If you work with female inmate in a jail or prison, you are likely to be involved in childbirth. Five to 10 percent of women entering the criminal justice system are pregnant, some in the last weeks of gestation. Most inmate pregnancies are high risk due to a number of factors including poor nutrition, lack of prior obstetrical care, sexually transmitted infections and drug or alcohol involvement.
Mismanagement of childbirth behind bars has been in the news lately with items from Georgia and Texas. Although news stories of inmate treatment can be sensationalized, the message is clear: officers need to know what to do in the case of potential impending labor. Here are three ‘knows’ for every setting.
Know who's pregnant
One of the simplest and most cost effective means of improving pregnancy outcomes at your facility is to know who is pregnant from the start. Pregnancy testing is convenient and inexpensive. All female inmates should be tested on intake and a thorough pregnancy history obtained during the medical screening process. Pregnancy is one of several medical conditions that correctional staff may be privy to. Duty officers in housing areas should be aware of pregnant inmates under their care and any high risk issues such as premature labor, miscarriage or fetal concerns.
Know what to do
Know what action to take when a pregnant female inmate reports that she is in labor. Your facility should have a standard procedure for dealing with labor initiation. Most often this involves alerting medical unit staff and obtaining a nursing assessment. Depending on facility resources, a laboring inmate may be moved to an observation or infirmary bed for more frequent evaluation. If an inmate in early labor remains in the housing unit, arrange for regular medical staff visits to assess progress. Do not accept the role of labor monitor nor allow the inmate to ‘let the nurse know’ when she reaches contractions of a certain timing or intensity. If there is any strong indication that labor has begun, health care staff must continue to monitor the woman at regular intervals.
Know who to call
If the medical unit is not staffed 24/7, be sure a procedure is in place for contacting a healthcare professional for direction. High risk labor must be managed by health care professionals. Labor may be premature or may be precipitous, requiring rapid medical attention. Ambulance transport to the local hospital obstetrics unit may be necessary. Clarity about the initiation of labor can be difficult in the best of circumstances. Seek medical management early.
The nature of the patient population and the cultural dynamic behind bars can cloud objectivity. Err on the side of caution when dealing with a pregnant inmate potentially in labor. Obtain medical unit assistance and prepare for emergency transport.
How do you deal with childbirth in your facility? Share your tips in the comments section of this post.
About the author
Dr. Schoenly has been a nurse for over 25 years and is currently specializing in correctional healthcare. She is a clinical education specialist and author actively advocating for excellence in this practice setting. Her web-presence www.correctionalnurse.net provides a forum to interpret correctional healthcare to the public and healthcare community. Lorry is a strong advocate for development of the specialty practice of correctional nursing. She speaks and writes frequently on correctional nursing practice issues. Her book, Essentials of Correctional Nursing, will be published in July, 2012.