Restraint of Pregnant Inmates

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Introduction

Pregnant inmates present special concerns for both the correctional administrator and health authority. Pregnancy is a medically fragile time where neither the expectant mother nor fetus should be exposed to unnecessary risks of falls or injury, particularly when security restraints are applied. Of course, pregnant inmates should receive medically appropriate prenatal, intrapartum, and postpartum care and treatment, including special diets, and these issues are addressed in the National Commission on Correctional Health Care’s Standards. This position statement provides additional guidance.

Position Statement

Restraint is potentially harmful to the expectant mother and fetus, especially in the third trimester as well as during labor and delivery. Restraint of pregnant inmates during labor and delivery should not be used. The application of restraints during all other pre-and postpartum periods should be restricted as much as possible and, when used, done so with consultation from medical staff. For the most successful outcome of a pregnancy, cooperation among custody staff, medical staff, and the patient is required.

Prepartum

1. Restraint should be done by the least restrictive means necessary and in a way that mitigates adverse clinical consequences.

2. Abdominal restraints that directly constrict the area of pregnancy should not be used.

3. Wrist restraints, if used, should be applied in such a way that the pregnant inmate may be able to protect herself and the fetus in the event of a forward fall.

4. Pregnant inmates should not be placed in a facedown position or in four-point restraint.

5. Leg and ankle restraints that restrain the legs close together should not be used because they increase the risk of a forward fall.

Partum

6. Restraints during transport to the hospital or during labor should not be used, except where necessary due to serious threat of harm to self, staff, or others.

Postpartum

7. Restraints should be avoided if possible during this period, because labor and delivery can result in exhaustion, dehydration, difficulty in urination or defecation, and complications such as hemorrhage. Necessary bed rest and rapid response to medical emergencies should also be taken into account, particularly for cesarean section (also known as a c-section) births.

8. If restraints are required, they should allow for the mother’s safe handling of her infant and mother-infant bonding, which is beneficial and very strong during the postpartum period.

Adopted by the National Commission on Correctional Health Care Board of Directors
October 10, 2010.