Doulas' Perspectives about Providing Support to Incarcerated Women: A Feasibility Study

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.

Death doula working practices and models of care: the views of death doula training organisations

BACKGROUND

The role of death doula has emerged in recent years, arguably as a result of overwhelming demands on carers, healthcare professionals and service providers in end-of-life care. Death doulas work independently without governing oversight and enact the role in various ways. The main driver of this evolving role is the organisations that train them. The aim of this study was to examine death doula training organisations' views with regard to DD business models, incorporating the death doula role into other existing models of care, and role enactment.

METHODS

An electronic survey was administered to 15 death doula training organisations in 5 countries asking additionally that they disseminate the survey. Responses were received from 13 organisations, based in Australia (n = 4), the US (n = 4), Canada (n = 2), the UK (n = 1), Sweden (n = 1) and New Zealand (n = 1). This paper provides the qualitative findings from four open-text questions posed within the survey related to models of care.

RESULTS

Qualitative data analysis was inductive, themes were determined in relation to: (1) standardised business model for death doulas, (2) death doulas incorporated into existing models of care or existing funding options, (3) death doulas who volunteer their services rather than charge money, and (4) role specialisation such as has occurred with birth doulas.

CONCLUSIONS

The death doula role has the potential to be formally recognised in the future under national registration schemes, accompanied by death doula training required via certification. Until such time the death doula role will continue to evolve much as the birth doula role has, organically and unstructured. How and if death doulas are incorporated into existing models of health or social care remains to be seen as the organisations that train them push for independence, flexibility and fiscal independence.

Reproductive Health Care for Incarcerated People: Advancing Health Equity in Unequitable Settings

There are over 150,000 incarcerated females in the United States. Structural inequities, including racism, adversely affect the reproductive health outcomes, autonomy, and access to care that people in custody face. This article reviews the status of reproductive health and health care among incarcerated women and describes ways that community OB/GYNs can address health inequities by providing comprehensive, compassionate care to incarcerated people, especially when they come to community settings for care while they are in custody. To address reproductive health disparities and inequities that adversely affect incarcerated individuals, community providers can implement these recommendations and also engage in advocacy.

Shackling and pregnancy care policies in US prisons and jails

OBJECTIVES

The number of incarcerated women in the United States has risen exponentially. Many are of childbearing age with 3-4% being pregnant at intake. Despite the need for comprehensive pregnancy-related health care in prisons and jails, there is no oversight that requires adherence to the established standards. The objective of this study was to assess prison and jail pregnancy policies and practices with an emphasis on restraint use and compliance with anti-shackling legislation.

METHODS

We conducted a survey of 22 state prisons and six jails, including the five largest jails, from 2016-2017 regarding pregnancy policies and practices including restraint use, prenatal care, delivery and birth, and other pregnancy accommodations. We compared reported restraint policies to state legislation at the time of the survey.

RESULTS

Data indicate that pregnancy policies and services in prisons and jails vary and compliance inconsistencies with anti-shackling legislation exist. A third of the prisons and half of the jails did not have accredited health care services. All study facilities provided prenatal vitamins and most provided supplemental snacks. Most facilities stationed an officer inside the hospital room during labor and delivery, but nearly one-third of facilities did not require a female-identifying officer.

CONCLUSIONS FOR PRACTICE

Limited oversight and standardization of carceral health care and accommodations for pregnant people lead to variability in prisons and jails. Prisons and jails should adopt and implement standards of care guidelines to ensure the safety and well-being of pregnant people who have unique healthcare needs. Incarcerated pregnant people should be viewed as expectant parents in need of comprehensive health care, rather than as criminals who forfeited their right to a safe, respectful, and humane childbirth.

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.

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.

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.

Justice for Incarcerated Moms Act of 2021: Reflections and recommendations

In the last five decades, the number of women behind bars in the United States has risen exponentially. It is now estimated that there are nearly 58,000 admissions of pregnant people—disproportionately women of color—to jails and prisons each year. Recognizing the urgency and consequences of mass incarceration on pregnant people, their families, and communities, House Resolution 948: Justice for Incarcerated Moms Act of 2021 was introduced to Congress as a part of the Black Maternal Health Momnibus. The Justice for Incarcerated Moms Act aims to improve health care and promote dignity for incarcerated pregnant and parenting people through an array of policies and oversight. In this article, we review and reflect on the components of this bill within their broader public health and reproductive justice contexts. We close with recommendations for policymakers and professionals committed to promoting equity and justice for pregnant and postpartum incarcerated people.

Health care and social justice implications of incarceration for pregnant people who use drugs

The experiences of and care for pregnant, incarcerated people with substance use disorders represent a convergence of numerous clinical, historical, racialized, legal, and gendered factors. Understanding how these forces shape how they became enmeshed in the criminal legal system as well as the context of the care they do or do not receive while in custody is essential for promoting equitable maternal health care. In this review, we describe the prevalence of SUD among pregnant people behind bars, the health care landscape of incarceration, access to treatment for opioid use disorder for incarcerated pregnant and postpartum people, and nuances of providing such treatment in an inherently coercive setting. Throughout, we highlight the ways that the child welfare system and mass incarceration in the U.S. have had a unique and discriminatory impact on pregnant and parenting people, and have done so in distinctly racialized ways. Situating the clinical care of incarcerated pregnant people who use drugs in this context sheds light on fundamental social justice and health care intersections.

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.

Birth Behind Bars: The Need for Labor Support in the Incarcerated Population

The population of women within carceral systems is growing rapidly. A portion of these individuals are pregnant and will deliver while incarcerated. Although shackling laws for pregnant persons have improved, incarcerated patients are forced to labor without the support of anyone but a carceral officer and their medical staff. We believe access to continuous labor support is critical for all pregnant persons. Carceral systems and their affiliated hospitals have the opportunity to change policies to reflect that continuous labor support is a basic human right and should be permitted for incarcerated pregnant persons in labor, either through a doula program or a selected person of choice.

Confined to Obscurity: Health Challenges of Pregnant Women in Jail

Research about pregnant women in jail is scant. This exploratory study begins to fill this gap by examining the demographics; background characteristics; and self-reported physical health, mental health, and substance use challenges reported by 27 pregnant women incarcerated in a large midwestern county jail. It further reports on the prenatal care before and during their incarceration, plans of these pregnant women for delivery of their child, caring for their infant after their release from jail, and their expectations of paternal or family support post-release. Among the sample, 66.7 percent reported a physical health care problem, 48.2 percent had received mental health treatment, and 18.5 percent had substance use treatment in the previous year, but only 51.9 percent had seen a health care professional before their incarceration. All women expected the father of their child to provide financial support, but only 76.9 percent expected the father to be involved with the child. The authors also discuss implications of the findings for jail health care services and reintegration policy and practice for pregnant women.

Corrections officers' knowledge and perspectives of maternal and child health policies and programs for pregnant women in prison

BACKGROUND

In response to the dramatic increase in the number of women incarcerated in the United States-and a growing awareness that a small proportion of women enter prison pregnant and have unique health needs-some prisons have implemented policies and programs to support pregnant women (defined here as maternal and child health [MCH] policies and programs). Corrections officers (COs) are key stakeholders in the successful implementation of prison policies and programs. Yet, little empirical research has examined prison COs' knowledge and perspectives of MCH policies and programs, particularly the impact such policies and programs have on COs' primary job responsibility of maintaining safety and security. The objective of this mixed-methods study was to understand COs' knowledge and perspectives of MCH policies and programs in one state prison, with a specific emphasis on the prison's pregnancy and birth support (doula) program.

RESULTS

Thirty-eight COs at a single large, Midwestern women's prison completed an online survey, and eight of these COs participated in an individual, in-person qualitative interview. Results indicated that COs' perspectives on MCH policies and programs were generally positive. Most COs strongly approved of the prison's doula program and the practice of not restraining pregnant women. COs reported that MCH policies and programs did not interfere, and in some cases helped, with their primary job task of maintaining safety and security.

CONCLUSIONS

Findings support expansion of MCH programs and policies in prisons, while underscoring the need to offer more CO training and to gather more CO input during program development and implementation. MCH services that provide support to pregnant women that are outside the scope of COs' roles may help reduce CO job demands, improve facility safety, and promote maternal and child health.

Preference, knowledge and utilization of midwives, childbirth education classes and doulas among U.S. black and white women: implications for pregnancy and childbirth outcomes

This secondary analysis explored preference, knowledge and utilization of midwifery care, childbirth education and doula care among 627 black and white women at three Midwestern U.S. health clinics. Women who were white, more educated, not living in a high crime neighborhood, and privately insured were more likely to attend childbirth classes. Sociodemographic factors that predicted having heard about doula care included being more educated and having a partner. None of the sociodemographic variables predicted midwifery care. Education about existing childbearing resources and availability of low-cost options should be expanded, particularly for black women and those with low resources.

Perceptions and experiences of labour companionship: a qualitative evidence synthesis

BACKGROUND

Labour companionship refers to support provided to a woman during labour and childbirth, and may be provided by a partner, family member, friend, doula or healthcare professional. A Cochrane systematic review of interventions by Bohren and colleagues, concluded that having a labour companion improves outcomes for women and babies. The presence of a labour companion is therefore regarded as an important aspect of improving quality of care during labour and childbirth; however implementation of the intervention is not universal. Implementation of labour companionship may be hampered by limited understanding of factors affecting successful implementation across contexts.

OBJECTIVES

The objectives of the review were to describe and explore the perceptions and experiences of women, partners, community members, healthcare providers and administrators, and other key stakeholders regarding labour companionship; to identify factors affecting successful implementation and sustainability of labour companionship; and to explore how the findings of this review can enhance understanding of the related Cochrane systematic review of interventions.

SEARCH METHODS

We searched MEDLINE, CINAHL, and POPLINE K4Health databases for eligible studies from inception to 9 September 2018. There were no language, date or geographic restrictions.

SELECTION CRITERIA

We included studies that used qualitative methods for data collection and analysis; focused on women's, partners', family members', doulas', providers', or other relevant stakeholders' perceptions and experiences of labour companionship; and were from any type of health facility in any setting globally.

DATA COLLECTION AND ANALYSIS

We used a thematic analysis approach for data extraction and synthesis, and assessed the confidence in the findings using the GRADE-CERQual approach. We used two approaches to integrate qualitative findings with the intervention review findings. We used a logic model to theorise links between elements of the intervention and health and well-being outcomes. We also used a matrix model to compare features of labour companionship identified as important in the qualitative evidence synthesis with the interventions included in the intervention review.

MAIN RESULTS

We found 51 studies (52 papers), mostly from high-income countries and mostly describing women's perspectives. We assessed our level of confidence in each finding using the GRADE-CERQual approach. We had high or moderate confidence in many of our findings. Where we only had low or very low confidence in a finding, we have indicated this.Labour companions supported women in four different ways. Companions gave informational support by providing information about childbirth, bridging communication gaps between health workers and women, and facilitating non-pharmacological pain relief. Companions were advocates, which means they spoke up in support of the woman. Companions provided practical support, including encouraging women to move around, providing massage, and holding her hand. Finally, companions gave emotional support, using praise and reassurance to help women feel in control and confident, and providing a continuous physical presence.Women who wanted a companion present during labour and childbirth needed this person to be compassionate and trustworthy. Companionship helped women to have a positive birth experience. Women without a companion could perceive this as a negative birth experience. Women had mixed perspectives about wanting to have a male partner present (low confidence). Generally, men who were labour companions felt that their presence made a positive impact on both themselves (low confidence) and on the relationship with their partner and baby (low confidence), although some felt anxious witnessing labour pain (low confidence). Some male partners felt that they were not well integrated into the care team or decision-making.Doulas often met with women before birth to build rapport and manage expectations. Women could develop close bonds with their doulas (low confidence). Foreign-born women in high-income settings may appreciate support from community-based doulas to receive culturally-competent care (low confidence).Factors affecting implementation included health workers and women not recognising the benefits of companionship, lack of space and privacy, and fearing increased risk of infection (low confidence). Changing policies to allow companionship and addressing gaps between policy and practice were thought to be important (low confidence). Some providers were resistant to or not well trained on how to use companions, and this could lead to conflict. Lay companions were often not integrated into antenatal care, which may cause frustration (low confidence).We compared our findings from this synthesis to the companionship programmes/approaches assessed in Bohren's review of effectiveness. We found that most of these programmes did not appear to address these key features of labour companionship.

AUTHORS' CONCLUSIONS

We have high or moderate confidence in the evidence contributing to several of these review findings. Further research, especially in low- and middle-income settings and with different cadres of healthcare providers, could strengthen the evidence for low- or very low-confidence findings. Ahead of implementation of labour companionship, researchers and programmers should consider factors that may affect implementation, including training content and timing for providers, women and companions; physical structure of the labour ward; specifying clear roles for companions and providers; integration of companions; and measuring the impact of companionship on women's experiences of care. Implementation research or studies conducted on labour companionship should include a qualitative component to evaluate the process and context of implementation, in order to better interpret results and share findings across contexts.

Making the case for innovative reentry employment programs: previously incarcerated women as birth doulas - a case study

Purpose The purpose of this paper is to make a case for novel and innovative reentry programs focused on women of color and to describe policy recommendations that are necessary to support the sustainability of these programs and in turn the success of the women who participate in them. Design/methodology/approach A review and analysis of the literature that described job-training opportunities specifically targeted to women exiting jail and the impact on recidivism provided limited information. The authors developed, implemented, and evaluated doula training program for low-income and women of color to determine if birth work could provide stable income and decrease recidivism. Findings Training low-income formerly incarcerated women to become birth doulas is an innovative strategy to solve employment barriers faced by women reentering communities from jail. Realigning women within communities via birth support to other women also provides culturally relevant and appropriate members of the healthcare team for traditionally vulnerable populations. Doulas are important members of the healthcare workforce and can improve birth outcomes. The authors' work testing doula training, as a reentry vocational program has been successful in producing 16 culturally relevant and appropriate doulas of color that experienced no re-arrests and to date no program participant has experienced recidivism. Originality/value To be successful, the intersections of race, gender, and poverty, for women of color should be considered in the design of reentry programs for individuals exiting jail. The authors' work provided formerly incarcerated and low-income women of color with vocational skills that provide consistent income, serve as a gateway to the health professions, and increase the numbers of well-trained people of color who serve as providers of care.

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.

Pregnancy and Parenting Support for Incarcerated Women: Lessons Learned

BACKGROUND

There are more than 200,000 incarcerated women in U.S. prisons and jails, and it is estimated that 6% to 10% are pregnant. Pregnant incarcerated women experience complex risks that can compromise their health and the health of their offspring.

OBJECTIVES

Identify lessons learned from a community-university pilot study of a prison-based pregnancy and parenting support program.

METHODS

A community-university-corrections partnership was formed to provide education and support to pregnant incarcerated women through a prison-based pilot program. Evaluation data assessed women's physical and mental health concerns and satisfaction with the program. Between October 2011 and December 2012, 48 women participated.

LESSONS LEARNED

We learned that providing services for pregnant incarcerated women requires an effective partnership with the Department of Corrections, adaptations to traditional community-based participatory research (CBPR) approaches, and resources that support both direct service and ongoing evaluation.

CONCLUSIONS

Effective services for pregnant incarcerated women can be provided through a successful community- university-corrections partnership.