From the ankles up, Khrista Erdman is just a hospital patient wearing a robe and carrying a wrinkly newborn.
The metal shackles on her ankles tell the full story. Erdman, 32, of Des Moines, is a felon and one of 13 pregnant women in Iowa’s prisons last year.
Prison pregnancies are rare, with fewer than 80 in the last five years in Iowa. When a pregnant woman is admitted to prison, the corrections department is charged with administering the same medical care expectant moms get on the outside.
“By court order, we are required to provide access to care,” said Dr. Harbans Deol, medical services director for the Iowa corrections department. “We provide the standard of care that is available in the community.”
University of Iowa Hospitals and Clinics in Iowa City dispensed nearly $5.2 million in medical services to nearly 1,600 Iowa prison inmates in the year that ended June 30. The hospital is not reimbursed for the care, nor are staff who provide medical treatments, ranging from chemotherapy and dialysis to surgery and specialist consultations.
Pregnancy is a little different from other medical conditions handled in prison, though.
First, there are two lives at stake. Prison officials and doctors treat the offender, as well as her fetus. Pregnancy is a temporary condition, but one that, in prison, ends with a mother saying goodbye to her baby two days after birth. This separation can result in other health issues, such as postpartum depression.
Restraining pregnant inmates has become a hot-button issue in the past year.
Note: First in a two-day series on pregnant inmates by Erin Jordan. Coming Monday, Iowa considers prison nursery concept, which allows new moms to have their babies with them in prison.
Washington state Gov. Chris Gregoire signed a bill in March prohibiting prisons and jails from shackling most inmates in labor or recovery. Former California Gov. Arnold Schwarzenegger vetoed a similar bill in September. This was after groups like the American Medical Association and the American College of Obstetricians and Gynecologists condemned the practice, saying it could harm the baby or mother.
Iowa will draft its first formal policy on restraints for pregnant inmates this spring, said Greg Ort, deputy warden at the Iowa Medical and Classification Center in Coralville. The center houses pregnant inmates in their final weeks of pregnancy and transports them to UI Hospitals and Clinics to give birth.
“If someone is in the first trimester and has a history of escape, restraints might still be appropriate,” Ort said. “We’re looking to see what other states are doing.”
Video by Liz Martin - "Now I wish she had waited because I don't want to let her go."
Prenatal care in jail
Erdman didn’t know she was pregnant until she was booked into the medical and classification center in May on charges of forgery and burglary as a habitual offender.
“They took me down for my pregnancy test and said, ‘Congratulations, you’re having a baby,’ ” Erdman said during a November interview.
Every female inmate younger than 50 takes a pregnancy test as part of 25 to 30 screenings at the medical and classification center. Some people believe offenders try to get pregnant before sentencing to seek leniency, Ort said, but many women first learn of the baby at booking.
New inmates are tested for HIV, but Iowa hasn’t had a pregnant inmate test positive for the disease in recent memory, Deol said.
In prison, all pregnancies are considered high risk because doctors don’t know the inmates’ medical histories. Drug and alcohol convictions are red flags, but inmates often have inconsistent medical care without a primary care doctor to contact for information.
Inmates age faster than people on the outside, paying for reckless behaviors by contracting hepatitis, AIDS and cancer, Deol said. While 77 percent of pregnant inmates in the past five years have been younger than 30, three women older than 40 gave birth in the Iowa prison system.
Most pregnant inmates are housed at the Iowa Correctional Institution for Women at Mitchellville for the early months. Particularly high-risk moms stay at the Coralville facility, where there is 24/7 medical care and they are near UI specialists.
Erdman spent the first eight months of her pregnancy at Mitchellville, where she saw the in-house doctor regularly, took prenatal vitamins and tried to maintain a healthy diet.
“I eat vegetables, and I ordinarily wouldn’t,” she said in November.
Mitchellville, a medium-security prison with about 550 female inmates, has a close-knit atmosphere where women quickly form allegiances, said Karin Bond, a women’s unit counselor from 2008 to 2010. Many of the women serving time at Mitchellville are mothers whose crimes separate them from their children.
“It’s a sad place sometimes,” Erdman said.
Erdman has three other children, ranging in age from 2 to 14, who live with family members in the Des Moines area.
The baby girl she had Dec. 26, Jeweliana, went home with her husband, Dan Copeland Jr. Erdman won’t be able to provide daily care for her children until at least June 2012, when she has her first opportunity at parole.
“That’s a very hard separation,” Bond said. “That is one of the hardest things anyone would ever have to do. I wish there was something I could say to ease the situation.”
In the hospital
Inmates give birth in the UI’s labor and delivery unit, in rooms right next to other mothers. This isn’t something the hospital likes to advertise. No doctors in UI obstetrics and gynecology wanted to be interviewed for this story.
Dr. Richard LeBlond, chief quality officer for the hospital, said doctors often feel apprehensive when treating inmates for the first time.
“We never discuss what they are incarcerated for,” LeBlond said. “That is irrelevant to the care we are going to provide them.”
The Iowa corrections department doesn’t use ankle irons for most pregnant inmates in their third trimester, Ort said. Officials put handcuffs on women they are taking to the hospital to give birth, but all restraints are removed once the moms are admitted, he said.
All prison inmates at UI are in the custody of an officer, but wardens might assign an additional guard to a high-risk offender who is giving birth, Ort said. Guards stand behind a curtain or outside the inmate’s room to verify who goes in and out. Only vetted visitors are allowed.
Erdman was glad to be free of restraints while she gave birth, but said the ankle cuffs snapped on afterward seemed unnecessary.
“I’m not going anywhere,” said the mom, who also had tubal ligation surgery after the baby was born.
The baby comes, goes
Like other moms who give birth at UI Hospitals and Clinics, inmates stay in the hospital for two days after a vaginal birth and three for a cesarean section. This is an inmate’s only time to bond with a baby that she will turn over to someone else when she goes back to prison.
The majority of babies born to female inmates in Iowa go to family members. Prison counselors work with the inmate to find a suitable, safe caretaker for the baby. Bond, the women’s unit counselor, has handled just one adoption in recent years.
“The agency we worked with was really fabulous,” Bond said. “Most are open adoptions, so the inmates can receive pictures and letters from the family.”
Some women who expect to be released quickly seek temporary foster care, Bond said. Iowa does not have a prison nursery where inmate moms can live with their babies, but other states who have tried these units say they reduce recidivism because mothers feel more committed to their children.
Just like new moms on the outside, female inmates go through physical and hormonal changes after giving birth, but there are some major differences.
Inmates can’t regularly breast-feed their babies, so they have to deal with breasts engorged with milk in the days and weeks following birth. At least one inmate in recent years has asked to pump breast milk for her baby, Mitchellville Warden Patti Wachtendorf said.
“She did it, but it didn’t last very long,” Wachtendorf said.
Prison officials would make arrangements for milk refrigeration if a mother wanted to pump milk for her baby, Ort said.
Inmates are at higher risk of developing postpartum depression following their baby’s birth, Deol said. Unlike a new mom who may be alone with the child during the day, inmate mothers have constant supervision and on-staff psychiatrists who can help the mother combat depression.
“When they come back (from the hospital), I want to check in with them to see how they are doing,” Bond said.
Mitchellville inmates are always excited for women to return from giving birth, Bond said.
“Everyone wants to see pictures,” she said. Other female inmates are eager to share stories of their children’s births and find out when the newborn will visit.
Copeland has, so far, lived up to his promise to bring Jeweliana to see her mother every weekend.
Not all pregnant inmates want their babies. When an inmate says she wants an abortion, prison officials are required to take them to UI Hospitals and Clinics “for guidance,” Deol said. “We don’t get into a discussion of right or wrong.”
UI Hospitals and Clinics performs abortions only when the life of the fetus or mother is at risk, hospital spokesman Tom Moore said. “A patient requesting an elective abortion would need to seek services at a community clinic,” he said.
The UI has performed no inmate abortions in the past five years.
Ort, who has worked in the medical and classification system for 10 years, can remember a couple of quick labors where women started to give birth in the van headed to the hospital. Ort is also a father and knows it is difficult for inmates to be away from their families.“I would have a hard time imagining what that’s like,” he said about giving up a baby to go back to prison.