Female prisoners in England left to give birth without midwife, report reveals

Women are giving birth in prison cells without access to proper medical care, according to a startling report shared with the Guardian.

Concerns for the welfare of pregnant women and their babies are raised by a detailed report into experiences in three prisons that highlights cases of women giving births in cells without a midwife present, including one where the baby was premature and born feet-first.

Research into the conditions of pregnant prisoners in England was undertaken by Dr Laura Abbott, specialist midwife and senior lecturer at the University of Hertfordshire, and flags up significant risks to the safety and wellbeing of the women and babies. The report does not name the prisons to protect the anonymity of those who spoke to the researchers, but all three are in England.

Births in cells are thought to be rare, although nobody knows exactly how many occur or even how many prisoners are pregnant because neither the Ministry of Justice nor the NHS collects the data. But the lack of direct access, even on the phone, to a midwife for a women who thinks she is in labour makes it a risk. Prison nursing staff are not often trained to know when a woman is in labour, nor to cope with emergency deliveries if they cannot get the woman to hospital in time.

“This is an area that we have become increasingly concerned about,” said Naomi Delap, director of the charity Birth Companions, which has been supporting women in prison for over 21 years. Last year they wrote to the prison service expressing concern for the safety of women and babies, asking for urgent measures to be put in place. “We had started to hear a number of stories from different places about women giving birth in prison.”

Abbott’s report includes the story of a woman she calls Layla, whom she interviewed in prison. “As a midwife, I felt really shocked at what I was hearing,” she told the Guardian. “She got upset – she hadn’t shared her story before.

“It was a risky birth. When she was telling me her story, there were red flags for me as a midwife. She was in premature labour – there was another four weeks of the pregnancy to go – and the baby was in the breech position.”

This was Layla’s second baby. She called prison staff, telling them she knew her body and was sure she was in labour, but was not believed.

“Layla’s distress as her labour progresses to the birth of her child in a prison cell at night reveals alarming and inappropriate behaviour on the part of the staff,” says Abbott in her report.

She had been to see the nurse in the daytime because she had lost her mucous plug, which happened in her last pregnancy just before labour began. With her first baby she had a quick labour, so felt she needed to go straight to hospital. “I was trying to explain this to health care, they were just like, ‘No, don’t worry about it,’ and I was like, ‘No, really, I know my own body”,” she told Abbott.

At 11pm she began to have contractions, she said. By midnight they were getting stronger and she called for the nurses, who told her she was not in labour. She described the exchange as: “I’m telling you I am in labour,’ ‘No, you’re not. Here’s some paracetamol and a cup of tea’.”

Ten minutes after the nurses had left, said Layla, her waters broke. The nurses, she said were in “absolute panic”, saying they needed to get her to hospital. “I was laid there on my bed, in my cell with a male nurse and a female nurse, not midwifery trained at all, trying to put gas and air in my mouth and I’m like, ‘I don’t want anything, I need to feel awake and I need to concentrate,’ and then out popped (baby) at twenty past one. Still no ambulance, still no paramedics and she came out foot first,” she told Abbott.

At the time, Layla had not been told whether she would be given a place in a mother and baby unit or whether her baby would be taken from her. She said she did not know what to do about breastfeeding. They were transferred to hospital. “I had nothing for her, no clothes, no nappies, because I was still in the main jail, and I wasn’t allowed any baby stuff in. It was September – freezing – so I had to just wrap her up in clothes, completely naked underneath my nightie. She had nothing.”

Abbott had confirmation of Layla’s account from prison staff.

Layla’s experience was not an isolated incident. “I interviewed 10 members of staff and eight had experiences of births in cells or knew of them,” said Abbott. None of the staff in two of the prisons she visited had specialist training in emergency births. In the third, there had been training for staff only in the mother and baby unit.

Amy, a former prisoner who is now at home with her 11-month-old daughter, told the Guardian of lying to prison staff that she could no longer feel her baby moving. She had heard stories of women giving birth in prison and was desperate to ensure she reached hospital in time. The first time she made the claim, she was taken to hospital for checks that showed the baby was fine. On the second occasion, hospital staff said she could stay in and be induced, to be on the safe side.

“You think, I will do anything to make sure my baby is safe,” she said. There were only two or three nurses on duty for a prison of about 1,000 women and they were not trained in midwifery, she said. When she went to hospital the first time, it took 20 minutes for the ambulance to get out of the prison because of the searches that had to be done.

She was in the mother and baby unit, so had a room to herself and her door was unlocked. But waiting past her due date for labour to start was hard. “It is petrifying,” she said. “You are in that room. You don’t have anybody trained to deal with a quick delivery if that happens. There’s no pain relief. You just hope for the best. Sometimes I had to ring the buzzer to be sure somebody was going to answer.”

Delap says they have a number of concerns, one of which is that nobody knows how many pregnant women are in prison or how many give birth inside or in hospital. Their guess is that there are 600 pregnant women in prison and 100 give birth each year.

“How can you really take this problem seriously if you don’t know what the numbers are? We think this is a systemic issue across the board. We’re saying it is not about what happens in individual prisons,” she said.

Urgent action is needed, say Birth Companions. Pregnant women should have 24-hour telephone access to a midwife or labour ward. Prison staff, including nurses, should not make the decision as to whether a woman is in labour. Pregnant women locked in at night who call for help should be prioritised. Staff should be trained in emergency deliveries and at least one person with such training should be on the premises at night. And all stillbirths – after 24 weeks – should be reported as deaths in custody to the Prisons and Probation Ombudsman.

She says the government’s aspirations for the prison service are good. “On paper the strategy is saying all the right things. But we see a real gap between what is recognised as should be provided and what is provided. Women are getting inadequate care which can at times be dangerous for them and their babies.

“If you have got women in prison who are pregnant or who have babies in prison then we really do need to look after them.”

A Prison Service spokesperson said: “Healthcare in prisons is provided by trained medics and nurses, but we have also made training on dealing with pregnant inmates available to all prison officers.

“Each pregnant prisoner has an individual care plan, while new guidance will make clear they should have access to 24-hour midwifery advice. We know it is extremely rare for a woman to give birth in prison – because every step is taken to get them to hospital – but those unique cases are invariably down to the unpredictability of labour.

“Our new Female Offenders Strategy made clear that we want fewer women serving short sentences in custody and more remaining in the community, making use of women’s centres to address needs such as substance misuse and mental health problems.”