Perinatal education needs of imprisoned mothers and fathers

Pregnant women and fathers-to-be in the prison system are a very vulnerable group with a wide range of needs which makes it important that they receive good quality perinatal education

Denise Coster 
Senior Evaluation Officer, National Association for the Prevention of Cruelty to Children (NSPCC) UK

Helen Brookes 
Evaluation Officer, National Association for the Prevention of Cruelty to Children (NSPCC) UK

Pregnant women and fathers-to-be in the prison system are a very vulnerable group with a wide range of needs which makes it important that they receive good quality perinatal education so as to experience healthy pregnancies and develop healthy attachment relationships with their babies. However, perinatal education provision in prisons is patchy and there is little evidence of what makes it effective. This article outlines some of the challenges and potential solutions and argues that much more work should be done to ensure that these vulnerable parents are able to give their babies the best start in life.

Pregnancy and the first few months of a baby’s life are an extremely important and challenging time for parents. Whilst this is true for any expectant parent, those who are undertaking this important life transition whilst serving a prison sentence face additional stresses and are likely to need extra support in the form of tailored perinatal education. The aim is that this will help them experience healthy pregnancies and go on to have secure relationships with their infants. 

Surprisingly, there is no official data on the number of pregnant women imprisoned in England and Wales each year but it is estimated that this number stands at about 600, and that approximately 100-150 babies are born in prison each year.  In Scotland, from 2010 – 2015, 107 pregnant prisoners were admitted to Cornton Vale, Scotland’s only women’s prison.  In Northern Ireland, from 2009 – 2014,   21 female prisoners received antenatal care whilst in prison (Galloway et al., 2014). Although there are no up-to-date figures on the numbers of fathers who are expecting a baby whilst in prison in the UK, this is likely to be a significant number as it is known that the majority of men in prison are parents (Department for Business Innovation and Skills and National Offender Management Service (NOMS) 2014). 

Perinatal education is important for these parents because they are particularly vulnerable and are likely to have experienced multiple adversities in their lives, such as childhood abuse, substance misuse (Ministry of Justice, 2013) poverty and unemployment (Corston, 2007).  Women in prison are also five times more likely to have a mental health problem than women in the general population (Plugge et al., 2006).  Whilst these factors don’t necessarily affect parents’ ability to provide sensitive, attuned care for their babies, they can increase the likelihood of them experiencing difficulty with parenting (Pajulo et al., 2006) and underline the need for effective perinatal education. 
Experiencing pregnancy and early parenthood in a prison context also presents additional stressors that parents in the rest of the population may not experience. Imprisoned parents can feel isolated and vulnerable as a result of separation from friends and family (including older children). Fathers may feel anxious about how their partner is coping with pregnancy and new parenthood without their emotional, practical and financial support. They can experience guilt both about not being in a position to provide this support and about missing their baby’s developmental milestones (Brookes & Coster, 2014). Pregnant women in prison are more likely to book late for antenatal care, face delays in being taken to hospital during labour due to prison regulations and processes, and give birth without the support of a family member. There is also evidence that some women receive inadequate nutrition during pregnancy and post-partum (Albertson & Renfew, 2012).  
Pregnant mothers may also experience anxiety because of the possibility of being separated from their baby if he or she is born whilst they are still in prison.  In the UK, only approximately 50% of women who give birth in prison will secure a place on a Mother and Baby Unit (Abbott, 2016). Those who do not will be separated from their child after the birth. 
For mothers who do secure a place on a Mother and Baby Unit, there are additional stresses associated with caring for a baby in an institutional context where they have little control over their lives (Brookes & Coster, 2014) and where staff are not always trained to provide appropriate support, for example with breastfeeding (Albertson et al., 2012).  New fathers may feel frustrated with the limited opportunities to maintain contact with their baby.  

In order to provide sensitive care which leads to the development of appropriate attachment relationships and good outcomes for infants, it is vital that this very vulnerable group of parents have access to perinatal education that addresses their needs. This is a unique opportunity for change and growth, as parents are literally a ‘captive audience’ (Shaw et al., 2015).

Delivering perinatal education in a prison context 
Despite the clear needs of this group of parents, there are many challenges to delivering perinatal education in prisons. 
Due to the limited number of pregnant women and fathers in custody at any given time, group based antenatal programmes need to accommodate parents who are at different stages of pregnancy and parenthood and who therefore have different needs. In addition, group membership is likely to change on a regular basis due to the transient nature of the prison population as new prisoners arrive and others are transferred or released (Brookes & Coster, 2014).  Parents in prison may also struggle to attend perinatal sessions as a result of mandatory duties within the prison, for example new mothers have to go back to prison work when their baby is eight weeks old, which can pose a difficulty in attending education sessions (Albertson et al.,  2012).  
Preliminary work should be undertaken with prison staff to establish what support is available to parents with additional needs within the prison e.g. counselling, substance misuse or domestic violence services. This is vital as parents in prison can’t be referred to agencies as they would be in the community (Brookes & Coster, 2014).  Co-ordination and collaboration between prison staff and those providing perinatal education is crucial. Prison staff may have little knowledge of maternal and infant care whilst those delivering perinatal care and education may not understand the constraints of the prison service (Albertson et al., 2012). 

It is important to tailor the content of education programmes to the constraints of the prison environment as this is likely to impact on the extent to which parents are able to put learning into practice.  Even if parents find the information and advice from the programme useful, they may not be able to implement it due to the rules of the prison and the lack of control that they have over their every-day lives. For example, pregnant prisoners may have no say in the decision about when they should be admitted to hospital in labour or what to pack in their hospital bag. Similarly, they may not be able to put information about healthy eating into practice as they have little control over their diet (Brookes & Coster, 2014; Albertson et al., 2012).  
Parents in prison report feeling defined more by their prisoner status than by their impending parenthood owing to the lack of acknowledgement of pregnancy in prison and the fact that pregnant women are not necessarily housed together. Education groups running in this context can create a safe and relaxing space to enjoy pregnancy, to feel like a ‘normal parent’ and to share experiences with other parents-to-be (Kennedy, 2016).   Parents also enjoy opportunities to do things like listening to their baby’s heartbeat and sharing experiences of pregnancy, and making videos of themselves interacting with their babies (Brookes & Coster, 2014).

Availability of perinatal education in prisons and its effectiveness
Perinatal education programmes in prisons across the UK are commissioned by individual prisons and provided by a range of voluntary sector organisations as opposed to being co-ordinated nationally. There is no comprehensive overview of what is available or the content of existing programmes. 
A recent scoping exercise conducted by the NSPCC (Galloway et al., 2014) identified a number of group-based perinatal education interventions which were running in prisons.  These varied widely in terms of focus, content, delivery methods and eligibility, and in terms of the timeframes within which they operated. Some provided support across the perinatal period such as the NSPCC’s Baby Steps programme (Brookes & Coster, 2014). This programme aims to equip parents in prison and their partners with practical parenting skills as well as improve their relationships with each other and with their babies and includes six pre-birth and two post-birth sessions. Some programmes focus solely on the antenatal period, for example Mellow Bumps developed by Mellow Parenting. This targets women at high risk of postnatal depression and aims to help them cope with stress  and prepare them for the arrival of their baby by providing them with information about babies’ brain development and social capacities from birth ( Other programmes focus on promoting attachment in the postnatal period such as The Baby Group running at Her Majesty’s Prison in Swansea, developed in collaboration with PACT (Parents and Children Together).

The PACT Baby Group
PACT (Parents and Children Together) is a UK national charity which supports people affected by imprisonment. It developed the idea for a baby group at HMP Swansea as a result of new mothers who had partners in the prison saying they were concerned about their partners bonding with their babies and the fathers saying that they felt unprepared for fatherhood. A specific group for fathers whose babies had been born whilst they were in custody was therefore provided every fortnight for two hours, with a focus on bonding between father and baby.

Many of the programmes are in the early stages of their development and have not yet gone through rigorous evaluation. There is therefore very little evidence currently of the effectiveness of antenatal or perinatal education programmes for mothers, or any evidence at all about how to support imprisoned fathers.  One exception is a UK based intervention, New Beginnings, which  has reported some promising findings among mothers and babies in prison during the postnatal period. An evaluation of the programme found it prevented deterioration in maternal psychopathology and promoted mother-infant interaction quality when compared to a control group (Sleed et al., 2013).

New Beginnings
New Beginnings is an attachment-based group intervention designed specifically for mothers and babies in prison. A cluster randomized trial examined the outcomes for 88 mothers and babies participating in the programme and 75 dyads residing in UK prisons where the intervention did not take place. The study concluded that ‘an attachment-based intervention may mitigate some of the risks to the quality of the parent–infant relationship for these dyads’ (Sleed et al., 2013:349).

Recent reviews (Shaw et al., 2015; Albertson et al., 2012) have identified an urgent need for further research into how mothers and fathers in prison through the transition to parenthood can be supported and helped to improve their life chances and those of their babies. In particular, there is a need to find out what parents in prison themselves feel their support needs are.

Parents in the criminal justice system face challenges, such as poor mental health and having experienced adverse childhood events, which can affect how they care both for themselves and their babies. They are often isolated and their relationships disrupted. Despite this level of vulnerability, the challenges of delivering education in the prison context mean that often their needs are not catered for and there is a risk to short and long-term health outcomes for their babies. Where services are available, they are often time- limited and not rigorously evaluated. Parents value education; much more work now needs to be done to demonstrate how challenges to provision in prison can be overcome and what constitutes an excellent transition to parenthood programme for imprisoned mothers and fathers.

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