Doula for Justice
Alumna works to support incarcerated women through childbirth
Inside a small cell in San Francisco’s County Jail, a pregnant woman awaits her first meeting with Darcy Stanley — co-founder of a program called Birth Justice Project, which provides labor support for incarcerated women.
The mom-to-be is more than 30 weeks pregnant and being kept away from other prisoners in what’s called “administrative segregation,” where Stanley (B.S. ’14, Nursing) explains women might be put for any number of reasons, ranging from fighting, to possession of contraband, to those who need medical attention for physical conditions or mental illness.
When Stanley enters the anterior chamber of the cell, she’s already nervous about working with her new “client” (the doulas eschew terms they feel are dehumanizing such as “inmate” and “prisoner”), who she says does not yet have reason to trust or like her. She will have to do her best to go over breathing techniques for labor through a small metal grate in the thick glass wall that separates them.
“It takes a lot more time and gentleness around building trust because of the dynamic of a free person coming in to talk to a locked up person,” Stanley says. “They have so many people coming in and out of their lives, so many social workers and probation officers, and some don’t come back when they say they will. [A pregnant woman] meeting a doula for the first time and deciding to let them into one of their most intimate life experiences and trusting them is incredibly courageous.”
Under normal circumstances, Stanley, a seasoned doula who began her work as a volunteer at San Francisco General Hospital in 2010, would meet a client at least a few times before labor to discuss myriad pre-childbirth concerns: how long to stay at home before going to the hospital, who the mom wants in the delivery room, whether or not she wants an epidural, and to practice pain management tactics such as relaxation, breathing and body positioning.
But in jail, women have few choices. Contact with outsiders is limited or prohibited altogether, and how many times — and for how long — Stanley can work with a pregnant woman is largely unknown.
To help today’s client, who reports back soreness from sleeping on a cement block topped with a thin foam mattress (Stanley says pillows aren’t allowed for reported safety and security reasons), she must do whatever she can to care for this woman through an envelope-size hole in a wall.
“There’s still the same component of what to expect in labor and how we can cope with it, but the story is very different for incarcerated women,” she explains. “It’s more about prepping them [with information such as] ‘If your water breaks and you start having contractions, put your paperwork in your bra so it doesn’t fall out.’ Because if they don’t have notarized paperwork that’s been approved by Child Protective Services saying where their baby is supposed to go, if they leave those papers in their jail cell, the baby will automatically be put in foster care. It’s a lot of coaching about things like that — how to get their needs met, and reminding them of their rights, such as pregnant women are not allowed to be shackled at any time. But the deputies can disregard that if they feel there’s a safety concern or flight-risk.”
Stanley has been providing these services to incarcerated women since 2011, when she and some fellow doulas were inspired to spearhead Birth Justice Project. She was attending what she thought would be her last volunteer meeting at San Francisco General Hospital (she planned to quit to focus on the fall quarter at Cal State East Bay) when an obstetrician-gynecologist who provided prenatal care within the county jail gave a presentation on pregnant incarcerated women, and the neglect and void in health care for them.
“My time at Cal State East Bay not only prepared me to be a nurse, but the nurse’s role in advocating for individual patients as well as the health of our communities,” Stanley says. “We had to do something. So I raised my hand and offered to put together a meeting.”
Cal State East Bay Professor of Nursing Lindsay McCrea, who maintains close ties with Stanley, says her initiative is no surprise.
“She’s one of those stars that we will see great things from. I think we had very little to do with her path — she brought that with her here, especially that commitment to social justice. That’s always been a core principal of our program, but she informed our perspective. She’s a great champion and advocate for the health of women and children in disenfranchised and vulnerable populations, including women in jail.”
It’s a demographic that continues to grow — and one with no shortage of need.
According to the U.S. Justice Department Bureau of Justice Statistics, 5-6 percent of female inmates are pregnant at the time of admission to jail or prison. At the end of 2015, the Bureau reported that the total number of females incarcerated in the U.S. was 111,495, approximating to more than 6,000 pregnant women — and that black women are incarcerated at twice the rate of whites.
Which led Stanley (who was awarded Cal State East Bay’s Alma M. Gessman Memorial Scholarship in Nursing for her community work) and her co-founders to start thinking about the services they were providing in the jail more broadly. In addition to providing doula services to individuals, Birth Justice Project began offering weekly group sessions on women’s health topics to all incarcerated females in the San Francisco County jail.
In 2013, Birth Justice Project, in collaboration with UCSF, applied for — and won — a grant from the Alameda County Public Health Department for $194,000. And with it, the doulas committed to expanding their program in San Francisco at Santa Rita Jail in Dublin, and to creating an outside training program for those who want to become doulas in their communities. To accomplish the aims of the grant funding, Birth Justice Project quickly connected with the advocacy group Black Women Birthing Justice, which aims to transform birthing experiences for women of color.
“People trust and prefer being treated by someone who looks more like them,” Stanley says. “It’s about creating a system that supports culturally appropriate care, including a way to destigmatize women who have been formerly incarcerated by giving them meaningful, empowering work. It’s so easy as a volunteer to see a problem and show up and think you know the answer without including the voice of the people you hope to help in that plan. We have to start with the community at the center [of the issue] and let the answers emerge from those most affected.”
It’s a strategy that’s given Birth Justice Project a new type of momentum. By partnering with Black Women Birthing Justice, the doula training program Stanley and her cofounders implemented has been so successful, it has spawned a collective of its own — Roots of Labor in the East Bay. Now, together, doulas from Roots of Labor are servicing the Santa Rita Jail along with those from Birth Justice Project, while Stanley and her partners pursue master’s degrees to transition from doula work to nurse-midwifery.
“People on the outside, most of them have somebody going to the birth with them,” Stanley says. “And people in jail don’t have that all — they don’t even have access to that. Giving these [women] the opportunity to have love and compassion and someone who’s there just for them, that’s what we want to provide. Birth is such a human experience. Having to go through it alone takes away some of that humanity.”
What’s A Doula?
By Professor Roberta Durham, RN
Rooted in the idea that women have historically always cared for other women during labor, doulas are non-medical laypersons who provide emotional support and physical comfort to women primarily during childbirth, but also before and after the arrival of a baby. Doulas are unique in that they are professionally trained to promote comfort, instill confidence to and advocate for laboring women — all of which promote success during childbirth.
Doulas can receive training and certification through many organizations, but do not perform clinical tasks and do not have direct communication responsibility to a woman’s care provider. (Midwives, by comparison, are licensed professionals that provide obstetric prenatal care and deliver babies at birthing centers, hospitals or in private homes.) Importantly, studies have shown that women who have continuous support during labor reap many benefits, including shorter labor, reduced use of analgesics and anesthetics, decreased cesarean rates and improved Apgar scores (a shorthand reporting system for the status of an infant at birth).