Rachel E. Bennett
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Conclusion

The Conclusion weaves together the strands examined throughout the book, tracing how prison administrators, doctors, officers, reformers and prisoners themselves have attempted to untangle the exigencies of pregnancy and birth in prison over the past two centuries. By illuminating the continued prescience of this often-overlooked aspect of England’s penal history, the Conclusion illuminates how the evidence presented in the book can offer a longer narrative to current debates which seek to confine ‘outdated’ penal practices to the past, especially for mothers and their children, but continue to struggle to find concrete answers to perennial questions that have been posed to the prison system since its inception in the mid-nineteenth century.

Should pregnant women and mothers with babies be placed in prison? Is prison a place of safe custody for this distinct group? Can it ever be? Exploring the history of women's prisons, the study has illuminated how these questions challenged the modern prison system in the century following its inception. They were propelled to the forefront of government and public debate again in September 2019, following the death of a baby whose mother had given birth alone in her cell in HMP Bronzefield. Speaking at a debate about the issue in the House of Lords, Liberal Democrat peer Meral Hussein-Ece commented ‘this Victorian incident of a woman giving birth alone in a prison cell illustrates the lack of care and support for pregnant women in prison, many of whom should not even be there’. 1 Labelling this case as ‘Victorian’ was intended to evoke images of an unyielding and uncaring system; crucially, one that was, or as Hussein-Ece alluded, should be, confined to a distant past. However, rather than being an isolated reversion to practices long since disappeared, the case is a stark demonstration of the historic and indelible challenges mothers and babies have posed to the criminal justice system.

In September 2021 a report was published by the Prison and Probation Ombudsman, Sue McAllister, following an independent investigation into the 2019 case. It identified several concerns about the care and management of pregnant women in prison and made a number of recommendations for the improvement of maternity services in the prison. The report found that the baby's mother, identified as Ms A, had been placed on ‘extended observations’ by the deputy head of health care. This meant she should have been checked by a nurse every morning, afternoon and evening and a minimum of twice during the night. However, this did not happen. Ms A rang the bell in her cell twice on the evening of 26 September. Although on one of the occasions an officer spoke to her via the cell call system, no nurse was called. The officer stated that they could not remember the conversation. Ms A's cell was checked later that evening and in the early hours of the morning, but the officers did not report anything out of the ordinary. On the morning of 27 September two other women prisoners alerted the on-duty officers that there was blood in Ms A's cell. It was discovered that she had given birth and her baby was unresponsive. Attempts to resuscitate the baby failed. The report's findings placed significant importance upon the staff in charge of Ms A not having a full history of her pregnancy or of her complex needs. More broadly, it labelled the maternity services at Bronzefield as ‘outdated’. 2

Undoubtedly significant, and founded in thorough investigation, the recommendations made in 2021 are perhaps best viewed not as a new departure in thinking about the imprisonment of pregnant women but as part of a wider narrative debating their custody and care. The tragic details of the case, the responses to it and the recommendations made thereafter have a long and contested history, one that continues to shape the justice system today. The Duchess of Bedford's 1919 landmark enquiry carried out in Holloway Prison was the first of its kind and placed maternity care in prison at its centre. A History & Policy article marking its centenary in 2019 demonstrated the longevity of several of the issues raised, including the conditions in which pregnant women are imprisoned and their access to specially trained maternity staff before, during and after the birth of their babies. It underlined how, despite the continued efforts of organisations and individuals to improve conditions, it is difficult to produce consistent and fully effective change. 3

Reform organisations such as the Howard League and non-governmental organisations (NGOs) have campaigned for improvements in the conditions in which pregnant women and those with infants are imprisoned; provided evidence of the impact of imprisonment upon their physical and mental health; and made recommendations regarding the arrangements in place for women to regularly receive antenatal care and to ensure the safe delivery of their babies in hospital. In 1995 and 1996 cases of female prisoners being shackled during their labour prompted campaigns from within and beyond the prison system to end this practice. The National Childbirth Trust petitioned the Home Secretary, Michael Howard, to overturn the policy of handcuffing pregnant women during birth and supported a report made by the Howard League on the issue. 4 An article published by the Association for Improvements in the Maternity Services focused upon the case of a woman named Annette who gave birth in Whittington Hospital in 1996 in shackles and was placed in chains even when walking with her baby in her arms to a scan after the birth. The article encapsulated an issue that surrounds the conditions in which women give birth while under a prison sentence when it stated she had been sentenced to prison for stealing a handbag but ‘she was not sentenced to public humiliation and degradation’. 5 Home Office minister Ann Widdecombe eventually announced in the House of Commons in 1996 that handcuffing during labour would cease. Although this was a key moment of change and improvement, it was acknowledged by reform organisations and charities alike that further significant improvements to maternity services in prisons were required.

The 1919 enquiry explicitly stated the belief that pregnant women in prison, ‘whatever their delinquencies’, and their babies, who were innocent in the eyes of the law, were entitled to proper care while in the charge of the state. 6 Today in the UK all mothers and babies have the right to high-quality maternity care. When babies are born to women in custody the midwives who attend them have a statutory duty of care which is governed by the Nursing and Midwifery Council's rules and codes of practice. However, following the case in HMP Bronzefield, the Royal College of Midwives released a position statement reiterating the need to ensure equality of care in prison, stating that ‘maternal and new-born healthcare should not be compromised by imprisonment’. 7 Ethnographical research, including that carried out by Dr Laura Abbott and Birth Companions, a women's charity dedicated to tackling inequalities and disadvantage during pregnancy and birth, has identified continuing difficulties in ensuring this right to maternity care on a consistent basis for both mothers and babies. This is variously due to women having limited agency in prison, not having the ability to maintain regular contact with a midwife during their pregnancy and not being taken out to hospital in time when they go into labour. 8

A position statement issued by the Royal College of Obstetricians and Gynaecologists in September 2021 recorded that the number of babies born to women serving prison sentences was sixty-seven in 2018–19 and that one in ten women delivered their baby before they reached a hospital. The statement recommended that maternity services located near to women's prisons should have a designated obstetric lead for the care of pregnant women in prison. 9 The investigation following the 2019 case in HMP Bronzefield concluded that all pregnancies in prison should be treated as high risk ‘by virtue of the fact that the woman is locked behind a door for a significant amount of time’ and there is likely to be a higher percentage of women who have experienced trauma and others who are fearful of engaging with any authorities, including maternity services. Among some of its main recommendations were that health care staff should have clinical expertise with pregnancy cases and that the midwifery services in prisons should be tailored to the specific needs of pregnant women in a custodial setting. 10

By tracing how prison administrators, doctors, officers, reformers and prisoners themselves have attempted to untangle the exigencies of pregnancy and birth in prison, this study has illuminated this often overlooked aspect of England's penal history. It has illustrated the conflicts that were played out in a variety of ways between containment and care, health and discipline, and how these debates manifested in a skein of experiences for mothers in prison. When they walked through the prison gates, pregnant women and those with young infants were entering into physical spaces that were not designed for their accommodation. Uniformity was a key principle underpinning the rules and regulations decided upon at policy level, which very rarely considered the specific needs of mothers and their children, in some cases to the detriment of their physical and mental health. However, this study has shown that these women and their children were a consistent feature of life in prison and that the terms of their incarceration were negotiated and adapted by prison staff and prisoners alike.

Heather Cahill explored the concept of visibility in relation to developments in maternal health care and how the importance of the appearance of safety promoted by scientific medicine was reinforced by politicians needing to be seen to be contributing to the protection of future generations. 11 Prisons offer a unique means of exploring this idea of medical care being visible, and pose something of a paradox. Physically, they had the appearance of heavily controlled environments and the regimes intended left little room for variation. However, the different realities prompted a range of experiences for women facing childbirth and mothering in prison. These experiences were shaped by physical factors such as the prison structure, the cells and the prison hospitals in which women gave birth. However, they were also shaped by factors that are far less visible in official records and instead have to be unearthed and pieced together from the testimonies of those who lived, worked and were incarcerated in prisons.

The Duchess of Bedford's 1919 enquiry was a significant step on a long path towards the acknowledgement, or indeed making more visible, of the fact that maternity cases in prison required distinct consideration. It more explicitly recognised the changes required and made strides towards enacting them. The impetus for the enquiry was born out of notable cases, such as those of May McCririck and Ellen Sullivan, who had given birth alone in prison cells and whose cases had made more visible the inadequacies of the system for pregnant women. Their cases coincided with broader debates about health in prison and the staffing of women's prisons which fuelled an official and public desire to look behind Holloway's high walls and open up the regime within to a greater level of scrutiny. A notable area focused upon, which had in many ways been part of the very bedrock upon which the modern prison system was built, was the practice of cellular confinement and women spending long periods of time isolated from the hundreds of prisoners occupying the cells around them.

Defenders of the principle of separation in prison have historically pointed to its indispensability in encouraging prisoners to repent of their crimes and achieve meaningful reform before the expiration of their sentence. Others have focused upon the logistical benefits of separation as a means of more effectively separating the first-time offender from the recidivist, the older prisoner from the younger, and its importance in managing the discipline of an institution. However, the consequences of imprisoning pregnant women in isolation for long periods of time, often with limited means of communication, were highlighted by the 1919 report and used to express in the most explicit of terms that such a practice required revision. However, a century later the need to address the conditions in which pregnant women are confined were starkly illustrated again. Perhaps ‘Victorian’ due to the omnipresence of the principles of isolation and separation, the safe custody of this group poses a perennial rather than an ‘outdated’ question, one for which the twenty-first-century justice system is yet to find a definitive answer.

Although it was significant and led to, or hastened, notable developments in the provisions for mothers in prison, the path to change in the wake of the 1919 enquiry was not a linear one. The allocation of resources and staff, and indeed the strength of the impetus for change, was dependent on a myriad of factors in the decades that followed, including funding, circumstances in individual institutions, public opinion and the proclivities of governments towards the administration of the criminal justice system. In the second half of the twentieth century it was also dependent upon the building and rebuilding of prisons for women in attempts to address the constant questions about female imprisonment.

The Report of the Departmental Committee on Persistent Offenders in 1932 found that in the case of the great majority of women, ‘prison buildings of the fortress type are unnecessary for purposes of security and the effect of such buildings seems to be in many respects worse than on men’. 12 At the time, Holloway was the principal penal institution for women. In 1938, three years into her role as Britain's first female Assistant Prison Commissioner, Lilian Barker proposed rebuilding Holloway as something of a ‘prison in a park’, on more open land and without the heavily secured fortress-type buildings. Although the plan did not progress and the question of rebuilding prisons for women was halted due to the outbreak of war in 1939, its proposal was nevertheless significant. It was developed further still by Joanna Kelley, appointed as Holloway's Governor in 1959. She advocated rebuilding Holloway in London. In 1966, following her appointment as Assistant Director of Prisons, with responsibility for women's prisons, plans were in place to rebuild the prison. Rock labelled the process of razing and reconstructing Holloway on the same site as unprecedented. 13

In December 1968, Lord Stonham, Minister of State for Home Affairs, spoke of the Holloway Redevelopment Project. He declared that ‘crime is almost exclusively a man's disease’, and continued that women who committed serious and violent crimes were exceptional, posing the question of whether prisons were the correct places for them and, if so, how they could ensure their effective treatment. 14 His comments echoed those made a century before during debates about the deficiencies and eventual closure of Brixton Convict Prison in the 1860s, discussed in Chapter 1. Like Holloway, it was considered the main penal institution for women at the time. However, also like Holloway, the efficacy of its structure and regime in containing women, and in many cases their children, came in for continued scrutiny. Reports upon the progress of the new establishment at Woking following Brixton's closure in 1869 placed great emphasis on arrangements in place to care for the health of women in prison, which had been found deficient in the old system. 15

Despite these intentions, a recent study concluded that addressing the health needs of the hundreds of women who came to prisons from different backgrounds, with complex needs, and indeed pregnant women and those with young infants, continued to be a ‘vital spoke on the problematic wheel of female incarceration’. 16 The new establishment at Woking did not, and perhaps could not, address the perennial problems that continued to face prisons attempting to balance the maintenance of health with the management of penal discipline. Similarly, the intention of the newly built Holloway in the 1960s was to develop an entirely different approach to the imprisonment of women, one shaped by ‘a humane environment for the treatment and rehabilitation of women and girls’. 17 Despite these intentions, the female prison estate continued to face criticism, including for the care offered to pregnant women and women with babies.

In 2015 the ‘problematic wheel’ of considerations when incarcerating women, including mothers, turned again when Chancellor George Osborne announced that Holloway would be closed and the land sold for housing development. He stated that in future women would serve their sentences ‘in more humane conditions, better designed to keep them away from crime’. 18 The rhetoric again was reminiscent of previous reviews of the provisions in women's prisons. Despite criticisms of conditions and enquiries into medical care in the prison, Holloway was regarded as central in the criminal justice system for women, especially in terms of location, and its closure without provisions in place beyond the removal of female prisoners to other establishments across the country was criticised. Holloway's situation in London meant that women could be held closer to their families and communities and have access to agency support when they finished their sentence. One article spoke of the importance of location in terms of Holloway's visibility, reminding those who might see it daily of the impact of inequalities in society and of the need to redress the treatment of women by the criminal justice system. The building of luxury homes on the site was labelled as ‘cruelly ironic’. 19 Holloway has been primarily a site of incarceration and suffering, but also one of medical care, a home as well as a site in the fight for the rights of women. Its long history of shaping the experiences of women reinforced arguments and petitions to repurpose the site for services supporting women. Currently, plans are ongoing for the demolition of the site and the building of almost a thousand new homes, which are intended to include affordable housing.

The history of motherhood in the modern prison system is a long and storied one, contested and complex, emotive and evocative. When they walked through the prison gates May McCririck, Ellen Sullivan, Annette and Ms A, like countless others, entered into a system not designed with the health needs of pregnant women at the forefront of consideration. Although each had her own individual story and set of experiences, their pregnancies and the conditions in which they gave birth to their babies were impacted upon by circumstances beyond their control and by perennial, historic and systemic questions that have been asked time and again of the criminal justice system in the past two centuries. Is prison a place for mothers and babies? Can it ever provide them with safe custody? Historically, it has been acknowledged by policy makers and reformers alike that mothers and babies are a distinct group with distinct needs. However, meeting the challenges of containing and caring for them has been dependent upon a range of logistical, ideological and political factors which impact upon the health outcomes for mothers and babies. Despite significant changes, policy shifts, major efforts by reform organisations and individuals and even the closure, building and rebuilding of establishments for women, perennial conundrums remain. So too does the question of if, when and how we can truly and completely confine ‘Victorian’ incidents to the prisons of the past.

Notes

1 Hannah Devlin, ‘Revealed: 47 pregnant women in prisons in England and Wales’, The Guardian (1 November 2019).
2 Independent investigation into the death of Baby A at HMP Bronzefield on 27 September 2019, Prisons and Probation Ombudsman (London: 2021), pp. 1–2.
3 Rachel Bennett, ‘Maternity care reform in English prisons: A century of unanswered concerns’, History & Policy (2019).
4 Wellcome Library [hereafter WL], SA/NCT/J/2/2/7, ‘A cause to campaign for?’ New Generation, 15 (1996), pp. 28–29.
5 WL, SA/WHL/1/28, Beverley A. Lawrence Beech, ‘Shackled women’, AIMS Journal, 7 (1995/96), p. 3.
6 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. 44.
7 Rebecca Gilroy, ‘RCM demands equal maternity care for prisoners in wake of baby death’, Nursing Times (November 2019).
8 For extensive research exploring the experiences of mothers in the criminal justice system see the collection of chapters in Lucy Baldwin (ed.), Mothering justice: Working with mothers in criminal and social justice settings (Hampshire: Waterside Press, 2015). For a discussion of the experiences of pregnant women see Laura Abbott's chapter ‘A pregnant pause: Expecting in the prison estate’, pp. 185–210. See also the findings and recommendations set out in Birth Companions’ Birth Charter for women in prisons in England and Wales (March 2016).
9 Royal College of Obstetricians and Gynaecologists position statement: Maternity care for women in prison in England and Wales (September 2021), pp. 2–3.
10 Independent investigation into the death of Baby A at HMP Bronzefield on 27 September 2019, Prisons and Probation Ombudsman (London: 2021), p. 3.
11 Heather A. Cahill, ‘Male appropriation and medicalization of childbirth: An historical analysis’, Journal of Advanced Nursing, 33:3 (2001), 334–342, https://doi.org/10.1046/j.1365-2648.2001.01669.x, p. 340.
12 Report of the Departmental Committee on Persistent Offenders (London: 1932), p. 39.
13 Paul Rock, Reconstructing a women's prison: The Holloway Redevelopment Project, 1968–88 (Oxford: Oxford University Press, 1996), p. 109.
14 Quoted in Rock, Reconstructing a women's prison, p. 86.
15 Report of the Directors of Convict Prisons for the year 1869 (London: 1870), p. 369.
16 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.
17 Rock, Reconstructing a women's prison, p. 120.
18 James Morris, ‘Holloway Prison to close George Osborne announces’, Islington Gazette (25 November 2015).
19 Sara Hyde, ‘Closing Holloway Prison to make room for luxury flats isn't a triumph, George Osborne – it's just cruelly ironic’, Independent (26 November 2015).
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Motherhood confined

Maternal health in English prisons, 1853–1955

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