Labor and delivery are "completely unpredictable," she said. A baby's heart rate may suddenly drop, requiring doctors to begin a series of maneuvers to get the baby out of distress.
"We're changing the position of the mother in order to increase blood flow to the baby" by putting the mother on her hands and knees, or having her put her legs into a frog's-leg position, she said. But a woman whose ankles are restrained cannot quickly switch positions, and there may not be time to wait for a guard to unshackle. If doctors need to do an emergency C-section, "how do you transfer a woman into an operating room if she's shackled to a bed?" Sufrin asked.
Sufrin said common sense should dictate that a woman in labor is in a lot of pain and the chances she might escape are "pretty slim." In addition, if she's been given epidural anesthesia, the numbness "makes it impossible to run off."
Saada Saar and other activists seeking shackling reforms are optimistic that more states will come around.
"There's an intense effort going on in Arkansas right now," Saada Saar said. She's also hopeful that Tennessee and Georgia will adopt legislation in the next year.
In California, where 4 percent to 7 percent of incarcerated women are pregnant, Gov. Arnold Schwarzenegger on Sept. 28 vetoed a statute that would have broadened the current prohibition on shackling during labor by extending that right to incarcerated women throughout their pregnancies. Legislative supporters plan to revive the legislation in 2011, said Alicia Walters, a reproductive justice consultant for the ACLU of Northern California.
"We're hopeful that California will become the first state to ensure the health and safety of incarcerated pregnant women and a new governor will not be as short-sighted as Gov. Schwarzenegger has been," she said. "Our legislative efforts thus far encountered no opposition. We've been successful in gaining the support of law enforcement and the corrections community."
Diana Kasdan, staff attorney for the ACLU Reproductive Rights Project, has been working with U.S. Immigration and Customs Enforcement officials on a broad revision of detention policies that she hopes will bring those policies on pregnant women in line with the federal Bureau of Prisons standard on the use of restraints.
Kasdan, who believes restraining a pregnant woman is unconstitutional, said she is heartened by actions of forward-thinking local officials, whose efforts may influence states. She cited Darron Hall, the sheriff of Davidson County, Tenn., who in 2008 instituted an internal policy change following a highly publicized incident in which a pregnant inmate was restrained on the way to a Nashville hospital. In 2009, he endorsed proposed state legislation -- which was not enacted -- modeled on the changes he made after researching the use of restraints on pregnant inmates and finding several states had outlawed or limited it.
That "led us to change how we do business. It is imperative that we develop procedures that are sensitive to the unique needs of pregnant inmates in our custody," Hall said.
On an average day, the Davidson County Sheriff's Office is responsible for the care and custody of 25 pregnant inmates, he said.
Saada Saar is looking forward to a mid-November meeting with representatives of the U.S. Department of Justice "to address how this practice might be ended." The gathering stemmed from a meeting with Attorney General Eric Holder, "where he did not know this practice was occurring and was quite upset to hear about it, especially because his wife is an ob-gyn."