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Midwives demand ‘equivalence’ in prison perinatal care

NHS trusts and boards near women’s prisons must work to facilitate a specialist midwife for pregnant women

Louise Prime

Wednesday, 13 November 2019

Perinatal care in prison must be equivalent to care outside the prison system, the Royal College of Midwives (RCM) has demanded. In its new position statement, it called on NHS trusts and boards local to women’s prisons to facilitate a specialist midwife to care for pregnant women, and for women in prison to have continuity of care by default.

The RCM said yesterday that – following the recent death of a newborn baby, born in a Surrey prison cell to an unaccompanied mother – it had developed its position statement on perinatal women in the criminal justice system*. It pointed out that even though, on average, female offenders commit less serious offences than male offenders and pose a lower risk to public safety, they are imprisoned at a higher rate. Yet lack of training means some staff are not aware of protocols and procedures around responding to calls for assistance and the basic needs of pregnant and postnatal women, and women in labour.

The College insisted "all women in prison must have access to equivalent maternity care" to women outside the prison system, and recommended that:

  • A specific Prison Service Instruction should be developed for perinatal women that covers every women’s prison in the UK, taking a First 1001 days approach.
  • All UK women’s prisons should implement the Birth Companions’ Birth Charter in full and without delay.
  • NHS trusts and boards local to women’s prisons should work in partnership to facilitate a specialist midwife to care for pregnant women.
  • Continuity of midwifery care should be a default care pathway for women in prison because of its ability to improve maternal and neonatal outcomes for vulnerable women.
  • All judges and magistrates should receive training on infant-maternal health and the importance of the First 1001 days of child development.

Furthermore, said the RCM, women separated from their babies are especially at risk of self-harm and suicidal ideation, and for the baby, early separation negatively affects the infant’s biological responses to stress; those babies who encounter adversity and stress are at significantly increased risk of depression, anxiety, behavioural disorders, substance misuse and cancer as they grow into adults – and children of prisoners have three times the risk of delinquent/antisocial behaviour compared with their peers.

The College said mother and baby units (MBUs) are “essential to allow women to serve their sentences in a safe environment that supports the pivotal infant-mother bond” – but only six prisons in England and one in Scotland have MBUs (and only half of women gain a place), and neither Northern Ireland nor Wales have an MBU. It said: “The RCM believes the processes and decision-making to grant access to MBUs deserve greater scrutiny and transparency as the health impact of separating mothers from their babies is so grave.”

RCM chief executive and general secretary Gill Walton said: “Maternal and new-born healthcare should not be compromised by imprisonment and we know some pregnant women have reported receiving inadequate healthcare during their pregnancy while in detention which can put the life of their unborn baby at risk too.

“The RCM believes all women in prison or custody must have equal maternity care to those women on the outside. What we need to see is women’s prisons working with their local NHS trusts and health boards to facilitate specialist midwifery care for pregnant women.

“Women in prison are some of the most vulnerable in our society and that is why continuity of midwifery care is so important for women detained in in the criminal justice system because it has the ability to improve maternal and neonatal outcomes for vulnerable women.

“While the RCM thinks that diversion to specialist services or community sentencing should be prioritised for perinatal women wherever possible, it’s also crucial judges and magistrates fully understand the impact of any proposed sentence.

“That is why the RCM is recommending all judges and magistrates receive training on infant-maternal health and the importance of the First 1001 days of child development to enable them to fully understand the impact of any proposed sentence on a woman and her unborn child.”


*Position statement: Perinatal women in the criminal justice system. RCM, November 2019.

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