By Elizabeth Thompson
It’s been two and a half years since Tracey Edwards went through a pregnancy, labor and birth while incarcerated at the North Carolina Correctional Institution for Women.
The suffering she experienced during her birth process still keeps her up at night.
That experience is behind the lawsuit she filed last year against state prison officials for “vindication” for “unlawful treatment during the most vulnerable time in her life.” Her lawyers say her case could be reflective of the way pregnant people are treated in prisons in North Carolina and beyond.
Edwards claims in the suit that during her pregnancy, she was shackled whenever she received medical care outside of the prison. She also claims she was shackled while she was in active labor at the hospital, something that has since been outlawed. Edwards also said prison staff denied her access to her mental health medications and that she was forced off treatment for her opioid use disorder once she gave birth.
“It was horrible,” Edwards said. “I don’t wish that on my worst enemy. I mean, it was just like an animal.”
Edwards labored for twelve hours with cuffs around her ankles and one leg and arm chained to her hospital bed before officers removed her shackles, according to the complaint. Less than an hour after she gave birth, she was in handcuffs again.
North Carolina Health News reached out to the North Carolina Department of Public Safety for comment, but spokesman John Bull said that the department “does not comment on pending lawsuits.”
Shackled during pregnancy
Edwards’ case involves events from 2019, but by then the use of restraints during labor and birth violated the state prison system’s own policy, which was established in 2018.
In 2021, Gov. Roy Cooper signed a bipartisan bill limiting the use of restraints on pregnant people incarcerated in North Carolina’s jails and prisons. But Edwards’ lawyer, Lauren Kuhlik, said she is “not sure” that even if the 2021 law were in effect it would have prevented her client from being shackled.
“At the time that she was shackled this way, there was a departmental policy prohibiting the use of shackling,” Kuhlik said. “I don’t think we can assume that just because there’s a law passed, that’s automatically going to trickle down to the prison.”
Shackling during pregnancy is also potentially dangerous. If someone stumbles or trips with their ankles or wrists chained together, they may be unable to break their fall, causing possible harm to them and their baby. Restraints during labor and delivery make it more difficult for patients to change positions if needed, NPR has previously reported.
Edwards noted this in her complaint as well. She “could not move or adjust her position to alleviate the pain and discomfort of labor. The skin around her ankles became red
and raw as the shackles constricted her circulation, leading to excruciating pain and suffering. Any attempt to move or struggle against her ankle shackles caused her even greater discomfort and pain,” the complaint reads.
In order to avoid a similar experience, Kristie Puckett-Williams, with the American Civil Liberties Union of North Carolina, said she took a plea deal 10 years ago when she was incarcerated and pregnant. She didn’t want to give birth in restraints.
“I made the decision to enter into second-class citizenship permanently,” Puckett-Williams said. “So that my children could be born free. That’s not a decision that anybody should have.”
The practice of shackling pregnant people has been condemned by the American College of Obstetricians and Gynecologists, the American Medical Association and the American College of Nurse-Midwives.
Still, one 2018 study found that 82 percent of hospital nurses who cared for incarcerated pregnant patients said they were shackled “sometimes” to “all of the time.”
State prison policy states that pregnant people should not be shackled or restrained unless “there are reasonable grounds to believe the offender presents an immediate, serious threat of hurting herself, staff, or others, including her fetus or child, or that she presents an immediate, credible risk of escape that cannot be reasonably contained through other methods.”
Edwards said she didn’t pose a flight risk.
“I was excited,” she said. “I was going to have a baby.”
Painful withdrawal symptoms
Edwards’ pain and discomfort did not stop after she gave birth, she argues in her suit.
Throughout her pregnancy, Edwards was prescribed Subutex, a form of buprenorphine which is a medication to treat opioid use disorder. It’s considered best practice to prescribe medications to prevent withdrawal for pregnant women with substance use disorders so as to not harm their fetuses.
Medications for opioid use disorder are approved by the U.S. Food and Drug Administration and are considered the gold standard of care for people with opioid addiction. It is the Department of Public Safety’s policy to provide these medications to pregnant prisoners with opioid use disorder. However, there is still no statewide program to make this addiction treatment accessible to the entire prison population.
Soon after giving birth, Edwards was tapered off opioid treatment over the course of nine days. She experienced severe opioid withdrawal symptoms including vomiting and diarrhea as postpartum changes were also taking place. She said she was in pain all over her body.
“You feel like your skin is crawling,” Edwards said. “You feel like there’s bugs, like, moving your skin.”
One study using data from North Carolina’s prison system recommended that people who started opioid addiction treatment during pregnancy continue that treatment during the postpartum period and upon entering the community. This is particularly important for women with opioid use disorder who are especially vulnerable to overdose in the postpartum period.
The report was co-authored by Elton Amos, the medical director of the NCCIW, the very institution that Edwards claims denied her the medications.
Most people with an opioid use disorder end up being forced to go through withdrawal upon being incarcerated, even as experts have urged correctional officials to screen people for opioid use disorder and prescribe treatment while they are incarcerated to reduce the chance of fatal overdoses.
When prisoners exit incarceration and re-enter their home communities, their drug tolerance is usually reduced from not having access to drugs while they were incarcerated. That puts them at increased risk once they walk free, something that’s proven in the data finding that within two weeks of their release, former inmates are 40 times more likely than other North Carolinians to overdose.
Meanwhile, states such as Rhode Island saw a 60 percent decrease in overdose deaths among the formerly incarcerated after initiating a program providing medication for opioid use disorder.
And North Carolina jails that have addiction treatment programs have reported success, reducing both overdoses and recidivism.
However, consistent treatment is key to success. People who have suffered withdrawal symptoms from being abruptly taken off their medications might be less likely to try the treatment again, said Andrea Knittel, medical director for Incarcerated Women’s Health at UNC School of Medicine.
“Having an aversive association with one of the most effective and evidence-based options that we have for treatment is potentially a really significant downside,” Knittel said. “Our research shows that it’s a disruption in care that adds some logistical hurdles to folks who are trying to continue treatment when they are released, and I think, as a result, poses some real challenges to recovery for our patients.”
As for Edwards, she is now at home, with her little girl and her mother, waiting as her lawsuit starts the long process toward resolution.
She said she tries to block out her memories from her time in prison, but it’s difficult.
“I don’t really know if it’s ever gonna go away,” Edwards said. “Just because I committed a crime or allegedly committed a crime or whatever you want to call it, I don’t feel like I should have a lifelong problem mentally because of what they done to me.”