Birth in Chains

AIMS Journal, 1995/6, Vol 7 No 4

In December, I received a distressing letter from a woman in Holloway Prison describing the appalling conditions there, see You Write, p14. I was so concerned about her story I arranged to visit.

We were shown into a small private room where we discussed Annette's experiences. She frequently broke down in tears when she described what was happening in the prison, and particularly when she described how the prison officers insisted on shackling het before she got into the van to take her to the Whittington.

She was due before Christmas, and had previously been taken into the Whittington in early labour. ln her second letter to me, she wrote: “two officers chained me to the bed and sat down next to me, I asked them to please leave as I was in pain imbarrest crying. But again no they said I shouldn’t be worried as they have had children, theme selves, I thought in my mind, But you had your family or husband with you, I can’t even call mine, as l wouldn’t want mine to see what l am having to go through as they couldn’t or wouldn't understand or believe this is happening to a human being who has never hurt anyone In her life Physically. But I just cried… I hid under the sheet, sobbing anyway they decided to take me to the labour ward, the shame I felt in these chains I just wanted to die, the nurses was very nice but I was Handcuffed to an officer at all times, the Baby didn't Come, and they kept me until monday everning, and Brought me back to Prison until go into labour, again…"

When she returned from the hospital she was strip searched. The rationale for this is difficult to understand as she was chained to an officer for the majority of her visit. Annette was in such a state about the forthcoming birth I felt extremely concerned, and offered to be there if she was willing. She leapt at the idea and calmed down. We know that having a companion in labour is beneficial'. But I was worried about what the strain was doing to her and the baby. Stress may reduce growth and increase the risk of premature birth’, and one recent study suggests it may reduce brain size’. Animal studies have shown that stress to the mother reduced heart rate and blood pressure in the fetus, followed by lack of oxygen‘.

ON THE ANTENATAL WARD…

A message on my ansaphone informed me that Annette would be taken from Holloway Prison to the Whittington. As I walked into Harvey Ward I spotted the prison guards in a side room They were in the process of taking off the 10ft custody chains. Annette burst into tears: “I have been chained like this since I got in here last night, its terrible, I have bad hardly any sleep, everytime I move the cbains jangle. I feel exhausted." Shortly after my arrival, the guards had a shift change and the male and female guards were replaced by two female guards.

Annette had been having niggling contractions and decided she wanted a bath, she gathered her clothes and toiletries and the officers immediately put on the shackles. I questioned the necessity for shackling her. “She has to be cuffed, its the rules.” This mantra was repeated whenever I questioned the guards' activities. Annette was flanked by two officers, while I brought up the rear. l could not believe my eyes, I felt appalled and humiliated to witness this scene in a British hospital. We proceeded down the antenatal ward, observed, with some astonishment, by some of the women. I felt shocked and increasingly angry that a pregnant woman could be publicly humiliated in this way. At the bathroom cubicle door the guards took off the shackles and Annette went inside while we sat outside patiently waiting.

One can only surmise about the thoughts of the women who witnessed this, perhaps this woman was a mass murderer? Why else should she be treated in this way? In fact, Annette had been sentenced to two years loss of liberty for stealing a handbag.

TO THE LABOUR WARD…

At 9.00am Annette was told that she would be moved to the labour Ward, where she would be put on a monitor and, if necessary, her waters would be broken. Before we went down to the labour ward I suggested to the guards that we discuss their behaviour and what the ground rules were. Was there any reason why they could not sit outside the room? “We have to have the prisoner in sight at all times.” Fair enough, why? I presumed that it was to ensure that Annette did not escape. As there was only one exit to the room it was hardly likely that they would not notice her leaving it. "There is always the window” commented Ms Aston, sarcastically. I looked out the window "We are on the fifth floor: What do you expect her to do, shin down the drain pipe” I suggested that we talk about the labour ward, and explained to them that labour is a time when women need privacy, and to feel secure and confident in their attendants and their surroundings. It was essential that the presence of prison guards should be minimal. At least during the labour, they should stay outside the room. "They will have screens, we can be behind those. If you want to change the rules you will have to speak to the Governor."

Annette was upset by the guards, she told me that “some of them are so spiteful, they make needling comments all the time just to wind me up, and if I reply that gets written down." I was fairly sceptical about this, but while we were in the labour ward it dawned upon me that I had no idea who these guards were and it was time l found out.

“What time do you go off duty?” l asked, "Oh, eight o’clock”. A short discussion about long days ensued and I then asked, “I don’t know your names?’. “I am Ms Pauline and this is Ms Aston” Her colleague, however, felt obliged to elaborate, "Aston, as in Aston Villa or Aston Martin, I do like people to get it right when they write it down." It was said through gritted teeth- now l understood what Annette meant.

At 9.30am we walked down to the Labour Ward. Annette was shown into delivery room 7 where she would eventually give birth to her baby.

l spoke to the midwives emphasising the importance of privacy. Annette had already pointed out that the guards spent some of their time carefully writing notes in a file. “Everything we say is recorded there, and a lot of it isn’t even right, but I don’t get to see it and they twist it around and use it against me later; you’ll see." Certainly, every move was recorded and the file was carefully guarded and carried around everywhere they went. While sympathising with the midwife's position, I pointed out that it was stressful for Annette to have the guards present all the time, screen or no screens, and it was highly questionable that they should be in the room during any examination.

Shortly after our arrival in the delivery room a midwife brought in a screen, and asked the guards to leave while she examined Annette. She decided to break the waters, but was not certain that she was successful. She asked the Registrar to come and do so. He was very gentle and kindly. The waters were broken and we kept our lingers crossed that labour would now get a move on. A fetal monitor was put on and a saline drip set up.

Annette needed to walk about as much as possible if she was to encourage this labour to progress. We regularly walked about and, on occasion, Annette went to the telephone or out to the stairwell to have a smoke, or down the corridor to the toilet. lf we stepped outsidethe delivery room door the guards put on the shackles. On one particular occasion, the futility of shackling her while her other hand was attached to a drip, (and she and l were trying to push the drip stand around) became apparent, even to the guards, and they gave up. But they both stuck to her like glue. How they imagined she was going to escape was beyond me.

When she got to the final stage of labour the midwife asked Annette if she wanted the prison guards out of the room. By this time she was so focused on the labour she shook her head and said no, so they remained behind the screens.

At 7.19pm Annette gave birth to a 8lb 9oz baby girl, Elizabeth. The afterbirth arrived shortly afterwards but Annette had some very fierce after pains and it took a little time to sort out some pain relief, and give her a wash and brush up. The midwife finished washing her and suggested that she ring her husband. Annette glanced at the clock, "l can’t, it’s too late he is already locked up." Everyone felt disappointed. Ten minutes later a midwife rushed in, "You must come now your husband is on the phone." GIeefully, Annette climbed off the bed. The prison guards reached for the custody chain (there had been a shift change ten minutes earlier and we now had a male and a female guard). I was furious, “Do you have to do that, can’t you give her a chance to speak to her husband without this kind of treatment.” I said, “if that is the way you want it." I reached for my camera. As Annette walked to the phone, I took photograph.The female guard was furious, "You will stop taking photographs." “I will stop taking photographs when you stop using those shackles."

Annette returned to the labour ward shortly afterwards. "You see what they are like, they are going to take this out on me later, just you wait and see. " She gathered her belongings to go to the postnatal ward and I left for home.

The Home Office has claimed that it is essential that pregnant women are shackled in order to stop them escaping. Yet a women about to give birth must be the most immobile creature there is. The Home Office also rules that the woman should be accompanied by two prison officers at all times. Annette spent the night shackled to a bed in a room which measured approximately 10ft by 8ft and both officers squeezed in there too. The cost to the Home Office of this unnecessary exercise has yet to be assessed.

When I first visited Annette in Holloway we discussed her options for feeding her baby. Breastfeeding would offer the baby greater protect against infection and increase her resistance to allergies; the Inspectorate of Prison’s report revealed how appalling conditions were in Holloway. Annette had also read about the advantages of breastfeeding and acknowledged that it would be better for her baby. She had breastfed two of her other three children and she would give it a try. However, when she was asked what she wanted by the midwife in the delivery room she thought for a moment and then decided that she would bottle feed.

When I saw her in Holloway a week later l asked her why she had changed her mind and was bottle feeding her baby. Her eyes filled with tears, “How could I tell my husband that I was breastfeeding with a man in the room?” (Shortly after the birth the shift changed and one of the guards was now a man). Angrily, she added, “Did you see him looking around the screen while I was trying to deliver the afterbirth? It was humiliating.”

Throughout her hospital stay, of five days, two prison officers, sometimes a man, remained in her room. Annette was deprived of privacy. The guards listened attentively to conversations and frequently made notes. There was no possibility of 'doctors or midwives following their professional codes of conduct to protect patient's confidentiality.

Annette was one of the few women I had seen give birth who did not immediately look at her baby and reach out to pick her up. When I asked later what was going on she said that after all she had been through she was convinced her baby was dead. It took time before she allowed herself to look at her baby, and a little longer to hold her.

Beverley A Lawrence Beech

REFERENCES

1. Hofmeyr GJ et al. Companionship to modify the clinical birth environment: effects on progress and perceptions of labour, and breastfeeding. BRITISH JOURNAL OF OBSTETRICS AND
   GYNAECOLOGY, August 1991, Vol 98, p756-764.
2. Lou HC et al. Psychosocial stress and Severe prematurity. LANCET, 1992, Vol 340, p54.
3. Lou HC et al. Psychosocial stress and human life affect fetal brain development. DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY, 1994, Vol 36, p826-832.
4. Meyers R. Maternal psychological stress and fetal asphyxia: A study in the monkey. AMERICAN JOURNAL OF OBSTETRIC AND GYNAECOLOGY. Vol 122, p47-59

Note: this article is an extended version of Beverley’s article “How could l breastfeed with that man in the room? “ first published in the BRITISH MEDICAL JOURNAL, 27th January, 1996.