Arizona inducing the labor of pregnant prisoners against their will

The Arizona Department of Corrections is inducing the labor of pregnant prisoners against their will, according to three women incarcerated at the Perryville prison in Buckeye.

The women say they were forced to have their labor induced, despite wanting to have a spontaneous birth.

Medical records reviewed by The Arizona Republic show all three women were induced before their due dates. The women consented to have their medical information released. Stephanie Pearson and Desiree Romero had their labor induced at 39 weeks gestation in 2022. Jocelyn Heffner was induced in the 37th week of gestation on two separate occasions during separate incarcerations in 2020 and 2022. 

Research has shown that labor can be induced safely at 39 weeks if it is an elective procedure, and health care experts say labor can safely be induced before 39 weeks if there is a medical reason to do so.

But all three women said they were told by prison medical providers they were being induced because it was a policy of the Arizona Department of Corrections for all pregnant incarcerated women, not due to their individual conditions. The women say they were given no explanation for the policy, but they believe it is being implemented to reduce liability for the prison system. 

The Arizona Department of Corrections did not respond to multiple requests for comment. NaphCare, the state’s prison health care contractor, denied having a policy of forced inductions. NaphCare’s contract began on Oct. 1, 2022. 

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Centurion, the previous prison health care contractor, did not respond to questions about the women who claim their labor was induced against their will during that company’s tenure in Arizona.

Since taking over the contract in October, a NaphCare spokesperson said one incarcerated patient was induced “per hospital specialist’s orders as a maternal-fetal safety precaution due to a pre-existing condition.” There are six pregnant patients in Arizona prisons, according to NaphCare.

While the NaphCare spokesperson said “any decision to induce is solely the patient’s choice,” all three women maintained they were not given a choice. They were told their labor was going to be induced.

“They said they induce everyone because they don't want anyone going into labor here,” Stephanie Pearson said of the explanation she was given by a prison obstetrician. “They just told me that someone on a different yard a few years ago went into labor in their cell, and had their baby in the cell, and that's why they induce everyone now.”

In 2019, attorneys from the Prison Law Office and ACLU documented an instance of a seriously mentally ill woman giving birth, alone, in the toilet of her cell at Perryville. The attorneys found the woman had been sent to the hospital after her water broke, only to be returned to the prison for unknown reasons before giving birth. 

Desiree Romero said she was told repeatedly by the Department of Corrections medical provider that it is a set policy to induce all pregnant prisoners one week before their due date.

“They induce us all now so that we don't go into labor in prison,” she said. 

Romero said she never had a choice in the matter. If she did, Romero says she would have waited to have the baby spontaneously.

“I'm quite used to the prison making all these decisions for us because we are still state property,” she said.

“I felt like I was viewed as a liability and walking around a prison yard nine months pregnant didn't comfort this state institution,” said Jocelyn Heffner. Heffner said she disputed the decision to induce her labor during two pregnancies while at Perryville, only to be denied each time. 

“Most ladies get induced here, I've caught on to,” she said.

More:A pregnant inmate went into labor, and then her baby died. Was a Starbucks stop to blame?

Loss of autonomy

All medical procedures in the United States, including induction of labor, should happen only with the patient’s full consent, said Dr. Laura Mercer, associate professor of Obstetrics and Gynecology at the University of Arizona College of Medicine in Phoenix.

Mercer said it was concerning to learn that there were incarcerated patients who said they did not know why they were being induced.

“Informed consent is an ethical requirement,” Mercer said. “From a medical perspective, we owe it to our patients to make sure that they are completely informed about what we are recommending, why we are recommending it, and what the alternatives are.”

While Mercer said there are valid medical reasons, like high blood pressure, for health care providers to suggest induction, patients should still have the autonomy to decline treatment, even if that decision results in risks to their health or the health of the fetus.

Kierra Otis is a full spectrum Doula and co-founder of the Rooted Doula Collective in Arizona. She says if the women's allegations are true, a policy of forced induction would “absolutely be a human rights violation.”

Otis said those rights, articulated by the reproductive justice movement, include “the right to not have children through abstinence, abortion care or contraceptives; the right to have children under the conditions that we choose; and the right to raise our children in safe and sustainable environments.”

Otis said the loss of autonomy during pregnancy can add to the difficulty of what she called a very tender period in a person’s life, physiologically and hormonally.

“People can be really vulnerable when they're going through these circumstances,” Otis said. “And so it is really important that they have as much control over the situation as they can.”

Pearson said she didn’t like the decision being made for her “especially because they didn’t explain any of the risks to me.”

“Just because I made some bad choices in my life, they shouldn't be allowed to make bad health choices for me and my baby,” she said.

Physical and emotional trauma

Otis said the loss of autonomy can also have impacts beyond the pregnancy.

“I've noticed, as a doula, when people feel that they have a choice in the matter, there's way less trauma,” she said. “But if that agency is taken away, and the person who's giving birth is having this trauma, it's going to impact their ability to parent, and it's going to have an impact on the child as well.”

While the women who spoke to The Republic believe their children are healthy, they say the loss of autonomy in the decision-making process added to an already stressful and painful medical procedure and led to increased symptoms of postpartum depression.

All of the women reported experiencing labor for a long time after they were induced.

“It makes your body do something it's not ready for, and the baby isn't ready for,” Pearson said. “It stresses the baby and the mother out.”

Pearson said her previous experiences with spontaneous labor lasted only a few hours, but the prison-induced labor took nearly three days.

“It’s a lot more active labor, which means a lot more contractions, and harder contractions,” she said. “After the birth, I was in so much more pain than my other ones, and it took a lot longer for my body to heal.”

Desiree Romero said her forced induction lasted two days.

More:Homicide is a leading cause of death during pregnancy. These women are more likely to be killed.

Arizona not following state law or best practices

Arizona passed a version of the Dignity For Incarcerated Women Act in 2021, providing some safeguards for pregnant people in state prisons. In addition to ensuring adequate amounts of feminine hygiene products are available to women at no charge, the law also prohibits shackling of pregnant prisoners during labor, requires appropriate prenatal care, and mandates the mother be able to spend 72 hours with the baby after the birth.

While the women who spoke to The Republic said they were not shackled and were given the allotted time with their child, they claimed the department was not providing adequate treatment for them during and after the pregnancy. The Dignity Act does not cover specific aspects of labor for incarcerated women. Two of the women interviewed had never heard of the law and said it was never explained to them.

Pearson said she was denied breast pads after the birth. All of the women said their special prenatal diet only consisted of an extra serving of milk each day, and sometimes a peanut butter sandwich.

Adding insult to injury, two of the women said they were receiving medical bills for the services provided during their labor — despite the Department of Corrections and its contractors’ bearing the financial responsibility — a common complaint voiced by people incarcerated in Arizona prisons.

A spokesperson for the federal Bureau of Prisons said while BOP does not have a policy in regard to inducing labor in pregnant women, “if there is a medical necessity in inducing labor, care would be coordinated with community hospitals and their respective specialists.”

The California Department of Corrections and Rehabilitation did not respond to specific questions about inducing labor, but the agency’s procedures have an entire section on “Patient Care During Pregnancy and Childbirth,” which outlines steps to be taken to transport women in labor to the hospital.

A spokesperson for the Texas Department of Criminal Justice said the agency does not have any policies on the induction of labor of pregnant prisoners, “as it is not done on TDCJ units.”

“The induction of labor is a clinical decision made by the attending obstetrician at the hospital,” the spokesperson said.

The Arizona Department of Corrections did not respond to questions about the treatment of pregnant prisoners. The Department’s Medical Service Technical Manual makes no mention of labor induction in the section on “Counseling and Care of the Pregnant Inmate.”

Dr. Carolyn Sufrin is an OB-GYN and researcher at Johns Hopkins School of Medicine who studies incarcerated women and reproductive health. She says best practices for prisons that house pregnant women involve close communication between security and medical staff.

“Custody staff should always alert medical staff, and then medical staff should be trained to appropriately triage and to know that labor is unpredictable,” she said. 

Sufrin says medical staff should have a low threshold for taking the patient off-site because the signs of pre-term labor are very subtle and warrant evaluation by a qualified provider.

“It’s another example of how medical practices are dictated by the lack of health care and custody staff,” said Corene Kendrick, an attorney with the ACLU national prison project. Security and medical personnel have reported dangerously low staffing levels in Arizona prisons for years. “If they had enough nurses and custody officers on-site 24/7, they could implement best practices.”

“I think another response also would be to improve training and culture,” Sufrin said, “to not distrust women’s reports of contractions and bleeding and other labor symptoms.”

“Because they're incarcerated, so much of their autonomy has been taken from them, and having some say in the conditions of their birth, I think, is really important,” Sufrin said. “And that's part of shared decision-making, which is a principle that we employ in obstetrics. Anything that they can medically, reasonably have some sense of agency and control over, is something that can improve their sense of well-being.”

Have a news tip on Arizona prisons? Reach the reporter at jjenkins@arizonarepublic.com or at 812-243-5582. Follow him on Twitter @JimmyJenkins.

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