provide appropriate prenatal care. Expansion of carceral perinatal care to include screening for SUD and psychiatric symptoms (e.g., PTSD) and referral to appropriate care is highly encouraged. Policies related to NICU admission for non-medical reasons should be further examined.

Custodial and perinatal care patterns of women who received prenatal care while incarcerated in the Arkansas state prison system, 2014-2019

BACKGROUND

The extraordinary growth in women's incarceration over the past several decades has resulted in calls for expansion of research into their unique needs and experiences, including those related to pregnancy and perinatal care. However, while research into the health outcomes of women who are incarcerated while pregnant has grown, research on women's custodial and perinatal care patterns has remained nearly non-existent. Here, we sought to describe (1) the characteristics of the population of women who came to be incarcerated in a state prison system during pregnancy and (2) the characteristics of women's custodial and perinatal care patterns during and after incarceration.

METHODS

We conducted a retrospective chart review of the population of women who received perinatal care while incarcerated in the Arkansas state prison system over a 5-year period from June 2014 to May 2019. Electronic medical records and state prison records were merged to form our study population. Data were from 212 women (Mage = 28.4 years; 75.0% non-Latina White) with a singleton pregnancy who received at least one obstetric care visit while incarcerated.

RESULTS

Drug-related convictions were the most common crimes leading to women's incarceration while pregnant, and violent crime convictions were rare. Nearly half (43.4%) of women who gave birth in custody did so within 90 days of admission and the great majority (80.4%) released within 1-year of giving birth, including 13.3% who released within 30 days.

DISCUSSION

The frequency with which women who became incarcerated while pregnant released from prison either prior to or shortly after giving birth was a striking, novel finding of this study given the implications for perinatal care disruption among a high-risk population and the harms of forced separation from infants within hours of birth.

CONCLUSIONS

Diversionary programs for pregnant women convicted of crimes, particularly in states without current access, are urgently needed and should be a priority for future policy work.

Reproductive health care for incarcerated women in the prenatal and postpartum periods

In 1976, the Supreme Court mandated that incarcerated individuals have a constitutional right to receive medical care; however, there are no mandatory standards so access to and quality of reproductive health care for incarcerated pregnant women varies widely across facilities. Without federal or state standards, there is variability in the type of prenatal care pregnant women receive, their birthing experience, how long they are able to stay with their infant after birth, and whether they are permitted to breastfeed or express milk. In this column, I review policies related to reproductive health care in carceral settings, the gaps in data collection and research, programs to support the needs of incarcerated pregnant women, and recommendations from professional organizations on reproductive health care for incarcerated women in the prenatal and postpartum periods.

Addressing health disparities in the criminal legal system: Translational benefits, challenges, and facilitators of impactful research with incarcerated pregnant women

This in-depth analysis illuminates a translational journey of a community-university research collaboration that examined health disparities among incarcerated pregnant women and spanned the translational spectrum, with the initial collaboration in 2011 paving the way for consequent research grants, publications, practices, programs, and legislation passed years later. The case study utilized data from interviews with research stakeholders, institutional and governmental sources, peer-reviewed publications, and news stories. Identified research and translational challenges included cultural differences between research and prison system; the prison system's lack of transparency; politics of using and translating research to policy change; and issues of capacity, power, privilege, and opportunity when doing community-engaged research/science. Among the facilitators of translation were the Clinical and Translational Science Award and institutional support; engagement of key stakeholders and influencers; authentic collaboration and team science; researchers as translation catalysts; pragmatic scientific approach; and policies and legislative activities. The research contributed to a variety of community and public health, policy/legislative, clinical/medical, and economic benefits. The case study findings enhance our understanding of translational science principles and processes leading to improved wellbeing and serve as a call for advancing the research agenda addressing health disparities related to criminal and social justice issues.

Prenatal care and pregnancy outcome among incarcerated pregnant individuals in the United States: a systematic review and meta-analysis

This systematic review and meta-analysis assessed the risk of inadequate prenatal care and pregnancy outcome among incarcerated pregnant individuals in the United States. PubMed/MedLine, Embase, ClinicalTrials.gov and Web of Science were searched from inception up to March 30th, 2022. Studies were included if they reported the risk of inadequate prenatal care and/or pregnancy outcomes among incarcerated pregnant individuals in the United States jails or prisons. Adequacy of prenatal care was quantified by Kessner index. The random-effects model was used to pool the mean differences or odds ratios (OR) and the corresponding 95% confidence intervals (CIs) using RevMan software. Nine studies were included in the final review. A total of 11,534 pregnant individuals, of whom 2,544 were incarcerated while pregnant, and 8,990 who were matched non-incarcerated pregnant individuals serving as control group, were utilized. Compared to non-incarcerated pregnancies, incarcerated pregnant individuals were at higher risk of inadequate prenatal care (OR 2.99 [95% CI: 1.60, 5.61], p<0.001) and were more likely to have newborns with low birthweight (OR 1.66 [95% CI: 1.19, 2.32], p=0.003). There was no significant difference between incarcerated and matched control pregnancies in the rates of preterm birth and stillbirth. The findings of the current systematic review and meta-analysis suggest that incarcerated pregnant individuals have an increased risk of inadequate prenatal care. Considering the limited number of current studies, further research is indicated to both assess whether the risk of inadequate prenatal care has negative impact on prenatal outcomes for this population and to determine the steps that can be taken to enhance prenatal care for all pregnant individuals incarcerated in the United States prisons.

Enhanced Perinatal Programs for People in Prisons: A Summary of Six States' Programs

Purpose

The purpose of this study was to examine enhanced perinatal support programs for pregnant and postpartum people in six state prisons, describe the service components offered by each program, and discuss similarities and differences of services offered between programs.

Methods

In-depth, semi-structured interviews were conducted with each program's site lead(s) in order to collect information regarding each program's historical context, conception, and key aspects of the implementation of service components offered at each site.

Results

Program components fell into five broad categories: group-based education and support, one-on-one support, labor and birth support, lactation facilitation and support, and other support services. Results highlight similarities and differences within and across programs and common themes that govern program success.

Conclusions

This study provides an initial understanding of the variation in enhanced perinatal programming in six state prisons and offers insights for other states interested in establishing these types of programs. These programs implemented individual components piecemeal to fit site-specific context and needs, instead of adopting the entirety of another program model. Programs' success was largely dependent upon collaboration between program facilitators and partnering prison sites.

Olhar profissional no atendimento em saúde às pessoas privadas de liberdade: revisão integrativa

Resumo O sistema carcerário pode ser marcado por um conjunto de fatores que dificultam a ressocialização do indivíduo e o acesso integral à saúde, revelando questões que afetam a assistência e dificultam a atuação dos profissionais de saúde. Para tanto, buscou-se neste texto descrever a visão de profissionais das diversas áreas da saúde a respeito do atendimento às pessoas privadas de liberdade por meio da leitura de artigos. A revisão integrativa foi construída com base em pesquisa nas bases de dados Medline, via PubMed, e Literatura Latino-Americana e do Caribe em Ciências em Saúde, por meio dos descritores education, medical, health personnel e prisoners, selecionando artigos publicados nos últimos dez anos. Após a etapa de exclusão, foram lidas na íntegra 68 referências, resultando em 13 estudos selecionados. Definiram-se três categorias com base na identificação dos temas mais frequentes nas publicações: estigma, barreiras no atendimento e saúde mental. Conclui-se que ainda existem lacunas importantes para a formação adequada voltada ao atendimento das pessoas privadas de liberdade, uma vez que estigmas e barreiras do sistema prejudicam a saúde mental desse grupo vulnerável no âmbito de acesso integral à saúde.

Peer doula support training for Black and Indigenous groups in Nova Scotia, Canada: A community-based qualitative study

OBJECTIVES

The objectives of this qualitative study were to explore participant experiences of doula training programs offered by a prisoner health advocacy organization and Indigenous and Black community groups.

DESIGN

This investigation employed a qualitative design. Recruitment was conducted through email. Interviews were conducted in Winter 2020. Data were analyzed using thematic analysis.

SAMPLE

A total of 12 participants were recruited to participate in this study. Six participants identify as Black and six identify as Indigenous. All participants identify as women.

MEASUREMENTS

Qualitative interviews were conducted using a semi-structured interview guide to elicit a breadth of information.

RESULTS

Key themes included training experiences, training improvements and ''bridging the gap''. The training validated participants' experiences of birth and began to address the exclusion of Black and Indigenous people from birth work. However, participants expressed concerns about not being adequately positioned for sustained participation in birth work.

CONCLUSIONS

Participants expressed receiving great value from the training programs. These trainings, which were fully subsidized, removed a financial barrier. However, these trainings do not address the exclusion of Black and Indigenous people from perinatal work or the lack or sustainable support systems for Black and Indigenous communities. This study makes several recommendations for future interventions.

Maternal and neonatal outcomes among incarcerated women who gave birth in custody

BACKGROUND

In the United States, the population of incarcerated women has increased by more than 600% since the 1980s. With this rise, correctional facilities have faced new challenges meeting the health care needs of women, especially those who are pregnant. This retrospective cohort study sought to describe five indicators of maternal and neonatal health among women who gave birth in custody, and to compare outcomes among incarcerated women who did and did not receive enhanced pregnancy support.

METHODS

We used deidentified electronic health records (EHRs) to examine maternal and neonatal birth outcomes (ie, mode of birth, low birthweight, preterm birth, APGAR score, NICU admission) among women who gave birth in custody. Regression models examined differences in outcomes between women who received enhanced pregnancy support-group prenatal education and one-on-one doula visits-and a historical control group of women who received standard prenatal care.

RESULTS

Adverse maternal and neonatal birth outcomes in this sample were rare. No differences in outcomes were found between incarcerated women who received enhanced pregnancy support and the historical control group.

CONCLUSIONS

Despite evidence for the benefits of enhanced pregnancy support in the general population, this study did not find differences in outcomes between incarcerated women who did and did not receive support. Integrated data from prison and hospital records are innovative, but effect measurement is limited by sample size. Future research should include primary data collection on maternal, neonatal, and dyadic outcomes longitudinally and across prisons.