D.16 Management of Pregnant Prisoners (National Policy)

Policy Standard

• Women prisoners who are pregnant are managed in a sensitive manner that takes into account their particular needs and risks while optimising the well-being of the baby.

Performance Standards

1. Women are enabled to meet their cultural, religious and spiritual customs and beliefs relating to pregnancy, birthing and babies without compromising safety and security.
2. All pregnant prisoners including those on remand are given a full antenatal assessment by a registered midwife or medical officer with obstetric qualifications as soon as is practical or immediately if there is any concern for the welfare of the prisoner or her unborn child.
3. Each women's prison has 24 hour access to, and liaison with, appropriate hospital and community based obstetric and midwifery services.
4. Pregnant women who are known substance abusers are referred to a medical practitioner with obstetric qualifications within 24 hours of reception.
5. Maternity care is selected in consultation with the prisoner and managed in a way that takes into account the particular risks and needs of the individual pregnant woman including her cultural and ethnic values.
6. Where practicable, there is continuity of obstetric and/or midwife staff providing care before, during and after birth.
   1. An information sheet/form Midwifery care for women in prison (D.16.01.F3) has been developed in consultation with the Women's Prison health staff and the NZ College of Midwives.  It was developed to provide information to staff and prisoners on the role of a Lead Maternity Carer (LMC) in the prison environment.
7. An individual health care plan is developed and incorporated into the prisoner’s health care management and sentence management plan. Mother and Child Health Plan (D.16.01.F2) has been developed in consultation with health staff at the Women's Prison's as an aide or checklist to ensure all people involved in the prisoner's pregnancy (both ante and post natal care) are consulted where appropriate and kept well informed.
   1. Should an eligible prisoner apply for admission to a Self Care Unit or Feeding & Bonding facility, this must be noted on the plan. The plan must also note the prisoner’s intention regarding breastfeeding. All plans must be documented and made available to all parties involved, including the prisoner.
8. Women assessed as being at risk of, or having, postnatal depression are monitored by staff and given appropriate support and counselling.
9. Pregnant women are placed in accommodation, which provides unrestricted access to a flush toilet and hand washing facilities.
10. Where necessary the prison provides suitable maternity attire for the prisoner.
11. Where necessary the prison provides a layette for a child born to a female prisoner including a night-gown, a singlet, a pair of booties, a helmet/bonnet, two nappies, safety pins where necessary, and a shawl or blanket.
12. Pregnant prisoners are offered information and counselling by qualified counsellors regarding pregnancy including advice on adoption, guardianship, early and temporary release, community support options and/or termination in order to make an informed choice.
13. Counselling and support is available to women who are separated from their babies, or who have a miscarriage or a termination of pregnancy, or whose babies die.
14. Pregnant prisoners on a recognised substance abuse maintenance/withdrawal programme are continued on that programme without interruption, under the direction of the Medical Officer.
15. Pregnant women are encouraged to participate in antenatal and parenting programmes at the appropriate time and supported through their sentence plan.
16. Pregnant women are provided with suitable employment and recreation, which ensures a balance of rest and participation in constructive activities.
17. Pregnant prisoners are offered access to, and support in participating in, programmes aimed at reducing or stopping smoking.
18. Pregnant prisoners are offered information as early as possible on release options, which may be applicable to them and their right to seek legal advice on such options.
19. Following a miscarriage before 20 weeks of gestation or a stillbirth, the prisoner is advised of the options appropriate to the prisoner’s cultural or religious beliefs for the disposal of the foetus or placenta.
20. The prisoner is assisted to select the most appropriate option for the disposal of the foetus or placenta and every facility is made available to the prisoner to achieve the option chosen in a sensitive, culturally appropriate and hygienically safe manner.
21. Where after 20 weeks of gestation a prisoner delivers a stillborn baby within the prison every opportunity is made for the prisoner to obtain appropriate funeral services and the support and advice of her family/whanau.
22. Gender specific professional support is provided on request and where practicable.
23. A sterile pack for the emergency delivery of a baby, which includes instructions on use, is available in the health centre.

Support Persons

1. If she so wishes a pregnant prisoner is supported to involve her partner/support person(s) in decisions and activities relating to the pregnancy, and have them attend the birth.
2. The decision as to whether a partner/support person shall be present will be made subject to the consideration of security risks for both the prisoner and the partner/support person, particularly if the partner/support person is a prisoner currently serving a sentence of imprisonment.
3. As a general guide, except in cases of emergency or complications, approval for prisoners to attend as partner/support person will be limited to the third trimester (last three months) of the pregnancy.

Escorts for Prisoners Giving Birth

Where a prisoner is escorted to a health facility for the purposes of giving birth:

1. They must be escorted by female staff only.
2. Physical restraints may not be used once they arrive at the health facility waiting room.
3. Physical restraints will not be applied during labour under any circumstances.
4. Where the prisoner is thought to present a high risk of escape, the Prison Manager must minimise this risk using steps other than physical restraints such as increasing the number of escorting staff.
5. Escorting staff will not be present in the delivery room, unless the prisoner has requested it in writing using Consent Form: Presence of Corrections Officer during an intimate examination or birth (D.16.01.F1) prior to the escort. Staff must check the room first for security risks and maintain a close watch on all exits from the room.
6. If the prisoner requests the staff to remain in the delivery room on the day of the birth, staff are to confirm with the prisoner in the presence of a health facility staff member as a witness that she consents to staff being present.
7. Staff must remain in the room whilst the prisoner gives birth or is examined if requested to do so by the health facility staff, or if there are any security concerns, or concerns regarding the prisoner’s behaviour.

Escorts for Prisoners Attending Other Medical Examinations by Health Professionals Related to Birth, i.e. Obstetric, Gynaecological, Antenatal or Postnatal

1. Where a pregnant prisoner is escorted for antenatal, gynecological or obstetric examinations, or a prisoner is escorted for post-natal related purposes, to a health facility:
   1. At least one of the escorting officers must be female;
   2. Under no circumstances are physical restraints to be used on a prisoner more than 36 weeks pregnant during a visit to a health professional, once she has arrived at the waiting room.
   3. There is otherwise to be a presumption against the use of physical restraints during the visit, once she has arrived at the waiting room. However, physical restraints may be used if the approving officer judges there to be a particularly high risk of escape. In this situation, requests by a health professional for removal of physical restraints during the examination itself will be considered.
   4. Any physical restraints must be removed at a health facility if during the visit a pregnant prisoner is diagnosed to be in labour by a health professional.
   5. Escorting staff are not to be present during intimate examinations unless the prisoner has requested their presence. Staff must check the room first for security risks and maintain a close watch on all exits from the room.
   6. The prisoner requesting the presence of escorting staff for an intimate examination (i.e. gynecological) or birth must complete Consent Form: Presence of Corrections Officer during an intimate examination or birth (D.16.01.F1).
   7. Pregnant prisoners attending appointments other than appointments related to pregnancy or birth are escorted under the conditions of C.02 Prisoner Escorts.