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Giving Birth in Shackles

Oct 7th, 2010 | Category: Medical care, Women and Jails

by Ginette Gosselin Ferszt, associate professor, University of Rhode Island Collegeof Nursing, in the American Journal of Nursing

Approximately 6% of women who enter American jails and prisons are pregnant. Many of them will go through labor, childbirth, and recovery with shackles around their wrists, ankles, or both. Some will be transported to the hospital in leg irons. Others will have chains wrapped around their abdomens.Although these practices don’t violate criminal laws, they do violate internationally recognized human rights standards, according to Amnesty International.

The organization’s 1999 report on U.S. jails and prisons, “Not Part of My Sentence”: Violations of the Human Rights of Women in Custody, revealed for the first time the widespread use of restraints on incarcerated women during transportation to medical facilities, labor, childbirth, and throughout the postpartum period.The use of shackles at these times is “especially cruel” because the majority of incarcerated women have been arrested for nonviolent crimes, such as drug-related offenses, larceny, and theft, argues the Rebecca Project for Human Rights, a national organization that advocates ending this practice.Restraining pregnant women may threaten the health of the woman and her unborn child, interferes with the work of health care providers, increases pain, and can lead to significant complications and trauma. Yet many states still allow it, many suspect, because no one has seriously reexamined it, at least until recently.

In the past few years, the Federal Bureau of Prisons and the U.S. Marshals Service have decided to limit the use of shackles on incarcerated pregnant women. At the same time, California, Vermont, and Illinois became the first states to pass legislation regulating the use of shackles and restraints. Other states followed, including New York, New Mexico, and Texas. Most of these states allow for the use of restraints if a woman poses a threat to herself, her baby, or others, or if she’s a serious flight risk, but none have reported any problems since the laws went into effect.In a letter supporting efforts to pass federal legislation banning the shackling of pregnant women (http://bit.ly/4d7Nja), the American College of Obstetricians and Gynecologists condemned the practice, saying it reduces a physician’s ability to properly assess the patient and fetus and unnecessarily complicates labor and childbirth. The American Public Health Association has similarly advised against the use of restraints during labor and birth in its book, Standards for Health Services in Correctional Institutions.

So far, nursing’s voice has been silent. But we must take action, both as individuals and as members of professional organizations. Here are some ways nurses can make a difference:
Become informed. Amnesty International (www.amnesty.org) and the Rebecca Project for Human Rights (www.rebeccaproject.org) are excellent resources, as are the American Civil Liberties Union (www.aclu.org) and Women on the Rise Telling HerStory (www.womenontherise-worth.org).
Help them to promote legislation that will eliminate the use of shackles and restraints on pregnant women in all 50 states.Discuss the issue with colleagues.
Talk to other nurses, physicians, and social workers in your facility or organization.
Lobby for a policy change.
Gather coworkers and meet with your facility’s patient advocate or administrators to discuss a plan of action, such as writing a proposed policy or standard of practice.Promote dialogue.
Suggest that a nurse and physician from your facility meet with the medical director or warden of the local women’s jail or prison to discuss changes in policy regarding the shackling of pregnant inmates.
Contact your professional organizations. Request that they formally condemn the use of restraints in pregnant women. Ask them to support state and federal legislation banning the practice, write position papers, and send letters of support to the Rebecca Project for Human Rights.

*Professor Ferszt can be emailed at ggf@uri.edu
This article is from
AJN, American Journal of Nursing:
February 2010 – Volume 110 – Issue 2 – p 11
doi: 10.1097/01.NAJ.0000368027.79459.7f

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