Crystal: When Medical Decisions Are Tied To Guards’ Overtime Schedule
“At the beginning of my labor, my hands and feet were cuffed to the hospital bed.”
Crystal Munoz, now age 41, recounted her experience of being pregnant and in prison to The News Station. In 2007, when Crystal was only three months pregnant with her second daughter, she was sentenced to prison for 20 years for conspiracy to possess with intent to distribute 1,000 kilograms of marijuana. While she was meant to be placed in a federal prison, she was sent to Ector County Jail in Texas to serve the first part of her federal felony sentence.
“I just remember being brought into a tank with girls that are coming on and off the street for different things — they were high or drunk,” she says. “I was stripped of my clothing and given this stinky outfit that gave me rashes on my skin. They didn’t care if I was pregnant.”
In the county jail, Crystal felt as if all her rights as a woman and mother-to-be were stripped away.
“At mealtimes, they would give us a jug of water that everyone drank out of,” Crystal recounts. “They didn’t give me extra water as a pregnant woman so I would fill up my chip bags with water so I could have good drinking water; otherwise my only option was this water fountain where the girls would brush their teeth and wash their underwear. We had about five minutes to eat our meal – beans, bologna, cornbread, grits or powdered eggs. The food came served on these trays that were always moldy.”
Whereas many expectant mothers would take extra care of their bodies during pregnancy, Crystal had to deal with the deficient maternity health services in the jail.
The Ector County Sheriff did not respond to a request for comment in the case.
As Crystal’s due date neared — right around Christmas — she overheard an argument between the U.S. Marshals and her doctor about whether to induce labor.
“Every department head and staff member in the Federal Bureau of Prisons gets every federal holiday off,” she says. “The only staff on duty at those times are the minimum number of guards to watch inmates and run the facility. I think the Marshals wanted to induce because they had that period of vacation time and wanted my labor to be done and over with. But I wasn’t ready to have my daughter.”
In a statement, a spokesperson for the U.S. Marshals Service (USMS) said: “It is the practice of the U.S. Marshals to not disclose information related to individual prisoners to protect their privacy,” but added “facilities housing USMS prisoners are responsible for the medical care that prisoners receive.”
On Dec. 26, when it came time for Crystal to have her labor induced, she was shackled and taken to a general hospital. “It wasn’t a normal room — it was very different to where babies are normally born. It was dark and my hands and feet were cuffed to the hospital bed. The doctor was furious I was handcuffed and he refused to do his job with me like that.”
Once her daughter, Nova, was born, Crystal had three days to spend with her and her eldest child, Sarai, before being taken back to jail. “I just wanted to hold her because I didn’t know when would be the next time I would hold her again. I didn’t even sleep — I just stayed up the whole time.”
Then, her husband took both of their girls home and Crystal was handcuffed and returned to a holding cell at the jail. “I just remember I had this gut-wrenching pain. I cried so hard – screaming and crying from my whole being. The guards told me to shut up and stop crying or I would be put on suicide watch.”
The separation “felt like it was a crime against me and my babies,” Crystal says, “worse than what I did to be incarcerated.”
Soon after, Crystal was transferred to a state prison to serve her remaining sentence, where she rarely saw her husband and two girls until she received clemency and was released in February 2020.
Prisons Make Little Effort Addressing Women’s Medical Needs
It is estimated that 58,000 pregnant women are admitted into American prisons and jails each year — thousands of whom give birth while still incarcerated. Historically, the study of pregnancy and its outcomes on incarcerated women and their babies has been minimal. Thus, Pregnancy in Prison Statistics Project was a groundbreaking start to understanding the maternity care offered to thousands of incarcerated, pregnant women.
It collected data on pregnancy outcomes in 22 state prison systems, six jails, three juvenile justice systems and the Federal Bureau of Prisons — representing 57% of women in prison and six percent of women in jail — from 2016-2017 and revealed some of what it’s like to be pregnant, give birth and be postpartum while incarcerated. It found pregnancy while in local jails, state and federal prisons and youth confinement facilities is characterized by a lack of supportive policies and practices.
The research revealed that, although the overall rate of miscarriage (6%) and preterm births (6%) in the facilities studied was lower than the national average (both of which are about 10%), in some state prison systems the rates were much higher. For instance, Kansas reported a miscarriage rate of 22% while Arizona’s rate was 20%. In Ohio, the rate of preterm birth in the period studied was 16%. Both kinds of outlier statistics indicate the strong potential of increased adverse outcomes of pregnancies while incarcerated.
Of the 22 prison systems and six jail systems represented in the study, researchers found only one-third had written policies on lactation, meaning the possibly untrained facility staff would be left, in many cases, to advise mothers about the importance of breastmilk for a newborn.
But advocates for incarcerated people found one aspect of the research particularly shocking.
“One of the things that stood out to me from the findings was the state prisons that are doing C-sections, rather than vaginal births,” Wanda Bertram at Prison Policy Initiative tells The News Station.
The research carried out by PIPS Project found while, on average, the high rate of Caesarean section in prison in the United States (32%) was comparable to the high rate of C-sections performed in America at large (31.7% in 2019, according to the Centers for Disease Control and Prevention), some states had much higher rates.
The project found 10 states — including Alabama (52%), Illinois (43%), Massachusetts (62%), Minnesota (48%) and Tennessee (58%) — had C-section rates far higher than the national average, and many were higher than the disproportionately high national average for African American women (35.9%).
Since 1985, the World Health Organization has considered the ideal rate for Caesarean sections to be between 10 and 15%.
The PIPS data suggests, in some states, C-sections could be taking place when not medically necessary.
“It makes me worry that this is being done for financial and administrative expediency without the consideration for the health of the mother and baby,” Betram says.
Angelique: Under Anaesthesia For A C-Section But Still Shackled
“I didn’t know I was pregnant when I first arrived,” Angelique Evans, now 35, tells The News Station of her time in jail and prison, starting in 2009, for the transport and sale of drugs. “When you go in, they put you through a medical process and part of the process is urinating to make sure you aren’t pregnant.”
The guards called her over and informed her she was carrying a child. Angelique worked out she probably would have conceived her child about six weeks prior.
As Angelique’s due date drew near, she started experiencing unusual pains and was transferred out to the hospital in case she was laboring.
“They put chains around my waist, my hands and my ankles to transport me. I felt like this was slavery. I felt like my ancestors felt — chained and enslaved.” At the hospital, she was told for the first time the baby was in the breech position and she would need a C-section.
Even as the doctors cut Angelique open under anesthesia, her hands and feet were handcuffed, loosened only slightly by a rookie guard.
“The three days after he was born was heaven on Earth,” Angelique says. “I totally forgot I was incarcerated.”
She was still shackled as she cuddled her newborn baby, J’mari Angel.
Just a week after her C-section, Angelique was put back to work in the kitchen at the prison against general recommendations not to lift anything heavier than a baby for a few weeks following a Caesarean section. Her pain and trauma led to her use of drugs and alcohol, obtained within the prison, to cope.
“I just wanted to get numb,” she says.
When she was granted parole in 2018, after nearly nine years inside, Angelique got to see her son for the first time since he had been born.
“My mom had a conviction from years earlier that denied her the ability to bring my kids for visits,” Angelique says.
“This is modern-day slavery,” says Angelique. “It’s a system that is punitive and perpetuates harm to incarcerated women and their families. We are still human. We are still mothers.”
What Can (And Is) Being Done for Pregnant Prisoners
“What we need is a mandatory set of healthcare standards, and a system of oversight institutions of incarceration have to follow,” Carolyn Sufrin, medical anthropologist and author of the book Jailcare, tells The News Station. “They have to include reproductive health care and pregnancy and postpartum care. Not standardizing care and not having accountability or oversight means that people are not getting pregnancy care that they are constitutionally required to receive.” These rights were established with the 1976 Supreme Court Case Estelle v. Gamble, entitling people in prison to healthcare.
If systems continue as they are, though, pregnant women and their babies will continue to bear the harms of inadequate care.
“Pregnant women who are incarcerated will continue to be traumatized by hospital and carceral systems,” Sufrin says. “There are high rates of substance abuse disorder and untreated mental illness in this population of women — we risk not getting them treatment they need. There may be short- and long-term impacts on pregnancy and other outcomes, and outcomes of the infants as well.”
Sufrin points to Minnesota as an example of how states can find alternatives to the incarceration of pregnant women.
In May, Minnesota Gov. Tim Walz, a Democrat, signed the Minnesota Department of Corrections Healthy Start Act into law. The Healthy Start Act allows the Commissioner of Corrections to offer alternatives to prison for pregnant women in the criminal justice system. Women who are pregnant or immediately postpartum in Minnesota can now be placed in halfway houses, be supervised in accordance with current statute and provided with treatment and programming in the placement location for the duration of their pregnancy and up to a year post-birth.
“They are paving the way in figuring out what it will look like for women to have access to care in the community so that they do not have to give birth or parent their children in custody or in chains,” Sufrin says. “I think that’s the direction we should be moving in.”
Autumn: How Reforms Can Play Out in Practice
Autumn Mason didn’t know in April 2014 — the time of the car crash that would soon send her to prison — that she was pregnant with her third child.
“I was sentenced with criminal vehicular homicide and sentenced to 32 months in prison,” Autumn tells The News Station.
She began serving her sentence at Shakopee Prison in Minnesota when she was seven months pregnant.
Autumn soon realized the women who surrounded her “were just other women” and appreciated their compassionate concern about Autumn and the baby.
But while her fellow inmates put Autumn at ease, the lack of medical care concerned her. “I made requests for medical attention just to be precautious. But I didn’t have any medical screening for five weeks after entering the prison.
“When they finally brought me in, they did my vitals and I was seen by the doctors, but I realized that the doctor had the wrong person’s chart,” she says. “After that, I didn’t receive any treatment at all in the prison.”
When Autumn passed the 36-week mark, she was — as a result of some reforms Minnesota had already put into place — able to see a doctor in a community clinic.
“I was so happy to get full medical treatments, but it was very degrading to walk through the clinic, handcuffed and with guards,” Autumn says.
Autumn’s contractions began in the prison and, to prepare to transport her to the hospital, she was strip searched and handcuffed.
With the support of the Minnesota Prison Doula Project, Autumn gave birth to Reality Mason on June 15, 2014.
“I had my daughter only 15 days after the Minnesota State Legislature stopped the shackling of women giving birth,” she recounts. “ For 36 hours, I experienced being a mom to a beautiful baby – I wanted every moment I could with her. But it was short lived.”
After Reality was handed off to Autumn’s mom, handcuffs were put back on and her nightmare began again.
“I didn’t know the next time I would see or touch her,” Autumn says.
Shakopee Prison became overpopulated, and Autumn was transferred to a county jail nearly four hours away from her 10-month-old baby and two other children. “I ultimately spent the duration of my incarceration without having any physical contact with my kids.”