Pregnant in Prison – A Recipe for High-Risk Pregnancy
As a mom who was unaware of the issues surrounding these moms-to-be, I was troubled when I read that women are “the fastest growing segment of the prison population.”1 Over a 30 year period, the number of imprisoned women went from 11,212 to nearly 113,000 women.1, 2
Within this population are huge state-to-state and regional disparities. In 2004, more than 10 times more women were imprisoned in Oklahoma than in Massachusetts or Rhode Island.1 Though the reasons for such differences are beyond the scope of this article, those states with high female imprisonment rates need to prepare for the very real issue of pregnant women within their system. More women= more moms-to-be in jail.
So, why the rise in women calling prison their home? According to The Rebecca Project for Human Rights, “Women have borne a disproportionate burden of the war on drugs, resulting in a monumental increase of women who are facing incarceration for the first time, overwhelmingly for non-violent offenses.”3 When compared to men, the crimes of incarcerated women are typically non-violent offenses, and often the result of alcohol, drug, and property offenses.4
The Reality: Pregnancy and Incarceration
Six to ten percent of women entering jail are pregnant.5 The nature of this population means the majority fall within the classification of “high-risk.” Medical problems that negatively affect pregnancy outcomes are common. These include: diabetes, epilepsy, HIV, hypertension, cardiac and renal diseases. Also, many of these women have not received adequate medical care prior to their imprisonment. They are more likely to smoke, be heavy drinkers and use illicit drugs.6 These factors have a significant impact on their requirements for increased (often specialized) prenatal care, as well as their need for education, counseling and substance abuse treatment programs throughout pregnancy and beyond.
Prematurity: A Difficult and Complex Problem in Obstetrics
A racial disparity exists, not only within the prison population where 67% are non-white6, but also in preterm birth (PTB) where Black women have the highest rates (17.5%), followed by Hispanics (12.1%), then Whites (11.1%).7 Research has shown that Black women are three to four times more likely to have their babies very early (between 20 and 24 weeks), in part because of their predisposition to infections.8 Many of the problems discussed mirror the risk factors for PTB (a birth occurring at less than 37 weeks gestation). PTB is a major global issue, where sadly the US ranks worse than most other developed countries. The conditions described in this article all contribute to prematurity.
The risk factors for early birth, the leading cause of infant morbidity and mortality, are those with8:
•A history of pregnancy loss or PTB ( #1 risk factor)
•Womb abnormalities or carrying multiple babies
•A family history of PTB
•Bacterial vaginosis (BV)*, and other genital infections like trichomoniasis, chlamydia, syphilis and gonorrhea.
•A history of cervical surgeries (including multiple D&C/abortions)*
As well as:
•Black women (who have a higher risk if they are underweight or overweight)*
•Obese women with a BMI of 35 or more or those with a low BMI
•Those taking certain antidepressants
•Heavy drinkers, cocaine or heroin users*
* These factors are highly likely in incarcerated pregnant massachusetts alcohol delivery women.
Of Special Concern for Prison Healthcare Personnel8 (Edited excerpts from the book High-Risk Pregnancy- Why Me?)
Based on risk factors of women within the prison system, certain conditions and issues are likely to be encountered in this environment. The following are probable pregnancy issues medical personnel may be faced with when working with this special needs population.
Preterm Premature Rupture of Membranes (PPROM)
Who’s at Risk? Women who:
* Have had a previous PTB
* Are at an economic disadvantage
* Have a low BMI
* Have had a cerclage or biopsy procedures to their cervix
* Are experiencing early contractions
* Have a urinary tract infection or STD
* Are experiencing vaginal bleeding
* Are smokers