Perinatal Nurses' Experiences With and Knowledge of the Care of Incarcerated Women During Pregnancy and the Postpartum Period

Published:December 07, 2018DOI:



      To describe perinatal nurses’ experiences of caring for incarcerated women during pregnancy and the postpartum period; to assess their knowledge of the 2011 position statement Shackling Incarcerated Pregnant Women published by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN); and to assess their knowledge of their states’ laws regulating nonmedical restraint use, or shackling, of incarcerated women.


      Cross-sectional survey.


      Online across the United States.


      AWHONN members who self-identified as antepartum, intrapartum, postpartum, or mother-baby nurses (N = 923, 8.2% response rate).


      A link to an investigator-developed survey was e-mailed to eligible AWHONN members (N = 11,274) between July and September 2017.


      A total of 74% (n = 690) of participants reported that they cared for incarcerated women during pregnancy or the postpartum period in hospital perinatal units. Of these, most (82.9%, n = 566) reported that their incarcerated patients were shackled sometimes to all of the time; only 9.7% reported ever feeling unsafe with incarcerated women who were pregnant. “Rule or protocol” was the most commonly endorsed reason for shackling. Only 17.0% (n = 157) of all participants knew about the AWHONN position statement, and 3% (n = 28) correctly identified the conditions under which shackling may ethically take place (risk of flight, harm to self, or harm to others). Only 7.4% (n = 68) of participants correctly identified whether their states had shackling laws.


      Our results suggest critical gaps in nurses’ knowledge of professional standards and protective laws regarding the care of incarcerated women during pregnancy. Our findings underscore an urgent need for primary and continuing nursing education in this area.


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        • Aday L.A.
        • Cornelius L.J.
        Designing and conducting health surveys: A comprehensive guide.
        3rd ed. John Wiley & Sons, San Francisco, CA2006
        • American Civil Liberties Union of California
        Reproductive health behind bars in California.
        (Retrieved from)
        • American College of Nurse Midwives
        Position statement: Shackling/restraint of pregnant women who are incarcerated.
        (Retrieved from)
        • American College of Obstetricians and Gynecologists
        Committee opinion number 511: Health care for pregnant and postpartum incarcerated women and adolescent females.
        (Retrieved from)
        • American Nurses Association
        Code of ethics for nurses, with interpretive statements.
        Author, Silver Spring, MD2015
        • American Psychiatric Nurses Association
        APNA position statement on the use of seclusion and restraint.
        (Retrieved from)
      1. An Act Concerning the Fair Treatment of Incarcerated Persons, Conn. Public Act No. 18-4 (October 1, 2018).

      2. An Act Relating to Prisons and Reformatories, 57 Okla. Stat. § 4.2 (November 1, 2018).

        • Association of Women's Health, Obstetric and Neonatal Nurses
        AWHONN position statement: Shackling incarcerated pregnant women.
        Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2011; 40: 817-818
        • Association of Women's Health, Obstetric and Neonatal Nurses
        Nursing care of incarcerated women during pregnancy and the postpartum period.
        Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2018; 47: 236-238
        • Bailey Z.D.
        • Krieger N.
        • Agénor M.
        • Graves J.
        • Linos N.
        • Bassett M.T.
        Structural racism and health inequities in the USA: evidence and interventions.
        The Lancet. 2017; 389: 1453-1463
      3. Births to Inmates of Correctional Institutions and Care of Children of Inmates of Correctional Institutions. 22 N.Y.S. Corrections Code 611 (2015).

        • Bleijlevens M.H.C.
        • Wagner L.M.
        • Capezuti E.
        • Hamers J.P.H.
        Physical restraints: Consensus of a research definition using a modified Delphi technique.
        Journal of the American Geriatrics Society. 2016; 64: 2307-2310
        • Bonczar T.
        Table 10. First releases from state prison, 2009: Sentence length, time served in prison, by offense, and sex.
        (Retrieved from)
        • Brenan M.
        Nurses keep healthy lead as most honest, ethical profession.
        (Retrieved from)
        • Carson E.A.
        Prisoners in 2016.
        (Retrieved from)
        • Carson E.A.
        • Anderson E.
        Prisoners in 2015.
        (Retrieved from)
        • Centers for Disease Control and Prevention
        HIV among incarcerated populations.
        (Retrieved from)
        • Chari K.A.
        • Simon A.E.
        • DeFrances C.J.
        • National Center for Health Statistics
        • Maruschak L.
        National survey of prison health care: Selected findings.
        National Health Statistics Reports. 2016; 2016 (Retrieved from): 1-23
        • Clair M.
        • Daniel C.
        • Lamont M.
        Destigmatization and health: Cultural constructions and the long-term reduction of stigma.
        Social Science & Medicine. 2016; 165: 223-232
        • Dignam B.
        • Adashi E.
        Health rights in the balance: The case against perinatal shackling of women behind bars.
        Health and Human Rights. 2014; 16: 13-23
        • Fazel S.
        • Hayes A.J.
        • Bartellas K.
        • Clerici M.
        • Trestman R.
        Mental health of prisoners: Prevalence, adverse outcomes, and interventions.
        The Lancet Psychiatry. 2016; 3: 871-881
        • Fazel S.
        • Yoon I.A.
        • Hayes A.J.
        Substance use disorders in prisoners: An updated systematic review and meta-regression analysis in recently incarcerated men and women.
        Addiction. 2017; 112: 1725-1739
        • Ferszt G.G.
        • Clarke J.G.
        Health care of pregnant women in U.S. state prisons.
        Journal of Health Care for the Poor and Underserved. 2012; 23: 557-569
        • Ferszt G.G.
        • Palmer M.
        • McGrane C.
        Where does your state stand on shackling of pregnant incarcerated women?.
        Nursing for Women's Health. 2018; 22: 17-23
        • Glaze L.E.
        • Maruschak L.M.
        Parents in prison and their minor children.
        (Retrieved from)
        • Goshin L.S.
        • Arditti J.A.
        • Dallaire D.H.
        • Shlafer R.J.
        • Hollihan A.
        An international human rights perspective on maternal criminal justice involvement in the United States.
        Psychology, Public Policy, and Law. 2017; 23: 53-67
        • Goulet M.H.
        • Larue C.
        • Dumais A.
        Evaluation of seclusion and restraint reduction programs in mental health: A systematic review.
        Aggression and Violent Behavior. 2017; 34: 139-146
        • Grella C.E.
        • Lovinger K.
        • Warda U.S.
        Relationships among trauma exposure, familial characteristics, and PTSD: A case-control study of women in prison and in the general population.
        Women & Criminal Justice. 2013; 23: 63-79
        • Holdt Somer S.J.
        • Sinkey R.G.
        • Bryant A.S.
        Epidemiology of racial/ethnic disparities in severe maternal morbidity and mortality.
        Seminars in Perinatology. 2017; 41: 258-265
        • International Human Rights Clinic
        The shackling of incarcerated pregnant women: A human rights violation committed regularly in the United States.
        (Retrieved from)
        • Kelly P.J.
        • Peralez-Dieckmann E.
        • Cheng A.L.
        • Collins C.
        Profile of women in a county jail.
        Journal of Psychosocial Nursing and Mental Health Services. 2010; 48: 38-45
        • Kelsey C.M.
        • Medel N.
        • Mullins C.
        • Dallaire D.
        • Forestell C.
        An examination of care practices of pregnant women incarcerated in jail facilities in the United States.
        Maternal and Child Health Journal. 2017; 21: 1260-1266
        • Köpke S.
        • Mühlhauser I.
        • Gerlach A.
        • Haut A.
        • Haastert B.
        • Möhler R.
        • Meyer G.
        Effect of a guideline-based multicomponent intervention on use of physical restraints in nursing homes: A randomized controlled trial.
        Journal of the American Medical Association. 2012; 307: 2177-2184
        • Legal Services for Prisoners with Children
        No more shackles II: A follow-up report on California’s counties’ written policies under the 2012 law limiting restraint of pregnant prisoners.
        (Retrieved from)
        • Maruschak L.M.
        Medical problems of jail inmates.
        (Retrieved from)
        • Maruschak L.M.
        Medical problems of prisoners.
        (Retrieved from)
        • Minton T.D.
        • Zeng Z.
        Jail inmates in 2015.
        (Retrieved from)
      4. Mo. S.B. 870 (July 6, 2018). Retrieved from

        • Möhler R.
        • Richter T.
        • Köpke S.
        • Meyer G.
        Interventions for preventing and reducing the use of physical restraints in long-term geriatric care—A Cochrane review.
        Journal of Clinical Nursing. 2012; 21: 3070-3081
        • National Resource Center on Justice Involved Women
        The use of restraints on pregnant women in jails and prisons.
        (Retrieved from)
      5. Pregnant inmates housed in jail, penitentiary, local or state correctional or detention facility, residential center, or reentry center–Permissible and impermissible restraints. KRS § 196.173 (2018).

        • Quinn A.
        In labor, in chains, the outrageous shackling of pregnant inmates.
        New York Times. 2014, July 26; (Retrieved from)
        • Rabuy B.
        • Kopf D.
        Prisons of poverty: Uncovering the pre-incarceration incomes of the imprisoned.
        (Retrieved from)
        • Sentencing Project
        Incarcerated women and girls, 1980–2016.
        (Retrieved from)
        • Sufrin C.
        • Kolbi-Molinas A.
        • Roth R.
        Reproductive justice, health disparities and incarcerated women in the United States.
        Perspectives on Sexual and Reproductive Health. 2014; 47: 213-219
        • Swavola E.
        • Riley K.
        • Subramanian R.
        Overlooked: Women and jails in the era of reform.
        (Retrieved from)
        • Thomas S.Y.
        • Lanterman J.L.
        A national analysis of shackling laws and policies as they relate to pregnant incarcerated women.
        Feminist Criminology. 2017; (Advance online publication)
        • Walmsley R.
        World female imprisonment list (4th ed.).
        (Retrieved from)
        • Women in Prison Project
        Reproductive injustice: The state of reproductive health care for women in New York State prisons.
        (Retrieved from)
        • Zeng Z.
        Jail inmates 2016.
        (Retrieved from)
        • Zust B.L.
        • Busiahn L.
        • Janisch K.
        Nurses' experiences caring for incarcerated patients in a perinatal unit.
        Issues in Mental Health Nursing. 2013; 34: 25-29


      Lorie S. Goshin, PhD, RN, is an assistant professor, Hunter-Bellevue School of Nursing, Hunter College, City University of New York, New York, NY.


      D. R. Gina Sissoko, BA, is a research assistant, Hunter College, City University of New York, New York, NY.


      Grace Neumann, BSN, RN, is a research assistant, Hunter-Bellevue School of Nursing, Hunter College, City University of New York, New York, NY.


      Carolyn Sufrin, MD, PhD, is an assistant professor, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.


      Lorraine Byrnes, PhD, FNP-BC, PMHNP-BC, CNM, FAANP, is an associate Professor, Hunter-Bellevue School of Nursing, Hunter College, City University of New York, New York, NY.