The significance of breastfeeding to incarcerated pregnant women: an exploratory study

Breastfeeding behind bars: Experiences of incarcerated mothers in the Spanish penitentiary system

This research aims to analyze the breastfeeding experiences of incarcerated mothers in the prisons of the Spanish penitentiary system. Additionally, it explores whether these mothers have perceived practices related to obstetric violence during pregnancy, childbirth, and the postpartum period. An exploratory-descriptive study was conducted using a qualitative approach and a critical ethnographic method. Fieldwork, including participant observation and semi-structured interviews, was carried out between December 2021 and April 2022. The study involved 30 adult women from Africa, Europe, Eastern Europe, and Latin America, all serving sentences with their infants in Mother Units located in the Spanish cities of Alicante, Barcelona, Madrid, and Seville. The main findings highlight the need for penitentiary policies with a gender and feminist perspective. These policies should aim to eliminate severe inequalities and discriminations faced by incarcerated women while protecting the basic rights of both mothers and infants.

Lactation Support for People Who Are Incarcerated: A Systematic Review

Background: Lactation support, defined here as the access to educational resources, supplies, mental health and psychosocial support, skilled lactation counseling, and peer support, has been identified as critical to optimal health outcomes for birthing parents and infants. People who give birth while incarcerated are likely to receive suboptimal lactation support. The purpose of this review is to explore the literature on lactation support for incarcerated people to identify existing programs and policies, gaps in lactation support and ways to address the gaps, and incarcerated people's perspectives on breastfeeding and lactation support. Methods: We conducted a systematic review of the peer-reviewed literature to identify studies that addressed two main concepts: (1) breastfeeding and (2) incarcerated populations in the United States. Results: After meeting the eligibility criteria, 29 studies were included in the qualitative synthesis of the findings. Studies highlight the importance of supporting birthing people who want to provide milk to their infants in a way that is desired, psychologically safe, and structurally supported. Programs are needed to delay or prevent parent-infant separation after birth, provide education around breastfeeding misconceptions, and link to resources and ongoing support for both breastfeeding and milk expression. Implementation of breastfeeding programs may be most effectively undertaken with clear policies and dedicated leadership either internally or through community or health care partnerships. Discussion: This review highlights the policies and practices that hinder adequate lactation support for birthing parent-infant dyads who are incarcerated and describes feasible policies, education, and clinical support that can be used to improve care.

Predictors for the duration of breastfeeding among ethiopia women of childbearing age with babies; application of accelerate failure time and parametric shared frailty models

Introduction

Duration of breastfeeding is the length of the time that infants who were initially breastfed continue to receive breast milk until weaning. The duration of breastfeeding is important for a child's health, growth, and development. However, the duration of breastfeeding decreases from time to time and further leads children to be exposed to malnutrition (stunting, wasting, and weight loss). Children who did not get enough breastfeeding are also exposed to different diseases. Previous studies used a simple survival model and didn’t see the shared frailty model on the variable of interest. Therefore, the current study aimed to investigate the factors affecting the duration of breastfeeding among Ethiopian women of reproductive age with babies.

Methods

A cross-sectional study design was conducted on 15,400 women of childbearing age with babies in nine regional states and two city administrations. The data source for the analysis was the 2016 EDHS data. The Cox-proportional hazard model, AFT, and parametric shared frailty models were conducted for the current investigation. Weibull-gamma shared frailty model was in favor of others for current data analysis.

Results

Among the covariates, women living in urban area (Φ = 0.96; 95% CI; (0.94,0.97); p-value = 0.001), non-educated women(Φ = 1.03; 95% CI; (1.00,1.06); p-value = 0.039), primary educated women (Φ = 1.13; 95% CI; (1.11,1.15); p-value < 0.001), age of a child (Φ = 0.99; 95% CI; (0.76.0.99); p-value < 0.001) and non-smoker mothers (Φ = 1.60; 95% CI; (1.57, 1.63); p-value < 0.001),birth interval between 2–3 years(Φ = 1.02; 95% CI;(1.09, 1.25, p-value = 0.027), birth interval, > 3 years(Φ = 1.28; 95% CI; (1.06, 1.43); p-value < 0.01 significantly affected the duration of breastfeeding. The median survival time of breastfeeding of women of reproductive age with babies considered under study was 23.4 months. Clustering had a significant effect on the variable of interest.

Conclusion

Residence area, level of education, age of the child, smoking status of women, and birth interval of successive birth significantly affected the duration of breastfeeding in the current investigation. Hence, the health staff should conduct health-related education for young women, educated women, urban women, smoker women, and women with a shorter interval of birth to increase the women's attitude and awareness towards the use of long-duration of breastfeeding.

Pregnancy and childbirth during incarceration: A qualitative systematic review of lived experiences

BACKGROUND

Incarcerated individuals who experience pregnancy or childbirth in correctional facilities face unique considerations for obstetric care and consequently are at greater risk of adverse maternal and fetal outcomes.

OBJECTIVES

To characterise patient experiences regarding pregnancy and childbirth during incarceration via qualitative synthesis.

SEARCH STRATEGY

Medline-OVID, EMBASE, CINAHL, Sociological Abstracts, Social Work Abstracts, Web of Science, Scopus and PsycInfo were systematically searched from inception to 24 December 2020. Supplementary searches were performed using the Scopus database.

SELECTION CRITERIA

Only original, peer-reviewed literature was examined. Eligible studies were assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research.

RESULTS

After screening 4173 original database citations, 24 studies that met inclusion criteria were included and analysed via thematic analysis. The 24 studies included perspectives from 645 female patients who had experienced incarceration, 69 healthcare providers and 70 prison staff. Key patient-reported concerns for the well-being of pregnant individuals during incarceration included mental health challenges, dehumanisation of prenatal care and delivery, lack of privacy, stigma, psychological trauma, lack of emotional support and shackle usage during pregnancy and/or labour. The studies reported a lack of support for patients to access female correctional officers or guards, privacy during intimate examinations, timely medical care and support for breastfeeding. Above all, the psychological trauma of separation from one's newborn after birth was of utmost devastation.

CONCLUSIONS

Our systematic review highlights the dire need for accountability and interventions to improve pregnancy and childbirth care for incarcerated individuals.

TWEETABLE ABSTRACT

This systematic review describes lived experiences of pregnancy & childbirth during incarceration, including dehumanisation, psychological trauma, and use of shackles.

Promotion, protection and support for breastfeeding in prisons: a scoping review

This article aims to identify and map the actions to promote, protect and support breastfeeding that are carried out within the prison system. Scope review, whose searches were performed in the Latin American and Caribbean Health Sciences Literature and Nursing databases, Virtual Health Library, Medical Literature, Analysis, and Retrieval System Online, via PubMed, Scientific Electronic Library Online and the Capes Periodicals Portal. A total of 465 studies were obtained, 177 duplicates and 175 by title exclusion were removed, 56 articles were eliminated by abstract, and eight articles were not found. After selection and reading by the review team, 16 articles were removed, thus constituting ten articles with relevant results for breastfeeding promotion in prison, 13 articles with important results for breastfeeding protection in prison, and ten articles with potential findings for breastfeeding support in prison. It is necessary to promote breastfeeding in prison with promotion, protection and support actions, because many children are still prevented from being breastfed soon after birth, which characterizes inequality in relation to the population in freedom.

Breastfeeding While Incarcerated: Evidence-Based Recommendations for Integrating Policy and Practice

Breastfeeding and pumping to express human milk are restricted practices for incarcerated women, and their infants are at high risk for not receiving human milk. Clinical practice guidelines are not applied to perinatal women who are incarcerated, and the rates of breastfeeding and the potential to do so in correctional facilities are extrapolated from small studies. The purpose of this analysis is to summarize current national trends in breastfeeding and lactation policy and the extent to which lactation in correctional facilities is addressed, identify ongoing lactation support programs and strategies in correctional facilities as potential areas for further study, and offer a context-specific, adaptable, and evidence-based approach to breastfeeding and lactation support using the Spatz 10-step model. This analysis calls for strategic updates to research and policy and offers recommendations in collaboration with existing programs to increase access to breastfeeding and lactation services for incarcerated women.

Evaluation of birth companions perinatal and peer support provision in two prison settings in England: a mixed-methods study

PURPOSE

This paper reports on insights from an evaluation of Birth Companions (BC) (a UK-based charity) perinatal support in two prison settings in England. The initiative involved the provision of group and/or one-to-one perinatal support and training women prisoners as peer supporters.

DESIGN/METHODOLOGY/APPROACH

A mixed-methods study was undertaken that involved observations of support groups and peer support supervision sessions (n = 9); audio recorded interviews (n = 33) with prison and health-care staff, women in prison, peer supporters and BC staff; analysis of existing routinely collected data by BC and notes undertaken during regular meetings (n = 10) with the BC Project Manager. Thematic analysis was undertaken supported by MAXQDA qualitative data analysis software.

FINDINGS

BC provided instrumental/practical support, emotional support, information support, signposting to services and advocating for women to the prison concerning their perinatal needs and rights. Key themes revealed that support had an impact on the lives of perinatal women by creating a safe place characterised by meaningful interactions and women-centred approaches that facilitated access to wider care and support. The service made a difference by empowering women and providing added value for peer supporters, prison, health-care and BC staff. Key enablers and strategies for the care of perinatal women and the delivery of perinatal support are also detailed.

ORIGINALITY/VALUE

Through longitudinal data and the involvement of a range of stakeholders, this study evidences the subtleties of support provided by BC and the potential it has to make a difference to perinatal women in prison and those volunteering or working within the prison system.

Does Maternal Incarceration Impact Infants with Neonatal Abstinence Syndrome?

OBJECTIVES

Opioid exposed infants born to incarcerated women represent a vulnerable and understudied subset of infants with neonatal abstinence syndrome (NAS). The impact of maternal incarceration on length of stay (LOS) for infants with NAS is unknown. We hypothesized that infants with NAS born to incarcerated women have longer hospitalizations compared to infants with NAS born to non-incarcerated women.

METHODS

This is a retrospective cohort study of infants with NAS born between 2011 and 2018 at the primary delivery site for Connecticut's only women's prison. Opioid exposed infants were assessed by Finnegan Scores for withdrawal and received morphine as a first line agent and phenobarbital as a second line agent. LOS was compared using Poisson regression.

RESULTS

Of 206 infants identified, 166 were included in the analysis, with 28 born to incarcerated women and 138 to non-incarcerated women. Incarcerated women were more likely to report prenatal alcohol use, 14.3% vs 2.2% p = 0.016 and benzodiazepine use 21.4% vs 7.3% p = 0.032. Infants of incarcerated women were less likely to be fed breast milk at discharge, 3.6% vs 37% p < 0.001. Adjusted mean LOS was longer among infants born to incarcerated women, 18.5 vs 16.6 days (p = 0.009).

CONCLUSIONS FOR PRACTICE

Infants with NAS born to incarcerated women in Connecticut had longer LOS, lower rates of being fed breast milk, and different prenatal substance exposures than infants with NAS born to non-incarcerated women. Supporting the maternal-infant dyad until infant discharge may mitigate the potential negative impact of maternal incarceration on the care of infants with NAS.

Promotion, protection and support for breastfeeding in prisons: a scoping review

Abstract This article aims to identify and map the actions to promote, protect and support breastfeeding that are carried out within the prison system. Scope review, whose searches were performed in the Latin American and Caribbean Health Sciences Literature and Nursing databases, Virtual Health Library, Medical Literature, Analysis, and Retrieval System Online, via PubMed, Scientific Electronic Library Online and the Capes Periodicals Portal. A total of 465 studies were obtained, 177 duplicates and 175 by title exclusion were removed, 56 articles were eliminated by abstract, and eight articles were not found. After selection and reading by the review team, 16 articles were removed, thus constituting ten articles with relevant results for breastfeeding promotion in prison, 13 articles with important results for breastfeeding protection in prison, and ten articles with potential findings for breastfeeding support in prison. It is necessary to promote breastfeeding in prison with promotion, protection and support actions, because many children are still prevented from being breastfed soon after birth, which characterizes inequality in relation to the population in freedom.

Breastfeeding in Incarcerated Settings in the United States: A National Survey of Frequency and Policies

Objectives: To assess the existence of prison and jail policies and practices that allow incarcerated women to breastfeed while in custody, and prevalence of women in custody who pumped human milk for their infants. Methods: We surveyed 22 state prison systems and 6 county jails from 2016 to 2017 about policies related to breastfeeding and other programs for pregnant and parenting women in custody. In addition, 11 prisons and 5 jails reported 6 months of monthly, prospective data on the number of women pumping human milk, as well as information on placement of infants born to women in custody. Results: Eleven prisons and five jails had policies that supported the practice of expressed milk, either through pumping or breastfeeding. Over 6 months at these sites that allowed lactation, there were 207 women who gave birth in the prisons and an average of 8 women/month who pumped human milk; at the jails, there were 67 women who gave birth and an average of 6 women/month who pumped human milk. Most infants born to women in custody were placed in the care of a family member. Conclusions: Breastfeeding and the provision of human milk are critical public health issues. Our data show inconsistent implementation of policies and practices supportive of breastfeeding in prisons and jails. However, there are institutions in the United States that are supportive of incarcerated women's breastfeeding and lactation needs. Further research is needed to identify the barriers and facilitators associated with implementing supportive breastfeeding policies and practices in the carceral system.

Development and Psychometric Testing of the Nurses' Confidence Scale: Unique Families

OBJECTIVE

To develop and evaluate an instrument designed to measure the confidence of nurses in their ability to provide neutral, compassionate care to unique families in perinatal settings: the Nurses' Confidence Scale: Unique Families.

DESIGN

Prospective instrument development and psychometric study.

SETTING

Health system in the U.S. Mountain West region.

PARTICIPANTS

Convenience sample of 62 perinatal/neonatal nurses.

METHODS

We developed a two-part scale to measure the confidence of nurses in their ability to care for complex/nontraditional families, termed unique families. Part A was focused on nursing care behaviors for any unique family; Part B was focused on providing care to seven specific unique family populations. Five experts in perinatal nursing or adoption evaluated the scale's content validity. To test the psychometric properties of the scale, we used item analysis, reliability analysis, and exploratory factor analysis.

RESULTS

The content validity index was 0.82. The Cronbach's alpha coefficient estimate of internal consistency for Part A was .92. Principal component analysis resulted in two factors that explained 64% of the total variance: skills and resources (Cronbach's alpha coefficient = .89) and awareness and sensitivity (Cronbach's alpha coefficient = .87). Part B had a Cronbach's alpha coefficient of .90. Parts A and B showed a strong positive relationship with one another (r = .77). The general self-efficacy measure was strongly and positively correlated with Part A (r = .81) and moderately and positively correlated with Part B (r = .48).

CONCLUSION

The Nurses' Confidence Scale: Unique Families is a new tool with which to measure the confidence of perinatal/neonatal nurses in providing sensitive, specific care to complex/nontraditional families. Results of our psychometric evaluation supported initial acceptable reliability and validity of the scale.

Partnership Between a Health System and a Correctional Center to Normalize Birth for Incarcerated Women

Women of childbearing age make up a growing segment of the prison population; many are pregnant while incarcerated. The care this population has received during pregnancy often has been characterized by inattention to nutritional needs, failure to provide for safe sleeping in lower bunks, and lack of childbirth education. These women may be unprepared for childbirth and the early postpartum period. To improve care for these women, staff from a health system and a correctional center collaborated to develop an infrastructure that offered supportive care to incarcerated childbearing women in their community. Organizational policies and processes were aligned to promote a normal birth and early postpartum experience for incarcerated women and provide them with opportunities to bond with their newborns. Family-centered care offers incarcerated women the opportunity to be mothers rather than simply prisoners giving birth.

"Breastfeeding in public" for incarcerated women: the baby-friendly steps

Background

Women are the fastest-growing population in carceral facilities in Canada. Most incarcerated women are mothers, with above-average parity. The incarceration of women has implications not only for women's health, but for that of their children. For example, how is breastfeeding and access to human milk supported in the context of imprisonment? Both carceral and health services are publicly-funded and administered in Canada. Due in part to the well-documented ill-health burden of imprisoned women, health and carceral functions overlap in the spaces of confinement. This paper discusses "breastfeeding in public" in relation to imprisoned women: separated from the public, yet in publicly-funded spaces under public servant control. With increasing adoption of Baby Friendly Hospital Initiative (BFI) Ten Steps in Canadian health centres, there is a need to consider the health centre spaces precluded from its application and make visible the women and children affected. This paper uses the BFI Steps as a lens to consider the environment of confinement for the breastfeeding incarcerated person. The exclusion of breastfeeding and access to human milk for imprisoned women and children extends the punitive carceral function beyond the experience of incarceration and beyond the experience of the convicted mother.

Discussion

Carceral facilities lack breastfeeding policies, foundational to breastfeeding support. Despite high fertility and parity among incarcerated women, carceral health care providers are not required to demonstrate maternity and reproductive health care specialization. The overarching mission of carceral institutions remains security, and support for breastfeeding among incarcerated women is hampered in spaces of conflict, punishment, surveillance and control. A minimal requirement to support exclusive breastfeeding is to promote the mother being with the infant and most incarcerated mothers are separated from their infants. Incarcerated women lack support, information, and community connections for extended breastfeeding beyond six months. Carceral facilities are not welcoming environments for breastfeeding families. Despite the incompatibility of breastfeeding with incarceration, BFI Step 10, coordinating discharge, demonstrates opportunity for improvement through community and health care provider engagement.

Conclusion

Incarceration challenges the reach and applicability of the BFI Steps to enhance breastfeeding and to problematize the idea of breastfeeding "in public."

PROMOÇÃO DO ALEITAMENTO MATERNO NO SISTEMA PRISIONAL A PARTIR DA PERCEPÇÃO DE NUTRIZES ENCARCERADAS

RESUMO Objetivo: desvelar a promoção do aleitamento materno no sistema prisional a partir da percepção de nutrizes encarceradas, à luz da estrutura dos sistemas abertos de Imogene King. Método: estudo qualitativo, desenvolvido em unidade prisional feminina. Foram realizadas entrevistas semiestruturadas com 14 nutrizes encarceradas e a análise dos dados foi orientada pela técnica do Discurso do Sujeito Coletivo. Resultados: emergiram sete ideias centrais agrupadas a cada um dos três sistemas abertos de King: Sistema Pessoal - A promoção do Aleitamento Materno com foco na saúde da criança; Promoção do Aleitamento Materno Exclusivo de forma impositiva; Sistema Interpessoal - Interação conflituosa com os profissionais da saúde; Relação harmoniosa e de confiança com o Setor Psicossocial; Sistema Social: as regras do sistema prisional definindo a duração do Aleitamento Materno; Estrutura física e confinamento como estressores; O ambiente carcerário e suas regras como geradores de estresse e perturbação para a prática do aleitamento materno. Conclusão: a promoção do aleitamento materno no cárcere é impositiva e nega a autonomia da nutriz para a tomada de decisão consciente. A organização prisional possui condições peculiares que interferem tanto na prática da amamentação como na assistência à nutriz, o que leva a uma interação ineficiente entre mulheres e profissionais de saúde, dificultando, dessa forma, o alcance da meta do cuidado de enfermagem efetivo e da satisfação com a assistência prestada.

SIGNIFICANDO O AMAMENTAR NA PRISÃO

RESUMO Objetivo: compreender os significados da experiência de amamentar atribuídos por mulheres privadas de liberdade. Método: trata-se de uma pesquisa qualitativa, desenvolvida por meio dos princípios da análise comparativa dos dados, adotando a codificação aberta e axial, e do Interacionismo Simbólico como referencial teórico. A coleta de dados foi feita por meio de entrevistas em profundidade, com 27 nutrizes e três gestantes, em seis penitenciárias do Estado de São Paulo, que compuseram três grupos amostrais. Resultados: a análise dos dados resultou em três temas: “Buscando a remissão pela maternidade”, onde a amamentação se insere como elemento de promoção vínculo entre mãe e filho e na promoção do bem estar materno, mas está inserida em um contexto de conflitos e perdas sociais; “Vivendo o cotidiano do apego e a expectativa da separação”, que reflete a possibilidade de ruptura da relação mãe e filho, com a conclusão do período de permanência regulamentar da criança no ambiente prisional; “Reconhecendo que houve perdas”, mas que valeu a pena, que revela uma avaliação materna sobre sua decisão de manter a criança junto a si na prisão. Conclusão: a amamentação é um dos cuidados fundamentais que a mulher privada de liberdade pode oferecer ao filho, e ainda, experiência alentadora que propicia o bem estar infantil e materno e que ela vivencia em meio a um contexto de rupturas, conflitos e preocupações com suas perdas pessoais e a condição penal.

Intention and Initiation of Breastfeeding Among Women Who Are Incarcerated

The Baby-Friendly Hospital Initiative recommends that all mothers be shown how to breastfeed, even when mothers and newborns are separated. Most incarcerated women are separated from their infants after the postpartum hospital stay, creating barriers to breastfeeding. We examined breastfeeding among a sample of women participating in a prison-based pregnancy program. Quantitative data indicated that women who discussed breastfeeding with their doulas were more likely to initiate breastfeeding. Three qualitative themes were identified: Benefits of Breastfeeding, Barriers to Breastfeeding, and Role of the Doula. We identified incongruence between the expected standard of breastfeeding support and the care incarcerated women received. Findings suggest that prison-based doula care might be an effective intervention for supporting breastfeeding among incarcerated women and highlight the importance of education for perinatal nurses about breastfeeding support of incarcerated women.

Maternal experiences of embodied emotional sensations during breast feeding: An Interpretative Phenomenological Analysis

OBJECTIVE

the purpose of this study was to explore mothers׳ experiences of embodied emotional sensations during breast feeding and to understand the meaning and consequences that such experiences may have on mothers' sense of self and the relationships they form with their children.

DESIGN

a qualitative design was applied to this study as it was judged as the most appropriate approach to this novel field of enquiry.

SETTING

the study was conducted in United Kingdom using a sample of mothers drawn from five different countries from Europe, America and Australia.

PARTICIPANTS

the sample consisted of 11 mothers who reported experiencing or having experienced negative embodied emotional sensations associated with breast feeding in the past five years.

MEASUREMENTS

semi-structured interviews were conducted with the mothers and interviews were transcribed to enable the process of data analysis. Interpretative Phenomenological Analysis (IPA; Smith et al., 2009a, 2009b) was chosen as a method of data analysis, enabling in depth understanding and interpretation of the meaning of mothers' experiences. IPA was chosen due to its idiographic commitment and particular interest in sense-making, phenomenology and hermeneutics.

FINDINGS

three themes were generated reflecting the multifaceted nature of breast feeding experiences (i) 'Breast feeding: An unexpected trigger of intense embodied emotional sensations incongruent with view of self', (ii) 'Fulfilling maternal expectations and maintaining closeness with the child', (iii) 'Making sense of embodied emotional sensations essential to acceptance and coping'.

CONCLUSIONS

breast feeding has the potential to trigger a range of conflicting cognitions and emotions in mothers that may impact on how mothers view themselves and relate to their children.

IMPLICATIONS FOR PRACTICE

increasing awareness about emotional breast feeding experiences and recognising the multifaceted, individual nature of difficulties around breast feeding enables professionals to offer mothers person-centred care and avoid making clinical decisions and recommendations based on inaccurate knowledge.