BLOG: A Day In The Life Of A Midwife In A Secure Environment


Nikki, Specialist Midwife In Health & Justice

Women in prison are some of the most vulnerable in our society and there is widespread evidence of poorer health outcomes for pregnant women and their babies in prison estates.

Working as a prison midwife has been the most challenging but rewarding part of my career. In the three years I’ve worked as a midwife in Health & Justice, no two days have been the same. Regardless of this, the one thing that never changes is starting my day with a cuppa… after all, you never know when you will get your next one!

Just Another Manic Monday

Monday comes along and my first job is to always read the wing brief. This gives me an idea of anything that has happened overnight, with any of my ladies.

Following this, I then visit the wing to see my lady who gave birth to twins last week, to complete her postnatal examination and ensure her mental health has not deteriorated (as she was unable to keep her children). It was so positive to speak to her and she was very optimistic about the future with her babies, which was a fantastic outcome.

“It is important as a Specialist Midwife that even though we don’t have a mother and baby unit in my estate, we continue to promote breastfeeding on any visits and support and encourage the women through expressing breastmilk – so they feel they are giving their babies the best positive start in life.”

First Time Introductions

I then visited my newly pregnant women to introduce myself and go through our ‘Pregnancy In Prison’ leaflet, to help alleviate any concerns they may have about being pregnant in prison and discuss their options.

“Confidentiality is so important for my role and my patients. Prior to visiting new patients, I always get the officers to have a private talk with the ladies to check whether they want to attend healthcare or have me personally visit them on the wings. It enables them to make decisions about their care and allows them to keep details of their care as private or as open as they wish.”

My first lady knew how far pregnant she was and wanted to carry on with the pregnancy. Understandably, she had some questions about what being pregnant in prison may look like. I was pleased to be able to tell her that after two years of hard fight and consultation, it’s been agreed that consultation appointments will be carried out virtually. This ensures more dignity for our patients and also saves money, as escorts are no longer required to attend appointments externally.

My next lady was unsure about her pregnancy; as a midwife, we must provide all information on either continuing with the pregnancy or terminating it. These are always difficult decisions for women to make, and maybe even more so with being in a prison environment. Factors such as the length of sentence, other family members, and the woman’s mental health all have a part to play in the decision.

“When discussing such a sensitive topic, I listen and let the patient talk and advise them when appropriate. I never judge them and provide as much information as I can. In this case, I leave her with lots of information and give her the time she needs to think about things, and agree I’ll discuss any questions with her the following week.”

Finally, before lunch I visit another lady who speaks no English and therefore I must use LanguageLine to interpret for me. This is challenging, as I am trying to set her up to express breastmilk for her baby.

However, we did it and when I left she knew exactly what she needed to do and how to get the breastmilk from her cell.

It’s All Go Go Go…

After a quick working lunch, the prison regime begins again and off I go to an assessment – care in custody (ACCT) review – where I’m discussing a patient’s birth experience.

Generally, I carry out full continuity of care – meaning I am with my patients for scans, to deliver their babies and to carry out the separation before bringing the patients back to prison… On this occasion, I was her birth support partner rather than delivering her babies.

She still tells everyone that she had amazing support and didn’t know what she would have done had she not had me there – this is fantastic to hear.

As usual, I am now running late for my next meeting, which is the perinatal meeting. This is where we discuss all the pregnant/postnatal women and address any current issues or needs/requirements for them.

Back in the office, I have minutes and notes to type up, before it’s finally home time!

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