This week's JAMA presents the case of a 25-year-old pregnant woman, Ms. A, who is in jail. On admission to jail, Ms. A reported a six-year-long habit of heroin use and a pack-a-day smoking habit.
Ms. A's prenatal course was significant for smoking cessation (enforced by the jail's no-smoking policy) and methadone replacement at 30mg/d, increased to 40mg/d late in the third trimester. While incarcerated, Ms. A went into labor. She delivered her baby girl under epidural anesthesia at a nearby hospital. Her daughter required supportive morphine and phenobarbital-supplemented care over several weeks for neonatal abstinence syndrome. Although intent on breastfeeding, Ms. A was unable to do so because of a combination of inhospitable surroundings and lack of privacy attributable to having a prison guard in the room at all times.
Shortly after returning to jail, Ms. A was granted paroled release to a community-based, residential parenting program.
The authors interviewed Ms. A, who said, "They didn't let the baby in the room with me. I don't know why. The officers told me that with other ladies they had been in the hospital with, they had let the baby in the room. They had to call me every time she needed to be fed. In the hospital, they aske me if I wanted to breastfeed. And at first I wanted to. And then I was uncomfortable. There was an officer in the room every time I went to feed the baby. So it took away the urge that I had to breastfeed."
Women make up a higher and higher percentage of the incarcerated population in the United States. Different states treat pregnant prisoners very differently. California has three "Community Prisoner Mother Programs" and allows babies to stay with their mothers until the end of the mother's sentence. Illinois has one residential program in which 15 qualified inmates can keep their babies for up to 24 months. South Dakota allows an incarcerated mother to keep her baby for 30 days. In most states, a pregnant woman with a state prison term outlasting the term of her pregnancy can expect to lose her child almost immediately after delivery.
What do you think? Should pregnant women in prison be allowed to keep their babies? JAMA is inviting readers to comment on this case. So are we. Tell us what you think.