Shela Williams, a 29-year-old mother living in Austin, was incarcerated when she was 18 weeks pregnant with her second son, Israel. Williams was seeing a specialist before she went to the Travis County Jail because Israel had spina bifida and the pregnancy was high-risk.
Williams told the Current that although she told the jail's medical staff about her condition when she was booked, they didn't schedule an appointment with a physician until weeks later. At 24 weeks, a doctor told Williams that her baby "wasn't going to make it," she said, remembering feeling uncomfortable and disrespected throughout the exam. A few weeks later, she was induced at an Austin hospital, more than two months before her due date. She gave birth with the help of a midwife while a jail guard watched from the corner of the hospital room. Israel wasn't breathing when he was born. She spent one night holding her baby, then returned to jail while her family planned and held Israel's funeral.
"That's really stressful for [family] to plan a funeral by themselves because they were expecting Israel to make it ... I'm blessed that my family was so strong," she told the Current. "Never in a million years did I think I wasn't going to get to go ... but I get through it, I go to his grave."
Williams carries a pale yellow box with a butterfly on top that contains the few photos she has of her son. She shares her story in the hope that it will raise awareness in the fight for better health care for pregnant women in Texas jails.
A coalition of organizations, including the Texas Jail Project, Austin-based Mama Sana/Vibrant Woman Pregnancy and Women's Clinic for women of color, Amnesty International and Moms Rising is calling on the Texas Commission on Jail Standards to implement more robust, detailed policies and procedures to ensure pregnant women get proper obstetric, prenatal and postpartum care while they're incarcerated in Texas county jails. The coalition argues that, with more than 200 county jails statewide, the commission's minimum standards aren't strong enough, nor are county jails held accountable if appropriate care isn't available, creating a dangerous situation for expectant inmates.
Kellee Coleman, Williams' friend and a birth companion with Mama Sana, was also incarcerated while she was pregnant. She shared Williams' experience with the Texas Commission on Jail Standards at a November 6 public hearing in Austin.
"Everyone deserves adequate care no matter where they are; babies don't have to die," Coleman said.
Diana Claitor with the Texas Jail Project has heard from hundreds of Texas women and their families about the inadequate medical care they've received while incarcerated. According the Sentencing Project's analysis of 2010 Bureau of Justice Statistics data, more than 205,000 women nationwide are incarcerated in federal prisons, state prisons and local jails, a number that has increased every five years since the 1980s. The data show women are more likely than men to be behind bars for nonviolent drug or property crimes.
According to the Texas Commission on Jail Standards, on October 1 of this year, 527 pregnant women were incarcerated in Texas county jails. The monthly average, Claitor says, hovers between 400 and 500.
"Most jails and prisons are built by men for men, and so as the increase of incarcerated women has occurred, a lot of these problems are having to be worked out," Claitor said at the November 6 hearing. "The needs of pregnant inmates are very important to the families and those children."
A state law passed in 2009 required the commission to adopt a framework of "reasonable" standards for county jails to determine if a female inmate is pregnant, and ensure that county jail health services plans, which are submitted to the commission for approval every five years or so, address the medical care, mental health, housing and nutritional needs of pregnant inmates. In 2012, the commission required county jails to add general language to their health services plan.
Diana Spiller is with the Texas Commission on Jail Standards. She said the agency doesn't outline specific services or standards of care because resources and availability of medical providers varies across the state. Larger jails in urban counties likely have more medical personnel available to treat and care for pregnant inmates, she said, while more rural counties may not even have an obstetrics specialist in the area.
"I think one of the complaints about our current standards is that they're too vague or too general," she said. "If we mandated specific treatment or protocol that might be setting [smaller, rural counties] up for failure and they cannot comply ... that's where we're trying to juggle."
The Current's review of county health-services plans in the San Antonio area reveals the lack of specificity. While the Comal and Guadalupe plans essentially repeat the general language provided by the commission verbatim, Bexar County's is a bit more robust—likely indicative of the resources available in our more urban area.
As of November 21, 26 inmates incarcerated in the Bexar County jail were pregnant. University Health System, the county hospital district, has a $10.8 million budget for detention health-care services. It employs more than 200 medical and counseling staff to provide medical and mental health services at the jail.
Martha Rodriguez, senior director of Detention Health Care Services, told the Current that every woman is screened and given a urine test when she arrives at the jail. Rodriguez said pregnant inmates are immediately put on a prenatal vitamin regimen and placed on a "pregnancy diet" that consists of more protein, extra fruits and vegetables, and an extra snack.
An ultrasound machine UHS purchased 18 months ago allows the physicians to do most prenatal care on site, but if women need more specialized care they are sent off-site to UHS-operated clinics. At 24 weeks, Rodriguez said, pregnant inmates receive an extra mattress to sleep on and expectant inmates are seen by a physician every two to four weeks, depending on where they are in their pregnancies. If a woman is scheduled to deliver while she is incarcerated, a bed is arranged at the hospital. Rodriguez said 17 incarcerated women have given birth during their sentences this year.
"We've been fortunate to be able to secure equipment that makes our services even better," she said. "It helps us ensure that we provide the same level of care for the ladies here that they would get out in the community."
A 2011 review of the implementation of the 2009 law in six urban areas, including Bexar County, by Claitor and the American Civil Liberties Union of Texas found that protocol like prenatal vitamins, high-calorie diets and low bunk-bed assignments varied from facility to facility. Claitor said an updated, more thorough review of what goes on at all county jails is a must.
"It's really hard to tell [if the standards are being implemented]," she said.
A related state law passed in 2009 banned the use of shackles and restraints on pregnant women during labor, delivery and after delivery, "unless the sheriff or another person with supervisory authority over the jail determines that the use of restraints is necessary to ensure the safety and security of the woman or her infant, jail or medical personnel, or any member of the public; or prevent a substantial risk that the woman will attempt escape."
While the commission does require that county jails document the use of restraints, counties aren't required to report those incidents to the agency. Matt Simpson, policy strategist with the ACLU of Texas, who worked on the two bills with Claitor, said the jail commission needs a way to review the use of restraints when inspecting the facilities.
"I think it's very rare that there'd be a public safety concern, but if that exception is used and [women] are shackled, I think it's important that the TCJS document it," he said.
Spiller said TCJS inspectors look at the overall medical care provided to inmates.
"When our inspectors go into the facility, that's when they start looking at the medical care of inmates," she said. "They've been known to ask specifically for pregnant inmates and look at their care."
The Current requested records related to the use of restraints at the Bexar County Jail well over two weeks ago, but the county has yet to release the information.
Claitor says Texas women who were incarcerated while pregnant have privately shared with her that they feel mistreated while in jail, that they don't receive appropriate medical attention when they request it and that they have been restrained or confined arbitrarily.
In the last several months, some, like Williams, have spoken publicly. Nicole Guerrero, of North Texas, who was five months pregnant when she was detained at the Wichita Falls County jail in June 2012 filed a lawsuit against the county in May alleging violation of her 14th Amendment due process rights. According to the original complaint, Guerrero was experiencing bleeding and cramping but was repeatedly told by medical staff that her baby was fine. Guerrero eventually went into labor and her baby was born "dark purple," the complaint states, and died several hours later. The case is set to go to trial next year.
Jessica De Samito, a 24-year-old pregnant veteran, was detained this summer at the Guadalupe County Jail after violating her probation. Incarcerated 24 weeks into her pregnancy, she was denied essential methadone medication needed to curb her opiate addiction. Without methadone, considered by national medical experts to be the gold standard of treatment for opioid-dependent pregnant women, De Samito was in danger of a stillbirth. Lawyers and advocates intervened on behalf of De Samito, and she was ultimately released back into the community.
Stories like these have prompted discussion between the commission and advocacy groups about how best to care for pregnant women in Texas county jails.
"Our board is committed to ensuring that the proper thing is done and has directed staff to do so as well," said Brandon Wood, executive director of TCJS.
In addition to implementing current standards and a more detailed framework for procedures, advocates are also calling for better data collection on the outcomes of jail pregnancies, as well as an expanded roster of service providers available to care for them while they're incarcerated.
Paula Rojas, a certified midwife and co-founder of Mama Sana/Vibrant Woman, wants the commission to make information about licensed midwives, doulas and nurse midwives readily available to county jails, especially facilities that don't have enough medical providers. Medical research shows stress can impact pregnancy, and given the stressful nature of incarceration, Rojas also recommends that all incarcerated pregnant women be given the same level of extra care high-risk pregnant women in the community receive, including more routine ultrasounds and extra monitoring. If an incarcerated woman is found to have a high-risk pregnancy, she should receive even more.
"That would be absolutely logical because it's about being in hyper-stressful conditions," she said.
Other recommendations include policies that prohibit pregnant women from being placed in solitary confinement and specific protocols for labor and delivery.
Since this summer, stakeholders have come together to discuss how to improve policies and Spiller says the commission is working to gather as much information as possible from advocates like Claitor and Rojas.
"Our role in this issue is still being developed," she told the Current. The next commission meeting is scheduled for February 5.
But do pregnant women really need to be in jail? If care isn't available, their offenses are nonviolent and they don't pose a public safety threat, why not consider alternatives like bond, Simpson asks. Health outcomes would improve, families wouldn't be separated and women could see the same doctor throughout their pregnancy.
"Unless there's a massive public-safety concern, maybe [pregnant women] need to be bonded out or go back in the community where they have access to medical care," he said. "Pregnant inmates are probably really good candidates for diversion."