Abstract
Background
Prisons face challenges in meeting the unique health care needs of women, especially those who are pregnant. This retrospective chart review sought to describe the maternal and infant health outcomes of incarcerated women who received prenatal care while in an Arkansas prison.
Methods
Using a hospital-based electronic medical records (EMR) system, we examined the maternal health history and current pregnancy characteristics of 219 pregnant women who received prenatal care while incarcerated from June 2014 to May 2019. We also examined labor and delivery characteristics and postpartum and infant birth outcomes for the 146 women from this cohort who delivered a living child while still incarcerated.
Results
Most records indicated complex health histories with several chronic illnesses, mental health diagnoses, history of substance use, and lifetime medical complications. Despite comorbid illness, substance use disorder (SUD), trauma-history, and post-traumatic stress disorder (PTSD) prevalence was lower than expected. Previous and current obstetrical complications were common. Although the Neonatal Intensive Care Unit (NICU) admission rate (41%) was high, few infants required extensive treatment intervention. Postpartum complications were rare; however, a small portion of women who gave birth in custody experienced severe complications and were re-admitted to the hospital post-discharge.
Conclusions
Incarcerated pregnant women and their infants are a marginalized population in great need of health care advocacy. To optimize maternal-infant outcomes, carceral agencies must recognize the health needs of incarcerated pregnant women and provide appropriate prenatal care. Expansion of carceral perinatal care to include screening for SUD and psychiatric symptoms (e.g., PTSD) and referral to appropriate care is highly encouraged. Policies related to NICU admission for non-medical reasons should be further examined.
Significance
What is already known on this subject? Pregnant incarcerated women are at high risk for poor perinatal outcomes; however, knowledge of maternal and infant outcomes remains limited. Studies that exist are limited to a small number of outcomes and focus on immediate birth outcomes (e.g., prematurity, birthweight, NICU admission) with little data related to maternal and infant complications experienced during labor, delivery and postpartum, and infant diagnoses at delivery and discharge.
What this study adds? Our study adds to what is known about the outcomes of incarcerated pregnant women by documenting their overall maternal health, previous and current pregnancy characteristics, and maternal and infant outcomes inclusive of the prenatal, labor and delivery, and postnatal periods.
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Data Availability
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Notes
We acknowledge that not all pregnant people in carceral settings identify as “women” and hold gender identities not captured by the term. However, all individuals included in the current sample self-identified as “women” in their medical record and are referred to as women in the manuscript.
References
ACOG. (2018). ACOG Committee Opinion No. 757: Screening for perinatal depression. Obstetrics and Gynecology, 132(5), E208–E212. https://doi.org/10.1097/AOG.0000000000002927
ACOG. (2021). Reproductive health care for incarcerated pregnant, postpartum, and nonpregnant individuals. Obstetrics & Gynecology, 138(1), 164–165. https://doi.org/10.1097/aog.0000000000004430
Baker, B. (2019). Perinatal outcomes of incarcerated pregnant women: An integrative review. Journal of Correctional Health Care, 25(2), 92–104. https://doi.org/10.1177/1078345819832366
Baldwin, A., Sobolewska, A., & Capper, T. (2020). Pregnant in prison: An integrative literature review. Women and Birth, 33(1), 41–50. https://doi.org/10.1016/j.wombi.2018.12.004
Bard, E., Knight, M., & Plugge, E. (2016). Perinatal health care services for imprisoned pregnant women and associated outcomes: A systematic review. BMC Pregnancy and Childbirth, 16(1), 285. https://doi.org/10.1186/s12884-016-1080-z
Carson, A. E. (2018, Jan). Sentenced population. Bureau of Justice Statistics.
Carson, E. A. (2022). Prisoners in 2021 (Issue Dec 2022, NCJ 305125). Retrieved from https://bjs.ojp.gov/library/publications/prisoners-2021-statistical-tables
Carter Ramirez, A., Liauw, J., Cavanagh, A., Costescu, D., Holder, L., Lu, H., & Kouyoumdjian, F. G. (2020). Quality of antenatal care for women who experience imprisonment in Ontario, Canada. JAMA Network Open, 3(8), e2012576. https://doi.org/10.1001/jamanetworkopen.2020.12576
Estelle v. Gamble. (1976).
Ferszt, G., & Clarke, J. (2012). Health care of pregnant women in US state prisons. Journal of Health Care for the Poor and Underserved, 23(2), 557–569.
Ferszt, G. G., Hickey, J. E., & Seleyman, K. (2013). Advocating for pregnant women in prison: The role of the correctional nurse. Journal of Forensic Nursing, 9(2), 105–110. https://doi.org/10.1097/JFN.0b013e318281056b
Fogel, C. I. (1994). Pregnant prisoners: Impact of incarceration on health and health care. Journal of Correctional Health Care, 2(2), 169–190.
Gold, K. J., & Marcus, S. M. (2008). Effect of maternal mental illness on pregnancy outcomes. Expert Review of Obstetrics and Gynecology, 3(3), 391–401. https://doi.org/10.1586/17474108.3.3.391.
Harner, H. M., Budescu, M., Gillihan, S. J., Riley, S., & Foa, E. B. (2015). Posttraumatic stress disorder in incarcerated women: A call for evidence-based treatment. Psychological Trauma: Theory, Research, Practice, and Policy, 7(1), 58–66. https://doi.org/10.1037/a0032508
Hayes, M. O. (2015). The life pattern of incarcerated women: The complex and interwoven lives of trauma, mental illness, and substance abuse. Journal of Forensic Nursing, 11(4), 214–222. https://doi.org/10.1097/JFN.0000000000000092
Howard, D. L., Strobino, D., Sherman, S., & Crum, R. (2008). Within prisons, is there an association between the quantity of prenatal care and infant birthweight? Paediatric and Perinatal Epidemiology, 22(4), 369–378. https://doi.org/10.1111/j.1365-3016.2008.00933.x
Howard, D. L., Strobino, D., Sherman, S. G., & Crum, R. M. (2009). Timing of incarceration during pregnancy and birth outcomes: Exploring racial differences. Maternal and Child Health Journal, 13(4), 457–466. https://doi.org/10.1007/s10995-008-0376-7
Howard, D. L., Strobino, D., Sherman, S. G., & Crum, R. M. (2011). Maternal incarceration during pregnancy and infant birthweight. Maternal and Child Health Journal, 15(4), 478–486. https://doi.org/10.1007/s10995-010-0602-y
Howland, M. A., Kotlar, B., Davis, L., & Shlafer, R. J. (2021). Depressive symptoms among pregnant and postpartum women in prison. Journal of Midwifery and Women’s Health, 66(4), 494–502. https://doi.org/10.1111/jmwh.13239
Karlsson, M. E., & Zielinski, M. J. (2020). Sexual victimization and mental illness prevalence rates among incarcerated Women: A literature review. Trauma, Violence, and Abuse, 21(2), 326–349. https://doi.org/10.1177/1524838018767933
Kim, Y., Ganduglia-Cazaban, C., Chan, W., Lee, M. J., & Goodman, D. C. (2021). Trends in neonatal intensive care unit admissions by race/ethnicity in the United States, 2008–2018. Scientific Reports, 11(1), 1–9. https://doi.org/10.1038/s41598-021-03183-1
Knight, M., & Plugge, E. (2005). The outcomes of pregnancy among imprisoned women: A systematic review. BJOG, 112(11), 1467–1474. https://doi.org/10.1111/j.1471-0528.2005.00749.x
Law, V. (2023, March 8). Arizona prisoners find hope in their fight against forced inductions. Retrieved 19 Sept 2023, from The Nation https://www.thenation.com/article/society/arizona-pregnant-prisoners-forced-inductions/
March of Dimes. (2020). Delivery method data for Arkansas. Retrieved from https://www.marchofdimes.org/peristats/data?reg=99&top=8&stop=86&lev=1&slev=4&obj=18&sreg=05
Maruschak, L. M. (2008). Medical problems of prisoners. Bureau of Justice Statistics.
Morse, D. S., Wilson, J. L., Driffill, N. J., Lauture, J., Khan, A., & King-Turner, S. O. (2019). Outcomes among pregnant recently incarcerated women attending a reentry transitions clinic. Journal of Community Psychology, 47(3), 679–697. https://doi.org/10.1002/jcop.22147
NCCHC. (2020). Women’s health care in correctional settings. Position statement. Retrieved from https://www.ncchc.org/position-statements/womens-health-care-in-correctional-settings-2020/
Osterman, M. J. K., Hamilton, B. E., Martin, J. A., Driscoll, A. K., & Valenzuela, C. P. (2022). Births: Final data for 2020. National Vital Statistics Reports, 70(17). https://www.cdc.gov/nchs/products/index.htm.
Paynter, M. J., Drake, E. K., Cassidy, C., & Snelgrove-Clarke, E. (2019). Maternal health outcomes for incarcerated women: A scoping review. Journal of Clinical Nursing, 28(11–12), 2046–2060. https://doi.org/10.1111/jocn.14837
Shlafer, R., Saunders, J. B., Boraas, C. M., Kozhimannil, K. B., Mazumder, N., & Freese, R. (2021). Maternal and neonatal outcomes among incarcerated women who gave birth in custody. Birth, 48(1), 122–131. https://doi.org/10.1111/birt.12524
Sufrin, C. (2018, Jan). Pregnancy and postpartum care in correctional settings. In: National commission on correctional health care. Retrieved from https://www.ncchc.org/filebin/Resources/Pregnancy-and-Postpartum-Care-2018.pdf
Sufrin, C., Beal, L., Clarke, J., Jones, R., & Mosher, W. D. (2019). Pregnancy outcomes in US prisons, 2016–2017. American Journal of Public Health, 109(5), 799–805. https://doi.org/10.2105/AJPH.2019.305006
Task Force on Correctional Care Standards. (2003). Standards for health service in correctional institutions (3rd ed.). American Public Health Association.
The Sentencing Project. (2022). Incarcerated women and girls. The Sentencing Project. Retrieved from http://www.sentencingproject.org/wp-content/uploads/2016/02/Incarcerated-Women-and-Girls-1980-2016.pdf
Wang, L. (2021). Unsupportive environments and limited policies: Pregnancy, postpartum, and birth during incarceration. Retrieved from https://www.prisonpolicy.org/blog/2021/08/19/pregnancy_studies/
Williams, L., & Schulte-day, S. (2006). Pregnant in prison—The incarcerated women’s experience: A preliminary descriptive study. Journal of Correctional Health Care, 12(2), 78–88.
Acknowledgements
The authors wish to thank Trey Spencer who served as our Biostatistician consultant on this project.
Funding
Execution of this study was supported by NCATS grant PTC2020-02 (PI: Zielinski), awarded by UAMS’ Translational Research Institute which is funded through the National Center for Advancing Translational Sciences (UL1 TR003107; PI: James). Manuscript preparation was also supported by K23DA048162 (PI: Zielinski) and T32DA022981 (PI: Kilts) which provided salary support for the first and last authors.
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MSS and MZ conceptualized and designed the study, collected data, assisted with data entry, data analysis, drafted the initial manuscript, and revised the manuscript. KHF, BSK, MV, and AW assisted with development of data measures, data analysis and interpretation of results. KHF, BSK, MV, and AV all provided revisions to the manuscript and approved the final version prior to submission.
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Steely Smith, M.K., Hinton-Froese, K.E., Scarbrough Kamath, B. et al. Characteristics and Outcomes of Women and Infants Who Received Prenatal Care While Incarcerated in Arkansas State Prison System, 2014–2019. Matern Child Health J 28, 935–948 (2024). https://doi.org/10.1007/s10995-023-03875-2
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DOI: https://doi.org/10.1007/s10995-023-03875-2