CorrectCare

Jail Lamaze Program Aids Anxious Mothers-to-Be

By Debby Lucas, RNC, MSN, CCHP

There is a high incidence of inmate pregnancy in county jails across the country. Most of these pregnancies do not happen to happily married women who have had adequate prenatal care or the support of a loving husband and family. Many of the women have histories of prostitution, rape, drug abuse and domestic violence and have nobody to care for their child while they finish their stay in jail or go on to prison. The typical lifestyles that envelope these women add to the complexity of their pregnancies and the postpartum period.

Pregnant inmates incarcerated in the San Bernardino County jail at West Valley Detention Center are no different. But thanks to a collaboration between WVDC and the county’s Arrowhead Regional Medical Center, these women now participate in Lamaze childbirth classes that prepare them not only for delivery but also for the decision making and follow-up that will place their babies in good hands.

Stressful Situation
Nurses and social workers at the jail and at the hospital noticed that inmates giving birth were usually scared, alone, unsure of their baby’s fate and often ill-equipped to deal with the situations and decisions confronting them after giving birth. Also, upon returning to jail, the new mothers were often anxious, tearful and in crisis from lack of information on the whereabouts of their child, what the future held physically and emotionally, and myriad other pressing concerns.

In response, hospital and jail health care administrators met to discuss the possibility of a joint venture to assist these inmates in making childbirth and the postpartum period as normal and stress-free as possible. The program began this year.

The medical/mental health specialty unit at WVDC has set aside an entire cellblock for female inmates in their third trimester of pregnancy. This unit also houses other female inmates with medical problems because it provides 24-hour nursing care and specially trained deputies.

A social worker employed by the jail routinely works with the mothers-to-be in planning for their trip to the hospital for delivery. This experience is not the happy occasion most of us imagine when we think about giving birth. The jail clothing, the presence of a deputy and the realization that the baby’s immediate future is in jeopardy all contribute to making the event one of despair instead of joyfulness.

Also, during her first visit with the pregnant inmates, the social worker must inform them of her obligation as a clinician to report any drug abuse during pregnancy. Although this is a difficult beginning, a therapeutic relationship that creates trust is almost always formed.

Jail-based Coaching
The Lamaze program, which is voluntary for the inmates, combines the teaching of childbirthing methods with the intense case management of the jail social worker who pairs the inmate with a hospital social worker at the time of birth. In addition, an RN, who first went through orientation to understand the complexities of the correctional setting, conducts weekly classes at the jail.

A certified Lamaze instructor who is employed in the hospital’s obstetrics department, the nurse spends 2 1/2 hours or more with the pregnant inmates in their cellblock. The instructor also encourages other women in the cellblock to join in the classes because she feels everyone can benefit from some part of the training. These other inmates often are excited about the program and enjoy assisting each other, as well as the attention they receive.

The class curriculum consists of five parts that can be taught in any order or any manner that fits with the population. Flexibility was a paramount consideration in planning the classes due to the participants’ tenuous length of stay in the jail. Each week’s class consists of one hour of teaching and one to two hours of videos and practice.

A sample of the routine course content includes the following subjects divided into five sessions.

1. Normal changes in the body during pregnancy, relaxation and breathing (each inmate comes to class with her mattress and two pillows for use on the floor)

2. Stages and phases of normal labor, introduction to breast-feeding, practice of progressive relaxation and breathing methods

3. Variations of labor, emergency childbirth, medications, anesthesia choices and exercises to prepare for childbirth and practice

4. C-sections, vaginal births, video with one hour of discussion after, what to expect in the hospital after delivery and what body changes are occurring

5. Postpartum depression—what is normal and what isn’t, and what to do about it—and proper care and nurturing of the newborn

Delivery and Postpartum
When it’s time for delivery, the nurse who instructs the inmates at the jail follows up with them when they are admitted. She is able to assuage their fears, often coach their labor and always answer their questions. When the mother is ready for release from the hospital without her baby, this nurse also ensures that she is given a picture of her baby to take with her back to the jail. Although a small gesture, it is one of compassion and reassurance for the incarcerated mother.

After the five classes are completed—and no later than upon hospital admission—the mothers are given questionnaires and asked to evaluate the quality of the Lamaze training and how it affected or altered their experience. Ratings consistently show that the program exceeds their expectations. The mothers are overwhelmed with the value of the training and how it prepared them for the birth and subsequent placement of their babies.

Jail nursing staff recognized a very different postdelivery inmate. The females who participated in the Lamaze classes experienced a calmer, less stressful postpartum period. They were more educated about what to expect and thereby were happier and less demanding of the medical staff. Having the baby’s picture allowed them “bragging rights” about their child, just like any other parent.

The jail social worker continues to work with the postpartum mothers and assists them in keeping contact with the youth authorities, relatives or whomever has custody of their child. She also provides the kindness and concern so vital to the well-being of a mother who has been forced to leave her child while she dwells behind four walls of a cell.

[This article first appeared in the Spring 2006 issue of CorrectCare.]