Testimony of Jennifer Robinson, MD, MPH

Physicians for Reproductive Health

In Support of HB 829

Submitted to the Judiciary Committee

Maryland House of Delegates

February 26, 2013

I offer this testimony today on behalf of Physicians for Reproductive Health, a

doctor-led national advocacy organization that uses evidence-based medicine to promote

sound reproductive health policies. As the national voice of pro-choice physicians, we

work to make quality reproductive health services an integral part of mainstream

medicine.

I received my medical education at Tulane University School of Medicine in New

Orleans, Louisiana, and then completed residency training in Obstetrics and Gynecology

at Drexel University School of Medicine/Hahnemann Hospital in Philadelphia,

Pennsylvania. Subsequently I completed fellowship training in Family Planning at Johns

Hopkins Bayview Medical Center. I live and practice medicine in the Baltimore area.

Physicians for Reproductive Health welcomes the opportunity to submit

testimony on HB 829, a bill that prohibits the use of any physical restraint on women in

correctional facilities during labor, delivery, and recovery. In fact, leading health

organizations including the American Congress of Obstetricians, the American Medical

Association, and the American Public Health Association all oppose the practice of shackling because it

poses serious health risks to the pregnant woman and her baby.1

Under current Maryland law, however, handcuffs, leg shackles and belly chains may be used to

restrain pregnant women during transport and medical appointments. Even during active labor,

pregnant women incarcerated in Maryland may have their wrists and ankles chained to the hospital bed.

As a physician who delivers babies and cares for women every day, I understand that allowing a

pregnant woman freedom to move about during labor helps women have a successful vaginal birth.

Being able to move around during labor also prevents blood clots, which is a leading cause of maternal

death.2

HB 829 prohibits the use of physical restraints in the second or third trimester of pregnancy,

absent a determination of substantial flight risk or security circumstances. Shackling poses a great risk to

both the pregnant woman and her developing baby. If she falls while having her ankles and wrists

shackled, she is more likely to fall forward and hit her abdomen. Such trauma to the pregnant belly can

result in the placenta separating from the wall of a uterus, a medical emergency that can ultimately

result in the death of the mother and developing baby.

I have a responsibility to my patients to provide them with the best, most comprehensive care

possible. HB 829 would change existing Maryland law, which does not require correctional staff to

consider input from medical providers in determining whether a pregnant woman should be shackled,

even during labor and delivery. HB 829 also puts doctors and medical professionals in charge of

determining when it is safe for a woman to leave the hospital after giving birth. 1 Health Care for Pregnant and Postpartum Incarcerated Women and Adolescent Females, Comm. Op. No. 511, at 3(Am. Coll. Obstetricians & Gynecologists 2011); RES. 203: Shackling of Pregnant Women in Labor (Am. Med. Ass’n 2010); Standards for Health Services in Correctional Institutions 108 (Am. Public Health Ass’n 2003). 2 New Recommendations to Prevent Blood Clots During Cesarean Deliveries Issued, Practice Bulletin No. 123 (Am. Coll. Obstetricians & Gynecologists), available at http://www.acog.org/About%20ACOG/News%20Room/News%20Releases/2011/New%20Recommendations%20to%20Prevent%20Blood%20Clots%20During%20Cesarean%20Deliveries%20Issued.aspx. Accessed February 25, 2013.

As a trained and experienced doctor, I need to be able to make decisions about medical care in

the exam or delivery room, not non-clinical correctional staff. Shackling a pregnant woman in labor is

not only painful and inhumane, it is dangerous. During labor and delivery, it is possible for related

emergency situations to arise—including heavy vaginal bleeding, seizures, and infections. HB 829 will

enable me to safely provide care to my patients and promptly diagnose or treat medical emergencies

without the threat of shackles.

During my residency training, I cared for several incarcerated women on Labor and Delivery. In

most cases, the guards who accompanied these women were sympathetic to the medical team’s

request to remove a woman’s restraints so that we could more easily examine and care for her.

However, on the rare occasion when a guard insisted that a patient be shackled during labor, I

constantly worried that the patient would develop a complication in which I would need to intervene

quickly and the restraints would get in my way. For example, when fetal monitoring done during labor

suggests the baby may be in distress, one of the first interventions we use is to change the mother’s

position. If she is handcuffed to her hospital bed, precious time would be wasted undoing her restraints

before we could employ a simple but effective intervention.

My patients come from all walks of life, from every situation imaginable. A physician’s first and

foremost responsibility is for the patient’s welfare. If H.B. 829 becomes law, women who are

incarcerated will no longer risk unnecessary, harmful, and inhumane restraint during their pregnancy,

labor, delivery, and recovery. This is about assuring patient safety and providing quality health care to

all pregnant women, including women who are incarcerated. I urge you to vote in support of H.B. 829.

On behalf of Physicians for Reproductive Health, I thank you for the opportunity to submit this

testimony.