Experiences of midwifery care in English prisons

Abstract

Background: In the United Kingdom (UK), all prisoners must receive healthcare equivalent to that available in the community. However, evidence suggests that equality in healthcare provision for perinatal women in UK prisons is not always achieved. The aim of this research was to examine pregnant women prisoners' and custody staffs' experiences and perceptions of midwifery care in English prisons. Methods:A qualitative approach based on institutional ethnography was used to research women's experiences in three English prisons over a period of 10 months. In total, 28 women participated in audio-recorded, semi-structured interviews. Ten staff members were interviewed, including six prison service staff and four health care personnel. Ten months of prison fieldwork enabled observations of everyday prison life. NVivo was used for data organization with an inductive thematic analysis method.Results: Women's experiences included: disempowerment due to limited choice; fear of birthing alone; and a lack of information about rights, with a sense of not receiving entitlements. Some women reported favorably on the continuity of midwifery care provided. There was confusion around the statutory role of UK midwifery.Discussion: Experiences of perinatal prisoners contrast starkly with best midwifery practice-women are unable to choose their care provider, their birth companions, or their place of birth. In addition, a reliance upon "good behavior" in return for appropriate treatment may be detrimental to the health, safety, and well-being of the pregnant woman and her unborn baby. Conclusion:Prison is an adverse environment for a pregnant woman. This study provides key insights into imprisoned women's experiences of midwifery care in England and shows that midwives play an essential role in ensuring that perinatal prisoners receive safe, high-quality, respectful care.

How are the Dietary Needs of Pregnant Incarcerated Women Being Met? A Scoping Review and Thematic Analysis

“…Of the sixteen included papers, six were from the United States of America (USA) (Ferszt & Clarke, 2012 ; Hackett, 2017 ; Kelsey et al, 2017 ; Kotlar et al, 2015 ; Kramer et al, 2023 ; Nair et al, 2021 ), four from the United Kingdom (UK) (Abbott, 2018 ; Abbott et al, 2023 ; Albertson et al, 2012 ; Bard et al, 2016 ), three from Iran (Alirezaei & Roudsari, 2020 , 2022a , 2022b ), two from Canada (Ifeonu et al, 2022 ; Kirubarajan et al, 2022 ), and one from Australia (Baldwin et al, 2020a ). Five of the included papers were literature reviews (Alirezaei & Roudsari, 2022a ; Baldwin et al, 2020a ; Bard et al, 2016 ; Kirubarajan et al, 2022 ; Nair et al, 2021 ), one a mixed methods study (Ferszt & Clarke, 2012 ), one a quantitative study (Kelsey et al, 2017 ), five qualitative studies (Abbott, 2018 ; Abbott et al, 2023 ; Alirezaei & Roudsari, 2022b ; Hackett, 2017 ; Ifeonu et al, 2022 ), two policy analyses (Alirezaei & Roudsari, 2020 ; Kramer et al, 2023 ), one a multi-component consultation paper (Albertson et al, 2012 ), and one a report (Kotlar et al, 2015 ).…”

“…Generally, these packs include additional sources of nutrition such as extra food (e.g., bread) and/or milk or milk supplements. The two studies by Abbott ( 2018 ) and Alirezaei & Roudsari ( 2022b ) discussed how women could ‘buy up’ extra foods, but lack of funds often limited this (Abbott, 2018 ), particularly when they were not allowed to work (Alirezaei & Roudsari, 2022b ), and the foods available to buy were often unhealthy (Abbott, 2018 ). A complete lack of extra food offerings was lamented in other studies (Albertson et al, 2012 ; Alirezaei & Roudsari, 2022b ; Kirubarajan et al, 2022 ).…”

“…The food that was provided was reported to be of poor quality, stodgy and either under or overcooked in three studies (Abbott, 2018 ; Alirezaei & Roudsari, 2022b ; Hackett, 2017 ) and several papers reported on the importance of providing vitamin supplements (Abbott et al, 2023 ; Albertson et al, 2012 ; Ferszt & Clarke, 2012 ; Kelsey et al, 2017 ; Kirubarajan et al, 2022 ; Kramer et al, 2023 ; Nair et al, 2021 ). These were seen as an easy way to ensure pregnant women’s nutritional needs were met.…”

“…Women were believed to require several litres of water each day to maintain healthy levels of hydration (Nair et al, 2021 ), however, access to a water source was sometimes restricted (Alirezaei & Roudsari, 2020 ). In other cases, the water was unappealing to the women due to its taste, temperature, and the crusty taps they were expected to drink from (Abbott, 2018 ). Just three papers referred to the provision of additional milk for pregnant women (Albertson et al, 2012 ; Ferszt & Clarke, 2012 ; Kramer et al, 2023 ).…”

Prison is a barrier to high-quality, comprehensive midwifery care

“…Despite international and national requirements for equivalent care to what is available in community, existing research in the field of prison perinatal health has found delays and gaps in care and poor neonatal outcomes associated with pregnancy in prison 1. This study by Abbott et al 2 focuses on incarcerated patient access to midwifery services, the leading type of perinatal care provision in the UK, and prison staff understanding of both midwifery care and the distinct need for care among pregnant people.…”