Rachel E. Bennett
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Maternity care in prison

Women giving birth or caring for very young infants featured as frequent parts of life in women’s prisons. They often appear in the backgrounds of the testimonies of ex-prisoners and staff alike, yet their specific needs are a notable chasm in official prison policy. Pregnancies and births varied in frequency from prison to prison and across the period between the mid-nineteenth and the mid-twentieth century, and provisions for them were inconsistent across the prison estate. For some, prison was posited as a refuge from even harsher conditions outside. For others, it was a place of heartbreak and isolation which severely impacted upon their health. At the outset of the modern penal system, prison buildings were modified to incorporate infirmaries, nurseries and, later, crèches for the reception of mothers and babies. Prisoners and staff each played roles in adapting the rules regulating the running of prisons so as to address the daily realities of life in prison for mothers and children.

Upon its inception in the mid-nineteenth century, the modern prison system was intended to regulate the prisoner in body and in mind. Every hour of the daily lives of the incarcerated population was governed by a set of officially sanctioned rules intended to uphold the strictest possible discipline. For much of the nineteenth and first half of the twentieth century, prisons were often fortress-like structures, intended to appear imposing to those who stepped through their gates. The system was subject to intense and lengthy debates and enquiries which led to the production of reams of reports and recommendations for its effective administration. However, the specific requirements for the confinement and care of the women who entered the system pregnant and gave birth in one of its institutions largely remained a notable chasm within the official discourse shaping penal policy. Instead, prison staff had to negotiate the terms of their incarceration within physical spaces not intended for their accommodation and as part of obdurate regimes not designed with their health needs in mind.

For much of the period under examination, identifying pregnancy was often difficult, and even framing what was meant by the maternal body and maternity care was complex. Some women chose to conceal their pregnancy or were not even aware of it themselves. This chapter also exposes the sparse consideration given to prison births at policy level, despite the fact that they were a regular feature of life in women's prisons. One significant consequence of this was the imprisonment of heavily pregnant women in separate confinement and in conditions where the limiting of association and communication was pervasive but potentially posed a danger to health.

A substantial part of this chapter is dedicated to examining a major enquiry into maternity care in English prisons. Led by Adeline Marie Russell, the Duchess of Bedford, the enquiry was carried out in Holloway Prison, the largest female prison in the country. It was prompted by an intensification of debates about health care in prisons as well as specific provisions for women, and coincided with broader debates about the appointment of more female staff to positions of greater power in prisons. The enquiry was the first of its kind to place maternity care at its centre and this chapter demonstrates that it marked a watershed in the history of the women's prison estate.

Provisions for maternity care in prisons

Women giving birth or caring for very young infants often appeared in the backgrounds of the testimonies of ex-prisoners and staff alike, and were discussed as an everyday feature of life in women's prisons. Their frequency varied from prison to prison and across the period under examination. Some prisons only ever accommodated a small number of women and may have only witnessed a couple of births in a year. However, in others births could be a monthly if not weekly occurrence. Some women spent a large proportion of their pregnancy in prison, others only a matter of weeks, due to the short nature of their sentence, while in some cases women entered only days before they gave birth. This was clearly demonstrated in a table of prison births between February 1852 and February 1854 compiled by the Medical Officer in Westminster Prison. Margaret Carey had been in the prison for almost eight months before she gave birth; however, Joanna Courier and Margaret Edwards each gave birth the day after their admission into the prison. 1 The prison occasionally had time to assess prisoners, in other cases the prison authorities would only become aware of an impending birth when it began.

In 1851 John Lavies, Medical Officer of Westminster Prison, reported to the Visiting Justices on the need for a greater number of beds in the infirmary and more officers to attend the prisoners, as the number of births and lying-in women meant that between ten and thirteen beds would be constantly required. 2 In the second half of the nineteenth century there were regularly in excess of twenty births per year in the prison, sometimes up to four in a month. The reports to the Visiting Justices demonstrate that there was also an average of between twenty and thirty children at any one time who had been committed with their mothers for varying sentence lengths. By the 1930s it appears that the number of births had slightly decreased, likely due to the decreased female prison population. Thirty-two births were recorded in the matron's journal between 1933 and 1937. 3

In Liverpool's Walton Gaol there were an average of twenty births annually in the second half of the nineteenth century. A reading of the reports made by the prison's governor, medical officer and chaplain to the Visiting Justices reveals repeated laments about the number of women in the prison who either were pregnant or brought young infants into the prison with them. This was believed to be particularly exacerbated by the harsher winter conditions and often meant that the number of women equalled, and sometimes surpassed, the number of male prisoners, and in this sense made Liverpool unique in terms of mixed-sex prisons. Officials repeatedly complained of a lack of space to accommodate these women and their children, of an inability to confine them according to the prison regime and of the fact that many of them were serving very short sentences but were notorious recidivists who returned to the prison gates time and again. In his first report to the Visiting Justices in October 1874, the chaplain, David Morris, conflated the issues of drunkenness, venereal disease and pregnancy when complaining of the crowded nature of the prison. He described it as being used as both a lying-in hospital and a ‘kind of lock hospital’, including by mothers bringing in young infants. He detailed the case of a twenty-eight-year-old woman who had been in the prison thirty-five times, sometimes pregnant, and each time brought her young children in with her and posed logistical as well as disciplinary difficulties for the prison officials. 4

By the 1920s there were an average of thirty to forty births annually across the eighteen prisons in England and Wales that accommodated women. However, this varied from prison to prison. In the early twentieth century Holloway usually witnessed between ten and twenty births annually. Some smaller local prisons or local prisons with a small number of female prisoners may have had only one or no births in a year. For example, between March 1922 and March 1924 there were forty births in the women's prison estate. Holloway accounted for thirteen of these, followed by Newcastle and Aylesbury Borstal with four each, three in each of Durham, Birmingham, Leeds and Winchester and one or two births each in other prisons. Some smaller prisons, including Hull and Portsmouth, recorded no births in those two years. In the same period twenty-seven women were discharged on account of their pregnancy, as was sometimes the practice if a woman's expected date of confinement coincided with their release date, so as to avoid her being detained beyond the expiration of her sentence. 5

By the early twentieth century, when a woman entered prison and pregnancy was identified the medical officer was required to complete a report. This report included details of the name, the offence committed and length of the prisoner's sentence, as well as information about the stage of her pregnancy and the date her confinement was likely to take place. The report would be forwarded to the Home Secretary only if it was probable that the woman's date of confinement was likely to mean she would be detained beyond the original term of her imprisonment. 6 This practice is further discussed in Chapter 4. Interestingly, Bristol, which had an average female population of 195, witnessed no births in the two years between 1922 and 1924, but its medical officer did recommend the discharge of three women on account of their advanced pregnancy. 7 This reinforced the argument that prisons had to be prepared to confine women in an advanced stage of pregnancy even if they did not give birth behind bars. The disparity in the numbers of births in prisons and the differences in the sizes of their female populations were also reflected in the provisions some prisons made for caring for these women and their infants.

Prisons of the mid-nineteenth century were built and modified to enact the penal regimes established at the outset of the modern prison system. They included separate cells, chapels, exercise yards, punishment cells and variously included laundries, bakeries, associated workrooms and space to accommodate members of the prison staff. They also included infirmaries and, later, hospitals and, in the case of prisons containing women, spaces for the accommodation of mothers and their children. However, the size of these spaces and the provisions within varied across different prisons. When women entered prison pregnant, they were predominantly placed into cellular confinement along with the hundreds of women around them. In cases of advanced pregnancy women could be placed two or three to a larger cell at the discretion of the medical officer, with the intention that the other women could raise the alarm if they needed to gain the attention of the staff on duty.

For much of the second half of the nineteenth century the majority of women remained accommodated in their cells until their expected date of confinement, at which point they would be placed in the infirmary and spend a short period lying in. In some prison infirmaries there would be a room designated for births and beds reserved for lying-in women. In several prisons this was a room that had been converted from a cell or a warder's quarters. Chapter 1 explored the pressures facing some of the larger local prisons which accommodated women in the second half of the nineteenth century, including Liverpool and Westminster, and how officials regularly reported that the number of women entering prison either pregnant or with young infants exacerbated these pressures. Sections of the infirmaries in these prisons were permanently designated for women in an advanced stage of pregnancy, who required closer monitoring, and women who had recently given birth.

Alongside the laments over the pressures mothers and infants could place upon penal institutions, being under the close supervision of a doctor was held up as an example of the benefits to pregnant women of a certain class. Although this is an area further discussed in Chapter 4, it is beneficial to highlight one such example here, as it illuminates not only debates about the condition of women upon arrival in prison, but also reveals the perceived importance of the prison infirmary in caring for the plight of some of the women who entered prisons. In July 1890 The Lancet reported upon the case of prisoner E.G., who was serving two months in Canterbury Prison. Her sentence commenced on 10 April and she was eight months pregnant. On 13 May she was delivered of a male child. However, during the labour she complained of an intense headache which did not cease when the child was born. Five hours after the birth she had an epileptic fit. In the space of the twenty-four hours thereafter she had twenty-seven seizures. The doctor gave her hourly drop doses of nitro-glycerine until the fits first relaxed in their violence and then ceased. Reflecting upon the case, the medical officer and the matron pointed to the fact that the woman had received quick access to treatment which she would not have had access to on the outside. They took pains to highlight that being in the prison infirmary meant she was monitored around the clock, and that the prison environment and having a place in the infirmary for some days after the birth had allowed her the time and care to recover prior to her release with her child on 10 June. 8

When it was opened for female convicts in 1853, Brixton's building was adapted to provide greater space for the infirmary, which was larger than those of other prisons for women at the time. A recent study has found that Brixton's infirmary was quickly put under pressure, due to the health needs of the women entering the prison. James Rendle, the medical officer, regularly reported overcrowding and the difficulties of caring adequately for the health needs of the women, who often entered the prison in ill health and could not be subject to the ordinary discipline of the institution. 9 Cases of pregnancy and new mothers were a distinct group of prisoners who required accommodation in Brixton's infirmary, in some cases being transferred to the prison from other penal institutions for that express purpose. Between 1853 and 1869 138 women were moved to Brixton from Millbank, Fulham Refuge or Parkhurst on medical grounds. Of these 138 cases, 22 women had been removed from Millbank due to pregnancy, so they could give birth in Brixton's infirmary, which was better equipped to accommodate lying-in women. 10

By the early twentieth century, some of the larger prisons containing women had specific landings for the accommodation of cases requiring greater medical supervision and care, including pregnant women. In Holloway, if pregnancy was identified the woman was placed on the A2 or B2 observation landing. However, the cells on these landings were also used for cases of mental illness, epilepsy and tuberculosis. It was then the practice in most prisons to move the women to the prison infirmary in the final month of their pregnancy, although this study has found evidence that this was not consistently done, due to logistical pressures such as space and availability of adequate staff in the infirmary, as well as uncertainties about a woman's expected due date.

In the second half of the nineteenth century, following a period of lying in, women who had recently given birth, or those who entered the prison with young infants, would be placed in the prison nursery. Similar to infirmaries, the provisions in place for nurseries varied in different prisons. The nurseries in which young infants would spend the first months of their lives were labelled by journalists Henry Mayhew and John Binny as the most distinguishing features of women's prisons. They described scenes that are at odds with the more common imagery of the imposing, fortress-like prisons built and modified in the mid-nineteenth century, of children clinging to their mother's skirts, of ‘toleration and true wisdom, if not goodness’. 11

At the turn of the twentieth century, prison nurseries were replaced with crèches in prisons including Wormwood Scrubs, Liverpool, Birmingham and Holloway. After the birth of their baby and a few days of recovery in the prison hospital, mothers would be placed back into cellular confinement. In Holloway the C1 landing was reserved for these women, but the cells in which mothers would spend the first weeks and months with their babies were described as being ‘cold, dark and draughty’. 12 With the establishment of prison crèches it was intended that children in the prison would receive greater care from a dedicated member of the prison staff during the day, before being accommodated with their mothers in their cells at night. Debates about the importance of these crèches and their role in the imprisonment and care of mothers are further explored in Chapter 3.

Figure 2.1 The nursery, Holloway Prison, c. early twentieth century.

Despite the fact that the hospital was a place for the reception of the sick, it was also intended that it would be subject to a strict set of rules in line with the broader discipline of the prison. Ex-prisoners spoke of a lack of privacy in the hospital and of rules dictating their behaviour within. Constance Lytton described how prisoners in the hospital were not allowed to lie in their beds unless they were so ill as to be undressed and in bed. Instead, they had to sit in the chair beside the bed. 13 Joan Henry described a ward in Holloway's hospital which contained eleven iron bedsteads, linoleum-covered floors and large windows. Adjoining it was the matron's office, and at its entrance was a large door with a grille through which she was aware of eyes constantly observing, even if no one entered or spoke to the women inside. 14 However, as with other aspects of the running of prisons explored in this study, implementation of the prison rules was adapted in practice. In turn, the treatment of women, including those who were pregnant and who gave birth, was shaped by the other prisoners and the staff around them. Kathleen Lonsdale recalled spending time in the prison hospital during her imprisonment in 1943. She remarked that some of the officers on duty were kind to those who were sick and went ‘beyond their duty to supply the deficiencies’ of the system when caring for the health of prisoners. However, others were not. 15

In addition to the physical spaces within prisons that were set apart for childbirth and for the accommodation of mothers and their children, the prison regime also played a major role in shaping their experiences. This began when women walked through the prison gates and became subject to an initial reception process. Cicely McCall summed up this process when she recalled that ‘kindliness, cleanliness and a deadly scepticism’ were what the new admission found when she arrived in prison. 16 Miss Whyte, the Matron in Holloway, described how the women would be given a bath and checked for verminous conditions such as head lice. Their possessions were confiscated, and they would change into the prison-issued clothing. 17 Women would then be placed in small, cubicle-style reception cells where, in the larger prisons especially, they could wait for hours for the medical officer to arrive to carry out examinations of the new arrivals.

Medical examinations upon entry into a prison were brief and often perfunctory in nature. Pat Collins recorded ‘seeing the doctor’ as an almost literal description of medical examinations upon entry into prison. 18 Kathleen Lonsdale recalled her medical examination on her entry into Holloway Prison in 1943. She stated that a nurse examined her hair, asked if her periods were regular and if she had children. A female doctor then checked her chest with a stethoscope but did not remove her blouse to do so. She continued that if a woman ‘wished to conceal a state of pregnancy, she could so quite easily’ under the circumstances she observed. On the basis of this examination Lonsdale was deemed fit for work and allocated her landing. 19 Joan Henry spoke of becoming accustomed to the question ‘are you all right?’ from the medical officer, the matron and the officers on duty and of the ‘correct replies’ expected unless you were ‘dying on your feet’. 20

In many cases of pregnancy, it was up to the women themselves to disclose their condition when they entered prison, especially in the early stages, if they themselves were even aware of it. Even in the early twentieth century, identifying pregnancy and then estimating the due date was ‘hit and miss’. For many women, they did not know for sure that they were pregnant until the baby started moving at sixteen to eighteen weeks. 21 In addition, relying on their menstrual cycles to identify pregnancy could be unreliable, as many of the women entering prisons were in ill health and were malnourished, which could have an impact on menstruation and its regularity. Some pregnant women asked to consult a prison doctor about their condition, but were afforded little consideration. One such case was that of Phyllis Ward.

Phyllis Ward served a seven-week sentence in Holloway, commencing at the beginning of January 1919. Upon her release on 22 February she went to a Church Army home for shelter. Sister Bryant, who ran the home, immediately asked Phyllis if she was pregnant and recommended sending her to Marylebone Infirmary on account of her having a weak heart. Phyllis gave birth to a stillborn child on 13 March. She told the doctor in the infirmary that she had not initially regarded the cessation of menstruation as a sure sign of pregnancy, as she was often irregular. However, shortly after entering Holloway she noticed that she was short of breath when climbing the stairs and felt weak. Phyllis recalled ‘booking’ to see the medical officer and asking him about her condition. She claimed that he had examined her breasts but not her abdomen or vagina and told her she was not pregnant. She had also spent the final week of her sentence in the prison hospital due to a heavy cough, but again her pregnancy remained undetected. The Medical Superintendent at Marylebone Infirmary reported to the Prison Commission regarding her case, stating that her child had been born about three weeks before her full term and that anti-syphilitic treatment had also been given. He added that there were multiple signs of pregnancy, including the dark pigmentation of the areola and clear signs when carrying out an abdominal examination, and stated that it was difficult to explain how these signs had been missed in the prison. Holloway's Medical Officer was asked to report on the case and replied that although multiple members of staff could recall Phyllis being in the hospital, they had not suspected pregnancy and would not have given a negative diagnosis of such without thorough examination. 22

In Phyllis's case, the brief nature of her medical examination upon entry into prison and the fact that the prison doctor did not thoroughly examine her even after she expressed her belief that she was pregnant meant that she remained subject to the ordinary prison discipline, despite being in an advanced stage of pregnancy. However, some women deliberately concealed their condition and it remained undetected, especially if they were serving relatively short sentences. As a result, they received no maternity care or adaptation to the prison regime at all. Others were either unaware of their condition or successfully concealed it until the birth of their child. In January 1870, Mary Ann Shaw was admitted to Wakefield Prison and was placed in an infirmary cell as she was suffering from a venereal disease. The matron suspected she was pregnant, but Mary had denied it and there was no further medical examination. However, another prisoner was in the cell that had recently been vacated by Mary Ann, when she felt something in the corner of the bed. This was called to the attention of the matron who found it to be the body of a female infant. Mary Ann was examined and confessed to having given birth to the child on 14 February. She claimed that the child was born in the early hours of the morning but had lived for only ten minutes. She feared punishment, and so hid the child's body in the bed. 23

This study has identified a few other cases similar to Mary's throughout the second half of the nineteenth century at several prisons. In some cases, it was not prison staff who noticed signs of ill health or pregnancy in women, but their fellow inmates. Ellen Evans reported her fellow prisoner Ellen Stammers in Westminster in 1874 for showing signs of recently having given birth when they were working together. When questioned, Stammers admitted that she had been delivered of a child at eleven o’clock the previous evening, and the child's body was found wrapped in a blanket in her hammock. The child's body was examined, and although there were no signs of violence the lungs had been thoroughly inflated, showing that the child had lived for a short time. Ellen was twenty years old and described as having ‘not a friend in the world’. The coroner returned a verdict of ‘found dead’ and Ellen avoided further punishment. 24 Cases such as these, and several others like them, offer perhaps the starkest demonstration of the isolation women in prison could face, an isolation exacerbated for pregnant women facing a life-altering moment without family or friends. They demonstrate a theme running throughout this study, namely the physical closeness but detached nature of prison life in which serious health conditions remained undetected despite a key principle of prisons at this time being the close surveillance of their inmates.

A refinement of cruelty? Prison regimes for pregnant women

Following their reception into prison, women would commence their sentence and be subject to a set of prison rules by which they had to strictly abide, and regulations that would heavily dictate every hour of their day. The chapter now turns to two major areas of these regimes that shaped the health experiences of mothers in prison, namely the prison diet and the terms under which they were confined. As part of their role in deciding if the prisoner's body or mind was likely to be injured by the discipline in the prison, medical officers could adapt a prisoner's diet. In the case of pregnant women and new mothers, medical officers could direct that they be given additional milk, tea, cocoa, sugar, bread and fish and meat. However, adaptations to their diet differed across this period and within different institutions; and in addition to being inconsistent, they were also subject to scrutiny on the part of prison authorities and observers, and steeped in debates regarding the role of the prison diet within the broader aims of the penal system and the need to maintain health but not pose a better prospect than provisions on the outside.

In Brixton the diet was adapted, following the opening of the prison in 1853, to offer greater provision for women undertaking more strenuous labour, notably working in the laundry, and for convalescents, which included women in the infirmary, those in an advanced stage of pregnancy and those who had recently given birth. They were given additional rations of bread and, on occasion, a half ounce of cheese. The ‘nursery breakfast’ consisted of a pint of milk for each child and tea for each mother in place of the cocoa served as part of the ordinary diet. In the infirmary the prisoners could be served pieces of boiled cod if they had been placed on a fish diet by the medical officer, and some were also given eggs, batter pudding or rice-milk to rebuild their strength or to aid in the recovery from illness. 25 Dietary information discussed at the Birmingham Petty Sessions in 1878 stated that the diet for all prisoners was predominantly comprised of bread, potatoes, suet pudding and gruel. After nine months, cocoa was given at breakfast instead of gruel. However, the medical officer had the ability to order items such as bacon, butter, cake, eggs, fruit, vegetables, jam, milk, poultry and even wine in cases where they deemed it necessary to ensure the health of the prisoner. 26

Zedner argued that there was some acknowledgement during official enquiries, such as the Royal Commission on the Penal Servitude Acts in 1863, that a sufficient prison diet was considered essential for women, as it was feared that their reproductive system could be damaged by prolonged privation of food. 27 In his 1863 report, John Lavies, Westminster's Medical Officer, argued that an insufficient diet could potentially affect the menstrual system, observing that ‘women under imprisonment for long terms are very apt to lose the healthy performance of functions peculiar to their sex’, due to the rigours of the prison system, including being subject to the prison diet for long and repeated periods. 28 However, these acknowledgements were not translated into official policy and this study has found limited evidence of specific consideration at policy level of the dietary needs of pregnant women, those who had recently given birth and those breastfeeding children. Instead, as with other aspects of medical care in prison, the administration of the prison diet for these women was subject to variation based upon questions of health and discipline within individual institutions, daily decision-making processes shaped by the proclivities of staff regarding prisoner welfare and the availability of resources.

In the case of pregnant women, decisions were also influenced by the need to consider the health of the unborn child while balancing the woman's status as a prisoner. In response to repeated entreaties regarding the number of women in Westminster Prison and the disruption to the regime and logistical pressures posed by those giving birth or bringing in children, the Middlesex magistrate Sir Peter Laurie wrote to the Visiting Justices in February 1854. When commenting upon the special arrangements for the accommodation of women and children, including additions to their diet, their reception into the infirmary where necessary and the care afforded to the children by the prison staff and the medical officer, he stated that ‘a mother in your prison is practically a lady’, as a means to rebuff calls for greater provision. 29

In 1943 a Miss Dorothy Borup wrote to her local Member of Parliament, Dr Haden Guest, to complain of the condition of her friend who was confined in Holloway Prison. This included her imprisonment in cellular confinement and elements of the regime. Dorothy stated that the food was inadequate and that pregnant women could become so hungry that they ate crusts of bread from the ground. In addition, it was only after their sixth month of pregnancy that women would be given an additional half pint of milk and some dry bread. 30 In response to this enquiry, the governor and medical officer compiled a report to the Home Office in which they stated that as soon as pregnancy was established a prisoner was located on the maternity landing and received extra food and milk, which increased at different stages of pregnancy; from the fifth month of pregnancy, it was an extra half pint of milk, from the seventh month it was an extra pint. Additional provisions of vegetables as well as milk and cocoa could be ordered by the medical officer following ‘any reasonable complaint of hunger’. 31 Dr Guest visited Holloway and, following his report back to the Home Secretary on his inspection of the kitchen, hospital and cellular accommodation, it was concluded that Miss Borup's account was ‘far from accurate’. 32

Despite this seeming vindication, correspondence between the governor and the Home Secretary reveals a long-standing issue in debates about prisoner health, but one that was further complicated when considering the case of pregnant women. The governor wrote of the Ministry of Health campaign that was ongoing at the time to persuade expectant mothers to drink more milk. The Ministry of Food was providing milk at a reduced price to women as soon as their pregnancy was established, which it stated was commonly around three months. He stated that this had likely evoked the criticism the prison system was facing. He added that it was difficult to justify the policy of providing women in prison with less milk, and only at a more advanced stage of pregnancy. Even among those who readily accepted the principle that prison food is ‘not meant to provide an optimum diet, but the minimum necessary for the maintenance of health’, he mused, would it likely be accepted that a more generous policy ought to be adopted in the case of pregnant women, where not only the health of the mother but also that of the child was involved. He continued that in such cases ‘generalisations about the principles of prison treatment may be thought inapplicable’. 33

Despite some modifications to the separate system within the female convict estate, the principle that association and communication between prisoners should be limited and carefully regulated remained a pervasive one into the early twentieth century. Ex-prisoners described experiences of desolation and isolation in tomb-like cells where they marked their day with the passing of footsteps, and a brief visit from the chaplain broke the silence. 34 Observers of the realities of prison life described the ‘wicked and unfeeling’ rules that were intended to prevent even the mothers in prison nurseries from finding some small semblance of human interaction within these obdurate regimes. 35 However, what garnered more debate and shock for some was the practice of locking up pregnant women in their cells for hours at a time, sometimes up to twenty-three hours in a day. Following debates about the practicalities of this in the case of the sick or those who required medical attention, in 1906 Birmingham's Winson Green Prison reissued its rules and regulations to all prison staff. Originally dated 1860, they placed particular reinforcement on the rule directing that every prisoner in separate confinement would be supplied with a means of communicating at any time with an officer, especially those who might require closer observation. 36 However, the study has uncovered examples of women crying out for help from officers on duty across this period, and of these cries going unheard, not responded to in time, being denigrated as attempts at malingering or seeking to break the monotony of cellular confinement or simply being ignored.

Hobhouse and Brockway lamented the practice of confining sick people alone in their cells for long periods of time. They stated their hope that highlighting this practice would ‘strike every ordinary humane person as monstrous’ and lead to a rethinking of how people in prison spent their time. 37 For pregnant women, the feelings of isolation and helplessness were already heightened due to their facing the prospect of giving birth in prison. They were exacerbated further still when facing up to twenty-three hours in a day alone in a cell with limited contact, prompting stress and psychological anxiety, especially for those nearing the date of their confinement. Kathleen Lonsdale labelled the practice of confining pregnant women for the same hours as the rest of the prison population as ‘a refinement of cruelty that one can only ascribe to lack of imagination on the part of those who are responsible for it’. 38

Although some prisons implemented the practice of incarcerating pregnant women two or three to a shared dormitory-like cell to ensure that they could call out in an emergency, it was not universally applied. It was also dependent upon individual staff members, the availability of adequate space and the correct identification of a prisoner's stage of pregnancy and expected due date. For many women, they remained in isolation. Some women suffered miscarriages or went into premature labour alone in their cells with no medical assistance. Lonsdale's fellow contributor to the Prison Medical Reform Council's account of medical care in Holloway, Vera Mayhew, spoke of the impact of confining pregnant women in isolation upon the hundreds of women locked in cells around them, physically close but unable to offer any support or assistance when it was required. She recalled often hearing the sound of the emergency bell go unheeded. She wrote of the case of a young girl whose cries throughout the night had become more distressed, alerting the attention of the whole landing who rang their bells in desperation to call for help. However, no one arrived until the following morning, when it was discovered that she had given birth in her cell. 39 Although in this case mother and child were eventually examined and recovered from their ordeal, there were others where the outcome was not the same.

On 20 August 1918 twenty-eight-year-old May McCririck entered Holloway Prison to begin her sentence of six months’ imprisonment. Like every prisoner to pass through the gates, May was subject to a brief medical examination as part of the reception process. She was found to be in the early stages of pregnancy and thus the medical officer recommended that she be placed on the ‘B2’ landing, reserved for prisoners believed to require additional observation. May, like all of the women incarcerated in Holloway, was locked in her cell for hours at a time, physically close but relatively isolated from the hundreds of women and prison staff around her. On the night of 9 February 1919, around seven months into her pregnancy, she went into premature labour. She rang the emergency bell in her cell to alert the attention of the officer on duty. Upon hearing her cries, the women in the cells next door joined in her calls for help. However, they went unanswered, and May gave birth to her son alone in the darkness of her prison cell. May described how he neither moved nor cried, so she ‘wrapped the child up in a sheet and put it under the bed’. It was not until their morning rounds, some hours later, that a prison officer discovered May and sent for one of the prison doctors. The child was believed to have died during or immediately after the birth, and thus a coroner's inquest was deemed to be unnecessary. May was moved to the prison hospital to recover, where she spent the remainder of her sentence until she was released on 26 February. 40 Sadly, May's story was not an isolated incident. Instead, this study has found other cases where similar circumstances prompted equally tragic experiences for women in prison. However, May's case was among those held up as a testimony of the inadequacies of the prison system for mothers and was used to call for a shift in how the country confined and cared for maternity cases.

A record of the greatest public value? The Duchess of Bedford's 1919 enquiry

In March 1919 a landmark enquiry was carried out in Holloway Prison. Chaired by Adeline Marie Russell, the Duchess of Bedford and a notable penal reformer in the early twentieth century, the enquiry was the first of its kind to focus exclusively on the health needs of women and their babies in prison and offered extensive recommendations regarding the provisions for maternity care. The ensuing report was labelled by the Prison Commission as a record of the ‘greatest public value’. 41 At the time of the enquiry Holloway was the largest women's prison in England and conditions behind its turreted gates had become increasingly visible to the public, due to the imprisonment there of several suffragettes, debates about the appointment of more female staff to positions of greater power in the prison system and an intensification of scrutiny regarding health in prisons in the wake of the First World War. The enquiry highlighted several cases, including that of May McCririck, to make recommendations regarding the conditions in which pregnant women were imprisoned, the arrangements in place for childbirth and the availability of specially trained staff, notably midwives.

At the time of the enquiry several cases had been reported upon in the press and raised with the Prison Commission regarding the provisions for health and sanitation in women's prisons. One such example was the allegations raised by Sister Grace of the Home at Highbury Park for women who had recently left prison, with Sir Evelyn Ruggles-Brise, Chairman of the Prison Commission. She wrote of women arriving at the Home with lice and venereal diseases, despite some of them having certificates stating that they were free from such diseases. Sister Grace made specific mention of the condition of Edith May Southgate when she arrived from Holloway on 25 November 1918, describing her as being ‘in a shocking state’, her flesh raw owing to the lack of proper sanitary towels despite asking for them in the prison. It took over a week for her skin to heal. 42

In response to these allegations, and the broader interest in health in prisons at the time, Ruggles-Brise wrote to the Duchess of Bedford expressing the need for an independent enquiry to be made into conditions in Holloway. He wrote of the difficulties of administering the prison estate during the war and the issue of the continuing shortage of medical staff to attend to the excessive number of cases requiring medical care and attention. He assured her that all records would be placed at the disposal of the committee and that they could invite witnesses to give evidence as they might think necessary, including interviewing the prison's staff. 43 The committee entrusted to carry out the enquiry consisted of the Duchess of Bedford as Chair, Miss Burrell and Miss Blunt, both Lady Visitors at Holloway, Mrs Gilbert Samuel, Chairman of the Prison Reform Committee in connection with the Joint Parliamentary Advisory Council, and Dr Ada Whitlock, a Lady Inspector of the Reformatory and Industrial School Department.

Adeline Russell was selected to chair the committee as she was a notable reformer who had led several campaigns aimed at the moral and occupational improvement of women's lives. She had been closely involved with the Associated Workers League, which was concerned with the well-being of women at work. In 1900, she became the president of the National Lady Visitors’ Association. The Lady Visitors visited women in prison and sought to educate them and to help them prepare for life after their imprisonment. Russell also regularly visited Aylesbury's Inebriate Reformatory after its opening in 1902 and the borstal wing of Aylesbury Prison, which opened in 1908. 44 Prior to the outbreak of the First World War she had criticised the conditions in which Royalist prisoners in Portugal were being kept. Reporting upon her involvement, the Illustrated London News stated that Russell had a ‘special qualification for criticising the management of prisons’ as, for many years past, she had taken a special interest in the matter. 45

In addition to her interest in prisoner welfare, the Duchess of Bedford was also involved in several other areas pertaining to the well-being of women. The National Society for the Prevention of Infant Mortality was founded in 1912. Its Honorary Secretary, Jeanette Halford, is credited with the initial promotion of the idea of a National Baby Week to advise mothers in matters of infant care. In February 1917 the renamed National League for Healthy Maternity and Child Welfare organised a meeting presided over by Adeline Russell to discuss plans for the event, which was held in July. Exhibitions during the event included information on lifestyle, hygiene, diseases, alcoholism and the importance of health visitors. Linda Bryder argues that, despite the health politics of the time often blaming mothers for their perceived inadequacies, the event also acknowledged the social and economic factors which shaped the lives of many working- and lower-class women. Bryder concluded that the women who led the event seized the opportunity presented by it to promote maternal, as well as infant, interests and well-being. 46

Following their brief medical examination upon entry into prison, the health experiences of pregnant women were shaped not only by the medical officer but also by female warders, who were not medically trained, infirmary and hospital staff and even their fellow prisoners. In the early twentieth century women were generally unlikely to receive any antenatal care and would call in a midwife or a doctor only during labour. 47 However, there were increasing debates about the availability of staff within prisons to care for the health needs of female prisoners, including mothers and their children. These debates were not only bound up in the question of the state's responsibility to these women and their children, who were deemed to be innocents in the eyes of the law, but were also aimed at avoiding public censure of the system in cases of poor or inadequate care.

One particular aspect of the prison regime which the committee highlighted as problematic for prisoner health was the placing of women in separate confinement. They pointed to the experiences of women including May McCririck and several others to state unequivocally that no cases of advanced pregnancy or those where there might be complications during pregnancy should be isolated in a cell for long periods of time. They stressed that isolation in these circumstances was especially liable to produce nervous depression and took no account of the danger posed by sudden confinement. In addition, their report stated that it ought not to be assumed that a pregnant woman would always complain of labour pains in time for help to be summoned. It stressed that, apart from the fact that a woman might deliberately conceal the fact that she was in labour, it was possible for delivery to occur unexpectedly. It spoke of additional complications, such as the mother collapsing or haemorrhaging after the birth and the possibility that she could die before assistance arrived. Furthermore, the report pointed to the potential dangers for the child if the mother gave birth in a cell. It could fall head first onto the floor or drown in the commode if the mother was sitting there. The child could also be strangled by the umbilical cord. The committee also warned that prisons rarely considered the possibility that the mother might not know how to care for the infant, or might not want to care for it or even to preserve the life of the child. 48

The committee recommended that the current remand side of the prison hospital instead be used for the reception of all prisoners in an advanced stage of pregnancy and for women who had recently given birth, to spend time convalescing. They recommended that the adjoining room could be used as a lying-in ward and the additional hospital cells could be repurposed for cases requiring special attention, where cell doors would be replaced by curtains. In his response to the committee following receipt of their reports, Ruggles-Brise gave assurances that the arrangements in place for the care of pregnant women would be considered and there were changes made to their accommodation and the staffing arrangements for their care, as detailed below. However, there was one area of contention that reveals the continued difficulties posed when attempting to balance punitive considerations with those of health. In answer to the recommendation of placing all maternity cases in the present remand side of the hospital, he replied that the Commissioners could not accept this suggestion, as it would seriously conflict with the ‘all important principle that there should be an absolute segregation of convicted and un-convicted cases’. 49 However, he acceded that there was a need for more specific consideration of the needs of maternity cases. An area believed to be crucial in this respect was the prison staff.

Dr Walker, Medical Officer of Holloway, told the Gladstone Committee in 1895 that women who gave birth in the prison infirmary were attended to by female infirmary warders, one of whom had experience of working in a London hospital, but advocated for greater provision in this area as it was inconsistent. 50 Correspondence between the Treasury and the Home Secretary in 1914 debated the provision of trained nursing staff in prisons. Although the outbreak of the First World War halted the debate, it was renewed in its wake. In this sense there were parallels with practices outside, as training provision for nurses more broadly was expanded after the conclusion of the war. Prisons offered a unique site to stage discussions around nursing and the training of nurses. At the time, Holloway was the first prison to have trained nurses as part of the staff, which included a hospital superintendent and twelve trained nurses. When the Prison Nursing Service was established in 1928, the position of hospital superintendent was superseded by nursing matron-in-chief, who would be based in Holloway but visited other women's prisons. 51 However, at the time of the debates immediately before and after the war, the small number of hospital patients in some of the smaller prisons meant that the employment of nursing staff was not deemed to be necessary. There were also cases that required specialist medical treatment that the medical officer deemed could not be carried out by the ordinary prison staff. In such cases the governor could authorise the engagement of the services of outside practitioners. 52 This was due to instructions issued by the Treasury in 1884 which authorised the bringing in of trained nurses from outside in cases where it was deemed ‘absolutely necessary’. It appears that some maternity cases fell within this remit, as correspondence in July 1919 remarked that in prisons such as Holloway the sheer numbers of pregnancy cases and venereal disease meant that it was currently necessary to use such provision, pending the employment of more trained hospital staff. 53

A long-running tension in the prison system has been the balancing of maintaining prisoner health and managing the discipline of the institution. It was often the case that it fell to prison staff to navigate the boundaries between the two. The enquiry found that the nursing staff's duties were not wholly devoted to nursing and the care of prisoner health, as they were expected to carry out other disciplinary duties. In addition, despite certain categories of prisoners being identified as requiring closer supervision, and perhaps ready access to medical assistance, for large parts of their time in prison they were largely under the charge of prison officers with little or no medical training.

The medical staff in Holloway at the time of the enquiry in 1919 consisted of three male doctors and one female doctor who were responsible for administering medical treatment and overseeing the prison's hospital. However, the nursing in the hospital was done by wardresses who were not trained nurses. There had been only one certified midwife among the staff, who had resigned and had not been replaced at the time of the enquiry. The committee found it somewhat difficult to give exact figures for the number of cases dealt with, but according to the records for the year beginning March 1918 and ending March 1919 the number of remand cases found to be pregnant was about 110 and a total of 120 convicted women had entered the prison pregnant. The number of births in the prison during the previous three years was fifty, an average of about sixteen per annum. Of these fifty confinements, forty were full term and in two of these cases the child was stillborn. Ten of the confinements were premature, the babies being born at between six and eight and a half months; in five of these cases the child lived and in five they died. 54 The committee identified twenty cases of pregnancy under treatment in the hospital on the days of their visits, including four cases complicated by haemorrhaging, three cases of mothers with a venereal disease, one of a woman with epilepsy and three women under observation for mental illness. 55 The committee stressed that specialised medical treatment was even more essential in these instances and used the case of seventeen-year-old Ellen Sullivan to illustrate the dangers of having inadequate maternity staff to attend cases of pregnancy and childbirth.

Ellen was a remand prisoner in Holloway and was almost seven months pregnant when she was placed in a hospital cell in January 1919 after she began to vomit violently. The medical officer had decided to place her in one of the ordinary hospital cells instead of the hospital ward where several prisoners would be in the same room – a common practice to try to separate younger, first offenders from older prisoners whenever possible., The impact of punitive considerations upon decisions about prisoner health is a recurring theme in the present study, and Ellen's case would demonstrate the potential consequences of such choices. The committee also noted that there were bells in the hospital cells, but they were placed close to the door and thus were separated from the bed by the whole length of the cell, which again exacerbated the isolation many pregnant women experienced, an isolation made more acute as they neared the time of their due date. During the night of 17 January Ellen was attended by a young, inexperienced wardress who was not a trained nurse and who was responsible for patrolling the two floors of the hospital. On her rounds she suspected something was wrong when she observed Ellen through the cell door. She woke up the day hospital officer who slept on the upper floor to ask for assistance, but by the time she returned, Ellen was found to have given birth. The baby had fallen onto the floor during labour and the umbilical cord had been ruptured. When the officer discovered this, she sent for one of the prison doctors and a midwife from outside, which was sometimes the practice when no midwives were employed within women's prisons. However, the child died before they arrived. When the doctor and midwife arrived Ellen delivered the placenta, after which they left her in the care of a member of the hospital staff who was not a trained midwife. Ellen died the following day. Her death was found to have been caused by traces of diabetes and severe kidney disease and due to her premature confinement. However, the coroner was at pains to conclude that Ellen's death and that of her child had not been caused by a lack of adequate care, despite the delay in the arrival of a midwife and the doctor. 56

When interviewing Dr Forward, the medical officer, the committee ascertained that nursing in the hospital was done by older and more experienced wardresses, who had built up considerable experience with sickness in the prison but were not trained nurses. They were assisted by younger wardresses who were placed on hospital duty, as in the case of Ellen Sullivan. Dr Forward stated that he had found it difficult to get reliable wardresses for the hospital staff, as when older members of staff left, others did not want to be placed on nursing duties due to the added worry and responsibility of the work, there being no compensating advantage in terms of salary or other benefits. He reported that efforts had been made to recruit more experienced hospital staff but without much success, attributing this in part to the shortage of medical practitioners generally in war time, and to the recent influenza epidemic. 57

In their report to the Prison Commission, the committee stated their firm conviction that the lack of proper provision for nursing the sick and caring for maternity cases marked a ‘serious defect in the prison administration’. They continued that it was unfair to the prison doctors, who had to try to manage prisoners’ health in such conditions and who could never ‘feel free’ from the weight of obligation resting upon them, and to the hospital staff, who had to undertake heavy responsibilities for which they had not been trained. However, a crucial point made in their report, and one that speaks directly to a key theme running throughout this study, was that prisoners, ‘whatever their delinquencies’, were entitled to proper care while in the charge of the state. 58

The committee strongly recommended that a fully trained and experienced nurse should be appointed as matron in charge of both sides of the hospital, the remand and the convicted, and should have a fully trained staff of nurses under her charge. They added that the hospital should never be left without a trained nurse in charge and that its staff should include nurses with special experience of mental and venereal cases. 59 They also recommended the appointment of at least two members of staff with a certificate from the Central Midwives Board. Furthermore, they advocated for an increase in the number of prison officers more broadly to facilitate the demarcation of duties that would help to avoid officers having to constantly shift from one landing to another and would allow officers to be assigned with responsibility for particular branches of work. 60

In the months following the report, a fully trained nurse with a certificate from the Central Midwives Board was placed in charge of the ‘B2’ observation cases and was to accompany prison doctors visiting the complaining sick. She would also be responsible for administering any medicines on the wings at the hours when they were due, replacing the practice where this responsibility was assigned to an officer. 61 Two nurses certified by the Central Midwives Board and nurses with experience in treating venereal disease and mental illness were appointed by June 1919. In addition, with a view to encouraging nursing staff to undergo the necessary training to acquire the Certificate of the Central Midwives Board, the Prison Commission successfully petitioned the Treasury to allow an additional fee to be paid in each midwifery case attended to by a prison officer holding this qualification. They pointed to the benefits to both the women themselves and, crucially, their babies, for whose health the state had a responsibility to care. 62 In the 1930s every nurse in Holloway was also a qualified midwife, and other women's prisons were gradually appointing qualified midwives to their staff. 63

Despite some of the recommendations of the committee being translated into practical change, the standard of medical care and health in prisons continued to garner commentary and debate. Reflecting upon the changes that had occurred during her career in the prison service, which spanned over four decades, Mary Size labelled the ‘skilled pre-natal care of expectant mothers, and the excellent training they received in child welfare’ as perhaps the most vital developments of all. 64 Following the establishment of the Prison Nursing Service in 1928, members of the Advisory Committee visited Holloway in March of that year. They spoke to several of the women in the prison hospital and reported that several expressed appreciation for the care they received and the care given to their babies. 65 Amid debates about the practice of having women give birth in prisons, which intensified in the post-war period, the standard of maternity care available in prison hospitals was used in its defence. In response to a petition to end the practice in 1949, Home Secretary Chuter Ede stated that he was not prepared to take steps to force all women to go to an outside hospital for the birth of their baby, as the hospital in Holloway was fully equipped to provide the necessary care in maternity cases. This included having a full nursing staff, including full-time midwives whom expectant prisoners had come to know and trust. 66

By the late 1940s pregnant women in Holloway attended a monthly antenatal clinic which was held in the prison. 67 Provisions for this were further developed amid debates about the number of women who would end their prison sentences and return to homes where they were believed to be ill equipped to properly care for their home and children. Chapter 3 will examine how courses in mothercraft, domesticity and home management were introduced, or provisions for them expanded, in several women's prisons in the wake of the Second World War. Several such courses were taught by external practitioners including doctors, nurses, health visitors and state-certified midwives, as well as by external reformers. Joan Henry, who served an eight-month sentence in Holloway and then in Askham Grange in the early 1950s, was fairly critical of the health and sanitary provisions for women in prison. However, she recalled that she was ‘quite impressed’ by the care given to the mothers and their children. 68

Despite improvements in some aspects of the provisions for mothers and their children, these changes did not address all of the issues raised by the enquiry of 1919, or indeed those which had posed significant challenges to the prison system since its inception in the nineteenth century. Some changes were not as immediate as others and were not implemented on a consistent basis, and were subject to policy shifts and changing prison personnel. In addition, certain practices, beliefs and inadequacies remained and had serious health implications for mothers. Pregnant women and new mothers were still being locked in their cells for several hours at a time, often from the late afternoon of one day until the following morning. In spite of the increase in maternity staff, pregnancy cases still went undetected. Cicely McCall described a case in the early 1930s where a paid domestic servant in the nurses’ quarters gave birth, but none of the qualified nurses or midwives in Holloway had suspected her condition. 69 Other women continued to suffer the isolation and anxiety of cellular confinement during advanced pregnancy and gave birth alone in their cells, crying out for help that did not arrive.

Conclusion

When they walked into prison, women entered an environment that was intended to be physically imposing and rigidly governed. For women who commenced their sentences pregnant, there was an added layer of uncertainty and isolation. For the staff charged with their custody and care, they posed significant challenges to systems and spaces that were not designed with their confinement in mind. At the outset of the modern penal system, prison buildings were modified to incorporate infirmaries, nurseries and, later, crèches for the reception of mothers and babies. Prisoners and staff each played roles in adapting the rules regulating the running of prisons so as to address the daily realities of prison life. Some made the argument that the prison environment was a safer place for the birth of their child than the conditions many women left behind on the outside. For others it was a place of suffering and heartbreak. The extent to which the terms of their incarceration caused ill health in mothers, the anxiety caused by the prospect of premature labour or isolation in a prison cell, and the impact of the deaths of babies upon their mothers and the other women, while often not easy to ascertain for all women, are starkly demonstrated in the cases illuminated here. What is clear is that placing pregnant women in separate confinement exacerbated their isolation and often left little room for support or reassurance at a life-altering moment.

The enquiry of 1919 was a landmark, due to its illumination of an issue that had previously been largely unaddressed within official prison policy, namely the specific provisions required for the care of pregnant women and those giving birth. It led to some practical improvements to maternity care provisions in women's prisons and made other long-standing issues more visible both within and beyond the higher echelons of the prison system administration. However, its significance in the history of women in prison in England is that it provides an early history of some of the fundamental questions that continued to emerge in reviews, debates, enquiries and policy shifts that have occurred in the century since, namely those centred on the questions of whether prisons were appropriate places for maternity cases and, if so, how the safe custody of mothers and their babies could be ensured. 70

Notes

1 LMA, WA/G/006, Minute Book, September 1850–December 1852, 1 February 1854.
2 LMA, WA/G/006, Minute Book, September 1850–December 1852, 25 January 1851.
3 LMA, CLA/003/ME/01/001, Matron's Journal 27 December 1933–23 November 1937.
4 LRO, 347 MAG 1/2/2, Minutes of the Visiting Justices 1870–1878, 29 October 1874.
5 These figures were collated from Home Office records. See TNA, HO 144/3982, Prisons and Prisoners: Childbirth in prison. Memorandum on existing practice and the arguments for temporary removal 1924.
6 The study has not found any of the reports completed by medical officers. However, for a blank copy of the report that would have been completed in these cases see TNA, HO 144/3982, Prisons and Prisoners: Childbirth in prison.
7 These figures were collated from Home Office records. See TNA, HO 144/3982, Prisons and Prisoners: Childbirth in prison.
8 ‘Notes, short comments and answers to correspondents’, The Lancet, Vol. 135 (1890), pp. 833–834.
9 Rachel Bennett, ‘Bad for the health of the body, worse for the health of the mind: Female responses to imprisonment in England, 1853–1869’, Social History of Medicine, 34:2 (2021), 532–552, https://doi.org/10.1093/shm/hkz066.
10 Bennett, ‘Bad for the health of the body’.
11 Henry Mayhew and John Binny, The criminal prisons of London and scenes of prison life (London: Griffin, Bohn and Company, 1862), pp. 190–191.
12 TNA, PCOM 7/40, Report of committee presided over by Adeline, Duchess of Bedford to inquire into various matters concerning Holloway Prison, May 1919, p. 21.
13 Constance Lytton and Jane Warton, Prisons and prisoners: Some personal experiences (London: William Heinemann, 1914), p. 102.
14 Joan Henry, Women in prison (London: White Lion Publishers, first published 1952, this edition 1973), pp. 52, 56.
15 Kathleen Lonsdale et al., with introduction by Ethel Mannin, Some account of life in Holloway Prison for women (London: Prison Medical Reform Council, 1943), p. 13.
16 Cicely McCall, They always come back (London: Methven & Co., 1938), p. 13.
17 TNA, PCOM 7/40, Report of committee presided over by Adeline, Duchess of Bedford, p. 11.
18 Lonsdale, Some account of life in Holloway Prison, p. 17.
19 Lonsdale, Some account of life in Holloway Prison, p. 6.
20 Henry, Women in prison, p. 54.
21 Tania McIntosh, A social history of maternity and childbirth: Key themes in maternity care (Abingdon: Routledge, 2012), p. 38.
22 TNA, PCOM 7/40, Report of committee presided over by Adeline, Duchess of Bedford: Appendix of pregnancy cases.
23 ‘Extraordinary case of concealment of birth in a prison’, Dundee Courier (4 March 1870), p. 2.
24 ‘Birth in a prison’, London Evening Standard (4 April 1874), p. 3.
25 Mayhew and Binny, The criminal prisons of London, pp. 185–191.
26 LB, PS/B/4/5/1/1, Birmingham Petty Sessions 1878–1892, 15 July 1878.
27 Lucia Zedner, Women, crime and custody in Victorian England (Oxford: Oxford University Press, 1991), p. 115.
28 LMA, WA/G/011, Minute Book, October 1862–1865, 15 February 1863.
29 LMA, WA/G/011, Minute Book, October 1862–1865, 7 February 1864.
30 TNA, HO 45/23653, Prisons and Prisoners: Report on the Conditions in Holloway. Treatment of Pregnant Prisoners (1940–49), letter from Miss Dorothy Borup to Dr Haden Guest MP, 2 June 1943.
31 TNA, HO 45/23653, Prisons and Prisoners: Report on the Conditions in Holloway. …, Observations by the Governor and Medical Officer of Holloway, 18 June 1943.
32 TNA, HO 45/23653, Prisons and Prisoners: Report on the Conditions in Holloway. …, letter from Herbert Morrison to Dr Haden Guest MP, 26 June 1943.
33 TNA, HO 45/23653, Prisons and Prisoners: Report on the Conditions in Holloway. …, Holloway Prison conditions for pregnant prisoners, 19 June 1943.
34 Susan Willis Fletcher, Twelve months in an English prison (New York: Charles T. Dillingham, 1884), p. 323.
35 Mayhew and Binny, The criminal prisons of London, p. 474.
36 LB, PS/B/4/5/1/2, Birmingham Petty Sessions 1896–1906, 7 February 1906.
37 Stephen Hobhouse and A. Fenner Brockway, English prisons today: Being the report of the Prison System Enquiry Committee (London: Longmans, Green and Co., 1922), p. 269.
38 Lonsdale, Some account of life in Holloway Prison, p. 14.
39 Lonsdale, Some account of life in Holloway Prison, p. 19.
40 TNA, PCOM 7/40, Report of committee presided over by Adeline, Duchess of Bedford, Appendix of cases.
41 TNA, PCOM 7/40, Holloway Prison: Duchess of Bedford's Committee of Enquiry into Various Matters 1919, letter from Sir Evelyn Ruggles-Brise to Adeline, Duchess of Bedford, 5 June 1919.
42 TNA, PCOM 7/40, Holloway Prison: Duchess of Bedford's Committee …, letter from Sister Grace of the Home at Highbury Park to Sir Evelyn Ruggles-Brise, 20 February 1919.
43 TNA, PCOM 7/40, Holloway Prison: Duchess of Bedford's Committee …, letter from Sir Evelyn Ruggles-Brise to the Duchess of Bedford, 25 February 1919.
44 Bill Forsythe, ‘Russell, Adeline Mary, Duchess of Bedford (1852–1920)’, Oxford Dictionary of National Biography, 2004.
45 ‘Duchess of Bedford’, Illustrated London News (3 May 1913), p. 33.
46 Linda Bryder, ‘Mobilising mothers: The 1917 National Baby Week’, Medical History, 63:1 (2019), 2–23, https://doi.org/10.1017/mdh.2018.60, p. 15.
47 McIntosh, A social history of maternity and childbirth, p. 38.
48 TNA, PCOM 7/40, Report of committee presided over by Adeline, Duchess of Bedford, pp. 23–24.
49 TNA, PCOM 7/40, Holloway Prison: Duchess of Bedford's Committee …, letter from Sir Evelyn Ruggles-Brise to Adeline, Duchess of Bedford, 5 June 1919.
50 Report from the Departmental Committee on Prisons (London: 1895), p. 184.
51 Mary Size, Prisons I have known (London: George Allen & Unwin, 1957), p. 91.
52 Hobhouse and Brockway, English prisons today, p. 272.
53 TNA, HO T1/12409, Staffing of the prison service: Improvement of arrangements for medical care of prisoners, 1919. Letter to the Treasury dated 2 July 1919.
54 TNA, PCOM 7/40, Report of committee presided over by Adeline, Duchess of Bedford, p. 20.
55 TNA, PCOM 7/40, Report of committee presided over by Adeline, Duchess of Bedford, p. 21.
56 TNA, PCOM 7/40, Report of committee presided over by Adeline, Duchess of Bedford, Appendix of cases.
57 TNA, PCOM 7/40, Report of committee presided over by Adeline, Duchess of Bedford, p. 41.
58 TNA, PCOM 7/40, Report of committee presided over by Adeline, Duchess of Bedford, p. 44.
59 TNA, PCOM 7/40, Report of committee presided over by Adeline, Duchess of Bedford, p. 44.
60 TNA, PCOM 7/40, Report of committee presided over by Adeline, Duchess of Bedford, pp. 62–64.
61 TNA, PCOM 7/40, Holloway Prison: Duchess of Bedford's Committee … Suggested alterations in the present nursing staff scheme at Holloway Prison, 4 August 1920.
62 TNA, HO 45/10429/A53867, Nursing Staff in the Prison Service 1892–1919, letter from Sir Evelyn Ruggles-Brise to the Home Secretary, 18 June 1919.
63 McCall, They always come back, p. 97.
64 Size, Prisons I have known, p. 125.
65 National Justice Museum, Nottingham, Prison Nursing Advisory Committee reports on prison visits, 1928–1954, 19 March 1928.
66 TNA, HO 45/23580, Birth of children in prison 1924–1949, letter from J. Chuter Ede to Michael Young, 19 December 1949.
67 TNA, PCOM 9/1435, Women convicted of child neglect: Investigations in prisons 1946–1950.
68 Henry, Women in prison, p. 84.
69 McCall, They always come back, p. 97.
70 For a more detailed analysis of how the 1919 enquiry can be situated within broader policy debates surrounding maternity care in women's prisons see Rachel Bennett, ‘Maternity care reform in English prisons: A century of unanswered concerns’, History & Policy (2019).
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Motherhood confined

Maternal health in English prisons, 1853–1955

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