When I was six weeks pregnant with my first child, my husband and I took a tour of the birth center where I hoped to give birth. The staff laughed at us (six weeks pregnant?!) but took us on a thorough tour, gave us booklets of information and connected us with their "most popular" CNM (certified nurse midwife). I bought books on how to write the most perfect birth plan, what it takes to be a "hip" mama and grilled women on the rhapsody and disaster of their own birth stories. After the birth of my son, my mother and mother-in-law provided endless fountains of patience, love and understanding as I cried when my son wouldn't eat or fretted when he wouldn't sleep. With the birth of my second child, I was lucky enough to have a close friend – a midwife by trade – act as my doula during the labor and delivery. Tracy fed me strawberries in between contractions, placed my husband's hands gently on my back when I needed support, and facilitated effortlessly my last-minute decision to birth standing up.

These were the memories flooding my brain during my phone conversation with Christy Hall, co-founder and Development Coordinator for The Birth Attendants – a non-profit organization that runs The Prison Doula Project, providing incarcerated women in the Washington Correction Center for Women (WCCW) with desperately needed pregnancy, labor and post-partum doula services. Christy's stories of the incarcerated women for whom The Birth Attendants provide these services are depressing, inspiring and unendingly educational. Where pregnancy is a time to share excitement, anxiety, information and hopes for the future for many women, for imprisoned women it is most often isolating and terrifying with a disturbing lack of resources and information.

Christy, a 27 year-old mother of a now 11-month old daughter, helped found The Birth Attendants in December 2002 when a friend of hers, Joanna – then a student at Evergreen State College in Olympia, WA – was doing a report for a class. Joanna called a local prison to inquire about what services the prison provided for pregnant prisoners. It just so happened that the woman on the other end of the phone had recently given birth with the help of a doula who had made it a "wonderful, empowering experience" and asked if Joanna would act as a doula at the prison for some of the female prisoners. Immediately, Joanna put a call out to her community and The Birth Attendants was born.

My phone interview with Christy – as her young daughter, who clearly inherited her mother's strong and proud voice, assertively protested sleep in the background – follows:

First of all, what is a doula?

A doula is a woman who provides physical, emotional and psychological support to pregnant women before, during and after the birth of the baby.

And can I just say that I think it's important to note that The Birth Attendants are a collective and we identify as a feminist, pro-choice, reproductive justice organization because of the nature of the work that we do and the population we serve.

You can say that! So, what do you hope to accomplish with The Prison Doula Project?

Our long-term vision is that all women have access to doula services. We are also really interested in helping other prison doula projects get started in other states. But in terms of what we hope to accomplish with the women we work with, we think that through having a supportive pregnancy and childbirth, by helping women have positive pregnancy experiences, we are also helping women to learn how to parent more successfully, how to find their own voice, how to be a positive force in the world. Most times it's really the first time that these women learn they have a voice and that people will listen to them. A large part of what we do is bear witness to these women's stories and we hope that their pregnancy and childbirth can be an empowering experience. The other part for us is that a lot of times, for many women, they become politically active as a result of personal experiences – they find their voice that way. The theory is that when you are able to understand your experience as part of a larger system, it can bring you to a certain level of political awareness. So we really provide the resources for people to have those empowering experiences that may lead to a sense of how your experience is connected with others – simple things like learning that you deserve more, that a positive birth experience is a human right for all women.

How are you received by the women in prison?

It tends to ebb and flow. A lot of times we have women that we've already worked with who are advocates for us on the inside. They'll tell other women, "You need to meet the doulas!" A lot of times those women will bring the new women to us. But sometimes when we're not there as often, there is a certain amount of explaining we need to do and sense of distrust among the women. Our doulas then will come in and define what a doula is and let them know, "We're here to provide you with resources because we understand the serious lack of resources available to you. If you have questions, come to a Friday discussion group. We're here to help you figure out what you want and help you get it." We say it over and over again with an emphasis on what the women want. We have no agenda. Some women say "I'm having an epidural and that's the end of the conversation." So we'll tell that woman that we want to figure out how she wants that to happen: "Alright. When do you want it? Do you have a childbirth plan? Do you know what a childbirth plan is? Let's talk to your doctor."

I have read that it is common for female prisoners to be shackled during childbirth. There are only two states that forbid the shackling of female prisoners during labor and delivery (California and Illinois). Have you seen that with the births you've attended and does Washington state have a similar law?

In Washington and Oregon there are not laws about women being shackled but the Department of Corrections (DOC) in both states have policies in place that allow for it. Oftentimes when you approach a legislator about creating a law that forbids this practice, they tell you that there is already a policy in place through the DOC that they feel good about – that the policy does that job that a law would do. But I've seen lots of women shackled during labor and deliver and ultimately it's up to the discretion of the officer present. I talked to a woman incarcerated in Oregon for eleven years and she told me she could tell me the names of plenty of women in Oregon that were shackled during childbirth as well. It's a huge issue that still needs to be dealt with. There aren't many women who would agree that it's an acceptable practice knowing what it's like to give birth. I believe The Rebecca Project for Human Rights is working on federal legislation that would do away with the piecemeal of state legislation on this issue. [Editor's Note: The Rebecca Project is working with Senators Richard Durbin (D-IL) and Tom Coburn (R-OK) to end the practice of shackling and restraining pregnant women, especially during labor and delivery, in all state and federal correctional facilities.]

How does labor and deliver for an incarcerated woman differ from that for a woman "on the outside"?

A lot of the issues that are the general issues for pregnant women are magnified in prison. For instance, which provider will you choose for pregnancy and childbirth? In prison, you don't get to choose your provider – not being able to choose who attends your birth is a big deal. Up until recently, in the prison we work in, there was only a male doctor available for labor and delivery. But for many women in prison – a huge number of whom have experienced sexual and domestic violence – having a male provider between your legs is not exactly ideal. Another issue is lack of informed consent – the lack of information and resources around having a healthy pregnancy for these women is huge. They just aren't given any information on pregnancy, their health, their bodies. The lack of access to proper nutrition during pregnancy is a big problem – the pregnant women in the prison we work with get "extra canteen" which means they get like an extra pack of Fritos. Also, the lack of access to health care in prison means that, in general, a health issue is not dealt with until it turns into a huge problem. It's a high-risk population anyway because, for the most part, these women lacked proper health care before coming to prison and being pregnant in prison doesn't change that. Also, there is a much higher rate of cesarean sections for women in prison as compared to women on the outside – mostly for the convenience of medical and prison staff.

What does the post-partum doula support you provide look like?

We go to the prison once a week and facilitate a two-hour class that women can attend both before and after they've given birth. But we do "one-on-ones" as well – pre-natal visits and post-partum support. We have provided some women with post partum support for a long time after they've given birth. As long as they keep asking we'll work with them – whether it's on custody issues with children or navigating the complex web you find yourself in once you've given birth in prison. And as I mentioned earlier, the importance of bearing witness to a woman's struggle to maintain a relationship with her kids, to help them figure out how best to go about that, how to stay in contact, acknowledging that they are having an emotional experience. You meet so many strong women but they stifle their feelings because there is no way or room to process them but it's essential to process all of what they are going through.

Do you connect the women with other resources once they give birth?

Yes, in so far as there are resources that exist. A lot of the resources are just addresses and phone numbers for treatment centers for when they get out. Sadly, there is a ridiculous lack of resources for keeping families together after a woman has a child in jail. There is a woman in Alabama, an incredible woman, who provides resources for women parenting from prisons – she helps bring kids in to the prisons. Her program picks up kids from foster care families or grandparents homes and brings them to visit their mothers. It's an amazing amount of work though and I kind of wish every prison had an organization to service it like hers. But, aside from that, there are very few resources for women wishing to keep their families together after they've given birth in prison.

Why do you do it?

I'm glad you asked me. I get asked that a lot and people tell me how amazing it is that I do this for the women.

But the truth is I get a lot out of it. I feel deeply inspired by the women. It amazes me what human beings go through and yet still remain warm and amazing. At the end of the day the gift to me is that I get to know a lot of people that most people never get the chance to know. I get to be with them at the most important time in their lives. It's why I'm a doula. You end up being a very important person to them. And their stories so desperately need to be told.

When I speak on a panel or at a conference, people ask – what can we do to address the harm that's being done to these women? There are a million different organizations you can join or give money to. My answer? Find a way to go inside. If you find a way to go inside and get to know these women you'll never stop going inside and you'll find your own way to make an impact. It hurts in a lot of ways but you'll find that you just can't let people stay inside and not go in to help them.

For more on The Birth Attendants:

Lockdown on Life: Stories from Women Behind Bars, a program of the National Radio Project.