Incarcerated Childbirth and Broader "Birth Control": Autonomy, Regulation, and the State

By Ahrens, Deborah | Missouri Law Review, Winter 2015 | Go to article overview

Incarcerated Childbirth and Broader "Birth Control": Autonomy, Regulation, and the State


Ahrens, Deborah, Missouri Law Review


4. Autonomy and Safety During Labor

For women outside the correctional context, preparing to deliver a child is an exercise in planning, requiring the expectant mother to make dozens of decisions large and small. While these choices are, as discussed below, (109) often constrained or coerced and are always contingent upon the progress of the pregnancy, they are central to the birthing experience and essential for the maintenance of autonomy and control. (110) As a general matter, pregnant inmates enjoy comparatively less control over their birthing experience. For most inmates, questions of how and when they give birth are dictated by correctional policies and/or the decisions of individual correctional and medical officials. (111) This subsection catalogs a number of the crucial birthing decisions that are routinely stripped from pregnant women. Some of the loss of autonomy reflected in the items below is unsurprising given the nature of incarceration and the logistical constraints faced by the state. Other items are more surprising in their lack of necessity, their pettiness, and/or their cruelty. (112)

a. The Timing and Method of Delivery

Women who have given birth while incarcerated persistently complain that correctional administrators and health care providers made decisions for them about when and by what method they would give birth. (113) Evidence suggests that correctional facilities routinely schedule inductions and Cesarean sections ("C-sections") (114) for prisoners that have neither been requested nor deemed medically necessary. (115) To some extent, these decisions are motivated by altruistic or, at least, understandable goals. For example, as discussed above, (116) women who go into labor unexpectedly in their jail cells sometimes face logistical difficulties that may delay transport and threaten maternal and fetal health; (117) scheduled deliveries reduce the likelihood of such a dangerous episode. Similarly, planned deliveries ensure the availability of necessary security, transportation, and medical personnel and resources, protecting health and limiting costs. Despite those considerations, inmates consistently report that officials make these decisions haphazardly and imperiously, without sufficient warning or consultation and with disdain for their health and psychological concerns. (118)

Prison officials and medical personnel also routinely schedule C-sections for pregnant women who might be able to labor and deliver vaginally. (119) In particular, prison officials and engaged medical personnel are likely to schedule such procedures for women who have previously delivered a child via C-section. (120) While medical resistance to vaginal births after C-sections ("VBACs") is common with regards to all women, (121) the dynamics of decision making in the prison context bring added pressures to bear on the expectant mother. While prisons probably lack the authority to order a woman to undergo a medically unnecessary C-section if she refuses, (122) pregnant inmates are unable to shop around for sympathetic facilities and providers, often lack the information necessary to make an informed choice, and face potential disciplinary consequences for challenging authority in ways that might be deemed confrontational. (123) This Article discusses the pressure towards C-sections for non-incarcerated women in Part II, demonstrating that while incarcerated women may face some bureaucratic obstacles that non-incarcerated women do not, C-sections are an issue for women generally, not incarcerated women specifically.

b. Pain Relief

Correctional personnel and affiliated medical staff often make decisions for prisoners about their ability to access pain relief during labor. A variety of pain relief options are available to laboring women, ranging from natural childbirth pain relief methods; to narcotic pain-relief medications, such as Stadol; to epidural anesthesia. …

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