Birth in Clarksville jail cell: What experts say could have prevented this

Dawn Harrington became frustrated over the phone when she was told the story of a woman who gave birth alone Sunday afternoon in a Clarksville jail cell.

"It's really infuriating that that happened,” said Harrington, the executive director of Free Hearts, a Nashville-based nonprofit that supports women in U.S. prisons and jails.

“She should have been in the hospital. I don't think jails are safe for pregnant women.”

Questions remain days after the unexpected birth at the Montgomery County Jail.

When did the woman arrive at the jail?

Did anyone know she was pregnant? (We do know the woman told staff she needed medical assistance. The Montgomery County Sheriff's Office has not specified what assistance she sought, citing confidentiality and the protection and welfare of the mother and newborn.)

Why was she left alone?

Regardless, it’s not an isolated issue.

While prison and jail facilities are required to provide health care to incarcerated people, there is no national standard of care for those who are pregnant, said Dr. Carolyn Sufrin, who for years has advocated for best practices and policies.

About 58,000 pregnant people annually enter U.S. prisons, jails and juvenile justice systems, according to the Advocacy and Research on Reproductive Wellness of Incarcerated People team at the Johns Hopkins School of Medicine. Approximately 95% are booked in county jails as they serve sentences for low-level crimes or await trial.

"How that's operationalized varies from jail to jail and prison to prison," said Sufrin, who also serves as an associate professor of gynecology and obstetrics at Johns Hopkins.

"So there are no required standards, which is a huge, huge problem that leads to harm, frankly."

Many of which lead to events like the situation a woman faced alone Sunday afternoon in Clarksville. Making matters worse: Harrington said pregnant people now have fewer avenues for recourse through the Prison Litigation Reform Act, passed in 1990.

"It's heartbreaking and sad, the momma and baby could have died," Harrington said.

Officials: What happened Sunday afternoon at Montgomery County Jail

Officials at the Montgomery County Jail said nurses checked on the woman twice Sunday morning before leaving deputies to monitor her while they "continued to assess the situation and order additional medical tests."

After being left unattended for at least 45 minutes, a deputy discovered the woman gave birth alone. The mother and baby were then taken to a hospital.

The Sheriff's Office declined requests for additional information.

No standard of care in place at prisons, jails for pregnant people

Sufrin said several variables account for the wide range of care offered to pregnant people in U.S. prisons and jails.

In state and federal prisons, there's typically a greater level of oversight and transparency, Sufrin explained. Some facilities enjoy in-house care, while others contract services to various physicians.

At county jails, especially in rural spaces, resources may be more limited. Some jails don't employ best practices because they haven’t faced this issue often or at all in recent years. All the more reason, Sufrin added, there should be an adopted standard of care.

"If a jail cannot safely house a pregnant person and avoid risk of harm to her and her baby or fetus, then why are we, as a society, incarcerating pregnant people?" Sufrin asked rhetorically.

Harrington, who was formerly incarcerated, said staff at Tennessee prisons and jails are not adequately trained.

"As a momma in Tennessee … families in Tennessee … we should be outraged," Harrington said. "We should demand that this never happens to any mom, to any baby."

Sufrin: How to solve the issue

Sufrin has outlined a list of solutions:

• Make pregnancy tests part of an intake health assessment.

Said Sufrin: "The first best practice is identifying pregnancy and our research has found that that is not always employed. Many jails and prisons do do that, but many do not and that's part of the story as well."

• Provide quality, full-scope pregnancy care — on site or at off-site clinics — including options for counseling and exams. The need is heightened during emergency situations.

Said Sufrin: "An incarcerated individual cannot just get themselves to a hospital or call up their health care provider. They rely on staff at the jail as gatekeepers for their access to medical care. ... It's not up to the custody officer to decide whether or not they think they're in labor. They should always call the health care provider."

Clarksville Leaf Chronicle reporter Kenya Anderson contributed reporting.

This article originally appeared on Nashville Tennessean: How experts reacted to unexpected birth at Montgomery County Jail