Born in chains

Prisons abandon women to give birth alone – at great risk to their lives, and those of their babies.

She had never been in trouble with the police before, never been pregnant before. Motherhood had seemed a promise of light, but she had found herself caught up in criminal activity. The plan had always been to stop once her son arrived. He was her reason to change, her anchor to a better life.

But she had pushed her luck – and been caught. Now Anna sat in the dock at her remand hearing, petrified. She expected to be granted bail. Instead, when the judge announced that she would be held on remand, a chill settled over her. At six months pregnant, with her trial scheduled for roughly half a year away, she realised with stark clarity: she would go into labour in custody. Her pregnancy went unmentioned at the hearing.

Anna’s ordeal is far from isolated. Every year, hundreds of pregnant women face the possibility that they will give birth behind bars – a systemic failure that goes beyond any single prison or individual case. In 2023-24, the Ministry of Justice (MoJ) recorded 215 pregnant women in prison – a significant increase from the previous year (194 women) – with 53 births occurring in custody. The majority were awaiting trial or sentencing. Most would not go on to receive a custodial sentence: in magistrates’ courts, 68 per cent of all women remanded did not go to prison; in the Crown Court, almost half (46 per cent) were spared.

The National Audit Office has been clear: the MoJ has made limited progress on its Female Offender Strategy, a 2018 initiative to improve outcomes for women in the criminal justice system, because it has not prioritised investment in this work. “Women in the justice system have distinct needs and worse outcomes than men,” its 2022 report stated. “They are more likely than men to have specific vulnerabilities that drive their offending, including experiences of trauma and abuse, and they also pose less of a serious risk to the public.”

And women present a challenge the justice system does not face with men: pregnancy. This has been a source of controversy for the MoJ for years.

On 27 September 2019, 18-year-old Rianna Cleary went into labour alone in her cell at HMP Bronzefield. She called for help, twice, but nobody came. She was on her hands and knees in labour when a prison officer walked past her cell with a torch, but did not stop. Guards found her the next morning with her dead baby, Aisha, in her arms. She had cut the umbilical cord with her teeth. An inquest concluded: “If Aisha’s mother’s labour had been identified and she had been transferred to hospital in a timely manner for Aisha’s delivery, there would have been an opportunity for effective steps to have been taken.”

Nine months later, in June 2020, another woman, Louise Powell, went into labour without medical assistance at HMP Styal. It was her first time in prison, and she was serving an eight-month sentence. She attempted to call the duty nurse three times. Her baby, Brooke, died. The prisons and probations ombudsman (PPO) found there were “missed opportunities” to identify her urgent clinical needs. (A third baby died in 2023, for which a PPO investigation is currently under way.)

These tragedies are part of a disturbing pattern of neglect that campaigners say is built into the prison system itself. In March 2023, Level Up – a UK gender justice campaign group – found that women in prison are seven times more likely to suffer a stillbirth, and twice as likely to give birth prematurely, than those in the general population. Together with Louise Powell, Rianna Cleary and Seema Misra – the former postmistress wrongly convicted in the Post Office scandal and imprisoned while pregnant – they have campaigned to shift public policy on the imprisonment of pregnant women. Their lobbying targeted the Sentencing Council, urging it to recognise the unique risks pregnancy poses in custody.

Two years after the publication of Level Up’s report, the Sentencing Council announced its new Imposition of Community and Custodial Sentences guidelines, which included hard-won reforms for pregnant women. The guidelines acknowledge the dangers faced by pregnant prisoners and instruct courts to “avoid the possibility of an offender navigating the risks associated with pregnancy, birth, and the postnatal period (up to 12 months after birth) in custody”. These guidelines came into effect on 1 September 2025. It’s far too early to say whether this will put an end to the suffering of women who find themselves in Anna’s situation.

Typically, just one midwife is assigned to each prison. In Anna’s case, that meant as many as 15 women waiting for an appointment. Her midwife only worked in two-hour shifts, once a week. “If you weren’t seen within those two hours,” Anna recalls, “you never got to see the midwife.” (Our interview was conducted on grounds of anonymity, so I have not disclosed Anna’s full name, crime, or the prison where she was incarcerated.)

Any medical complication was only magnified by this narrow window. When she experienced reduced foetal movements, she wasn’t taken to hospital for an entire day – there simply weren’t enough staff to facilitate it. Her gestational diabetes test had to be repeated four times – the midwife didn’t have the time to complete the process in one visit. “It was an absolute logistical nightmare,” Anna says.

Her pregnancy magnified the sense of dread that she felt. She knew that when the baby came, she would be flanked not by loved ones but by two complete strangers: prison guards. “If I could have kept my son in my stomach forever, I would have,” she says. “I didn’t want to bring him into the world.”

Two days before her due date, in the early hours of the morning, she felt the first pangs of labour. Padded up with her co-defendant, she turned to her only trusted friend in prison for advice. Around 5.30am, they decided it was time to ring the bell and alert the doctors – her labour had begun. For two hours, Anna waited, pressing the bell four times, but no one came. It wasn’t until 7.30am, when night staff handed over to the day team, that anyone responded. The nurse took one look, checked her blood pressure, and confirmed the obvious – her baby was on the way.

By 10.30am, five hours after they first alerted the guards, Anna was finally in the back of an ambulance en route to the hospital. Security clearance had taken three hours.

Once in the ward, Anna was cuffed to a prison officer – despite the prison governor having assured her that this would not happen, and that it was not standard procedure. When she questioned the female officer, she was told to be grateful: the cuffs were longer than usual, linked by a chain rather than wrist-to-wrist.

[See also: The millennial parent trap]

Shackling women in labour is not only morally questionable but legally fraught. Government guidance states that restraints should be removed from pregnant prisoners when they attend medical appointments, that restraints should only be used where there is a justification for doing so (such as prevention of escape) and that prisons should aim to facilitate escort by female members of staff with whom the woman is comfortable. None of this was the case for Anna’s birth. The practice also violates articles 7 and 10 of the International Covenant on Civil and Political Rights, article 16 of the Convention Against Torture, and the United Nations Standard Minimum Rules for the Treatment of Prisoners. Still, in February of this year, Channel 4 alleged that some prison officers at HMP Bronzefield in Surrey were continuously shackling and restraining prisoners during labour. It claimed that two of these women were cuffed to officers for 34 and 48 hours, respectively. The MoJ said it would investigate “urgently”.

By this point, Anna was in blinding pain. A male officer present told her he “couldn’t understand what all the fuss was about” – his wife had gone through it six times. Anna felt unable to protest, fearing that she would be marked as difficult. She was awaiting the board’s decision on whether she would secure a place in a mother and baby unit (MBU), where women who give birth in prison can keep their baby for the first 18 months. After this period, social services arrange for the child to be cared for by other family members or to be placed with foster parents. If a mother is denied a place on the MBU, similar arrangements will be made.

Represented by a social worker she had never met, Anna faced a process of rigorous, invasive questioning. She had been told the MBU would be a safe place to care for her baby: no one in prison for a violent crime stood a chance of being approved for a place. Yet she also knew a woman on the unit who was serving a sentence for stabbing her partner nine times. The rules and procedures were inconsistent – it was essentially a prison potluck. Between April 2023 and March 2024, 92 applications were made for a place within an MBU – 54 applications were approved and 14 refused (the remaining applications were pending or moot due to prisoner release).

“I should have been able to say something to [the guard],” Anna says, “but if you say anything, you are seen to be difficult. My record had to be squeaky clean. Otherwise, I wouldn’t have been accepted for [the MBU].”

Anna’s mother and the father of her child had previously been cleared to attend the birth, yet neither officer seemed particularly motivated to contact them. Anna couldn’t bear it any longer and pleaded with her doctor, who said he would consult with the guards. “We’ll call soon,” was all he was told. Frustrated by the delay, the doctor called her mother. When the officers heard, they removed her cuffs. Her family just managed to arrive on time. (A women’s charity, Birth Companions, sometimes provides birth support for women who might otherwise give birth on their own. They currently only have permission to operate out of three of the UK’s 12 women’s prisons.)

Everyone had always told Anna that when she gave birth, the sudden rush of love would soften the blow of her dire situation. “I had none of that,” she says. “It just wasn’t there. My initial thought was, ‘I’m leaving this hospital and I’m taking my son to prison.’ I just felt like the worst person in the world.”

She had only a few hours alone with her baby before being moved to a new prison with an MBU. Her family stayed for just one hour. In the evening, she arrived and waited for several hours in reception with her newborn. New arrivals were coming in by bus, a scene Anna describes as a “circus”. By 7pm, everyone else on the unit had been locked in, as per the rules, and Anna was sent to her new cell, with the door shut behind her.

“I didn’t have a clue what to do with him. It was my first child; I didn’t really know what I was doing. I had no way of contacting my family, because I’d come from one prison to another and my phone numbers hadn’t come with me. I just basically sat there and cried my eyes out.”

[See also: The age of deportation]

Anna’s story starkly contrasts with the glossy portrayals of prison MBUs as a safe refuge for new mothers. In February of this year, when the Princess of Wales resumed her public duties, her second engagement was a visit to HMP Styal’s MBU. Kensington Palace said the visit aimed to “highlight the importance of strong, loving and consistent mother-and-baby relationships to a child’s development, even in the most challenging of environments. Prisoners live in a separate area of the prison and are supported to care for their babies by trained prison staff and early years and family support practitioners.” Her visit was celebrated by Town & Country magazine.

Anna found this visit absurd. Her room contained a wardrobe, a cot, a barred window, a toilet and a bed. The floors were hard, cold concrete. Chains and keys clanged constantly behind the heavy metal door. “When Princess Kate went and visited the MBU, they tried to make it look very homely. The one I was in definitely wasn’t like that. It’s still a prison.”

Life on the unit was harder than Anna had anticipated. In her first week, she was in a “very, very dark, horrible place”. After giving birth, she hadn’t yet been permitted to shower, and when she was finally allowed, officers told her she had to bring the baby with her. “It’s my firstborn baby, I’m like, ‘Is he gonna be all right with all the steam in the room? Is this normal? Should I have him in here? Am I doing the right thing?’”

Anna couldn’t bear the guilt she was feeling and began struggling with suicidal thoughts for the first time in her life. She pleaded with her solicitor: either she was “leaving this prison now, or leaving it in a box”. She was granted bail and sent home, serving the remaining two and a half months before her trial on an electronic tag. It wasn’t until she returned home that she was finally able to see a midwife.

She was sentenced to just over three and a half years, but taking into account her time on remand and on tag, she would be serving one more year in prison. The application process for an MBU spot began again – a gruelling six-week process. With no women’s prisons in the London metropolitan area, women are often placed far from home. In Anna’s case, her mother travelled hours to bring her baby to visit in the interim. These brief reunions were traumatising for both – a mother and baby, deeply bonded, forced to reunite and separate repeatedly. Anna asked her mother to stop visits until she had secured their MBU space; saying goodbye was too painful.

The reality of motherhood behind bars is far from the sparkling, cosy images of Kate Middleton’s visit. Whenever a mother moves around her MBU cell, her child must be strapped into a buggy – she is not permitted to carry the baby in her arms around the room. For meals, mothers submit a list to prison staff, who do a weekly food shop. The list is then checked by the health visitor, who determines whether the foods are appropriate. For women from diverse ethnic backgrounds, this can often be contentious. A health visitor decides when a baby will be weaned.

If a child falls ill, the mother must contact the prison doctor, who alone decides whether the baby can be taken to hospital. In Anna’s case, when her son began struggling to breathe after a severe case of bronchiolitis, she was told she would have to wait for the doctor’s approval before an ambulance could be called. The doctor, shocked that this was even a debate, sent an ambulance himself, which waited outside for an hour while security clearance was obtained. Her son ended up in the ICU for three days. The prison officer accompanying her to the children’s hospital complained that it was highly inconvenient for him – someone else was supposed to cover his shift, and he wanted to go home.

Several years later, now a campaigner and a mother of two, Anna still has not had the painful conversation with her son about the circumstances of his birth. “Even now, I don’t know if I made the right decision by keeping him in the MBU,” she says. This lingering torment is common among women who have given birth in prison, explains Janey Starling of Level Up: “I don’t know a single mother who has spent time in a mother and baby unit who doesn’t carry an absolutely crippling sense of guilt about it – and about how they will one day explain it to their child.”

With 73 per cent of all women serving sentences of less than four years, most are already near the upper limit for eligibility in an MBU. The majority of female prisoners are convicted of non-violent offences (69 per cent), and many have themselves been victims of domestic abuse and sexual assault. As Starling notes, if they are separated from their child, that child may end up in the custody of the perpetrator. “The rupture caused by separating a child from their mother – its impact on attachment, emotional development – is absolutely devastating, and lasts far beyond the mother’s prison sentence.”

When female offenders are waiting for a hearing or a trial, they might be given bail, or the court might decide to put them on remand, meaning they will go to prison until their trial begins. However, along with September’s sentencing guidelines, the MoJ announced a package of amendments to the Bail Act, stating that the court will now be asked to “consider whether a defendant is pregnant, a primary caregiver, or victim of domestic abuse” when deciding whether to refuse or grant bail in certain cases. This reform, which was a surprising addition, may finally deal with the record-high numbers of remand prisoners and, more importantly, put a stop to women giving birth in the prison environment before they have even been tried.

The UK, with the highest incarceration rate in western Europe, has funnelled pregnant women into the prison system at an alarming rate. Such profound, life-altering trauma may now be avoided if pregnant women are granted bail and permitted to serve their remand within the community. However, there is still a chance, even a likelihood, that women will give birth in these environments, if it is still possible for them to be held on remand while pregnant. Eleven countries worldwide either prohibit the imprisonment of pregnant women outright or impose strict limitations, favouring alternatives such as house arrest, electronic monitoring, or probation. The Ministry of Justice Female Offender Strategy asserts that “custody is particularly damaging for women” and emphasises that community-based support not only mitigates harm but also leads to significantly better outcomes, including lower rates of reoffending.

Starling is cautiously optimistic about the remand reform. While the change is “long overdue”, the challenge will be to ensure that the advice to “consider” pregnancy as a mitigating factor for granting bail is actually enforced. “We hope that this means they no longer remand pregnant women,” she said.

Around one in four women is currently being held on remand for longer than the six-month limit, increasing the chances that those who are pregnant will give birth in prison before trial. As James Timpson, minister for prisons, probation and reducing reoffending sees it, this is the “prison system we inherited” which is “simply not working for most women”. These reforms, he has said, will “see more women facing tougher community sentences, so they tackle the root cause of their crime”.

“When people think of a woman in prison, they just think she’s a monster and that she wouldn’t have kids, or she wouldn’t be pregnant,” says Anna. “Prison doesn’t work for most women, let alone women that are pregnant or just had children, and then you’re separating them. You just add to the cycle, you never break it.”