Any maternity service can be measured by the care we provide to the most vulnerable in our society. Women in prison and their babies deserve the best of care. The Birth Charter for women in prisons in England and Wales, launched by Birth Companions (2016) in May 2016, gives us a wonderful opportunity to improve the support given to women and babies in prison, not just for the prison service, but for everyone involved in their care.
The newest strategy for midwifery, nursing and care staff in England (Cummings, 2016) implores us to end unwarranted variation in health care. Health inequalities must be tackled, and the best way to do this is to start at the very beginning of life. Women in prison are experiencing some of the most stark health inequalities (Delap, 2016):
This means women in prison are more likely to have higher-risk pregnancies, and that their babies face risks that could affect their wellbeing and development.
Most importantly, the foundations of a healthy life are being laid while pregnant women and new mothers are in prison. Therefore, it is especially important for these women and their children that we try to minimise the adverse effects that the prison environment can have. We know that children who encounter adversity and stress in infancy have significantly increased risk of adverse mental and physical health outcomes later in life (All Party Parliamentary Group for Conception to Age 2, 2015).
But we also know that this period presents an opportunity to communicate important health messages and to support women to make positive, informed choices about pregnancy and parenting.
This group of women and babies in prisons is small. But there is an argument that getting things right for this very disadvantaged group generates important learning that can be applied to other vulnerable women, both in the criminal justice system and beyond.
The Birth Charter gives our prison service a blueprint to ensure that every baby and every new mum is on the path towards optimum health and wellbeing. It will be a great document for all maternity staff in understanding the needs of this group of women and children, and how best to address these needs. The Birth Charter also helps us, as midwives, to fulfil our vital role as advocates for women; for example, by establishing whether a woman wants prison officers in the room while she gives birth. This means she is able to have the kind of birth she wants. The concept of woman-centred care underpins all we do as midwives, and this concept is true wherever women are receiving care.
The Royal College of Midwives (RCM) advised Birth Companions on the content of the Birth Charter. Our organisations are working together practically to develop training for midwives in the support of women affected by the criminal justice system, and an online learning resource is available on the RCM i-learn platform (www.ilearn.rcm.org.uk).
As we saw in the Queen's Speech on 18 May (BBC News, 2016), the UK Government is waking up to the idea that we can—and must—do better for our justice system. We must see the potential in everyone and uphold their dignity. The National Maternity Review (2016) in England and the ongoing Review in Scotland have put tackling health inequalities centre stage. The Birth Charter is well-timed to help make a huge difference to a special group of women and babies who need our support.
If the NHS is serious about addressing the needs of the hardest to reach—and, indeed, it is—then midwives working together with the prison service and organisations such as Birth Companions, and using the Birth Charter, is a great place to start.