Are you a health care worker? We’d love to hear from you. Email editor at northcarolinahealthnews.org
By Hannah Critchfield
Fifteen minutes outside Durham, an abandoned hospital stretches across a bed of verdant land. The concrete-potted plants lining the entrance have begun to crumble, with erosion and wear visible on the walls of the red brick building.
Long before a global pandemic descended upon the state and its correctional centers, even before Barack Obama was elected as the nation’s first Black president, North Carolina planned to create a home out of the abandoned facility, where incarcerated women could live with their infants and toddlers.
“It really is outside of the box,” said Melissa Radcliff, a program director at Our Children’s Place of Coastal Horizons Center. When the organization was created, the intent was to partner with the state to help allocate funding for the renovation and programming of the center in the 2000s.
“The moms would have still been incarcerated, they just would have been serving their incarceration in this residential facility off-site,” Radcliff said. “It is about as radical as you can get, I think, short of not incarcerating to start with.”
Then the 2008 financial crisis hit, and North Carolina clawed back the funding earmarked for the project and shuttered its plan for a child care center for incarcerated mothers.
Today, birthing women serving time or awaiting trial behind bars are often restrained using shackles while receiving medical care at hospitals and health centers. Once they give birth, new mothers behind bars typically have about 72 hours to spend with their newborns.
House Bill 608 would end shackling of pregnant women behind bars. The bill passed in the House on Monday and heads to the Senate for final ratification before heading to Gov. Roy Cooper’s desk for a signature.
Although it’s still early in the lawmaking process, HB 608 has strong bipartisan support and is expected to become law. Child advocates and law enforcement alike are reflecting on future reforms for incarcerated women, including the child care model from North Carolina’s recent history.
“I think it’s also our motivation to say, but where do we go from here?” said Radcliff. “This is a huge first step, emphasis on first. Let’s not forget when kids are born, and what they need and what their parents need and how to keep them and that relationship strong.”
Restrained throughout labor and delivery
In 2019, Dr. Kerianne Crockett watched as a young woman was brought into her care at Vidant Medical Center in Greenville, North Carolina from a local detention center.
Her ankle was cuffed to the side rail of the stretcher, and she was visibly upset. Though she’d given birth while in transit, she still needed to deliver her placenta.
Her newborn had died on the way to the hospital.
“Part of what was so terrible about her story is that she was restrained through the whole labor [and] delivery process,” said Crockett, an obstetrician-gynecologist, through tears. “All of my efforts to get the restraints removed once she was in my care – it took a lot of calls, and by the time the restraints were removed, the delivery was already done and a lot of the really sad things had already happened.”
The experience led her to advocate for different treatment of pregnant women who come into contact with the criminal justice system.
“In the days, weeks, months, followed, I couldn’t make sense of what had happened to her,” Crockett said. “I felt like I had failed to protect her from something really terrible. I tried to figure out, had something gone wrong, or was this just the way things are? And if this is the way things are, how do we change it?”
Proponents of such reform have focused on setting guidelines for a standard level of care to be provided to pregnant women in the custody of correctional facilities throughout North Carolina.
“There’s a lot of reasons why shackling is dangerous,” said Amanda Brown, a certified nurse midwife who works exclusively with pregnant and postpartum people at the University of North Carolina Hospital in Chapel Hill. “There’s space for interpretation from hospital to hospital, which is really problematic.”
Brown said there are policies around shackling in place at UNC Hospitals, but the many different correctional officers are not always operating from the same playbook.
And, at times, Brown said she has ended up in conflict with those officers.
“Correctional officers are wonderful human beings, but sometimes may have limited experience caring for incarcerated people in the postpartum period,” she said. “Most of them are very well-meaning, sometimes even very supportive, even helping with breastfeeding or helping to change a diaper, but there shouldn’t be any reason to have a discussion because there should be just a standard understanding of how we care for people.”
The Dignity for Women Who are Incarcerated bill would require prisons and jails to limit the use of shackling after the second trimester, during labor, and in the six weeks after delivery.
While the bill was being drafted, Crockett personally called each of North Carolina’s 100 sheriffs, who oversee county jails as elected officials, to speak to them about the importance of the legislation and solicit their support.
At first, the North Carolina Sheriffs’ Association opposed the bill.
Law enforcement officials Terry Johnson, a Republican sheriff from Alamance County most recently in the spotlight for his policies around the treatment of detained immigrants and Black Lives Matter and voting rights demonstrators, and Garry McFadden, a Democratic sheriff who ran on a platform of liberal reforms in Mecklenburg County, got on board.
“A child didn’t ask to come into this world,” said Johnson. “We need to keep that child’s welfare a top priority. There’s a bond between mother and child, and if that child is separated from his mother, their chances of making it good in the world, I would say, are slim to none.”
With compromise language, the sheriffs’ organization fell in line.
“This brought people together who will probably agree on nothing else this year,” said McFadden. “The thing that sticks with me is you have the moment of birth, and then you have to give your child up right after. And we’re taking away their dignity by putting them in chains and cuffs while expecting. It was a no-brainer for me to fight for these young ladies.”
In addition to banning shackling for pregnant women receiving medical care, the proposed HB 608 would formalize allowing women who have just given birth to bond with their child for the duration of time they stay in the hospital.
The bill would also mandate that women be placed in correctional facilities within 250 miles of any of their children under the age of one and allow for visits with newborns twice a week.
It would additionally set basic requirements for providing menstrual and nutrition products, establish guidelines for body inspections that limit interaction with male officers and prevent pregnant or postpartum women from being held in restrictive housing, such as solitary confinement or isolation.
Mother-infant care program
While many other states have passed legislation banning shackling, some have taken reforms a step further.
Back in the aughts, Radcliff and her team visited California, which has for decades used an innovative model known as the “mother-infant care program.”
Also called the Community Prisoner Mother Program, mothers in the custody of the state who are serving time for nonviolent, non-serious offenses have the opportunity to live at a child-safe rehabilitation center with up to two of their children under the age of six.
The program serves a dual purpose of reuniting mothers with their children and preparing them for reintegration into the larger community upon their release.
North Carolina planned to adopt a similar model for its state prisoners. The original Our Children’s Place facility would have housed 20 women and 40 children at a time, according to Radcliff and program pamphlets. Located on the old John Umstead Hospital campus in Butner, a mother and her children would have had their own bedroom and shared a common space with other families.
“It would almost be like a dorm-type arrangement, where there will be separate space for some quiet if a mom was nursing, for example,” said Radcliff. “There was classroom space and a huge kitchen, and that led to lots of conversations about whether we could eventually start to do some culinary classes there so women could learn job skills, in addition to feeding their children.”
A child would have been able to live with their mother at the facility until they start preschool.
“A weekly visit is amazing, but it’s not day-to-day,” said Radcliff. “It ties in to the question: If mom gives birth and then a child is taken, who is caring for the child? Is it going to be the other parent, grandparents, or social services? And is whoever’s caring for the child going to be able to bring the child to visit?”
Underlying both the mothballed child-mother center initiative and the proposed anti-shackling bill is an understanding of the importance of early childhood attachment and bonding with caretakers.
“I don’t know if we’ve gone full circle, but it feels like we’re having some similar conversations with the anti-shackling bill,” said Radcliff. “So much of what we do focuses on kids who are in our schools, but this really brings it back to, ‘But what about really, really young kids who’ve just been born, or haven’t even been born at this point?’”
The idea of a center for incarcerated new mothers and their kids lives on — Sheriff Johnson of Alamance County, unprompted, also voiced his support of such a home.
“I would love to see, somewhere down the road, the government — since we’re giving away money left and right — build a facility, so if we do have a lady that is pregnant in our jail, we can send her to this home to have that baby, and the baby and the mama can be together,” he said. “It may be a facility that you can’t leave, but that child needs that mother during those formative years when they come into the world.”
Strengthening mother-child bonds
Health care professionals who work with incarcerated women during and after pregnancy said the bill could be a springboard for other manageable, cost-effective reforms.
“I think there’s sort of four main areas that I feel like could be improved upon once this bill is passed: visitation, medication-assisted therapy for people who have a substance use disorder in the postpartum period, contraceptive options, and lactation support,” said Brown.
She said she’d like to see increased visitation options apply beyond the first year of a child’s life.
“We know that about 75 percent of women are serving for less than two years, and after people are leaving the prison system, they’re going to be caring for their babies,” she said. “It’s really essential that they have a bonded relationship — both the parent’s health and probably even more, for the baby’s health. Increased visitation allowances all through childhood are appropriate.”
The shackling bill passed in the House on May 10 with unanimous support and is now parked in the Senate Committee on Rules and Operations.
“I am acutely aware of the fact that the absolute worst day, and the worst thing to happen to my patient, has become a springboard for something for a lot of people to celebrate – like an accomplishment – in moving this bill forward,” said Crockett.
“I don’t want to lose sight of the fact that she and a lot, a lot, a lot of other unrecognized, unnamed women have endured really hard things without the gain of being able to celebrate,” she added.