By Kaeleigh Terrill, Fertility and Body Literacy Educator

The Minnesota Prison Doula Project (MnPDP) is a program of the Ostara Initiative, a non-profit working to improve conditions for pregnant and parenting people who are incarcerated in the United States. MnPDP provides pregnancy and parenting support to incarcerated individuals, offering birth support from trained doulas and group-based and one-on-one education and support. MnPDP began as a prison-based pregnancy, delivery, and parenting program at the Minnesota Correctional Facility-Shakopee and has expanded to serve people held in county jails throughout Minnesota.

MnPDP was formed in response to two needs expressed by pregnant and parenting incarcerated individuals: the need for peer support and community, and the need to end unaccompanied birthing. Doula support is offered to individuals as soon as they are identified as pregnant. The individual and doula meet throughout the pregnancy, and the doula attends the delivery at the hospital, regardless of whether the birth is spontaneous or scheduled. When the parent is physically ready to return to incarceration, the doula comes back to the hospital to support the discharge and separation of parent and baby and continues to work individually with the parent postpartum. Beyond the option of one-on-one doula support, incarcerated individuals can also meet weekly in a peer-support group throughout pregnancy and postpartum. MnPDP has found that individuals report higher satisfaction with their birth and postpartum experiences when they have access to both peer and doula support.

Doulas are non-clinical healthcare providers that offer emotional, physical, and educational support for a birthing person throughout pregnancy, labor, and the postpartum period. Doulas offer pregnancy and birth education, breathing and movement techniques to cope with labor, advocacy support for birthing people, facilitation of communication with medical providers, emotional support, and breast/chest-feeding education. MnPDP’s doulas are trained professionals who provide highly individualized care and play the invaluable role of offering real human support to individuals that otherwise might experience the pregnancy and birth process alone. MnPDP prioritizes employing a group of doulas that reflect the diverse population that they work with.

Doula care is a critical intervention to address maternal health inequities experienced by pregnant and parenting individuals in prison and jail. The United States has one of the highest maternal mortality rates among high-income countries, with people of color being three to four times more at risk than White birthing people. Evidence shows that doula support results in better birth outcomes and overall satisfaction with the birth experience by providing emotional and physical support throughout the birthing and postpartum year. The American College of Obstetricians and Gynecologists links doula support to shorter labors, fewer cesareans, and lower rates of unnecessary medical intervention and names this support as one of the most effective evidence-based practices for birth. Doulas’ advocacy and support can help birthing people access services and result in higher satisfaction rates for their birthing experiences. Doulas alone will not eliminate the existing maternal mortality inequities, but they are essential for improving birth outcomes and experiences, particularly for people of color, for whom the medical and prison outcomes have historically been disproportionately negative.

Mental and substance use disorders are prevalent among those who are incarcerated, and pregnant and postpartum individuals that are incarcerated are particularly vulnerable to mental illness. Research done within MnPDP found that within their sample study of 67 women, 78 percent reported a prior mental health diagnosis. Furthermore, 22 percent reported a chronic illness, and 60 percent reported experiencing domestic violence. Compared to pregnant and postpartum people outside of the prison system, these rates are higher, and these individuals have less access to adequate mental, physical, and social support. By law, mental and physical healthcare must be provided for incarcerated individuals, but the standard of care is not federally regulated. Like many other social systems, current behavioral health systems within correctional facilities often cannot meet all the need for services. MnPDP’s doulas help incarcerated individuals build their social support and have their substance use and mental health needs met so they are not continuing to fall through a porous social system.

Data collection on the pregnant and incarcerated population has been quite limited. However, available research has shown that rates of perinatal mood disorders are higher among individuals who are incarcerated. Established risk factors for perinatal mood disorders are trauma and victimization, poverty, low social support, and previous mental disorders exacerbated by incarceration. Barriers to adequate physical and mental health care and the stress and isolation caused by incarceration can add to depressive symptoms, which can initiate a vicious cycle, wherein symptoms prompt increased isolation, which further worsens the symptoms. For instance, when incarcerated people experience suicidal ideation, which often accompanies perinatal mood disorders, the response is frequently to place the individual in isolation; isolation is known to worsen depressive symptoms. MnPDP has found that the pregnant individuals they work with need and benefit from community and peer support. Providing more understanding and social support through group-based peer support gives more opportunity for connection and advocacy. The doula support offered by MnPDP could play a major role in reducing the impact of mental health disorders for those participating in this program.

MnPDP prioritizes individual and group-based support through the direct care of the doula program while also working to create legislative changes, such as banning the use of shackles on pregnant people who are incarcerated and the Healthy Start Act [PDF]. MnPDP played an integral role in helping pass an anti-shackling law in Minnesota in 2015, which also includes the right to a doula for individuals giving birth within the prison system. The Healthy Start Act was passed in 2021 and gives the commissioner of corrections authority to release pregnant and postpartum individuals for up to 1 year. This could result in fewer disruptions to family systems and stronger starts for babies and parents. Before this act was passed, babies of incarcerated people were separated from their parent within 48-72 hours of birth and released to a caregiver in the community, often a family member or foster care.

To capture a more personal perspective on those they work with, MnPDP created the Prison Birth Storytelling Project, with a website that shares of a booklet, video series, and podcast series that explore the variety of lived experiences of those that give birth while incarcerated.  Finally, the Ostara Initiative, the larger non-profit that MnPDP works within, supports incarcerated pregnant and parenting individuals in nine correctional facilities across Minnesota and Alabama. Ostara offers a virtual support group for formerly incarcerated parents, which can be found here.