UK: pregnancy and childbirth in prison: what do we know?

The recent tragic death of a baby born at HMP Bronzefield raises serious questions about the care of pregnant women in prison in England, particularly when they are in labour. There has rightly been widespread condemnation of what happened, and the story has yet again highlighted how little we know about this small but vulnerable group of women.

There are currently 3,834 women in prison, and today the Guardian has published welcome new figures from NHS Digital about the numbers of births to women in custody or prison over five years. Yet prior to the tragedy in late September at HMP Bronzefield there were no formally reported figures of how many women in prison are pregnant and how many give birth in any given year.

The government has released some basic figures, indicating 47 pregnant women in prison on one specific day in October and fewer than five births in prison itself over the past year. But the means by which these figures were collected (a ‘bespoke counting exercise’) shows the lack of readily available and rigorous information in this area, and therefore the challenge of holding people to account when things go wrong.

What does Nuffield Trust analysis show?¶

Our forthcoming research will provide the most in-depth look yet at how prisoners are using hospital care, drawing on over 110,000 patient records. The full report will be published in the new year but today, as interest mounts on the topic of pregnancy and childbirth in prison, we publish some focused findings on this salient area of health care.

Our analysis found that, in 2017/18:

• 83 female prisoners were admitted to hospital for medical care relating to pregnancy or childbirth. 28 prisoners were in hospital for supervision of high-risk pregnancies.
• A significant proportion of these women also had co-occurring mental health concerns, including 34 with tobacco-related issues, 26 with concerns related to opioid use and 23 experiencing depressive episodes.
• There were more than 600 outpatient appointments for women in prison to attend midwifery services or obstetrics.
• 56 female prisoners gave birth during their prison stay, and over one in 10 of these (six prisoners) gave birth either in prison or on their way to hospital.

Being pregnant in prison¶

This week the Royal College of Midwives issued a call for pregnant prisoners to be given equivalent care to those outside of prison. Our research highlights a number of areas that need particular focus if this is to be achieved.

Where routine outpatient appointments are concerned, we can see that pregnant prisoners are experiencing fewer missed appointments than their non-pregnant counterparts in prison (22% of midwifery appointments compared to 39% of general outpatient appointments for women in prison). This suggests that prisons may be prioritising pregnant women’s health needs.

But when we compare outpatient appointments to the wider population, the numbers of missed appointments are far higher (22% of midwifery appointments compared to 14% in the wider population). This raises serious questions about whether pregnant women are able to access the same level of care as the wider population.

Moreover, the data also reveals that many of these women are admitted to hospital for supervision of high-risk pregnancies and that many of them have significant mental health needs. Clearly any policy to improve the outcomes of pregnant women in prison needs to be based in the reality that these patients have especially high needs.

Why shouldn’t women in prison give birth in their prison cell?¶

Our finding on the women that gave birth either in a prison cell or en route to hospital is worthy of particular focus. While the absolute number (six women) is small, this represents over one in 10 of all births that year. And yet prisons are in no way equipped to meet the needs of a woman in labour, or ensure the safe delivery of a baby.

For example, prisons are not staffed with round-the-clock midwives who are trained to support women in labour and know how labour is progressing, and there is no access to a range of pain relief options that a woman might use if she gave birth in hospital.

What’s more, the emotional impact of giving birth in a prison cell can be very significant. According to first-hand accounts, women prisoners often don’t feel that staff “believe” them when they say they are in labour. This may stem from the fact that the prison staff who are a first point of contact for a labouring prisoner are not health care professionals, and will inevitably have very different priorities.

Taken together with the finding that pregnant women in prison are likely to have significant co-occurring mental health problems.

It is clear that this is a group of prisoners who are not being adequately supported at one of the most important and potentially stressful times of their life.

Caring for pregnant women in prison¶

The tragedy at HMP Bronzefield has rightly focused attention on the plight of female prisoners and the safety of prison as a place for pregnant women and their babies, prompting a further debate about the extent to which prison is ever the right place for pregnant women.

Answering this complex question is beyond the scope of our research, but our work makes clear that this is a small but highly vulnerable group of prisoners whose health needs are not being adequately met.

Surely it is not unreasonable, therefore, to expect that policy-makers can – and should – work harder to tailor services for pregnant women in prison. And if the death of a newborn baby behind bars doesn’t lead to real and lasting change, it is hard to know what will.

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