Beyond Shackles As Battles for Pregnant Women in Prison

Authored By: Natalia Collins

“I was suffering from postpartum depression, I had been on drugs, and I was locked in a room all day,” writes Tabatha Trammel, after giving birth at only 15 in the Atlanta City Detention Center. Trammel did not receive treatment for her bleeding post-birth, and after having her son, was unable to leave her bed while suffering from postpartum depression. [1] Like many mothers in prison, Trammel was battling with mental health following her pregnancy, exacerbated by her experience in prison. Incarcerated mothers have significantly higher rates of depression, anxiety, and postpartum depression. The conditions of birth in prisons, including the use of shackles, the isolation during and following birth, inadequate pre and postnatal care, lack of mental health services, and stigmas surrounding pregnancy in prison each contribute to increased mental health disorders. [2] To improve maternal care in prisons, current interventions, which focus on the physical needs of mothers in prisons, must extend to mental health support, to consider the diverse influences of both physical and mental conditions on maternal outcomes. 

Tabatha Trammel’s experience points to the interaction between physical complications of birth and subsequent mental health issues that result. Trammel resorted to using torn-up sheets when she did not receive pads, and was given no fluids to replace lost blood. She describes her experience in the weeks after birth, explaining that she “cried and slept all day. I didn’t want to deal with the other ladies in the pod. I didn’t even want to deal with the reality of getting up and showering.” Both feelings of isolation, after being separated from her child, and the physical effects following birth, contributed to her postpartum depression.  [1] Trammel’s postpartum depression went undiagnosed when with proper mental health care, as is more readily accessible in traditional medical systems, is treated with counseling, medication, and other behavioral therapies. [3] 

Nearly 8-10% of women entering prison are pregnant, and mental health conditions are the leading cause of pregnancy-related-preventable death for incarcerated women. [2] Underlying mental health conditions, which are most often anxiety or depression related, go untreated in prison systems. During birth, distress due to physical constraints and inadequate emotional support from physicians increase rates of mental health disorders. Social isolation, lack of counseling, and lack of physical interventions for postnatal conditions, like bleeding and infections, are further contributing factors to depression [5]. Most women lack access to both behavioral treatments and medications, and only 17-50% of mothers with depression or anxiety receive any treatment for mental health conditions. [4] Increased rates of maternal stress impact not only the health of the mother but also fetal outcomes. Maternal anxiety and depression increase the risk of miscarriage, low birth weight, preterm delivery, and preeclampsia. Babies may also be slower to develop or have neurodevelopmental issues following birth.  [5] 

National screenings for mental health disorders among mothers often exclude incarcerated women. Incarcerated pregnant women are continually marginalized, and their battles with mental health go unrecognized. [2] A 2016 to 2017 review in Women’s Health found that incarcerated individuals are almost 10% less likely to receive psychiatric diagnosis. [2] If diagnosed, female prisoners are not included in maternal databases on mental health disorders. The mental health of incarcerated mothers is understudied, a result of systemic biases in research, contributing to structural issues in providing maternal care in prison systems. 

For Trammel, one solution to battling mental health crises for women in prison is through personal care in the use of doulas. She has started “Women with a Plan,” an organization that provides emotional support for both pregnant women in prison and mothers returning home who need assistance. Trammel describes the importance of a doula, especially for births in prisons, since “a lot of times - especially in prisons and jails - a birthing person doesn’t have a voice. I serve as a second voice.” [1] A Doula's work in prison is unique and requires thoughtful interventions, including nutritional advice, discussions of medical visits, and ensuring the mother is informed about any procedures or complications that may arise. Trammel also explains that following birth, a doula can support the mother after being separated from her child. She suggests that the mother give the baby a blanket with her scent, allowing the two to feel connected even while they sleep apart. Doulas provide emotional and physical support through methods that work within the constraints of a prison system.

Other support mechanisms suggest changes to the current structure of maternal care in prison. One solution, increased visitation, may be beneficial for mental health. Mothers who have longer family visit times following birth have lower rates of postpartum depression. [6] In addition, medical workers can receive specific training in empathetic language that is geared to the experience of a mother in prison. Of most importance is addressing the mental health needs of prisoners through counseling, drug interventions, and medications. Mothers require strategies for anxieties surrounding birth and methods for battling depression post-birth, which must be provided by therapists trained specifically to treat pregnant incarcerated women. [6]

Addressing the medical care of mothers in prison remains essential, and care must extend to mental health support, a leading contributor to birthing complications for both mothers and babies. Systemic alterations, through specialized medical training or the use of doulas, are essential for the wellbeing of incarcerated pregnant women. Where prison systems fail, fights for reform must serve as a “second voice” for underrepresented mothers. 

References: 

1. Robdriguez, B. (2023, May 30). I Survived Pregnancy and Postpartum Depression. Now I Guide Others like Me. The Marshall Project. https://www.themarshallproject.org/2023/06/30/post-roe-prison-doula-pregnancy-support

2. Hendricks, C. A., Rajagopal, K. M, Sufrin C. B, Kramar C, Jiménez M. C. (2024). Mental health, chronic and infectious conditions among pregnant persons in US state prisons and local jails 2016–2017. Women’s Health (Lond), vol 20. 10.1177/17455057241228748. 

3. (2024, November 24). Postpartum Depression. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/postpartum-depression/diagnosis-treatment/drc-20376623

4. Howland M. A, Kotlar B, Davis L, Shafter R. J. (2021). Depressive Symptoms among Pregnant and Postpartum Women in Prison. Journal of Midwifery and Women’s Health, vol 66, 494-502. https://doi.org/10.1111/jmwh.13239. 

5. Mukherjee S. Pierre-Victor D, Bahlear R, Madhivanan P. (2014). Mental Health Issues Among Pregnant Women in Correctional Facilities: A Systematic Review. Women & Health, vol. 54, 816-842. https://doi.org/10.1080/03630242.2014.932894. 

6. Hidayati N. O, Suryani S, Rahayuwati L, Widianti E. (2023). Women Behind Bars: A Scoping Review of Mental Health Needs in Prison. Iran J Public Health, vol 52, 243-253. 10.18502/ijph.v52i2.11878.