The American Medical Association's House of Delegates voted in June in favor of a model law that states could adopt, which would extend the prohibition on shackles during labor and delivery to the second or third trimesters of pregnancy, when facilities should use the "least restrictive restraints necessary."
The U.S. Court of Appeals for the Eighth Circuit last year ruled that the shackling of an Arkansas woman's legs to a hospital bed when she was in the late stages of labor violated the 8th Amendment prohibition on "cruel and unusual punishment."
Malika Saada Saar, founder and director of The Rebecca Project for Human Rights in Washington, D.C., was instrumental in lobbying the U.S. Bureau of Prisons for a 2008 policy change that prohibited the shackling of pregnant federal inmates while they're in labor and delivery.
On Thursday, the Rebecca Project and the National Women's Law Center released a new report, "Mothers Behind Bars," with report cards for each state, and an analysis of federal policies affecting pregnant women in custody. The two organizations are part of a broad coalition of civil rights and reproductive rights groups that have lobbied vigorously for a statutory end to what they call "barbaric policies" affecting the growing numbers of expectant mothers doing time in prison. Most of them are non-violent, first-time felons sentenced for drug-related offenses, credit fraud, or parole violations. "There really isn't a security justification for having women shackled during labor and delivery," Saada Saar said.
Saada Saar said incarcerated women who are giving birth in custody tend to have traveled a similar path. Most are drug felons who "ought to be in the public health system because they're struggling with untreated addiction." Most have been sexually or physically abused, and self-medicate their pain and depression.
"They turn to what's available: crack cocaine on the corner, as opposed to a therapist," Saada Saar said.
At some point, they've tried to get treatment, but dropped out of "one of these family-unfriendly, single adult treatment programs. With mothers, you have to deal with them as mothers."
Saada Saar said these women encounter an attitude that, because of their wrongdoing, "they are in some way not worthy of being mothers, and not worthy of dignity in childbirth because they are incarcerated."
In addition, Saada Saar said she also perceives a lack of understanding among many of the men who implement corrections policies.
"I don't have a sense a lot of those men have personally witnessed labor and delivery, and if they have, something stops them from recognizing the women who deliver behind bars go through the same agony and physical hardship as their wives when they gave birth," she said.
Restraining a pregnant woman by the arms, legs or belly can pose significant medical risks to her and her unborn child, said Dr. Carolyn Sufrin, an ob-gyn at UC San Francisco, who cares for incarcerated women at the San Francisco County Jail. Pregnant women have a different center of gravity from others and are more prone to tripping and falling. Shackling their arms or ankles could increase the risk of them falling on their bellies, which could jeopardize the baby's health.