Angela was eight months pregnant when she entered the Maryland Correctional Institution for Women in Jessup, Maryland.

One day after her arrival, she was brought to the prison’s medical infirmary and placed in a cell, where she was locked behind a steel door nearly 24 hours each day—which prison officials call “restrictive housing,” and prisoner rights’ advocates call “solitary confinement.”

Regardless of the terminology, Angela was miserable. “There was no rec time to go outside. They barely let you out to use the phone,” she told Rewire.News. At times, she had to decide between waiting to use one of the unit’s two phones to call her three children or taking a shower during the 30 minutes she was allowed out of her cell.

She was in the process of appealing her conviction and four-year prison sentence. But while she waited for the courts to decide, this was how she’d be forced to spend the last month of her pregnancy.

The Maryland Department of Public Safety and Correctional Services (DPSCS) has a policy in which pregnant people are automatically, and involuntarily, placed in the medical infirmary during their third trimester. After publication, DPSCS officials said that “expectant inmates are placed in MCIW’s infirmary two weeks before they are scheduled to go into labor, or sooner if determined to be necessary by a medical treatment provider.”

This includes people who haven’t been convicted: In Maryland, pregnant people awaiting their day in court are often confined to the single women’s prison at Jessup because the local jails do not have the facilities to accommodate or address pregnancy.

On the surface, that might not seem like a bad idea—after all, pregnant people would have easier access to medical care if they went into labor or a medical emergency arose. Otherwise, they might have to wait in their housing unit to be escorted to the infirmary by an officer or wait for medical staff to arrive at their housing unit.

But that’s not the reality, says Angela: Her cell had no emergency call button. While her cell was close to the nurses’ enclosed desk area, she recalls that the nurses were rarely at their post. Instead, they were often at the other end of the hall, where the prison’s officers were stationed. If a woman needed their attention, she would have to scream and bang on her cell door repeatedly. Other women on the unit would join in and, eventually, the combined cacophony would catch the nurses’ attention.

Sometimes even that wouldn’t be enough. Two weeks before her due date, Angela says, another pregnant woman went into labor behind her cell door. But no medical staff came to her aid. “They didn’t believe she was in labor because she was mentally ill,” Angela said. “The lady was screaming, and everyone could hear her. All of us told [medical staff] that she was in labor and they ignored us, they ignored her. She ended up having her baby in the room.”

The baby was fine, but the apparent disregard of the unit’s staff shook Angela. To avoid another in-cell birth, the prison’s obstetrician—whom Angela saw shortly afterward for the first and only time—scheduled Angela to go to the hospital on her due date, where she would have her labor induced.

After press time, DPSCS officials said that “every room in the infirmary has an emergency call button.”

A new state bill seeks to stop the practice of involuntarily placing pregnant people in restrictive housing. SB 809 would not disallow all placements in the medical unit. If a pregnant person has a condition that necessitates closer medical attention, or if they wish to be in the infirmary, they can still be placed on that unit. But they must be given access to outdoor recreation, classes, work, and other prison programming. They must also be able to access phone, mail, and visits in the same way they would if they were still in general population. In other words, pregnant people can’t be left in their cells for nearly 24 hours each day.

SB 809 also includes monitoring. It mandates that the prison system must establish a process by which a pregnant person can safely report violations of the new law. It also requires that, if a pregnant person is placed in restrictive housing, the prison official who made that decision must submit a written report within 30 days that details the placement itself, their justification for it, and any physical or mental health effects of isolation on the pregnant person or fetus that have been observed by health-care providers.

Kimberly Haven, who helped draft SB 809, has never been pregnant while in prison. But she did serve a 15-month sentence at the Maryland Correctional Institution for Women and saw how pregnant people were isolated there. Now, out of prison, Haven is part of the Reproductive Justice Inside coalition, which helped pass legislation last April mandating that incarcerated women receive feminine hygiene supplies.

“That opened the door for us to look at what else we subject incarcerated women to,” she told Rewire.News. That led her to work on SB 809 as well as two other bills to limit the use of solitary confinement and prohibit releasing people straight from isolation to the streets.

Haven notes that the DPSCS maintains reports on the numbers of people in restrictive housing. But, she says, these reports do not include pregnant women who are placed in the medical infirmary. “The way it’s set up is restrictive housing,” she said. “They have no fresh air, no exercise, their programming stops, they’re isolated from any type of social support.”

Dr. Carolyn Sufrin is a medical anthropologist, OB-GYN, and an assistant professor at Johns Hopkins University School of Medicine. From 2007 to 2013, Sufrin served as the OB-GYN at the San Francisco County Jail, an experience that she chronicled in Jailcare: Finding the Safety Net for Women Behind Bars. She is also the founder of the Pregnancy in Prison Statistics (PIPS) project, which has embarked on the first systematic study of pregnancy and pregnancy outcomes in prisons across the United States. According to PIPS findings, 36 pregnant women entered Maryland’s prison system over a 12-month period starting December 2016, making up 16.7 percent of prison admissions.

Sufrin recognizes prison officials’ concern that pregnant people have timely access to medical care. But she also notes that medical emergencies can happen at any time, not only in the third trimester. At the same time, she reminded Rewire.News, “it’s very isolating to be pregnant in prison.” Although there are no studies about the effects of isolation on pregnant people—conducting such a study would be unethical—being confined to an infirmary cell for nearly 24 hours each day “is further isolating and can impact a person’s mental health,” Sufrin said. Numerous studies have shown that isolation can have severe, long-lasting damage to a person’s mental health. In other words, while immediate access to medical care should be a concern, she is not advocating for pregnant people be placed in medical isolation.

Sufrin also sees the lack of outdoor recreation as problematic during pregnancy. “Outdoor exposure gives you vitamin D,” she said. Studies point to the mental health benefits of sunlight during pregnancy and the role that lack of sunlight plays in postpartum depression.

Furthermore, cells used in medical isolation are often too small for any meaningful exercise. Angela’s cell, which she shared with a woman who used a wheelchair, was slightly larger than the others on that unit. But, she recalled, that slightly larger space had to accommodate the two women’s beds, two lockers in which to keep their belongings, the toilet/sink combination ubiquitous in prisons across the country, and her roommate’s wheelchair and television. That left virtually no space to exercise, or even pace the floors.

Sally, who asked that her real name not be used, entered the prison in Jessup in 2002 when she was five months pregnant with twins. This was before the prison began involuntarily isolating pregnant people in their third trimester, and so she was allowed to stay in general population—where she tutored women in reading, writing, and GED prep—until she went into labor. Then she was placed in the infirmary in a cell by herself all weekend before being brought to the hospital the following Monday.

She was not allowed any of her belongings to help pass the time. “I didn’t even have a book to read,” she said. “I just sat there and waited for the time to go by.”

That too is concerning. “The American College of Obstetricians and Gynecologists has come out against bed rest,” Dr. Sufrin said. “Immobility is dangerous during pregnancy,” she continued, noting that doctors recommend a moderate amount of exercise during pregnancy. Doing so prevents blood clots and deep vein thrombosis, which are risks for people who are pregnant.

Being locked in a cell for nearly 24 hours each day made it impossible for Angela to exercise, which in turn, she says, made her labor more difficult. Angela had given birth three other times before this pregnancy. “All of my deliveries had been all natural,” she said. “I never had an epidural.” Unlike her previous three births, the baby she delivered after spending a month restricted to a cell didn’t come easily. “I was so stiff from laying in bed,” she said. “I was in so much pain, I couldn’t move.”

In Maryland, incarcerated mothers are typically allowed 24 hours with their newborn before they are returned to the prison. But because Angela went to the hospital on a Friday, she was able to spend the entire weekend holding her newborn daughter, though it was with her right wrist and left ankle cuffed to the bed the entire time. (Four years later, in 2018, Maryland passed a law prohibiting restraints on pregnant people who are in labor, delivery, or postpartum recovery unless they are deemed an escape or safety risk. After press time, DPSCS officials said “inmates giving birth are never shackled during pregnancy, delivery, or postpartum.”)

Sally, meanwhile, was allowed 48 hours with her newborn twins, whom she delivered via cesarean section. She too was restrained during her postpartum hospital stay. “Usually it was my leg,” she recalled, adding that the officer asked whether she preferred to have her leg or her wrist cuffed to the bed while holding her twins. Because Sally had undergone a c-section, she needed to walk the hospital halls to discharge gas. She was always placed in leg irons, or heavy shackles around both ankles.

After giving birth, Angela returned to the medical unit, where she remained in isolation for over a month. “I had to demand to be released from medical,” she said. During that month in the infirmary, she never received a postpartum checkup. While SB 809 would not address postpartum medical care, it does prohibit placement in any type of restrictive housing, including medical isolation, for the first eight weeks of postpartum recovery.

When she returned to the prison after giving birth, Sally was at first placed in a cell with a woman who had seizures. There was no call button and, with 11 staples from surgery, Sally was unable to help her cellmate. Instead, she says she had to scream through the door to try to get attention.

Then, Sally was moved to a cell on an upper floor. Climbing the stairs was difficult, but that wasn’t the worst of it—her cell had vomit and blood from the previous inhabitant. An officer gave her bleach and rubber gloves, but Sally says she had to clean it. She spent another week in the infirmary before she was sent back to general population.

Angela won her appeal and was granted a new trial. She was found not guilty and released from prison two days after her daughter’s first birthday. But the effects of isolation stayed with her. “It made healing difficult,” she said. “I had depression afterwards. It was really hard.” The depression lingered for nearly a year even after she came home and was reunited with her children.

When asked for comment about Angela and Sally’s stories, DPSCS officials said after publication that “the Department would not be able to comment on specific medical care as that is prohibited under federal law (HIPAA).”  

SB 809 is awaiting a hearing by the Senate Judicial Proceedings Committee before it can go to the floor for a bill reading or vote. “We’re feeling cautiously optimistic,” Haven said. In the weeks before the vote, she has visited legislators and delegates to push the bill. They were always shocked, she recalled, asking incredulously, “We don’t really do that, do we?” before agreeing to support SB 809.

Sally is long out of prison and at home with her twins, who are now teenagers. But she still remembers that weekend before their birth and wants to see this practice ended. “It was horrible,” she said. “You don’t want to go through [labor and birth] alone, and you go through it alone.”

“We shouldn’t be punished because we’re pregnant and incarcerated,” she continued. “We’re already being punished for our crime.”