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Table 3 Descriptive summary of included studies

From: Perinatal health care services for imprisoned pregnant women and associated outcomes: a systematic review

Reference Setting Study design Participants (imprisoned pregnant women and control women) Outcomes Description of care in intervention group
PRISON category
Bell 2004 [17] King County Jail, Seattle, Washington, US Cohort. Disadvantaged comparison group. Intervention group: 468 women imprisoned while pregnant in County jail delivering live, singleton births in the state 1994–1998.
Disadvantaged comparison group:144 women delivering live, singleton births in the state 1994–1998 who spent time in jail at a time other than during pregnancy. They received community care coordination throughout pregnancy and one year postpartum.
Perinatal health service use: inadequate prenatal care, Maternity Support Service use, Maternity Case Management use, any family planning services post-birth, any prenatal care use, no prenatal care use On-site health clinic staffed by local health department. Prenatal care offered on arrival to jail. Women in jail are not eligible for Maternity Support Services or Maternity Case Management. Those with history of substance abuse referred for post-release case management.
Kyei-Aboagye 2000 [24] Two Correctional Facilities, Massachussetts, US Cohort. Population and disadvantaged comparison groups. Intervention group: 31 women imprisoned at 2 facilities during 2nd trimester of pregnancy delivering at one hospital between 1993 and 1996.
Population comparison group: 71 unmatched randomly chosen non-imprisoned women delivering at the same hospital.
Disadvantaged comparison group: 47 women enrolled in a methadone maintenance programme.
Low birthweight, mean birthweight, APGAR scores Boston Medical Center signed agreement in 1993 to provide obstetric care at 2 facilities. All basic prenatal care provided in jail by obstetricians and nurse practitioner or registered nurse, with transfer to Boston Medical Center for delivery and if needed at other times.
Leifer 2003 [25] Holloway Prison, London, UK Case series. No comparison group. 120 pregnant prisoners who delivered at the Whittington Hospital up to December 2002. Mean birthweight, stillbirth, neonatal unit admission Since 1998 maternity services provided by Whittington Hospital. Escorted to hospital for birth; officers leave unless security risk. Detoxification 12–28 weeks if necessary. Progress recorded in maternity notes, used by paediatric staff at Whittington and by social services to prove detoxification. Can apply to mother and baby unit.
Mertens 2001 [26] County Jail, Illinois, US Cohort. Population comparison group. Intervention group: 72 pregnant women imprisoned in a county jail in one calendar year.
Population comparison group: 52 pregnant women identified from state records and matched by age, race, gravidity and zip code of residence.
Miscarriage, low birthweight, stillbirth (cases), inadequate prenatal care Pregnancy test and examination on admission. Health services provided by family practice physician and registered nurses. One full-time counsellor for whole women’s unit, no nutrition services, periodic head counts meant missed prenatal appointments.
Shelton 1989 [30] Missouri, Maryland, US Case series. No comparison group. 26 English-speaking women in last trimester of pregnancy in two women’s correctional centres with expected deliveries May – December 1982 while still imprisoned. Preterm labour, neonatal unit admission, caesarean, pregnancy complications, newborn complications, reproductive tract infections, hypertension, diabetes, varicosities, uterine dysfunction, breech presentation, placenta praevia, placental abruption, incompetent cervical os, cephalopelvic disproportion, first trimester bleeding, iron deficiency anaemia, postpartum depression One facility: health centre nurse held sick call each day. Appointments made with obstetrician for the day they monitor obstetric patients at County Health Department. Private doctor attends once per week and provides for obstetric emergencies only if present when happens. Other facility: from 8th month to one month post-partum, women admitted to intake area in prison hospital. Sick call every day with nurse. Transferred to hospital if needed or referred to physician who attended regularly.
Stauber 1984 [33] Berlin Prisons, Germany Cohort. Population comparison group. Intervention group: 43 women from Berlin Prisons who delivered babies at Charlottenburg University Hospital 1973–1982.
Population comparison group: 172 women matched with cases by age, parity and marital status who delivered babies at the same hospital.
Preterm delivery, small for gestational age, congenital anomaly, postpartum asphyxia, for adoption, breastfeeding, placental retention, postpartum haemorrhage, congenital syphilis, heroin withdrawal, umbilical cord infection. Illness or complications related to pregnancy treated by women’s clinic in Charlottenburg which also provides prenatal testing and ultrasound. Basic prenatal care provided at prison site by midwives and gynaecologists. Some extra nutrition provided. No reduced duties or access to pregnancy-related education.
Terk 1993 [32] Two prisons, Texas, US Cohort. Population comparison group. Intervention group: 76 imprisoned pregnant women who delivered January 1987 – May 1990.
Population comparison group: 117 unmatched randomly chosen non-imprisoned pregnant women delivering at the same hospital in the same time period.
Low birthweight, neonatal death, preterm delivery, APGAR scores, caesarean, prolonged rupture of membranes, birthweight < 1 kg. Prenatal care provided by University of Texas Medical Branch medical personnel at least twice per month (obstetrician + physician assistant). Patients needing hospitalisation for prenatal complications or 1–4 weeks before estimated delivery date transferred to Department of Corrections hospital unit on University of Texas Medical Branch campus.
PRISON + category
Clark 2006 [20] Multiple jails, Florida, US Cohort. No comparison group. 515 pregnant imprisoned women in jails in 4 counties enrolled in programme between February 2002 and December 2004. 16 HIV-positive women delivered as of December 2005. HIV test in pregnancy, HIV outcome in child Targeted Outreach for Pregnant Women Act (TOPWA) programme uses outreach workers to identify women in jails in 4 counties for eligibility (pregnant, lack adequate prenatal care, risk of HIV-infected or substance-exposed infant). TOPWA staff advocate for incarcerated clients to receive prenatal care, HIV related services, pregnancy and HIV testing, education on prenatal care and antiretroviral therapy use. Linked to health and social services on release. Women tracked by TOPWA until birth with phone calls and visits.
Cordero 1992 [21] Ohio Reformatory for women, State Prison, Ohio, US Cohort. No comparison group. 233 pregnant women imprisoned in the state medium-security prison 1986–1990. Mean birthweight, stillbirth, preterm delivery, small for gestational age, neonatal unit admission, APGAR scores, caesarean, inadequate/adequate prenatal care, number of prenatal visits Prenatal care at prison infirmaries and Ohio State University Hospital antepartum clinic; women transferred in 3rd trimester to pre-release centre (low security near hospital); 2800 calorie diet, vitamin and iron supplements, additional 400 calorie snack until 1988; light duties only; health education classes and Lamaze classes.
Inoue 2003 [22] Cook County Jail, Chicago, US Case series. No comparison group. Intervention group: 50 pregnant women imprisoned in County Jail in the programme’s first year (2001) and receiving doula services. Caesarean, epidural rates. Support before, during and after childbirth. Prenatal education, doula visits, support to develop birth plan. Prenatal class with doulas in last trimester. Birth companion, pictures of baby, diary to write birth narrative. Visits every day of hospital postpartum stay.
Rowles 2007 [27] Holloway Prison, London, UK Case series. No comparison group. 9 pregnant women and 5 postnatal women in Holloway prison between January and March 2007. Postnatal: Breastfeeding, positive contact with programme, companion present at birth, breast counsellor visited within 24 hours of birth, supported by breast counsellor. Prenatal: aware of birth companions, wanted birth companion present at birth. Antenatal classes, birth plans, prison visits, support by birth companion during labour and birth, hospital visits, practical assistance, breastfeeding support, community visits.
Safyer 1995 [28] Rikers Island Jail, New York City, US Cohort. No comparison group. 114 pregnant women imprisoned in correctional facility in 1994 who delivered at Elmhurst hospital. Mean birthweight, caesarean, termination of pregnancy requested/obtained in prison, Collaboration with Montefiore Medical Center and Elmhurst Medical Center. Care includes blood tests, pelvic examination, ultrasound scan, vitamins and iron; regular physician/nurse practitioner/prenatal nurse visits ; prenatal counselling and education; special diet; housed separately in 3rd trimester; birth at Elmhurst Medical Center; jail nursery after birth if eligible; drugs counselling and methadone if needed.
Schroeder 2005 [29] Urban Jail in Seattle, Washington State, US Case series. No comparison group. 18 women imprisoned in urban jail during 2-year period who chose to have doula support. Mean birthweight, gestational age, satisfaction, mean APGAR scores Primary and back-up doula meets women prior to birth to review expectations, assess knowledge of birth, teach, develop birth plan. Doula meets women at hospital for birth support, photos and birth story. Doula follows infant placement after birth through contact with social worker. Doula visits 3 days postpartum to review experience, provide info and share photos and story.
PRISON++ category
Carlson 2001 [18] Nebraska Center for Women, Prison,, US Cohort. Disadvantaged comparison group. Intervention group: 44 women in nursery programme Nov 1994–Nov 1999 (37 answered survey).
Disadvantaged comparison group: 30 women who delivered in Nebraska Center for Women (mixed-security confinement facility) Jan 1991–Nov 1994, before the nursery programme existed. Mothers and babies separated 3 days after birth.
Recidivism, misconduct reports, mother retained custody of child after leaving, tested positive for drugs while in programme, involuntary release, sent babies home. Survey outcomes: stronger bond with child, better self-esteem, parenting classes helped, better prepared to be working mother, would do programme again, other states should have similar programmes Prenatal, delivery and postpartum care at local hospital. Prenatal, parenting, infant care, child development, Lamaze, breastfeeding, CPR, alternative to spanking classes. Half-time work after birth for 6 months, General Educational Development classes if not already qualified, develop and coordinate community resources during imprisonment and after release, mentor programme with follow-up after release.
Carlson 2009 [19] Nebraska Center for Women, Prison, US Cohort. Disadvantaged comparison group. Intervention group: 65 women in nursery programme Nov 1994–Nov 2004.
Disadvantaged comparison group: 30 women who delivered in Nebraska Center for Women (mixed-security confinement facility) Jan 1991–Nov 1994, before the nursery programme existed. Mothers and babies separated 3 days after birth.
Recidivism Prenatal, delivery and postpartum care at local hospital. Prenatal, parenting, infant care, child development, Lamaze, breastfeeding, CPR, alternative to spanking classes. Half-time work after birth for 6 months, General Educational Development classes if not already qualified, develop and coordinate community resources during imprisonment and after release, mentor programme with follow-up after release.
Barkauskas 2002 [16] Michigan State adult corrections system, US Case series. Disadvantaged comparison group. Intervention group: 37 pregnant women transferred to residential programme from county jail or state prison July 1996–Dec 1998.
Disadvantaged comparison group: 35 women who entered Michigan state prison pregnant Aug 1997-Aug 1998, were eligible for programme but did not participate.
Low birthweight, mean birthweight, small for gestational age, gestational age at birth, APGAR scores, caesarean, breastfeeding, meconium at birth, oxygen at birth, respiratory difficulty at delivery, discharge weight, haemoglobin, haematocrit, spontaneous delivery, episiotomy, normal amniotic fluid amount, clear amniotic fluid, blood loss. Women and Infants at Risk programme (WIAR): Women with a substance abuse history transferred to residential programme while pregnant until 4 months postpartum. They have their own room with baby equipment provided; prenatal, family planning and childbirth education; nutritional supplements; transport and accompaniment to appointments; birth at local hospital supported by family or volunteer; bonding room for 1 month after birth; onsite childcare facility; counselling, therapy, substance abuse education, narcotics anonymous group; employment classes, arrangements for housing, aftercare, medical care and day care on release with comprehensive coordination of care.
Kubiak 2010 [23] Michigan State Prison, US Cohort. Disadvantaged comparison group. Intervention group: 48 women who entered prison pregnant 1996–1998 and were transferred to the residential programme while pregnant.
Disadvantaged comparison group: 36 women who entered prison pregnant 1996–1998, were eligible for programme but did not participate.
Crown Prosecution Service file on child, foster care file on child, adoption file on child, maternal rights terminated, child formally away from mother, evidence of mother as caregiver, no evidence of caregiver besides mother, informal caregiver, formal caregiver, maternal arrest post-birth, convicted post-birth, recidivism. See above (WIAR)
Siefert 2001 [31] Michigan State Prison, US Case series. Disadvantaged comparison group. Intervention group: 44 pregnant women transferred from prison to residential programme outside the prison in 1991–1995.
Disadvantaged comparison group: 120 pregnant prisoners in Michigan corrections system 1987–1991, before residential programme began. Mothers and babies separated after birth.
Preterm delivery, small for gestational age, low birthweight, stillbirth, neonatal death, neonatal admission, congenital anomaly or serious delivery complication, fetal alcohol syndrome, meconium aspiration syndrome, severe intra-uterine growth retardation, hepatitis, anaemia, suspected sepsis, discharged to maternal friend, place in foster care, infants born drug-free. See above (WIAR)