1. Nelson, Roxanne BSN, RN

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Awoman shackled to the bed rails while giving birth sounds archaic. However, it is practiced in a number of regions in the United States; female prisoners are restrained during labor and childbirth routinely.

Figure. An inmate in... - Click to enlarge in new windowFigure. An inmate in California before the statewide ban was enacted, this woman was shackled to her hospital bed during labor and delivery.

"We believe that according to international law, this denies women basic rights and is a cruel and degrading form of treatment," said Sheila Dauer, director of the Women's Human Rights Program at Amnesty International USA. She points out that the United Nations has set standards called Standard Minimum Rules for the Treatment of Prisoners, Rule 33. According to Amnesty International USA, the rule states that "shackles should not be used on inmates unless they are a danger to themselves, others or property or have a history of absconding."


"Using shackles on pregnant prisoners in labor is in violation of both the United Nations Convention against Torture and the International Covenant on Civil and Political Rights; the United States has ratified both," said Dauer.


The number of incarcerated women has escalated over the past two decades, at a rate nearly double that of men. According to the U.S. Department of Justice statistics, at the end of 2003 there were 101,179 women in state or federal prisons, a figure that represents 6.9% of all prison inmates.


The dramatic increase is primarily due to stricter drug laws, explained Vicki Sirockman, the executive director of Lydia's Place, a Pittsburgh-based organization that offers services to incarcerated women and assists them upon release. According to the Sentencing Project, a nonprofit, nationally recognized source of criminal justice policy analysis, data, and program information, about one-third of female prisoners in the United States are serving a sentence for a drug-related offense.


"We provide services for the local county jail," said Sirockman. "And there has been a 500% increase in the number of women incarcerated due to drug laws."


Increasing female prison populations has also increased the number of prisoners who are pregnant and give birth while incarcerated. In an update to its 2001 report, Abuse of Women in Custody: Sexual Misconduct and Shackling of Pregnant Women, Amnesty International found that almost half of all states and the Federal Bureau of Prisons permit women to be restrained while in labor. Furthermore, 38 states and the Federal Bureau of Prisons allow restraints to be used on women in their third trimester.


Thus far, only Illinois and California have passed legislation that explicitly prohibits this practice; a similar bill is currently pending in New York. A number of states do not have a written policy governing the use of restraints on pregnant women, and the majority of state departments of corrections did not provide details to Amnesty International USA on the type of restraints that were allowable during labor, nor did they provide details of their overall policy.


Several states, however, did provide information about their policies and protocols. They are as follows (as taken directly from


* Alabama stated that restraints depend on the security class of the woman, but that "often two extremities are restrained."


* Arkansas reportedly has a policy stipulating that women with "lesser disciplinary records" will at times have one arm and one leg restrained by flexible nylon "soft restraints." Arkansas did not provide information on how women with other disciplinary records are restrained.


* Louisiana allows restraints including leg irons to be utilized.


* Nevada reported that "normally only wrist restraints" are used.


* New Hampshire stated that one foot may be shackled to the bed during labor depending on security class of the woman in labor.


* West Virginia reports that leg restraints would not be used during labor.


* Illinois, Massachusetts, Pennsylvania, Oklahoma and Wisconsin allow restraints until the inmate is in "active labor" or arrives at the delivery room



It is difficult to gauge how prevalent the practice is, since there are no available data on the actual of number of incarcerated women who deliver in restraints. Deborah LaBelle, a civil rights attorney from Ann Arbor, Michigan, whose legal practice focuses on class action suits on behalf of women prisoners, said that shackling is Michigan's standard policy.


"They shackle during delivery and abortions," said LaBelle. "In fact, we just had this issue at a Planned Parenthood in Ann Arbor."


All pregnant inmates in the state deliver at Hutzel Women's Hospital in Detroit, she added. "If the staff refuses to perform the procedure under these draconian conditions and inform the correction staff that they are endangering the woman's life by failing to take off the restraints-I believe that has worked on occasion."


However, nurses and other staff members can be reprimanded for removing the restraints and can even lose their jobs. "The policy is crazy," said LaBelle, "because there is plenty of security."


However, Edward Harrison, president of the National Commission on Correctional Health Care (NCCHC), believes that the practice is not widespread and in fact, uncommon. The NCCHC is an independent, not-for-profit organization that has helped set standards for health care in correctional facilities, and they have offered a voluntary health services accreditation program since the 1970s.


"If a correctional facility shackles women in labor, it is rare," he said. "In our accreditation program, which reviews health care at hundreds of correctional facilities nationwide, we have never come across this practice."


Mary Raines, who is on the board of directors of the American Correctional Health Services Association and the health services manager for the women's prison in Oregon, said that despite the lack of protective legislation, the practice does not exist in Oregon.


"The Oregon Department of Corrections goes to great lengths to balance public safety with the health of pregnant inmates and their babies," said Raines. "Indeed, beyond relaxing its restraint policies, the department facilitates visiting during the hospital stay and following the inmate mother's return to prison."


Obstetric care begins when a pregnant inmate is admitted to prison; all pregnant inmates are assigned to Coffee Creek Correctional Facility in Wilsonville. Medical care is provided both in the health services department at the prison and, if necessary, by providers in the community.


Normal restraint procedures are modified for pregnant inmates at a time determined by health services staff, usually between three and five months gestation, explained Raines. The policy is to simply handcuff inmates in front of their body, rather than behind their backs.


When an inmate is believed to be in labor, she is transported to the hospital handcuffed in the front of her body, and once at the hospital the cuffs are removed to facilitate medical evaluation. The inmate is not restrained during labor, delivery, and recovery.


But overall, Dauer believes that shackling women during labor is part of the larger neglect of rights for incarcerated women. This includes a lack of states laws concerning custodial sexual misconduct and the failure of existing laws in most states to provide adequate protection, and the use of "pat-down" searches by men under certain circumstances.


"We do applaud the progress that has been made," Dauer said. "But a lot more still needs to be done."


Roxanne Nelson, BSN, RN