The first formerly incarcerated mothers I ever met were Naomi and Leuka, survivors of the Holocaust who had relocated to Washington Heights, an upper Manhattan neighborhood near The Cloisters. It was the summer of 1971, and Washington Heights was a predominantly German-Jewish community, home to many who had been traumatized by the War and by captivity in the concentration camps.

In the summer and fall of 1971, I was a research intern at Columbia University, where a double-blind study of the efficacy of Lithium Bicarbonate in the treatment of Depressive and Manic-Depressive Disorders was being conducted. Both Naomi and Leuka were participants, and because I knew a little German, I was designated to provide some social services to the two women.

This idea that I might provide any truly meaningful assistance to these women as they woke day after day to memories and trauma that confounded even the best aspects of my imagination, seemed both absurd and impossible. At the time, I was only 25, living on the edge of Washington Heights with my husband (a psychiatric resident) and pregnant with my first child. My education, it seemed, had trained me to process my patients' experiences, and to then counsel and provide appropriate services—but I was left to wonder if my training, like my address, left me simply on the edge of this simultaneously collective and private trauma.

As our days together went by, I was profoundly stirred by these two women, also mothers, who were now childless and without family. I thought often of the peculiar cruelty of having had those identity-defining roles and relationships wrenched away. What did it mean to be a mother without a child? And could Freedom ever truly be refunded to those who had been quite literally caged? It was clear that distance from their children could never diminish their motherhood, whether that distance was measured in kilometers or the metaphysical distance of death.

During our many meetings, it was difficult to get them to talk about any subject other than my baby. Knitting booties of various colors for the unborn child, these two women seemed as full of life and excitement as I was. They celebrated the coming of this baby, this promise of new life, and eagerly received news of the freedoms pregnant women were beginning to enjoy in those first years of the 1970s. Natural childbirth, husbands coaching in the labor room—these were new and interesting changes to them. I deeply valued our time together, observing their continued celebration of new life. Such attitudes were surprising given their histories of inhumane treatment. How did they maintain this "maternal hope"? These formerly imprisoned mothers had survived the worst inhumanity in recent history. Our relationship left an indelible mark, though I was left to wonder how my connection to these two women would play itself out in my own adult life. Certainly I would never meet any other women who, denied dignity and humane treatment, would continue to value life.

I moved from New York to Little Rock, Arkansas, my hometown, and in 1993, I volunteered to teach parenting classes to incarcerated women in my state's prison. In 1998, I was asked by the warden to develop a prenatal/post-partum class for the increasing number of pregnant women in the prison, whereupon I requested the inclusion of women who had delivered within the last year. From 1998 until 2004, I participated in a community group of pregnant and post-delivery incarcerated women for an hour and a half each week, fifty weeks a year.

We shared everything except the truly impressive portions of carbohydrates and grease that were delivered on plastic trays during our lunchtime class. The laughter and humor they shared regarding the food was endearing, but the food was maddeningly unhealthy, especially given their pregnant condition. Equally frustrating was the fact that some of the pregnant mothers who had just entered the prison did not receive any prenatal vitamins for weeks or months. Most startling was the absence of a folic acid supplement, proven critical to the health of both the mother and child. As most of the women suffered from addiction, an illness that necessarily distracts one from attending to one's own wellness, they had not been receiving prenatal services prior to their arrest. This delay in receipt of either vitamins or folic acid, compounded by the dangerous physical effects of the mother's trauma upon incarceration, often worked to harm the unborn child.

Many of the prison's policies appeared to purposefully withhold any pregnancy-specific accommodations until the last possible moment, and often this was too late to have any real effect on the health or comfort of either the mother or the child. For example, the policy of the prison was not to provide an extra one-inch sleeping pad until the last trimester, and often these were not forthcoming. Sleeping on a one-inch pad was difficult and painful for most of the pregnant women. Sometimes other women in the barracks would give up their only pad to the pregnant women. I heard many stories of how other women would protect their pregnant prison-mates.

As the first members began to deliver their babies, they were, in many cases, appearing back in my prenatal class only two or three hours after their deliveries. Cramping, exhausted, hormonally zigzagging, and in great despair after being separated from their newborns, they still came to the class. Not surprisingly, they required immediate comfort, both emotional and physical (including massages), and desperately sought the chance to describe their experiences. What they shared was difficult to hear and had little in common with my own childbirth experiences, or those I had witnessed years before as a Lamaze instructor.

Here were women living in the first-world at the end of the 20th century, who were forbidden any free movement during labor. Instead, they were handcuffed by one wrist, and the opposite ankle shackled. Iron tools of restriction, restraint, and oppression do not belong in any one's experience of childbirth. Although attachment theory is not solely concerned with immediate contact at birth, most mothers have vivid recollections of their first time holding their newborn, nursing them, checking out all their parts and features. When incarcerated, some states do not allow any contact between the mother and infant after delivery; other states permit some time together, but the mother is usually restrained, either by the wrist or the ankle, or in two-point restraints.

After years of listening to my students' painful recollections of this process, it is clear that none were allowed any semblance of a positive, meaningful birth. Instead, their childbirths wounded them, deepening their feelings of stigma and shame. Many of the mothers expressed a sense of being further devalued, and felt their babies had been devalued as well. Among the many questions raised here is one addressing the philosophical and pragmatic goals that necessarily direct the course of legal decision-making. When we ask a judge to weigh-in during the sentencing stage of a case, what exactly are we asking of him/her? More to the point: Are the sentencing judges also sentencing these women to a traumatic, hostile childbirth—one that can only effect negatively the health and well-being of both mother and child? When a person is incarcerated, do they deserve to lose the humanity, health, and dignity demanded by most at this stage in civilization? And should those losses reverberate into future generations?

"What should have been the happiest day of my life was the worst."
—Otha, the first woman in the class to give birth, recalling the day of her delivery

How will I tell my child about her birth? Should I tell her I was in prison when she was born and had to go right back there? I did not get to nurse her. Do I tell her I took many deep breaths so I would know her smell? How was my baby ever to know me? Can I ever be a good mother with this hanging over us? These are questions I have heard repeated by every mother who has returned to the prison and the prenatal/post-partum class after childbirth. I am still in contact with many of these mothers, and again and again, the same concerns persist.

Edith, a young, petite white woman, thin with brownish hair and hazel eyes, more reminiscent of a freshman in college than a prisoner, was having her second baby. She was serving time in our state's only women's prison, a minimum to maximum security facility, for writing a hot check for around $4,000—her first offense, not simply her first felony. The judge in her trial, who also served as both the juvenile- and the family-court judge for the county, sentenced her to fifteen months, "to make an example." She had a twelve-month old son and no family members to call upon, save the baby's paternal grandparents. The judge denied her any visitation whatsoever with her baby, with the exception of so-called "phone visits." Each collect call she made to the paternal grandparents was denied. She knew she had lost her son. The grandparents eventually acquired permanent guardianship over the child from the same judge, who again prohibited any visitation between the mother and the toddler. But for Edith, who was all the while pregnant with her second child, the struggle had just begun.

Edith was a small woman, and was presumably carrying a small baby. She listened and learned all that she could from the childbirth education. She had no family and was hoping a church group would care for her baby until she was out. One day, I came to class to find her missing; she had gone into labor the evening before. Around 1:30 in the afternoon, before our class had even ended, Edith returned. Just three hours earlier, at 10:30 that morning, she had given birth to a baby boy weighing over nine pounds. I was appalled, and quite physically taken aback, not only by the fact that she was rushed back from the hospital, but by her shocking appearance.

She was ashen and cold, shaking as many new mothers do after delivery. She had given birth to another son. We all laughed and cried together. A group home, funded by the Church of Christ, would be picking her baby up at the hospital within the hour. Edith had not met the church representative, but they had talked on the phone. The home would not involve Child Protective Services, and Edith was assured that she would have her son returned to her once she had been released and had found a place to live. The photographs taken at the hospital showed a beautiful new child. She had other photos taken with the disposable cameras that my program left for the mothers at the hospital. However, she could only keep three photographs at the prison. I recirculated them for her each week. She would not receive additional photos from the caregivers of her baby, nor would there by any visits with the child.

At the following week's meeting, Edith shared her despair and depression at being separated from her baby. She was also unsure when she would see him again. It was immediately evident that this loss was compounding the loss of her firstborn. The prison permitted her one collect call to the home per week. But that was not real contact. And while photos might have served to lessen this loss and provide some semblance of connection to the child, she still was allowed only three at a time. She carried the three photos of her newborn behind her ID badge at all times.

When she began to describe her labor and delivery to the prenatal/post-partum class, she also shared other past traumas, including her history of childhood sexual abuse. During labor, she was shackled and handcuffed—the standard procedure. Now, a month later, she was in constant pain in her shoulder and back. (In fact, few of the mothers ever received a six-week check-up.) Edith finally arranged an appointment, and there learned she had torn her rotator cuff in the left shoulder, which corresponded to the hand that had been cuffed. She recalled how she shook with cold, and remembered that all she had wanted during labor was to move around. But she had not been permitted to get up. During labor, her arm hurt, sometimes tingling, sometimes cramping. She kept asking to have her arm released. The doctor and other medical staff also asked, but she wasn't released until she had already entered the final stage of labor and delivery.

When her son was brought to her after delivery, she was again under two-point restraints, her wrist above her head and the opposite ankle shackled to the bed. Not surprisingly, this made holding her baby quite precarious. And since neither family nor friends are allowed to visit new mothers from the prison, Edith was alone with her new son, and fearful of dropping him. She repeatedly asked the officer to release her wrist, suggesting that handcuffing her wrist to the bedrails at waist-level would make her less afraid of dropping her baby. In the class, she reported recurring nightmares where she drops the newborn.

Today, she is reunited with her prison-born son, but never regained custody of her first-born. She calls me sometimes, worried about her lack of emotional connection to this son. She has had a third baby, and compares her feelings of intimacy with the new baby, worried that she and her three-year old son are not adequately attached because of their separation just after birth. The question is a nagging one: Is this child potentially more at-risk for future abuse because of the attachment issue?

This description of feeling distant from their prison-born babies is repeated by other mothers with whom I have been in touch after their release. They request professional support to cope with the guilt, shame, and memory of having had the child while imprisoned, and the added trauma of being under shackles and restraints.

In May 2006, having served parents in our state prisons and community correction therapeutic units since 1993, I received a call from the chairman of the Department of Correction. It was an intimidating voice on the phone, a stranger's voice. He chastised me for speaking to the press in 2004 and 2006 about the Department's use of restraints during childbirth. He informed me that I had "disrespected" the department, and I have never since been permitted to return to their prisons. Both the parenting and the prenatal/post-partum classes came to abrupt end.

Currently, there are seven states that outlaw the use of restraints during incarcerated childbirth: California, Illinois, New Mexico, New York, Texas, Vermont, and Washington. A national coalition to support policies protecting pregnant and birthing mothers who are incarcerated is rapidly developing. Our shared mission is the education of policymakers. Hopefully, this will lead to the swift enactment of statutes universally prohibiting the use of restraints during childbirth while incarcerated. Laws are the only effective way to insure that all incarcerated mothers and their babies will be allowed safe and dignified childbirth.

In the summer of 2007, the Federal Bureau of Prisons, in cooperation with U.S. Senator Durbin of Illinois, reconsidered their policies about restraints during pregnancy and childbirth, intending to make their use the exception rather than the rule.

In an initial effort to reform the practice in Arkansas, I brought more than a thousand letters from national organizations decrying the practices of restraints and shackling of incarcerated pregnant and child birthing mothers to a legislative committee hearing in 2005. But legislators who had agreed to support my position and hear testimony from mothers who gave birth in prison, national experts, and me, a first-hand witness, rolled over when the Arkansas Department of Correction showed them the substitute, non-metal, soft restraints they agreed to use in place of iron shackles and handcuffs. In 2007, the same committee members deferred to the Department of Corrections to set policy, in the interest of "public safety." The bill died in committee.

In 2009, with the sponsorship of a strong senior legislator and the support of the Arkansas ACLU, we went back once more with a bill banning the use of restraints during medical transport, labor and childbirth, not only in our Department of Corrections facilities, but in our jails and juvenile detention centers. We also had the support of the Family Council, an evangelical group that has great influence on the religious right in the state legislature, an unlikely partnership between the conservatives and the ACLU. At the hearing, a conservative woman legislator asked the director of our Department of Corrections in all seriousness if it was true that women prisoners often tried to "kill" their babies during delivery. Can we demonize our prisoners any further than what was implied by this question? Not surprisingly, the bill failed again.

Needless to say, we will return again in the 2011 legislative session, and again and again until these inhumane practices are banned.