Supporting incarcerated women.

In the winter of 2002, three doulas from the Lake Erie Association of Doulas began working with the Cambridge Springs State Correctional Institution in Cambridge Springs, PA, to provide doula care for women who would be birthing during their incarceration. Michelle Totleben (DONA) initiated the program and, along with Chris Reinelt (ALACE, DONA) and Alice Edwards (ALACE), completed her application for volunteer status at the prison. In January 2002, we drove out to the facility for a brief security training.

The first births were in the late winter and early spring of 2002 and, by the end of a year, we had provided services to eight women. In 2003, the population of pregnant women at the prison grew dramatically and we were up to five doulas and a childbirth educator (a CPM who volunteered her time as well). She is planning to begin classes shortly.

Cambridge is a minimum security prison that was built to house about 500 women. Now, it has a population of between 800 and 900 women. According to the parenting coordinators, about 80 percent of those women are mothers, and their mothering does not end when they are incarcerated. Frequent phone calls to home and schools, letters, power of attorney, and custody arrangements all must run through the parenting office, which has only two counselors. The doula program is relatively freestanding and cannot rely on the over-extended coordinators for leadership or direction.

When the coordinators have identified a mother that would like a doula at her birth they call Totleben, who matches the mother with an available doula. Then it is up to the doula and the mother to have one or two prenatals, share information, and plan for the best possible birth experience.

Assisting a woman in prison is quite different from accompanying a "free" mother. First, the mother cannot choose her physician. The doctor is hired on contract by the prison, so all conversations about caregiver satisfaction are moot. There are, at present, no childbirth classes available.

The mother cannot access a variety of nutritional support items; she can't use herbs or homeopathics. Even a request for Tums can take weeks to resolve. A mother suffering from leg cramps only gets bananas once a week; we had to settle for calf stretches and drinks of water to remedy them.

The mother spends the ten days prior to her due date in the prison infirmary, with women who are sick with a variety of illnesses or sometimes all by herself. The boredom is profound. When a nurse determines she has gone into labor, the mother is transported to the hospital (about 45 minutes away) in an ambulance, accompanied by guards. Although the women arrive at the hospital with a leg shackled to the stretcher, the irons are removed in the room and are not replaced until after the baby is born and the mother has washed up.

According to Sheila Kitzinger's website, some hospitals have used epidurals as a form of "medicinal" shackling of prisoners, removing all need for additional restraints since the mother could not run or even walk away. Luckily, perhaps due to the minimum security classification of the women at Cambridge, the mothers we work with have been relatively unfettered during their labors. Normally, all walking and movement must take place in the room, although the doctor can, and does, send orders for her to walk the halls. In these cases, the guard walks the halls as well.

Some mothers may have family members with them as well. She can request that her partner or mother accompany her during birth. Often, the family member will be taking the baby home within 48 hours and the mom will have a chance for a visit even if her partner doesn't get there in time for the birth. The family members often need attention and support as well. In several cases, our bilingual doulas have played the additional role of translating for Latino families.

After an initial hesitancy, the prison gave us permission to take photographs during the birth. We buy disposable cameras and take copious pictures of the baby and mail them back to the mother in prison. For women who want photos of the birth itself, or of the baby without clothes or blankets, we mail those pictures to their families and they can have them when they leave prison; the presence of sex offenders in the prison rules out the cute naked baby pictures as well as any photos of the undressed mother. The mom is not allowed to return to the prison with anything--footprints, "appropriate" photos, or birth records; all must be mailed in later.

After the birth, we follow the baby to the nursery and take pictures, and help make the mother comfortable. At some point, the mother will have to call the caregiver to let her know that she should come for the baby within the next 48 hours. Most mothers leave the hospital and their babies within 24 hours and they have a great need to know that everything is in order for the caregiver to take custody of the infant. Many mothers choose to room-in with their babies, but only one has wanted to nurse, although several have nursed with previous births when not incarcerated. A few hours after birth, we leave the mother and baby with the promise that we'll see her the next week.

The postpartum visit is especially important. The loss of their babies is enormous and, unlike mothers on the outside, these women have few people to support them. A good birth and the opportunity to be with their babies for the 24 hours allowed, especially if it has been documented with photos, can be something to hold on to until the first phone calls from the caregiver begin or, for the luckiest ones, until the first visit from the baby.

Some mothers might receive frequent visits from their infants if their families live close by or if the babies are being fostered by the generous Mennonite families who live in and near Cambridge Springs. But most women return to prison alone and unsupported, without the company of their pregnant bellies and without knowing when they'll hold their babies again. At the postpartum visit, doulas and mothers go over the details of the births, share the photographs, compare impressions of events, and conclude--sometimes quite emotionally--their brief, intense relationship.

In the security training the prison gives to all volunteers, guards emphasize the need to avoid "fraternization" (don't tell them your personal information, don't have sex with them, don't do them favors, and so on). While these rules are necessary for the security of both volunteer and inmate, this boundary is a little more blurred when it comes to the doula-mother relationship.

First, our presence helps to relieve the guard of potential fraternization issues; in the past, since the guard was the only one with the mother to witness the birth, some guards provided labor support, appeared in postpartum photos with mother or baby, or even cut the cord. Having a doula allows the guard to maintain a less ambiguous position in the room. Their presence is often friendly and supportive, but now they do not have to be a birth sister one day and an enforcer the next.

The doula's role, by its very nature, is essentially a kind of fraternization. We have long conversations about previous births, sexual trauma, fears, and hopes. We hold and massage, encourage and validate. We share our knowledge and some of our experiences, we see the women in various states of undress, we hold their babies, we cut cords and call family members. In order for our work to be effective, we must create a quick but profound trusting relationship.

We have been doing this work for almost two years, and the demand is growing. Although in the first year we had eight births, in 2003 there were 17 babies born with doula assistance. At the 2003 spring prison volunteer dinner, the doulas were honored as Volunteers of the Year. With the greater need that is developing, the volunteer nature of the work can be taxing; it does, after all, take time away from private clients as well as one's other work or family time.

But the emotional satisfaction of doula work is magnified in this sometimes stressful setting. The moms have been so clear about their need for our presence and so generous in their gratitude. "I am convinced more than ever that it's necessary," says the founder of the program, Michelle Totleben. "I am persuaded--absolutely--that it is worthwhile, needed, and deeply appreciated.... It rubs the hard edges off of difficult experience. We see them as the women they were before they were prisoners. [Their gratitude] still moves me beyond words."

In the words of one mom who wrote her doula, "You were exhaustingly vigilant. Your selfless diligence contributed incalculably to my survival during a very joyous and traumatic time. You made it impossible for me to choose depression and despair, giving me the courage and strength I needed. There aren't enough words to express my appreciation."

--Alice Edwards, CD, PHD., is an ALACE certified doula practicing in Erie, PA; a member of LEAD; and a volunteer with the Inmate Doula Program at Cambridge Springs State Correctional Institution. Alice is also a professor of Spanish at Mercyhurst College and the mother of two children, Maia, 9, and Jesse, 5.