This guest blog from Naomi Delap of Birth Companions looks at Public Health England’s recently published standards to improve the health and wellbeing of women in prison. It shares Birth Companion’s ideas on how some of the significant change which is needed across the criminal justice system might be achieved.
Long-needed improvements in the care of pregnant women and new mothers in prison came a step closer in March with the publication of Public Health England’s (PHE) Gender Specific Standards to Improve Health and Wellbeing of Women in Prison. With a substantial section on pregnancy and families, a commitment to overarching principles such as a trauma-informed approach and peer support, and buy-in from NHS England and Her Majesty’s Prison and Probation Service (HMPPS), the document presents a vision of a system fully aware of the needs of women and the support they require to address the multiple challenges in their lives and give their babies the best start possible.
As it stands however, the Standards are a bit like being told about a wonderful beach, where the sea is translucent and the sand is soft and golden, and then trying to reach it with no map and limited phone signal. The document’s signatories state that implementation “is a shared objective of HMPPS, NHS England and PHE” but acknowledge that “currently not all standards are being met”. This rather understates the scale of the challenges facing the system today which get in the way of providing good care for perinatal women. Women are still reporting being hungry, not having access to basic provisions such as breast pads, and waiting months for a decision on whether they will have a place on a Mother and Baby Unit.
We have no intention of undermining these Standards; they represent a significant breakthrough and we are fully supportive of the changes they would bring about. So, ever practical, Birth Companions has some ideas to contribute on how some of that change might be achieved:
A detailed Policy Framework for perinatal women
Having an aspirational document is one thing, having detailed legislation that sets out clearly for prison staff their responsibilities towards perinatal women is another. Policy Frameworks will shortly be replacing existing Prison Service Instructions as the core prison operational policies. Birth Companions has been calling for a comprehensive legislative framework to ensure consistent and effective care since we launched our Birth Charter for Women in Prison in England and Wales in 2016.
Low Newton Prison, County Durham and Darlington NHS Trust and NHS North East and Cumbria have led the way in appointing a Specialist Midwife for the Judicial System to develop a comprehensive pathway for perinatal women in the prison, deliver services and ensure partnership working. We’d like to see this replicated across the system, and midwives’ remit broadened to include women affected by the criminal justice system, whether pre-sentence, on release or serving community sentences.
Greater awareness of how trauma affects perinatal women
The prison service has embraced a trauma-informed approach but staff working with pregnant women and new mothers need to understand the specific risks of past trauma being re-triggered during this period (particularly during birth), and the nature of post-traumatic stress disorder arising from some experiences of childbirth in order to give truly trauma-informed care.
Quick, cheap wins
Some of the recommendations in the Standards will take time and resources to implement; others are more straightforward to enact. Giving pregnant women the opportunity to be housed on the same wing, for example, would enable women to benefit from staff who have built up expertise in this area and from peer support. This has been demonstrated to work in the past in HMP Holloway.
And please, please could we ensure that all women in prison who need breast pads are given them?