Legal Services for Prisoners with Children

1540 Market Street, Suite 490

San Francisco, CA 94102
(p): 415-255-7036; (f): 415-552-3150
info@prisonerswithchildren.org
www.prisonerswithchildren.org

PREGNANT WOMEN IN CALIFORNIA

PRISONS AND JAILS:
A Guide for Prisoners and Legal Advocates
Third Edition, 2006
 Legal Services for Prisoners with Children
1540 Market Street, Suite 490
San Francisco, CA 94102
(p) 415-255-7036; (f) 415-552-3150
www.prisonerswithchildren.org
info@prisonerswithchildren.org

PREGNANT WOMEN IN CALIFORNIA

PRISONS AND JAILS:

A Guide for Prisoners and Legal Advocates

Third Edition, 2006
This manual is intended for use by prisoners, attorneys, and legal workers. This edition is
an updated and expanded version of the second edition that was published in 1993.
Contributors and co-authors of the earlier edition include: Ellen M. Barry, Vicki
Cormack, Harriette Davis, Monica Freeman-Brennan, Carrie Kojomoto, Kirby Randolph,
Keriena Yee, and Linda Yu.

This edition contains some general information on pregnancy that may not be specifically
relevant to an incarcerated woman’s experience. However, we decided to include it so
that women would have access to information not readily available in prison or jail.

Our sincere appreciation goes out to the following people who assisted with this third
edition:

Research: Andras Farkas, Legal Intern, University of Michigan School of Law

Nora Searle, Student Volunteer, Berkeley High School
Review: Harriette Davis, RN
Rachel Felix, Center for Young Women’s Development
Sophia Sanchez, Center for Young Women’s Development

DISCLAIMER
The information in this manual is not intended to be, and should not be used as, a
substitute for the advice of an attorney or a medical professional.

Co-editors: Cassie M. Pierson, staff attorney, and

Karen Shain, co-director
Legal Services for Prisoners with Children

The publication and distribution of this manual have been made possible by funding from
the State Bar of California Legal Trust Fund.
 Table of Contents

Introduction 1

General Information on Being Pregnant and Incarcerated

What are my rights as a pregnant woman at reception? 2
Do pregnant women get special housing considerations? 2
What if I am pregnant and on the methadone program? 2
What are my medical rights as a pregnant prisoner while
I am in prison? 2
Does the prison have to provide me with a special diet? 3
What if a pregnant prisoner must be disciplined/physically
restrained? 3
Can a pregnant prisoner be put in Administrative Segregation? 3
What other services must the prison provide? 3
What will happen when I go into labor? 4
May I have visitors while I’m at the outside hospital? 4
What rights do I have for special medical care after I give birth? 4

Conditions and Diseases That Can Affect Your Pregnancy

Postpartum Blues 5
Postpartum Depression 5
Sickle Cell Anemia 6
Diabetes 8
Chickenpox (Varicella) 12
Flu 13
Group B streptococcus 14
Listeriosis/Salmonellosis 14
Rubella (German Measles) 15
Toxoplasmosis 16
HIV and Pregnancy 16

Sexually Transmitted Infections/Diseases (STDs) During Pregnancy

Bacterial STDs—Infections that are curable (chart) 18
Viral STDs—Infections that are not curable (chart) 19
Definitions of STDs 20
What can I do to prevent STDs? 21

Abortion
Can I legally obtain an abortion while I am incarcerated? 22
If I am a juvenile can I obtain an abortion? 22
How do I arrange for an abortion? 22
What are the different types of abortions? 23
Nutrition and Pregnancy
Fruits and vegetables 24
Whole-grains or enriched breads/cereals 24
Dairy products 25
Proteins 25
Should I limit how much fish I eat when I’m pregnant? 25
What other nutrients do I need for a health pregnancy? 26

Drugs and Pregnancy

Cocaine, Crack, Speed & Methamphetamine 27
Heroin & other Narcotics 27
Inhalants 27
PCP 28
Marijuana 28
What will happen if I tell my doctor about my drug use during my
pregnancy? 28
Can I face legal penalties for using illegal drugs during my pregnancy? 28
What happens if my baby is made a dependent of the court? 29

Frequently Asked Pregnancy Questions

What are the first symptoms of pregnancy? 30
How is the baby’s due date calculated? 30
How does a woman know if she has an ectopic or tubal pregnancy? 30
When should a woman have her first prenatal visit? After the first visit,
how often should a woman see her doctor? 30
When should a woman have her first ultrasound? 31
What are the signs of a miscarriage? 31
Is cramping during pregnancy normal? 32
Why do I feel more tired than usual? 32
Should all women have a test for Tay-Sachs disease? 32
What are the safest treatments for nausea and vomiting in early
pregnancy? 33
How much alcohol is safe to consume during pregnancy? 33
What should I do if I cannot stop drinking alcohol? 34
How much caffeine is safe in pregnancy? 34
What are the effects of smoking on pregnancy? 34
Can women safely dye their hair during pregnancy? 34
Can pregnant women safely take medications during pregnancy? 34
Why does a woman’s posture change during of pregnancy? 35
When is fetal movement usually felt? 36
What tests can be performed to detect preterm (early) labor? 36
At what stage of pregnancy are babies considered viable (able to
Survive? 36
What special risks are associated with a multiple pregnancy? 36
Why do women undergo skin pigmentation changes during pregnancy? 37
Why is acne increased during pregnancy? 37
 Will changes in headache patterns occur during pregnancy? 37
Is feeling the heart racing a common occurrence during pregnancy? 37
What are the common respiratory system changes during pregnancy? 37
Is gallbladder disease more common during pregnancy? 37
What hair changes are common during pregnancy? 38
What is Rh disease? Why is a pregnant woman’s blood type
important? 38
How much does the uterus grow during pregnancy? 38
Why do women get varicose veins during pregnancy? 38
Why are my breasts larger and more tender than usual? 39
Is it normal to secrete milk from the breast prior to delivery? 39
Can I breast-feed my baby while I’m incarcerated? 39
Why is a baby born in the breech position? Can this pose a problem? 39
How often is a woman put on the fetal monitor during labor? 40
Why do I have to urinate so often? 40
Are urinary tract infections (UTIs) more common during pregnancy? 40
Are yeast infections more common during pregnancy? 40
Is heartburn more common during pregnancy? 40
Constipation has recently become a problem. What can I do about it? 41
How can stretch marks be prevented? 41
Should newborn boys be circumcised? 41
When will the uterus return to normal size? 41
What is the purpose of folic acid supplementation during pregnancy? 41
What vaccinations are necessary prior to pregnancy? 42
What vaccinations are safe during pregnancy? 42

Alternatives to Incarceration
California Prisoner Mother Program 43
Family Foundations Program 44
CPMP and FFP Programs (locations) 45

California Penal Code sections 3419, 3423, 3424, and 6030 Appendix 1

Welfare and Institutions Code section 222 Appendix 2

The Pregnant Patient’s Bill of Rights/Summary of the Pregnant

Patient’s Bill of Rights Appendix 3
 INTRODUCTION
Recent estimates indicate that eight to ten percent of women who enter prison are
pregnant. Not until the past 10 years has much attention been given to the specific
needs of pregnant women in prison. Prisons are still far from providing adequate health
care to pregnant prisoners. The major problems are access to health care, the
completeness of care and the care providers= sensitivity to the emotional needs of the
prisoners. Other problems include lack of childbirth preparation classes and an
increased rate of cesarean delivery. One of the major problems that is specific to
prisons is a lack of adequate dental care. Studies have shown that gum disease may
lead to pre-term delivery and low birth rate. The California Department of Corrections
and Rehabilitation (CDCR) as a result of a lawsuit, Plata v. Schwarzenegger, recently
adopted policies specifically relating to the care of pregnant prisoners and although the
dental care of prisoners was not included in the Plata lawsuit, legislation in 2005, did
address the issue of dental care and pregnant prisoners in adult and juvenile facilities.

If you are an expectant mother in prison or jail, you may be anxious and concerned
about having a healthy and comfortable pregnancy. You may also find it difficult to
make plans for your baby=s future while you are incarcerated. If you are an advocate for
pregnant women in jails and prisons, you may also have many questions about how to
obtain the best quality medical care for your pregnant clients.

This booklet is intended to address some of these legal and practical concerns and to
help you become better prepared and informed about your pregnancy. You must be all
the more vigilant and assertive about taking care of yourself when you are pregnant and
incarcerated. This manual is not intended to take the place of your doctor or lawyer. It
is important that you contact your physician for medical advice and your lawyer for legal
advice. We hope that you will find this booklet useful, and that it will enable you to have
a healthy baby in spite of your incarceration.

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 GENERAL INFORMATION ON BEING PREGNANT AND
INCARCERATED
(All information in this section can be found in Chapter 24, Vol. 4, AInmate Medical
Services Policies and Procedures,@ California Department of Corrections, June 2003).

Due to a major lawsuit settled in 2001, Plata v. Schwarzenegger, the California

Department of Corrections and Rehabilitation (CDCR) has been forced to adopt policies
concerning pregnant women prisoners. In addition, recent legislation (AB 478)
addressed the issues of shackling and dental care as they apply to pregnant prisoners.
AB 478 was signed into law by the governor and is now codified under Penal Code
sections 3419, 3423, 3424, 6030, and Welfare and Institutions Code section 222. It is
important to know and exercise your rights for the health of you and your baby.

What are my rights as a pregnant woman at reception?

After an initial health screening by a Registered Nurse (RN) and a Medical Technical
Assistant (MTA) the medical staff must notify the Obstetrical Coordinator (pregnancy
doctor) of your pregnancy. If you have any possible medical conditions that might place
your pregnancy at a high-risk status then the Supervising Obstetrician (OB) must be
notified. You must also be provided with a priority ducat to be seen by an OB Physician
or an OB Nurse Practitioner within seven business days. You will also be ducated to
the Reception Center for laboratory work to verify your pregnancy within three working
days.

Do pregnant women get special housing considerations?

You must be issued a chrono for a lower bunk and housing on the first floor unless the
OB places you in the Outpatient Housing Unit (OHU) or Correctional Treatment Center
(CTC).

What if I am pregnant and on the methadone program?

The CDCR is required to provide methadone treatment to all pregnant prisoners who
have been on heroin or who are currently receiving methadone treatment. If you are
pregnant and on methadone maintenance you will be recommended for immediate
transfer to the California Institution for Women (CIW) in Corona. While awaiting transfer
the OB Physician or the Physician on Call (POC) after hours will admit you to the OHU
or CTC, where you will stay until the transfer process is complete.

What are my medical rights as a pregnant prisoner while I am in prison?

You must be seen for a thorough medical examination within seven business days by
an OB. The doctor should go over your medical history, your family medical history as
well as the father=s medical history. The doctor may then order certain tests to
determine your health and the health of the baby. You should also be issued a chrono
for any medical clearances or restrictions.

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After the first visit the OB (unless otherwise indicated by the Supervising OB) must
schedule you for visits:
Every 4 weeks in the first trimester and up to 24-26 weeks into your pregnancy.
Every 3 weeks up to the 30th week into your pregnancy
Every 2 weeks between the 30th and 36th weeks.
Every week after the 36th week and up to delivery.

You are also entitled to see a dentist on a priority basis. Seeing a dentist is very
important because certain studies have shown that gum disease can lead to lower birth
weight for your baby or premature delivery. You should have your teeth cleaned at
least once during your pregnancy.

If you go for treatment to an outside facility the prison must ensure that copies of all
your health records including prenatal forms are sent with you.

Does the prison have to provide me with a special diet?

You are entitled to receive prenatal vitamins, iron and folic acid. If the institution for any
reason does not provide three meals a day then you are entitled to an extra carton of
milk and an extra snack each day.

What if a pregnant prisoner must be disciplined/physically restrained?

Health care staff must only use physical restraint if you pose a threat to the physical
safety of yourself or others (including the fetus), threat of substantial damage to state
property, or attempted escape. When the state does physically restrain a pregnant
prisoner special efforts must be taken to avoid harm to the fetus. Handcuffs must only
be applied with your hands in front of your body. When you are being transported for
medical care the only restraint that can be used are handcuffs to the front of your body.

Can a pregnant prisoner be put in Administrative Segregation?

Pregnant prisoners who commit a serious disciplinary offense will be placed in
Administrative Segregation (Ad-Seg) pending medical evaluation and Administrative
Review. When escorting you to Ad Seg the only restraint that may be used is handcuffs
to the front of your body. The Physician or RN will perform a medical evaluation within
24 hours to see if you are suitable for Ad Seg. Even when you are in Ad Seg you
should still be housed on the first floor on a lower bunk. The case will be referred to the
Institutional Classification Committee (ICC) if you are to be held in Ad Seg beyond ten
(10) days. You must still receive the same medical and prenatal care in Ad Seg as you
would if you were living in a regular housing unit.

What other services must the prison provide?

You will be required to undergo HIV counseling. The prison will also provide you with
pregnancy information pamphlets. In addition, the CDCR is required to provide you with
information on terminating your pregnancy but you must ask for it (see section on
Abortion, page 22).

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You will also be referred to a medical Social Worker for Case Management to discuss
the options available for placement and care of your child after delivery. The social
worker must provide you with access to a phone to contact your relatives regarding the
placement of your newborn.

What will happen when I go into labor?

When you go into labor it will be treated as an emergency and you will be transported to
a local hospital in an ambulance. The Supervising Obstetrician, Physician or RN should
immediately be notified so they can provide you with the appropriate assistance.
Custody staff will accompany you in the ambulance to the hospital. It is the
responsibility of the RN to ensure that all copies of your prenatal forms accompany you
to the hospital. Emergency medical transports should be allowed to depart institutional
grounds before, during, or after any institution count.

You should not be shackled when being transported to the hospital, during labor, during
delivery, or during recovery at the hospital. This means that you should not be
handcuffed or restrained in any manner—in front of your body or to the bed at the wrist
or ankle. (This applies to pregnant prisoners in state prison, county jails and juvenile
detention; see Appendices 1 and 2).

May I have visitors while I=m at the outside hospital?

Appointed guardians of your baby and others who wish to visit you at the hospital, must
comply with Title 15 visiting regulations. They must also notify and obtain the approval
of the Watch Commander. Because it may take weeks for a person to be approved to
visit you while you are incarcerated, you should begin the visitor’s application process
as soon as possible after arriving at the prison, jail or juvenile facility.

What rights do I have for special medical care after I give birth?
If you delivered the baby via C-section you must be admitted to OHU or CTC. Any
prisoner who delivered vaginally will be assessed in the Emergency Treatment Area
(ETA) to determine housing and to initiate post-partum (after-birth) care. The
Supervising Obstetrician or the RNNP (OB nurse practitioner) will determine when you
are ready for housing in the yard. A ducat will be issued for your 6-week post-partum
checkup. At your 6-week checkup the OB or the RN will decide whether you can be
cleared for full duty or further medical restrictions are warranted.

If your release date or parole date falls within six to eight weeks after you deliver your
baby, you are to be given family planning services.

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CONDITIONS AND DISEASES THAT CAN AFFECT YOUR PREGNANCY
(General information in this section was taken from the March of Dimes web site
www.MarchofDimes.com)

The Postpartum Blues

After the baby is born, many new mothers have the Apostpartum blues@ or the "baby
blues." You may feel more irritable, you may cry more easily, or you may feel sad or
confused.

The postpartum blues peak three to five days after delivery. They usually end by the
tenth day after the baby=s birth. Although the postpartum blues are not pleasant, you can
function normally. The feeling of the "blues" usually lessens and goes away over time.

Medical experts believe that changes in the woman=s hormones after delivery cause the
postpartum blues. The fact that you are incarcerated and separated from your baby may
also add to your feelings of sadness.

There are things you can do to help relieve the "postpartum blues": Talk to a friend or
someone you trust about how you feel. Try to get as much rest as possible.

If your symptoms last for longer than two weeks or worsen, you may have postpartum
depression, which is a serious medical condition.

Postpartum Depression
About one out of every eight women has postpartum depression after delivery. It is the
most common complication among women who have just had a baby.
Postpartum depression is a serious medical condition. It is not something you can
control. It is not a sign of being a bad mother. It may pose a risk for the woman and her
baby. The most important things to do are:
Recognize the signs of postpartum depression (see below)
Reach out and get help because a range of treatments is available
Medical experts believe that changes in the woman=s hormones after delivery cause
postpartum depression. Postpartum depression is not the same as the “postpartum
blues.” (See above)

What Is Postpartum Depression?

A woman who has postpartum depression feels sad, "down" or depressed. She also has
five or more of the following symptoms lasting two weeks or longer:
Trouble sleeping
Lack of interest

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 Feelings of guilt
Loss of energy
Difficulty concentrating
Changes in appetite
Restlessness or slowed movement
Thoughts or ideas about suicide

Postpartum depression can begin at any time within the first three months after delivery.
If you have any of the symptoms listed above, talk to your doctor. If necessary, your
doctor can refer you to a mental health professional.

Treatments
Postpartum depression can be treated in several ways. Support groups may help. Some
women go to therapy or counseling with a mental health professional. Your doctor may
prescribe antidepressant medication.

The most commonly used antidepressants for postpartum depression come from a
group of drugs called selective serotonin reuptake inhibitors (SSRIs). Here are the
names of some of those drugs:
Zoloft (sertraline)
Paxil (paroxetine)
Celexa (citalopram)
Prozac (fluoxetine)

Like many drugs, antidepressants can have side effects. Women differ in the type and
seriousness of the side effects that they have. Because no drug is proven to be entirely
safe, a woman and her health care team must look at her case and weigh the risks and
benefits of various drugs.

Sickle Cell Anemia and Pregnancy

Sickle cell anemia is a genetic, chronic (persists over a long period of time) form of
anemia. Due to an abnormal type of hemoglobin, the red blood cells are sickle or
crescent-shaped. Hemoglobin is the protein in the red blood cells. Its function is to
carry oxygen from the lungs to the tissues. When the blood cells are deformed, they do
not flow normally and may clog the blood vessels. The sickle shaped cells also break
down more easily, causing anemia.

Sickle cell anemia occurs most commonly among people of African descent and people
from the Mediterranean. About one out of every 500 African Americans has sickle-cell
anemia.

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 What are the symptoms?
If you have sickle-cell anemia you will feel very weak and tired, and may experience
fainting or breathlessness. You may also have sickle cell crises, which are marked by
acute pain in the abdomen and bones. If you or your partner has sickle cell anemia
make sure that the medical staff at the prison or jail knows your medical history. The
doctor will probably analyze a sample of your blood to confirm that you have sickle-cell
anemia.

Can a woman with sickle cell disease have a safe pregnancy?

Yes. However, women with sickle cell disease are at increased risk of complications that
can affect their health and that of their babies. During pregnancy, the disease may
become more severe and pain episodes may occur more frequently. A pregnant woman
with sickle cell disease is at increased risk of preterm (early) labor and of having a low
birth weight baby. However, with early prenatal care and careful monitoring throughout
the pregnancy, women with sickle cell disease can have a healthy pregnancy and deliver
a healthy baby.

What are the risks that my child will get sickle cell anemia?
There is a 50 percent chance that a child born to parents who both carry a sickle cell
gene will have the trait. There is a 25 percent chance that the child will have sickle cell
disease if only one of the parents carries the trait. There also is a 25 percent chance that
the child will have neither the trait nor the disease. These chances are the same in each
pregnancy.

Is there a test for sickle cell disease or trait?

Yes. You can have a blood test to find out if you have either the sickle cell trait or a form
of the disease. There also are prenatal tests to find out if the baby will have the disease
or carry the trait.

Is there a cure for sickle cell disease?

A small number of children with severe sickle cell disease have been cured through a
blood stem cell transplant. The stem cells (immature cells that develop into blood cells)
come from bone marrow, or less frequently from umbilical cord blood, usually donated by
siblings who are a good genetic match. Most children with sickle cell disease, however,
do not have siblings who are good genetic matches. For this reason, researchers have
recently begun performing stem cell transplants using umbilical cord blood from
unrelated donors with apparent success.1

1
Vichinsky, E. New Therapies in Sickle Cell Disease. The Lancet, volume 360, number
9333, August 24, 2002, pages 629-631.

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About 150 children worldwide with sickle cell disease have had blood stem cell
transplants, and about 85 percent of them appear to be cured of the disease.2 However,
this approach carries a high risk: about 5 percent of children who underwent bone
marrow transplants died. The transplant did not cure the disease in another 10 percent.3
Gene therapy may someday offer a cure with less risk.

Diabetes in Pregnancy
Diabetes is a disorder in which the levels of sugar in the blood are too high. This occurs
because the body doesn’t produce enough insulin or can=t use insulin properly. Insulin is
a hormone made by the pancreas that lets the body turn blood sugar into energy or store
it as fat. In untreated diabetes, high blood sugar levels can damage organs, including
blood vessels, nerves, eyes and kidneys. Some people with diabetes need daily insulin
injections to prevent these complications. About 1 woman in 200 of childbearing age has
diabetes before pregnancy (preexisting diabetes). Another 2 to 5 percent develop
diabetes during pregnancy (gestational diabetes). Today, most of these women can
look forward to having a healthy baby. While diabetes poses some risks in pregnancy,
advances in care have greatly improved the outlook for these pregnancies.

What risks does diabetes pose to the baby?

Women with poorly controlled preexisting diabetes in the early weeks of pregnancy are
three to four times more likely than non-diabetic women to have a baby with a serious
birth defect, such as a heart defect or neural tube defect (NTD; a birth defect of the brain
or spinal cord). They also are at increased risk of miscarriage and stillbirth.
Women with gestational diabetes, which generally develops later in pregnancy, usually
do not have an increased risk of having a baby with a birth defect. However, some of
these women may have had unrecognized diabetes that began prior to pregnancy. They
may have had high blood sugar in the early weeks of pregnancy, which increases the
risk of birth defects. Poorly controlled gestational diabetes also increases the risk of
stillbirth. However, with improvements in medical care, stillbirth is rare.

2
National Institutes of Health. Hematopoietic Cell Transplantation, in Management of
Sickle Cell Disease. NIH Publication Number 022117, revised May 28, 2002, accessed 04/19/04.
3
Id.

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Women with poorly controlled diabetes (gestational or preexisting) are at increased risk
of having a very large baby (10 pounds or more). Macrosomia is the medical term for
this. These babies grow so large because some of the extra sugar in the mother=s blood
crosses the placenta and goes to the fetus. The fetus then produces extra insulin, which
helps it process the sugar and store it as fat. The fat tends to accumulate around the
shoulders and trunk, sometimes making these babies difficult to deliver vaginally and
putting them at risk for injuries during delivery. During the newborn period, babies of
women with poorly controlled diabetes are at increased risk of breathing difficulties, low
blood sugar levels and jaundice. These problems can be treated, but it=s better to
prevent them by controlling blood sugar levels during pregnancy. Babies of women with
poorly controlled diabetes also may be at increased risk of developing obesity and
diabetes as young adults.

Does diabetes cause other pregnancy complications?

With advances in medical care, women with diabetes are almost as likely as women
without diabetes to have an uncomplicated pregnancy and a healthy baby, as long as
blood sugar levels are well controlled beginning before pregnancy. However, women
with poorly controlled diabetes, especially preexisting diabetes, are at increased risk of
certain pregnancy complications. These include miscarriage, pregnancy-related high
blood pressure, polyhydramnios (an excess of amniotic fluid, which can contribute to
preterm labor), preterm delivery, and stillbirth.

What tests are recommended to detect complications?

The doctor will carefully track the size and well being of the fetus, especially during the
third trimester of pregnancy. He or she may recommend one or more ultrasound
examinations to assure that the fetus is growing at a normal rate. If the baby reaches a
weight of 9 pounds, 14 ounces or more, the doctor will likely recommend a cesarean
delivery at term. The doctor also may recommend a nonstress test (which may be
repeated weekly or more frequently), a procedure that monitors the baby=s heart rate. In
most cases, these tests will show that the pregnancy is progressing normally. Although
women with diabetes are at increased risk of cesarean delivery, most have normal
vaginal deliveries.

Why is pre-pregnancy care crucial for women with diabetes?

Women with diabetes should consult their doctors before pregnancy to ensure that their
blood sugar levels are well controlled. This is important because the most serious birth
defects associated with diabetes originate in the early weeks of pregnancy, before a
woman may realize she is pregnant.

Studies have shown that blood sugar control begun before pregnancy largely eliminates
the extra risk of birth defects for women with diabetes requiring insulin. Studies also
show that excellent blood sugar control before and during pregnancy reduces the risk of
miscarriage, stillbirth, macrosomia and complications in the newborn period.

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When a woman with diabetes plans to conceive, doctors often recommend a blood test
that measures glycosylated hemoglobin (a substance formed when glucose in the blood
attaches to the hemoglobin protein in red blood cells) every one to two months. This test
shows how well blood sugar has been controlled during the past two to three months. It
can help determine when it is safest to try to conceive. The test also may be used to
monitor blood sugar control during pregnancy.

All women should take a multivitamin containing 400 micrograms of the B vitamin folic
acid, as part of a healthy diet, starting at least one month before pregnancy, to help
prevent neural tube defects (NTDs). Women with preexisting diabetes are at increased
risk of having a baby with an NTD, so taking folic acid may be especially important for
them. A recent study found that taking a daily multivitamin supplement before and during
early pregnancy appeared to reduce the risk of birth defects in babies of women with
preexisting diabetes. At a preconception visit, women with diabetes should ask their
doctors whether they should take a daily dose of folic acid greater than 400 micrograms.
While there are no studies on the use of larger doses of folic acid to prevent NTDs in
women with preexisting diabetes, daily doses of 4,000 micrograms have proven
successful in reducing the risk of having another baby with an NTD in women who
already have had an affected baby.

Women with preexisting diabetes who take medications to control their blood sugar
levels will probably need to switch to insulin before conceiving and during pregnancy
because it is not known whether medications are safe during pregnancy, especially
during the early weeks.

What are the symptoms of gestational diabetes and how is it detected?

Gestational diabetes is one of the most common pregnancy complications. It usually
develops during the second half of pregnancy, when hormones or other factors interfere
with the body=s ability to use its insulin. Most women with gestational diabetes have no
symptoms. Blood sugar levels generally return to normal after delivery. Women at
increased risk of gestational diabetes include those who are over age 30, are obese,
have a family history of diabetes, or have had a very large (over 92 pounds) baby or a
stillborn baby. According to the Centers for Disease Control and Prevention (CDC),
gestational diabetes occurs more frequently in African-Americans, Hispanic/Latina
Americans, Pacific Islanders, South or East Asians and Native Americans.

Most pregnant women are screened for gestational diabetes between the 24th and 28th
week of pregnancy. Women who are considered at high risk (including women who have
had gestational diabetes in a previous pregnancy) often are screened at an early
prenatal visit and, if test results are normal, screened again at 24 to 28 weeks. According
to the American Diabetes Association (ADA), women under 25 years of age who have no
other risk factors for diabetes do not require screening because they have a very low risk
of having the disorder. The test involves taking a blood sample one hour after consuming
a drink of 50 grams of glucose (a form of sugar). Women with high blood levels of
glucose will take the similar, though longer, glucose tolerance test, which involves

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drawing blood samples while fasting and at one, two and three hours after drinking 100
grams of glucose. Once gestational diabetes is diagnosed, most women can control their
blood sugar levels with diet and exercise, but some women may need to take insulin to
control their blood-sugar level (BSL).

What diet is recommended for pregnant women with diabetes?

The number of calories a pregnant woman with diabetes should eat and the proportion of
foods from the various food groups (i.e., fat, carbohydrates, proteins, dairy, fruits and
vegetables) depends upon many factors, including weight, stage of pregnancy and
baby=s rate of growth. Ask the prison OB/GYN to recommend a special diet if you have
diabetes.

As a general rule, a pregnant woman with diabetes (gestational or preexisting) who is of

average weight should consume about 2,000 to 2,200 calories a day. This should help
her gain the recommended 25 to 35 pounds during pregnancy. Daily calories are usually
divided among three meals and about three snacks, including one at bedtime. The
doctor will most likely recommend a diet that includes: 10 to 20 percent of calories from
protein (meat, poultry, fish, legumes); about 30 percent from fats (with less than 10
percent from saturated fats); and the remainder from mainly complex carbohydrates
(whole-grain bread, cereal, pasta, rice, fruits and vegetables). Sweets should be
avoided. (For more information see Nutrition section, page 24)

Should a pregnant woman with diabetes exercise?

Exercise can help control diabetes by prompting the body to use insulin more efficiently
and is recommended for most women with gestational diabetes and some women with
preexisting diabetes. However, pregnant women with diabetes always should talk to their
doctors about exercising. Pregnant women with poorly controlled diabetes or certain
complications, such as high blood pressure or blood vessel damage (caused by
preexisting diabetes), should exercise only upon the advice of their health care provider.

Many women with preexisting diabetes require insulin injections to keep blood sugar
levels under control. Insulin requirements increase during pregnancy, generally rising
most rapidly between about 28 and 32 weeks of pregnancy. Some women with
preexisting insulin-dependent diabetes find that an insulin pumpCa beeper-sized device
that delivers insulin via a tiny plastic tube inserted through the skinChelps improve blood
sugar control.

Up to 40 percent of women with gestational diabetes require insulin treatment. Insulin is

recommended for the remainder of the pregnancy if blood sugar levels do not stabilize
after two weeks on a special diet. Soon, however, women may have the option of taking
a pill instead of injections. A recent study found that women with gestational diabetes
could be treated successfully with an oral diabetes medication called glyburide. This drug
does not cross the placenta. Women treated with the oral medication did not have more
pregnancy complications than women in the insulin-treated group. While additional
studies to confirm these results are needed, some doctors have begun to offer glyburide

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to women with gestational diabetes that can=t be controlled with diet. (Because the
women in the study received the drug after the first trimester, the study does not
demonstrate whether or not treatment is safe to use earlier in pregnancy.)

How can a pregnant woman monitor her diabetes?

Pregnant women with preexisting diabetes should monitor their blood sugar levels
several times a day. This is also advised for women with gestational diabetes controlled
by diet. They use a spring-loaded finger-stick device to obtain a small blood sample,
which is placed on a strip and inserted in a meter. This makes it easy to check blood
sugar levels and adjust insulin dosage between prenatal visits.

The doctor may suggest a urine test to measure levels of ketones, weak acids produced
when the pregnant woman is not consuming enough calories and her body burns fat
instead of blood sugar for energy. Moderate to large amounts of ketones in the urine can
also be a sign of poorly controlled diabetes and of ketoacidosis, a complication that,
unless promptly treated, can lead to death of the fetus.

Do women with diabetes require special care after delivery?

Some women with preexisting diabetes find that their blood sugar levels may be more
difficult to predict in the weeks after delivery. This is especially true if a woman is breast-
feeding. Women with preexisting diabetes should monitor their blood sugar levels
frequently, so that they and their doctors can adjust their insulin dose.

After delivery, blood sugar levels return to normal for most women with gestational
diabetes. The ADA recommends that women who had gestational diabetes have their
blood sugar level checked six to eight weeks after delivery to make sure sugar levels are
normal. Women who have had gestational diabetes have about a 40 to 50 percent
chance of developing diabetes in the future, so the ADA recommends a blood sugar
check every three years. These women can help reduce their risk by starting a weight
loss and exercise program after delivery. They also face about a 35 to 50 percent risk of
gestational diabetes in another pregnancy. Studies suggest that achieving a healthy
weight between pregnancies and after pregnancy also may reduce this risk.

Chickenpox (Varicella)
Chickenpox (varicella) is a viral illness that mainly affects children. Its symptoms include
an itchy rash and fever. Between 85 and 95 percent of pregnant women are immune to
chickenpox, meaning that they cannot catch it. About 1 woman in 2,000 will develop
chickenpox during pregnancy, however.

If a woman does catch chickenpox during pregnancy, there can be serious

consequences to the baby, depending on when in pregnancy the infection occurs. If
infection occurs in the first 20 weeks of pregnancy, there is a very small risk (less than 1

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percent) that the baby will be born with congenital varicella syndrome, a group of serious
birth defects.

If infection occurs around the time of delivery, the baby may be born with chickenpox
infection. If this infection is treated, most babies have only a mild illness. Without
treatment, up to 30 percent of infants die.

What you can do:

There is a blood test that can determine whether you are immune to chickenpox. If you
are not sure if you have had the disease, you can get this blood test before pregnancy or
early in pregnancy. Women who are not immune, and not yet pregnant, can get
vaccinated. (See the Frequently Asked Questions section, page 30).

Pregnant women who are not immune should avoid anyone with chickenpox and anyone
who has had contact with someone with the disease. An infected person is contagious
(can give the virus to someone else) before he or she develops the disease.

Contact the doctor right away if you are pregnant and have been exposed to chickenpox.

Flu and Pregnancy

Influenza (commonly called Athe flu@) is a contagious respiratory illness caused by
viruses. It can result in severe illness and life-threatening complications. Symptoms of flu
include fever (usually high), headache, extreme tiredness, dry cough, sore throat, runny
or stuffy nose, and muscle aches. Some people, especially children, also have nausea,
vomiting and diarrhea.

Influenza viruses are spread when a person who has the flu coughs, sneezes, or speaks.
The viruses spread into the air, and other people inhale them. Flu can also be spread
when a person touches a surface that has viruses on it (such as a door handle) and then
touches his or her nose or mouth.

Pregnancy can increase the risk for complications from the flu, such as pneumonia.
Pregnant women are more likely to be hospitalized from complications of the flu than
non-pregnant women of the same age. Pregnancy can change the immune system in the
mother, as well as affect her heart and lungs. These changes may place pregnant
women at increased risk for complications from the flu.

Preventing the Flu

The following steps may help prevent the spread of respiratory illnesses like flu:
If possible, avoid close contact with people who are sick. When you are sick,
keep your distance from others to protect them from getting sick too.
Clean your hands. Washing your hands often will help protect you from germs.

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 Avoid touching your eyes, nose or mouth. Germs are often spread when a
person touches something that has germs on it and then touches his or her
eyes, nose, or mouth.
Cover your mouth and nose with a tissue when coughing or sneezing. This
may prevent those around you from getting sick.

If You Get the Flu

Tell the doctor if you think you have the flu. Get plenty of rest, and drink a lot of liquids.

Group B streptococcus
Group B streptococcus (GBS) infection is a common bacterial infection that is generally
not serious in adults but can be life-threatening to newborns. GBS affects about 1 in
every 2,000 babies born in the United States. Anyone can carry GBS, and between 10
and 30 percent of pregnant women carry it.

If a pregnant woman carries the GBS bacterium in her vagina or rectum at the time of
labor, there is a 1 in 100 (1 percent) chance that her baby will become infected. Babies
infected with GBS can get pneumonia, sepsis (blood infection) or meningitis (infection of
the membranes surrounding the brain). Infected babies can be treated with antibiotics.
Most have no long-lasting damage, but about 5 percent die, and some babies who
develop meningitis suffer lasting neurological damage.

What you can do:

You can be screened for GBS infection during the last few weeks of pregnancy. If you
carry GBS, or the doctor determines you are at risk for GBS infection, you may be
treated with intravenous antibiotics during labor and delivery.

If you have any questions about GBS, ask the doctor near the end of your pregnancy.

Listeriosis/ Salmonellosis
Listeriosis is a form of food poisoning caused by bacteria called Listeria
monocytogenes. If a pregnant woman has listeriosis, she may have a miscarriage or
stillbirth, or her baby may become very ill.

Foods that may be contaminated with Listeria include unpasteurized milk, foods made
from unpasteurized milk, poultry, fish and ready-to-eat meats (such as cold cuts or deli
meats). Symptoms of listeriosis can include a flu-like illness with fever, muscle aches
and chills and sometimes nausea and diarrhea. It can progress to meningitis (an
infection of the membranes surrounding the brain) and blood infection. A blood test can
determine if a person has listeriosis.

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Salmonellosis is a food-borne infection caused by the bacteria Salmonella. Symptoms
include diarrhea, fever and abdominal cramps, which can be severe in pregnant women.
Occasionally a pregnant woman passes the infection to her baby, who can develop
diarrhea, fever and, rarely, meningitis.

Foods that can become contaminated with Salmonella include raw or undercooked
meats, unpasteurized milk and foods made from it, raw or undercooked eggs and alfalfa
sprouts

What you can do:

The U.S. Centers for Disease Control and Prevention (CDC) recommends that all
pregnant women take steps to protect themselves and their babies from listeriosis. You
should:
Eat only meats, poultry and seafood that have been cooked thoroughly.
Avoid cold cuts or deli meats or undercooked hot dogs.
Avoid unpasteurized milk and foods made from it.
Avoid soft cheeses such as Brie, feta, Camembert, blue-veined and Mexican-
style. (Hard cheeses, processed cheeses, cream cheese and cottage cheese
are safe.)
Avoid alfalfa sprouts.

Rubella (German Measles)

Rubella (German measles) is a mild childhood illness that can cause serious birth
defects in an unborn baby. About 25 percent of babies whose mothers get rubella in the
first trimester of pregnancy are born with one or more birth defects (congenital rubella
syndrome) including eye defects, hearing loss, heart defects, mental retardation and,
less frequently, movement disorders.

With the widespread use of the rubella vaccine, major outbreaks of rubella no longer
occur in the United States. Still, small outbreaks do occur. As many as 20 percent of
childbearing women are susceptible to rubella infection.

What you can do:

There is a simple blood test that can determine if you are immune to rubella. Pregnant
women are routinely tested for rubella immunity at an early prenatal visit. Be sure to ask
the nurse or doctor at the prison/jail if this blood test is part of your initial examination. If
you find out you are not immune, you should not be vaccinated during your pregnancy.
All you can do is try to avoid exposure to anyone with the illness. You can get vaccinated
soon after delivery so you are immune during any future pregnancies.

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Toxoplasmosis
Toxoplasmosis is a common infection that, when contracted by a pregnant woman, can
pose serious risks to her fetus. An estimated 400-1,000 babies in the United States are
born with toxoplasmosis each year. Babies born with toxoplasmosis often develop eye
infections that can cause blindness. Some develop hearing loss and/or learning
disabilities. Some babies are so severely infected at birth that they die or have serious
long-term physical and mental disabilities. Toxoplasmosis in pregnancy can also cause
miscarriage and stillbirth.

The major carriers of toxoplasmosis are cats. Pregnant women should avoid having any
contact with cat feces and should not change a cat’s litter box.

What you can do:

Try to wash all raw fruits and vegetables before eating them. Avoid raw or undercooked
meat.

HIV and Pregnancy

The virus that causes AIDS can be transmitted from an infected mother to her newborn
child. Without treatment, about 20% of babies of infected mothers get HIV. Mothers with
higher viral loads (the amount of HIV in your blood, this can be tested) are more likely to
infect their babies. However, no viral load is low enough to be "safe." Infection can occur
any time during pregnancy, but usually happens just before or during delivery. The baby
is more likely to be infected if the delivery takes a long time. During delivery, the newborn
is exposed to the mother's blood. Drinking breast milk from an infected woman can also
infect babies. Mothers who are HIV-infected should not breast-feed their babies. The
risk of transmitting HIV is extremely low if antiviral medications are used. Transmission
rates are only 1% to 2% if the mother takes combination antiviral therapy.
The rate is about 4% when the mother takes AZT during the last six months of her
pregnancy, and the newborn takes AZT for six weeks after birth.

Perinatal transmission rates of less than 2% have been achieved with the combination
antiviral drug ZDVE (Zidovicedine) and cesarean section. A cesarean section prior to
the rupture of the membranes has been shown to decrease HIV transmission. The
American College of Obstetricians and Gynecology (ACOG) recommends that women
who are HIV-infected and pregnant be offered a scheduled cesarean delivery at 38
weeks gestation to reduce the risk of vertical transmission.

Remember: Mothers can reduce the risk of infecting their babies if they:
Use antiviral medications;
Deliver the baby by cesarean section (this keeps the delivery time short); and
Don't breast-feed the baby.

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How do we know if a newborn is infected?
Most babies born to HIV-infected mothers test positive for HIV. Testing positive means
the baby has HIV antibodies in his/her blood. Babies get HIV antibodies from the mother
even if they aren’t=t infected.

If babies are infected with HIV, their own immune systems will start to make antibodies.
They will continue to test positive. If they are not infected, the mother's antibodies will
disappear and the babies will test negative after about 6 to 12 months.

Another test, similar to the HIV viral load test can be used to find out if the baby is
infected with HIV. Instead of antibodies, these tests detect the HIV virus in the blood.

What about the mother=s health?

Recent studies show that HIV-positive women who get pregnant do not get any sicker
than those who are not pregnant. Becoming pregnant is not dangerous to the health of
an HIV-infected woman.

However, "short-course" treatments to prevent infection of a newborn are not the best
choice for the mother's health. Combination therapies are the standard treatment. If a
pregnant woman takes medications only during labor and delivery, she might develop
resistance to them

A pregnant woman should consider all of the possible problems with antiviral
medications.
− Pregnant women should not use both ddI and d4T in their antiviral treatment due
to a high rate of a dangerous side effect called lactic acidosis.
− Do not use efavirenz (Sustiva) or indinavir (Crixivan) during pregnancy.
− If you have more than 250 T-cells, do not start using nevirapine (Viramune).

Some doctors suggest that women interrupt their treatment during the first 3 months of
pregnancy for two reasons:
− The risk of missing doses due to nausea and vomiting during early pregnancy,
giving HIV a chance to develop resistance.
− The risk of birth defects, which is highest during the first 3 months. There is
almost no evidence of these birth defects, except with efavirenz.

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Sexually Transmitted Infections/Diseases (STD's) During Pregnancy
(The following two charts are from the American Pregnancy Association;
www.americanpregnancy.org)

Bacterial STD'S - Infections that are curable

Infection Risks (M=Mom; B=Baby) Method of Transfer Treatment

M - Can result in ectopic

pregnancies and leads to
Pelvic Inflammatory Disease M - Antibiotics approved
(PID), which can cause by OB/GYN
Gonorrhea infertility Can transfer in the B - Antibiotics are given
B - Premature birth, stillbirth, birth canal during in the eyes to prevent
eye infections delivery infection

M - Can result in ectopic

pregnancies and leads to
Pelvic Inflammatory Disease
(PID), which can cause
infertility Can transfer in the
B - Pneumonia, eye infections, birth canal during M & B - Antibiotics
Chlamydia blindness delivery approved by OB/GYN

M - Can cause fallopian tube

damage Can transfer in the
Trichamonis B - Premature birth, low birth birth canal during M & B - Antibiotics
Vaginalis weight delivery approved by OB/GYN

Can transfer in the

BacterialVagi B - Premature birth, low birth birth canal during M & B - Antibiotics
nosis weight delivery approved by OB/GYN

M - Miscarriage Can cross the placenta M & B - Antibiotics

B - Stillbirth, congenital syphilis during pregnancy and approved by OB/GYN
which can result in mental & can transfer in the birth can be given to prevent
Syphilis physical problems canal during delivery damage to the fetus

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 Viral STD'S - Infections that are not curable

Infection Risks (M=Mom; B=Baby) Method of Transfer Treatment

M - Can lead to genital cancer

Human B - Warts can develop in the
Papilloma baby's throat which will require
Virus (HPV) surgery M & B - Wart treatment
also known as M & B - Warts in birth canal can Can transfer in the can occur during
AGenital cause complications during birth canal during pregnancy but has to be
Warts@ delivery. delivery, but very rare approved by OB/GYN

M - Can cause significant

damage to the liver
B - Unless treated within an Can transfer in the B - No cure, but can be
hour of birth 90% of babies will birth canal during prevented with
Hepatitis B be a carrier for life delivery vaccinations

M - Severe outbreak in the first M - No cure, but

trimester can result in outbreaks can be
miscarriage Can transfer in the treated with drugs.
B - Fetus is at higher risk if birth canal during B - Treatment
herpes is contracted during delivery and rarely can immediately following
pregnancy, and can lead to cross the placenta birth improves chances
Herpes neonatal herpes. during pregnancy of a healthy baby

M - Antiviral medication
Can cross the is given to reduce
placenta during symptoms during
pregnancy and can pregnancy
transfer in the birth B - Treatment during
canal during delivery. pregnancy greatly
Human M & B - HIV can develop into Also possible to reduces the chance of
Immuno- AIDS, which can be fatal transfer through transmission to the
deficiency without treatment. breast-feeding baby
Virus (HIV)

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(The following definitions are from Web MD; www.webmd.com)

Bacterial vaginosis (BV)- A change in the balance of bacteria that are normally present
in the vagina, which can cause bothersome symptoms. BV is the most common cause of
vaginal symptoms in women of childbearing age. The most noticeable symptom is an
excessive grayish-white discharge (fluid) coming out of the vagina. A Afishy@ smell after
sex is also a telltale sign. However, about half of women with BV have no symptoms.

Chlamydia - A bacterial infection of the cervix, urethra or upper reproductive organs, or

sometimes all three. Chlamydia can also infect the rectum and the lining of the eyelids.
Between 50% and 75% of babies born to mothers with chlamydia get the infection. The
symptoms for women are: Painful urination, cloudy urine, abnormal vaginal discharge,
abnormal vaginal bleeding with sex or between periods, genital itching, irregular bleeding
during your period, pain in the lower abdomen, fever and feeling tired, swollen and
painful glands at the opening of the vagina and conjunctivitis (pinkeye). Most severe
symptoms appear as the disease progresses. There may be no apparent symptoms in
the early stages of infection.

Hepatitis - Hepatitis B is a liver disease caused by infection with the hepatitis B virus
(HBV). Symptoms include jaundice (a yellowing of the eyes and the skin), extreme
tiredness, mild fever, headache, loss of appetite, nausea, vomiting, discomfort in the liver
area (below the rib cage on the right side), diarrhea or constipation, muscle aches, skin
rash, and, joint pain.

Herpes - A viral infection caused by the Herpes Simplex Virus (HSV). Symptoms may
include: Flu-like symptoms such as fever, headache, and muscle aches; Tingling,
itching, redness and burning where the outbreak is about to occur; Painful itchy blisters
on the vulva or the vagina; Blisters may also occur on the anus, buttocks, thighs or
scrotum, either alone or in clusters (blisters that break become slow, painful, oozing
sores; Painful urination and abnormal vaginal discharge. Some or all of these symptoms
may be present, from mild to severe.

Human Papillomavirus (HPV) - HPV is the virus that causes genital warts. The primary
symptom is warts on the genitalia. Warts look like tiny bunches of cauliflower or like flat
white areas that are difficult to see. Irritation, itching or bleeding may occur with the
warts. A person may appear symptomless in early stages of infection. (Note: HPV has
been shown to lead to cervical cancer).

Gonorrhea - A bacterial infection of the cervix. About half of men and women who are
infected do not have symptoms. Symptoms usually occur within 2 to 5 days of infection.
The symptoms for women are: Painful or frequent urination; anal itching, pain, bleeding,
or discharge; abnormal vaginal discharge; abnormal vaginal bleeding with intercourse or
between periods; genital itching; irregular menstrual bleeding; lower abdominal pain;
fever and general tiredness; swollen and painful glands at the opening of the vagina. A

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woman may not have apparent symptoms until the infection has progressed to the
fallopian tubes.

Syphilis - A bacterial infection that can cause serious medical problems if left untreated.
Usually sexually transmitted, but can be transmitted orally or by contact with someone
else=s genitalia or rectum. The first symptom is a painless chancre (sore) that develops
where the bacteria entered the body. This commonly occurs within 3 weeks of
diagnosis. In women, chancres can develop on the outer genitals or on the inner part of
the vagina. A chancre may go unnoticed if it occurs inside the vagina or at the opening to
the uterus (cervix) because the sores are usually painless and are not easily visible. The
chancre lasts for 28 to 42 days, heals without treatment, and may leave a thin scar.
However, just because the chancre has healed does not mean the syphilis is cured or
that a person cannot pass the infection to others.

Trichomoniasis - Sometimes called Trichamonis vaginalis infection or trich (pronounced

"trick"). Trich should be treated to prevent transmitting it to others and to prevent
complications if you are pregnant. Trich is the second most common STD in the United
States. Both men and women can get a trich infection. However, Trich is more common
in women. About 50% of women and 90% of men infected with Trich do not have
symptoms. Symptoms may be worse during pregnancy or right before or after a
menstrual period. If symptoms develop, they may include: Large amounts of pale yellow
or gray-green, sometimes foamy discharge from the vagina, vaginal itching or irritation,
large amounts of pale yellow or gray-green, sometimes foamy discharge from the
vagina, itching or irritation in the vagina, abnormal musty order of the vagina, pain with
sexual intercourse, patchy red areas on the genitals or in the cervix, painful urination or
frequent urination.

What can I do to prevent STD’s (sexually transmitted diseases)?

The best way to avoid becoming infected with a sexually transmitted disease is to be
sure to never have unprotected sex. Use a condom or dental dam every time you have
intercourse or oral sex. While it is true that you will probably not have access to
condoms or dental dams while you are incarcerated, it is important to remember that to
avoid STDs you should not engage in unprotected sex.

Remember: using birth control methods may keep you from becoming pregnant but
they will not protect you from STDs. To avoid STDs, always use protection.

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 ABORTION

Can I legally obtain an abortion while I am incarcerated?

Yes. Abortion is legal in the state of California. If you are in a California state prison or
jail, California Youth Authority facility or local juvenile facility, you have the legal right to
have an abortion should you decide to terminate your pregnancy. Cal. Penal Code §§
3405, 4028; Cal. Welfare and Institutions Code §§ 220, 1773.

If you are in federal prison in California, the Bureau of Prisons may pay for an abortion
only where the life of the mother would be endangered if the fetus were carried to term
(such as an ectopic pregnancy) or if the pregnancy is the result of rape. 42 C.F.R §
50.304 50.306 (2005). If you want to end your pregnancy under other circumstances,
you have to pay for the abortion with your own funds. The Bureau may, regardless of
whether they pay for the abortion or not, pay for transportation to an outside facility to
receive an abortion. (A Birth Control, Pregnancy, Child Placement and Abortion Program
Statement 6070.5, August 9, 1996).

The choice to continue or terminate your pregnancy is yours alone to make. No one has
the legal right to force you to have or not to have an abortion. Each woman makes her
decision based on her personal beliefs and individual circumstance. As an incarcerated
woman, other factors you may consider are the quality of the medical care you will
receive during your pregnancy and potential separation from your infant at birth. Be
aware of your options and talk with someone you trust to help you make the decision that
is best for you.

If I am a juvenile can I obtain an abortion?

Yes, even if you are under the age of 18, you may obtain an abortion. You do not need
the consent of your parents, your legal guardian, or a judge. It is your decision to make.

How do I arrange for an abortion?

If you think you are pregnant, you should ask to be tested as soon as possible. You
have the legal right to receive the services of a physician to determine if you are
pregnant. (Cal. Penal Code §§ 4023.6 and 3406; Cal. Welfare and Institutions Code
§220). The medical officer must tell you the results of the pregnancy test as soon as it
becomes available.

The regulations for receiving an abortion may vary among the different institutions. If
you are at CIW or VSPW it is your choice to have an abortion up to 16-18 weeks. You
must fill out a “Request for Services” with the prison doctor. Currently the CDCR will pay
for your non-therapeutic abortion. Between the 18th and 24th week (2nd trimester) the
clinic that the prison contracts with will decide whether it is safe for you to have an
abortion. After the 24th week you may not receive an abortion unless your life is in
danger.

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Ask a health worker at your facility for specific information about obtaining an abortion.
The prison, jail, CYA, or juvenile detention medical staff may have to locate an outside
medical facility that performs abortions. Consequently, you should promptly notify the
medical staff to request an abortion, so they can schedule the procedure and arrange for
transportation and security. If you wait too long, you will be too far along in your
pregnancy for an abortion to be performed unless your life is in danger.

What are the different types of abortions?

Generally, the simplest type of abortion, a vacuum aspiration, can be performed until
the twelfth week of pregnancy. You will be given local anesthesia around your cervix
(you will be awake during this procedure). With this method, the cervix is first expanded
with slender rods. Then a flexible tube is inserted into the cervix from the vagina. One
end of the tube is connected to a suction machine, which removes the fetal tissue. The
procedure usually lasts 10-15 minutes, but you may have to stay at the clinic for a few
hours. Common side effects of this procedure include cramping, nausea, sweating and
feeling faint. Less common side effects include heavy or prolonged bleeding and
damage to the cervix. You should ask to see a doctor if these symptoms don’t go away.

More complicated procedures must be performed if you want an abortion after the twelfth
week of pregnancy. A dilation and curettage abortion is performed between the 12th
and 15th week of pregnancy. Dilation and curettage is similar to vacuum aspiration
except it uses a curette. A curette is a long, looped shaped knife that scrapes the lining,
placenta and fetus away from the uterus. A cannula may be inserted for a final
suctioning. This procedure usually lasts 10 minutes with a possible stay of 5 hours. A
dilation and curettage has the same side effects as a vacuum aspiration.

A dilation and evacuation procedure is performed between the 15th and 21st week of
gestation. 24 hours before the procedure your doctor will insert Laminaria (a plant) or a
synthetic dilator into your cervix which will dilate (expand) your cervix. The next day your
physician will place a clamp-like device on your cervix to keep it from moving and then
will insert a cannula (a long silver tube) to begin removing tissue from the lining of the
uterus. Forceps may be used to remove the larger parts. The last step is a final
suctioning to make sure the contents are completely removed. This procedure is usually
performed in hospitals, as there is a greater risk of complications.

A dilation and extraction procedure is used after the 21st week of gestation. Two days
before the procedure Laminaria is inserted vaginally to dilate the cervix. Your water
should break on the third day and you should return to the clinic. The fetus is then
grasped with forceps by the legs and pulled through the birth canal. A small cut is made
at the base of the skull and a catheter is inserted to remove any cerebral matter. The
fetus is then completely removed.

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 Nutrition and Pregnancy
(The information in this section is from the U.S. Department of Health and Human
Services web site: www.hhs.gov )

Nutrition is a very important part of prenatal care. A healthy diet can contribute to a
successful pregnancy by reducing complications and promoting adequate fetal growth
and development. The purpose of this section is to provide you with general guidelines
for maintaining good nutrition during pregnancy.

It may be hard for you while incarcerated to get some of the most nutritious foods, but try
to choose comparable substitutes. Use the example foods listed below as a guide of
what and how much you should consume in your daily diet.

According to the American Dietetic Association, pregnant women should increase their
usual servings of a variety of foods from the four basic food groups (up to a total of 2,500
to 2,700 calories daily) to include the following:

Fruits and Vegetables B

Seven or more servings of fruits and vegetables combined (three servings of fruit and
four of vegetables) daily for vitamins and minerals. Fruits and vegetables with vitamin C
help you and your baby to have healthy gums and other tissues, and help your body to
heal wounds and to absorb iron. Examples of fruits and vegetables with vitamin C
include strawberries, melons, oranges, papaya, tomatoes, peppers, greens, cabbage,
and broccoli. Fruits and vegetables also add fiber and other minerals to your diet and
give you energy. Plus, dark green vegetables have vitamin A, iron, and folate, which are
important nutrients during pregnancy.
One Serving Size Fruit = 1 medium apple, 1 medium
banana, 2 cup of chopped fruit, 3/4 cup of fruit juice
One Serving Size Vegetable = 1 cup raw leafy
vegetables, 2 cup of other vegetables (raw or cooked),
3/4 cup vegetable juice

Whole-grains or Enriched Breads/Cereals Aim for nine or more servings. Whole grain
products and enriched products like bread, rice, pasta, and breakfast cereals contain
iron, B vitamins, some protein, minerals, and fiber that your body needs. Some breakfast
cereals have been enriched with 100% of the folic acid your body needs each day. Folic
acid has been shown to help prevent some serious birth defects. Choosing a breakfast
cereal or other enriched grain products that contain folic acid is important before and
during pregnancy.
One Serving Size = 1 slice bread, 2 cup of cooked
cereal, rice, or pasta, 1 cup ready-to-eat cereal

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Dairy Products B
Aim for four or more servings of low-fat or non-fat milk, yogurt, or other dairy products
like cheese for calcium. You and your baby need calcium for strong bones and teeth.
Dairy products also have vitamin A and D, protein, and B vitamins. Vitamin A helps
growth, resistance to infection, and vision. Pregnant women need 1,000 milligrams (mg)
of calcium each day. If you are 18 or younger, you need 1,300 mg of calcium each day.
Try to have low-fat or non-fat milk and milk products to lower your fat intake. Other
sources of calcium include dark green leafy vegetables, dried beans and peas, nuts and
seeds, and tofu. If you are lactose intolerant or can=t digest dairy products, you can still
get this extra calcium. There are several low-lactose or reduced-lactose products
available. In some cases, your doctor might advise you to take a calcium supplement.
One Serving Size = 1 cup of milk or yogurt, 1 2 oz.
natural cheese, 2 oz. processed cheese

Proteins B
Pregnant women need about 60 grams of protein per day. This is about the same as two
or more 2-3 oz. servings of cooked lean meat, poultry without the skin or fish, or two or
more 1 oz. servings of cooked meat. Don=t eat uncooked or undercooked meats or
fish. These can make you sick. Pregnant women should avoid deli luncheon meats,
too (bologna for example). Eggs, nuts, dried beans, and peas also are good forms of
protein. Protein builds muscle, tissue, enzymes, hormones, and antibodies for you and
your baby. These foods also have B vitamins and iron, which is important for your red
blood cells. Your need for protein in the first trimester is small, but grows in your second
and third trimesters when your baby is growing the fastest, and your body is working to
meet the needs of your growing baby.

One Serving Size = 2-3oz. of cooked lean meat, poultry,

or fish, 1 oz. meat also = 2 cup cooked dried beans, 1
egg, 2 cup tofu, 1/3 cup nuts, 2 T. peanut butter

Should I limit how much fish I eat when I=m pregnant?

Some fish have mercury, which, in high doses, can hurt your baby=s growing brain and
nervous system. There are some fish you should NOT eat if you are pregnant.

Here are some guidelines:

Do not eat any shark, swordfish, king mackerel, or tilefish (also called golden or white
snapper) because these fish have high levels of mercury.
Do not eat more than six ounces of Awhite@ or Aalbacore@ tuna or tuna steak each week.
Limit your fish to no more than 2 servings (12 ounces total) per week. When you eat fish,
choose shrimp, salmon, pollock, catfish, or Alight@ tuna as they are usually low in
mercury.

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What other nutrients do I need for a healthy pregnancy?
Folic acid: Folic acid is an important vitamin for any woman who could possibly become
pregnant. Folic acid is a B vitamin that helps prevent serious birth defects of a baby=s
brain or spine (called neural tube defects) and other birth defects like cleft lip and
congenital heart disease. Folic acid is needed very early in pregnancy, usually before a
woman knows she is pregnant. That is why it=s so important that every woman who could
possibly become pregnant gets enough folic acid every single day, starting at least one
month before pregnancy. One easy way to ensure getting enough folic acid every day is
to take a daily multivitamin. Most multivitamins sold in the U.S. contain enough folic acid
for the day. Your vitamin should contain 400 micrograms (400 mcg) or 100% of the Daily
Value (DV) for folic acid. The prison should provide you with a vitamin that contains your
daily folic acid needs.

Iron: You need iron to keep your blood healthy for you and your baby. Bones and teeth
also need iron to develop properly. Too little iron can cause a condition called anemia. If
you have anemia, you might look pale and feel very tired. Pregnant women should take
a low-dose iron supplement, beginning at the first prenatal visit, or even before, when
you are planning to get pregnant. If your doctor finds that you have anemia, he or she
will give you a higher dose of iron supplements to take once or twice a day. You can help
prevent anemia by eating more iron-rich foods like lean red meat, fish, poultry, dried
fruits, whole-grain breads, and iron-fortified cereals.

Water: Water plays a key role in your diet during pregnancy. It carries the nutrients from
the foods you eat to your baby and helps prevent you from getting constipation,
hemorrhoids, excessive swelling, and urinary tract or bladder infections. Drinking enough
water, especially in your last trimester, prevents you from becoming dehydrated. Not
getting enough water can then lead you to have contractions and premature or early
labor. Pregnant women should drink at least six eight-ounce glasses of water per day
and another glass for each hour of activity. You can drink juices for fluid, but they also
have a lot of calories and can cause you to gain extra weight. Coffee, soft drinks, and
teas that have caffeine actually reduce the amount of fluid in your body, so they cannot
count towards the total amount of fluid you need. Women exposed to heat and humidity
may need more than ten cups of fluid each day. Enough fluid should be consumed to
replace that lost in sweat. That may mean drinking water or other fluids regularly whether
you feel thirsty or not.

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 Drugs and Pregnancy

Cocaine, Crack, Speed & Methamphetamine

Cocaine (including crack) and Methamphetamine (speed, or ice) are powerful stimulants
of the central nervous system. They suppress the mother=s appetite and exert other
drastic forces on her body, causing the blood vessels to constrict, the heart to beat
faster, and the blood pressure to soar. The growth of the fetus may be hindered, and
there are higher risks of miscarriage, premature labor, and a condition called abruptio
placentae (the partial separation of the placenta from the uterus wall, causing bleeding).

According to the American College of Obstetricians and Gynecology (ACOG), women

who use cocaine during their pregnancy have a 25 % increased chance of premature
labor. Babies born to mothers who use cocaine throughout their pregnancy may also
have a smaller head and their growth hindered. There may also be deformation of the
kidneys, brain and genitals. (Source: American Pregnancy Association)

If these drugs are taken late in pregnancy, the baby may be born drug dependent and
suffer withdrawal symptoms, such as tremors, sleeplessness, muscle spasms, and
sucking difficulties. Some experts believe learning difficulties may later develop.
(Source: American Council for Drug Education)

Heroin & Other Narcotics

Heavy narcotics use increases the danger of premature birth with such accompanying
problems for the infant as low birth weight, breathing difficulties, low blood sugar
(hypoglycemia), and bleeding within the head (intra cranial hemorrhage).

The babies of narcotics-dependent mothers are often born dependent themselves and
suffer withdrawal symptoms, such as irritability, vomiting and diarrhea, and joint stiffness.
Women who inject narcotics may become infected with the HIV virus from dirty needles
and may subsequently develop AIDS. HIV-infected women run a high risk of passing the
virus on to their babies.

If you are pregnant and addicted to heroin, trying to go Acold turkey@ can be very harmful
to the fetus. Becoming slowly detoxified in a methadone maintenance program, where
the mother and fetus=s health are carefully monitored, appears to be a safer option.
(Source: American Council for Drug Education). According to the CDCR, women who
are addicted to heroin and found to be pregnant must be given methadone maintenance
treatment. (See General Information section, page 2).

Inhalants
At least one inhaled substance has been clearly connected with birth defects. The
organic solvent toluene, widely used in paints and glues, appears to cause
malformations like those produced by alcohol (which is itself an organic solvent). It is
possible that all organic solvents may cause birth defects.

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PCP
PCP (phencyclidine, or angel dust) taken late in pregnancy can cause newborns to have
withdrawal symptoms, such as lethargy alternating with tremors. PCP use can also lead
to low birth weight, poor muscle control, brain damage, and withdrawal syndrome if used
frequently. Withdrawal symptoms include lethargy, alternating with tremors. LSD can
lead to birth defects if used frequently. (Source: American Pregnancy Association and
American Council for Drug Education)

Marijuana
THC (the active ingredient in Marijuana) crosses the placenta to your baby. Studies of
marijuana in pregnancy are inconclusive since many women who smoke marijuana also
use tobacco and alcohol. Smoking marijuana increases the levels of carbon monoxide
and carbon dioxide in the blood, which reduces the oxygen supply to the baby. Smoking
marijuana during pregnancy can increase the chance of miscarriage, low birth-weight,
premature births, developmental delays, and behavioral and learning problems.

What will happen if I tell my doctor about my drug use during my pregnancy?
If you are on the streets, inform your doctor if you cannot quit, so that your pregnancy
can be closely monitored and any specialized treatment given to minimize injury. There
are also many agencies you can call for help. We have listed some organizations in a
resource list included with this manual.

Be aware that you might have problems with the department of social services if you
notify your doctor of your drug use. You should weigh this risk against the risk to your
baby if she/he goes untreated. Many hospitals routinely test newborns for drug
exposure.

Can I face legal penalties for using illegal drugs during my pregnancy?
Recently some jurisdictions have tried to impose legal penalties on pregnant substance-
dependent women, supposedly to discourage them from using substances. Women who
used cocaine or heroin during pregnancy have been charged with violating criminal and
civil child abuse or neglect laws. See Whitner v. South Carolina, 328 S.C. 1 (1997).
In 2005, two women in Maryland were convicted of child endangerment as a result of
using drugs while pregnant and sentenced to prison. However, the Maryland Court of
Appeals overturned those convictions in August 2006, holding that the state’s reckless
endangerment statute was not intended to apply to women in relationship to their own
pregnancies. The Court reasoned that if the statute applied to women who ingested
cocaine during their pregnancy, it would also have to apply to women who failed to wear
a seat belt while pregnant or to women who engaged in any injury-prone activity while
pregnant.

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So far California courts have declined to prosecute women who have given birth to an
addicted child. See Reyes v. Superior Court, 75 Cal. App. 3d 214, 141 Cal. Rptr. 912
(1977).

Under Penal Code '11165.13, if an infant tests positive at the time of delivery, that factor
alone is not enough to report the mother for child abuse or neglect. However, it is
enough to require that an assessment of the mother=s and child=s needs be made under
Health & Safety Code section 123605. A report on this assessment will be made and
given to county welfare or the probation department. According to California Penal Code
§ 11165.13, the report is not to be given to law enforcement.4

Even though you may not be facing charges of abuse or neglect because your baby
tested positive for drugs, your baby could be made a dependent of the court due to other
circumstances. In one 1989 case, the court held that the fact that Troy D. was
diagnosed as being born under the influence of drugs was enough to give the juvenile
court jurisdiction. Furthermore, the court held that the toxicology report, the testimony of
a physician regarding the effects of prenatal drug use, and the fact that the parents had
lost custody of an older child was sufficient to declare Troy D. a dependent child. (In re
Troy D., 215 Cal.App.3d 889, 263 Cal.Rptr. 869)

What happens if my baby is made a dependent of the court?

If your baby is made a dependent of the court, it means that you will have to work very
hard to have the baby returned to your custody. If you will be incarcerated for only a
short amount of time, you may be given a reunification plan. Reunification plans might
require that you take parenting classes, substance-abuse classes, anger management
classes and/or attend NA or AA. You will have a social worker who will make reports to
the court about your progress with the reunification plan.

If you will be incarcerated for more than two years, you may not be given a reunification
plan because you won=t be able to complete the plan within the time limits under
California law. For example, if your child is under the age of three years at the time she
is made a dependent of the court, you would only have six months (might be extended to
12 months) to comply with the court-ordered services (reunification plan). For children
who are older than three years old at the time they are removed from the parents=
custody, the time to reunify is limited to 12 months (might be extended to 18 months).
However, in cases where there are two or more children (a sibling group) removed from
the home, if any one of the children is under the age of three years, the time to reunify is
limited to six months for all of the children. In some circumstances it is possible to have
the time extended to 18 months. However, the court will only extend the time of
reunification to 18 months if it finds that there is a Asubstantial probability@ that the child
will be returned to the parent=s custody within that extended time.

4 A report based on risk to a child which relates solely to the inability of the parent to provide the child with regular
care due to the parent’s substance abuse shall be made only to county welfare or probation department and not to a
law enforcement agency. (Cal. Penal Code § 11165.13)

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 FREQUENTLY ASKED PREGNANCY QUESTIONS
(All the following information is from WebMD and/or
http://www.emedicine.com/med/topic3238.htm)

What are the first symptoms of pregnancy?

Missing a period is usually the first sign of a new pregnancy, although women with
irregular periods may not at first recognize a missed period as pregnancy. During this
time, many women experience a need to urinate frequently, extreme fatigue, nausea
and/or vomiting, and increased breast tenderness. All or some of these symptoms are
normal.

How is the baby's due date calculated?

Pregnancy lasts 281-282 days, according to most studies of normal pregnancies.
Determine the first day of the last menstrual period, add 7 days, and then subtract 3
months. This is the expected month and date the baby will be due.

How does a woman know if she has an ectopic or tubal pregnancy?

Normally, at the beginning of a pregnancy, the fertilized egg travels from the fallopian
tube to the uterus, where it implants and grows. In nearly 2% of pregnancies, however,
the fertilized egg attaches to an area outside of the uterus, resulting in an ectopic
pregnancy (also known as tubal pregnancy or extrauterine pregnancy).

Nearly all ectopic pregnancies develop in a fallopian tube; the remainders occur in an
ovary, the cervix, or the abdomen. Generally none of these areas are capable of holding
or sustaining a growing fetus.

The most common symptom of an ectopic pregnancy is cramping or tenderness on one

side of the lower abdomen. If the tube ruptures pain becomes very sharp and steady
before spreading throughout the entire pelvic region. Other symptoms include brown
vaginal spotting, light bleeding, or heavier bleeding if the tube ruptures. If rupture leads
to bleeding severe enough to cause anemia, a patient may experience dizziness or
weakness.

If you are diagnosed with an ectopic pregnancy your pregnancy must be ended right
away, as this condition can become life threatening.

Factors that increase your risk for ectopic pregnancy include previous ectopic
pregnancies, Pelvic Inflammation Disease (PID) (often caused by gonorrhea or
chlamydia) and smoking cigarettes.

When should a woman have her first prenatal visit? After the first visit, how often
should a woman see her doctor?

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Ideally, patients should see their physician before becoming pregnant for preconception
counseling. If this is not possible, patients should see their physician as soon as
pregnancy is suspected to maximize prenatal health care and to minimize risk for birth
defects and complications. Seeing a health care provider to begin prenatal care by the
10th week of pregnancy is recommended. Screening blood tests, starting prenatal
vitamins, and early detection of problems are better accomplished sooner rather than
later. A physical examination and screening for sexually transmitted diseases are part of
the first prenatal visit. An ultrasound is recommended for women who are uncertain of
their menstrual cycle. A woman who experiences bleeding, unusual pain, or unrelenting
vomiting should seek care immediately.

When should a woman have her first ultrasound?

Each obstetrician has his/her own guidelines. The earliest a pregnancy can be visualized
on transvaginal sonography is at 4-5 weeks' gestation; if the patient has bleeding, a
suspected ectopic pregnancy, or a suspected error in the dating of the pregnancy, a first
trimester ultrasound is indicated. If the pregnancy is proceeding normally, most women
will have their first ultrasound early in the second trimester. A scan at 18-20 weeks'
gestation is a common and acceptable time for accurate detection of most major fetal
anomalies. This timing allows a woman to make a decision regarding termination;
however, diagnosing problems is easier with a slightly later scan at 22-24 weeks'
gestation.
Later in pregnancy, at 23-28 weeks' gestation, growth and development can be better
evaluated, and second ultrasounds usually are performed at that time.
Central nervous system abnormalities are most likely to be detected and cardiac and
skeletal anomalies are more likely to be missed, when routine ultrasounds are performed
early in pregnancy rather than after 23 weeks' gestation.

What are the signs of a miscarriage?

The medical term for a miscarriage is a spontaneous abortion. Abortions that are in the
process of occurring are called inevitable abortions. Pregnancies that have actually
passed tissue (but not all tissue) are called incomplete abortions; those in which all
tissue is passed are referred to as complete abortions.
Bleeding, passing tissue, rupturing membranes (passing clear fluid), and clotting are all
typical signs of a miscarriage. However, not all women who bleed during pregnancy
miscarry. If all the tissue is passed, the bleeding has slowed, and the cervix has closed,
the pregnancy is termed a complete abortion. Almost one fourth of women experience
implantation bleeding (bleeding in early pregnancy). Fewer than half of women with first
trimester bleeding have a miscarriage. Typically, women who have miscarriages report a
loss of the usual side effects of pregnancy, such as resolution of nausea or loss of breast
tenderness.

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Spontaneous abortion (miscarriage) is usually caused by the death of the embryo, which
then becomes detached from the placenta and is expelled. Researchers estimate that
the embryo in at least sixty percent of these cases does not survive because they are
anatomically or genetically abnormal. In other words, most of these early miscarriages
are not due to anything that the mother could have prevented. The less frequent
spontaneous abortions that occur later in the pregnancy are more likely to be caused by
a severe illness or trauma. Remember: Bleeding should always be reported to the
medical staff at the prison or jail. In some circumstances there may be some treatment
that will prevent you from losing the pregnancy. Even if you are in the process of having
a miscarriage or if there is nothing that can be done to prevent the loss of pregnancy, it is
extremely important that you receive appropriate medical care during this time.

Is cramping during pregnancy normal?

Early in pregnancy, uterine cramping can indicate normal changes of pregnancy brought
on by hormonal changes; later in pregnancy, it is a sign of a growing uterus. Cramping
that is different from previous pregnancies, worsening cramping, or cramping that
happens with any vaginal bleeding may be a sign of ectopic pregnancy (see above),
threatened abortion, or missed abortion. A missed abortion refers to when there is a
fetal death before the 24th week of pregnancy, but the fetus is still in the uterus.

Why do I feel more tired than usual?

Feeling tired in early pregnancy is very normal. Many changes are occurring as your
pregnancy develops, and many women experience this as fatigue and an increased
need for sleep. Lower blood pressure, lower blood sugars, hormonal changes, changes
in metabolism, and the physiologic anemia (not enough iron in your blood) of pregnancy
all contribute to fatigue.
Other physical effects that are normal during pregnancy, and not necessarily signs of
disease, include nausea, vomiting, increase in stomach size, changes in bowel habits,
increased need to urinate, palpitations or more rapid heart beat, up-heaving of the chest
(particularly with breathing), heart murmurs, swelling of the ankles, and shortness of
breath.

Should all women have a test for Tay-Sachs disease?

Tay-Sachs is a rare disease that causes a build up of substances called gangliosides in
the central nervous system. The eventual result is a severe, progressive illness in the
brain with death at a very young age. Jewish individuals of Eastern European descent
(Ashkenazi) have a 1 in 30 chance of carrying the gene. Parents of Cajun descent also
have an increased incidence of carrying the gene for Tay-Sachs. In others, the risk is
about 1 in 300. If 2 individuals who are carriers have a baby, there is a 25% risk that their
baby will have the disease.
The carrier status of a woman can be determined by a blood test prior to pregnancy.
However, even if one parent does not appear to be from a group at high risk for carrying

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the mutant Tay-Sachs gene, the parents still should be offered testing. American College
of Obstetricians and Gynecologists (ACOG) also recommends testing for Canavan
disease in women at risk for Tay-Sachs.

What are the safest treatments for nausea and vomiting in early pregnancy?
Nausea and vomiting occur frequently in pregnant women, especially during the first
trimester. As in the nonpregnant state, causes of nausea and vomiting include stomach
problems (infection, gastritis, cholecystitis, peptic ulcer, hepatitis, pancreatitis), urinary
tract infection (UTI), ear/nose/throat disease (motion sickness, labyrinthitis), drugs
(digoxin, morphine), metabolic disorders (hypercalcemia, hyperparathyroidism), and
psychological problems. Nausea and vomiting often are difficult to treat, especially
because they generally occur in the first trimester. Because this is the most critical time
for the fetus= organ development, drug usage is not recommended.
Watching your diet is usually the best treatment. It may be difficult to be picky in prison,
but try to eat foods you know you will tolerate well. Dry crackers, lemonade, and ginger
products (for example, ginger ale) may be helpful. Vitamin B-6 also can decrease
nausea and may be administered orally, straight to the muscle, or intravenously.

How much alcohol is safe to consume during pregnancy?

No amount of alcohol is considered safe. Fetal alcohol syndrome (FAS) has been
reported with very low levels of drinking. Pregnant women who drink even minimal
amounts of alcohol may be affecting fetal development. Heavy drinking (3.5 drinks per
day) during pregnancy remains an established risk factor for FAS and other negative
outcomes. FAS is completely preventable, but it is not curable once alcohol has
damaged the fetus. Consequences of FAS include mental retardation or borderline
mental deficiencies and a decrease in the length, weight and head circumference of the
fetus.

Further consequences include abnormal brain development and/or behavioral difficulties.

Physical abnormalities of FAS are a smooth groove in the upper lip; narrow, small, and
unusual eye shape; a small skull; an upturned nose; and a small or malformed upper
jaw. Abnormalities of the heart have been reported but remain relatively rare, as are
other limb abnormalities, such as hand and feet deformities. In the United States today,
doctors diagnose about 1 in 750 newborns with FAS.
Research has shown that even minimal consumption can have detrimental effects on
fetal development. Children exposed to moderate levels of alcohol during pregnancy
show growth deficits and intellectual deficits along with behavioral problems similar to,
although less severe than, those found in children with FAS. Drinking during the seventh
month increases the odds of preterm delivery, even for light or moderate drinking.
Additionally, moderate consumption of alcohol by pregnant women can have significant
consequences on the developing nervous system of the fetus. Research has begun to
examine the extent to which these problems affect the child's ability to function on a day-
to-day basis at school and with peers. A number of factors, including gestational period,

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how often the mother drinks, and genetic factors, play important roles in determining the
effects of drinking alcohol on the fetus.

What should I do if I cannot stop drinking alcohol?

If you can=t stop drinking alcohol, try to cut down as much as possible. There are many
agencies that can help you deal with this problem. Use their services. We have listed
many organizations in the resources packet included with this manual.

How much caffeine is safe in pregnancy?

For most women, drinking 2 cups of coffee a day is safe, but a large amount of caffeine
should be avoided in pregnancy. It is a natural stimulant that is found in many plants and
is present in many foods. A typical brewed cup of coffee might contain about 150 mg of
caffeine. One can of soda (for example, Coke8, Pepsi8, Mountain Dew8) can contain
anywhere from 35 to 70 mg of caffeine. Caffeine levels of over 500 mg (4 cups per day)
are too high. Caffeine affects the central nervous system 15 minutes after intake. It
slightly increases blood pressure and heart rate and stimulates urination, which lowers
the amount of fluids in your body. This may potentially cause harm in pregnancy
because good hydration is thought to be essential to good pregnancy health. The
amount of caffeine found in chocolate is very low.

What are the effects of smoking on pregnancy?

Low birth weight (LBW) is the most common problem with babies born from mothers who
smoke. Babies born to mothers who smoke weigh about 170-200 grams (6-7 ounces)
less than those whose mothers do not smoke. An increased risk of miscarriage also is a
factor. In some studies, an increase of mental retardation and cleft lip/palate has been
associated with smoking. This may be a smoke-related effect, and, although not
specifically approved for use during pregnancy, nicotine patches probably are safer than
smoking cigarettes. You should also try to avoid second hand smoke as much as
possible.

Can women safely dye their hair during pregnancy?

Women absorb chemicals through their skin, and chemicals applied to the scalp can be
a source of toxic chemical exposure. Because hair dying was not established as safe in
the past, obstetricians have been advising women against exposure to both hair dyes
and perm chemicals. However, hair dyes are thought to be safe to use during pregnancy
because actually very little is absorbed through the skin. The hormonal changes of
pregnancy and the speed of hair growth (usually improved during pregnancy because of
better nutrition and more vitamin use) will make the color of the hair vary in response to
dying and the roots growing out faster.

Can pregnant women safely take medications during pregnancy?

Each medication has specific considerations, and when in doubt, you should check with
the RN or the Supervising Obstetrician. However, some generalities do apply.

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The FDA requires a system of ranking drugs that appears on the labels and in the
package inserts and is reprinted in the Physician Desk Reference (PDR) as follows:
Category A: These medications have been available for many years, have been
tested for safety during pregnancy, and have been found to be safe. Remember
the medication may not remain in this category (i.e. be considered safe) if the
recommended dose is changed. This would include folic acid, vitamin B-6, and
thyroid medicine.
Category B: These include drugs that have been used a lot during pregnancy and,
through reporting by physicians and patients and uncontrolled studies, do not
appear to cause major birth defects or other fetal problems, including drugs such
as many antibiotics, acetaminophen (Tylenol), aspartame (artificial sweetener),
famotidine (Pepcid), prednisone (cortisone), insulin (for diabetes mellitus), and
ibuprofen (Advil, Motrin) before the third trimester. Pregnant women should not
take ibuprofen during the last 3 months of pregnancy.
Category C: These drugs may still be used if the benefits of use outweigh the risks,
but they are more likely to cause problems for the mother or fetus. This category
also includes drugs for which safety studies have not been finished. The majority
of these drugs do not have safety studies in progress. These drugs include
prochlorperazine (Compazine), fluconazole (Diflucan), and ciprofloxacin (Cipro)
and some antidepressants.
Category D: This category includes drugs that have clear health risks for the fetus
and include alcohol, lithium (treats bi-polar disease), phenytoin (Dilantin), and
most chemotherapy drugs to treat cancer. Most physicians recommend finding a
different drug to treat the condition with before planning a pregnancy.
Category X: This category includes drugs that have been shown to cause birth
defects and should never be taken during pregnancy. These include drugs to treat
skin conditions such as cystic acne (Accutane) and psoriasis (Tegison or
Soriatane), a sedative (thalidomide), and a drug to prevent miscarriage used until
1971 in the United States and until 1983 in Europe (diethylstilbestrol [DES]).
Proper birth control should always be used when taking any of these drugs.
Most physicians recommend avoiding aspirin use in pregnancy.

Why does a woman’s posture change during pregnancy?

Women experience a progressive increase in the curvature of the spine during
pregnancy. This change, termed lordosis, helps keep the center of gravity stable as the
uterus gets bigger. Late in pregnancy, aching, weakness, and numbness of the arms
may occur because of posture changes due to lordosis. A shifting center of gravity can
contribute to an increase in unsteadiness while walking. These changes are most
exaggerated in later pregnancy. Over 50% of women complain of back pain during
pregnancy. About 4-6 women per 1000 will have scoliosis. Spinal changes usually are
not severe enough to affect the pregnancy or the lung's functional capacity.

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Treatment for back pain includes heat and ice, acetaminophen, massage, proper
posturing, good support shoes, and a good exercise program for strength and
conditioning. Pregnant women also may relieve back pain by placing one foot on a stool
when standing for long periods of time and placing a pillow between the legs when lying
down.

When is fetal movement usually felt?

Most women feel the beginnings of fetal movement before 20 weeks' gestation. In a first
pregnancy, this can occur around 18 weeks' gestation and, in following pregnancies, as
early as 15-16 weeks' gestation. Early fetal movement is felt most commonly when the
woman is sitting or lying quietly and concentrating on her body. It usually is described as
a tickle or feathery feeling below the umbilical area. As the fetus grows in size, these
feelings become stronger, regular, and easier to feel. The medical term for the point at
which a woman feels the baby move is quickening. Babies should move at least 4 times
an hour as they get larger, and some obstetricians advise patients to count fetal
movement to follow the baby's well being.

What tests can be performed to detect preterm (early) labor?

Many tests have been proposed, but few are considered universally reliable. First, a
pelvic examination or ultrasound can detect thinning or opening of the cervix. A swab
test can detect ruptured membranes. A recently proposed test, called fetal fibronectin
(fFN), also has been used to detect a preterm labor. In addition, fetal monitoring can
detect uterine contractions. Finally, some hormone tests can be used to detect
abnormalities (e.g., salivary estrogen testing). Most cases of preterm labor cannot be
predicted.

At what stage of pregnancy are fetuses considered viable (able to survive)?

This is a complex topic. No definite age or stage exists, and even experts may disagree.
The survival rate of infants born after 23-25 weeks' gestation increases with each
additional week of pregnancy. The survival rate of infants born before 23 weeks'
gestation is very low. Babies born during these early weeks may require prolonged and
intensive medical care, including care with a variety of life-support measures.

What special risks are associated with a multiple pregnancy?

Twin pregnancies have a higher rate of complications than single pregnancies.
Complications for the mother include anemia, polyhydramnios (too much amniotic fluid),
hypertension (high blood pressure), premature labor, postpartum hemorrhage (excessive
bleeding), diabetes, preeclampsia, and cesarean delivery.
Fetal complications include incorrect positioning of fetus at birth, placenta previa (when
the placenta is unusually low in the uterus), abruptio placentae (separation of placenta
from the uterus wall after the 20th week but before birth), premature rupture of the
membranes, prematurity, umbilical cord prolapse (Umbilical cord prolapse occurs when
the cord slips into the vagina after the membranes have ruptured, before the baby

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descends into the birth canal. This complication affects about 1 in 300 births), congenital
anomalies, and increased perinatal morbidity and mortality (death during childbirth).
Although single pregnancies are considered term at 37 weeks' gestation, half of all twin
pregnancies deliver at 36 weeks' gestation. The average age of triplets is 33.5 weeks'
gestation, and, in a small series of quadruplet pregnancies, the average gestational age
at delivery was 31 weeks' gestation (Spellacy, 1999).

Why do women undergo skin pigmentation changes during pregnancy?

Increased levels of hormones cause your skin to darken in certain areas of your body.
There may be a darkening of the nipple area and the area down the middle of your
stomach from the navel to pubic region. The facial pigment may also darken. The
darkening of the skin usually disappears after birth. Do not try to bleach your skin
because the solutions may be harmful to your baby.

Why is acne increased during pregnancy?

Progesterone, is increased during pregnancy, resulting in more secretions from the skin
glands. Drinking a lot of water should help. Most acne medications including tetracycline
are not recommended during pregnancy

Will changes in headache patterns occur during pregnancy?

For most women, headaches remain unchanged during pregnancy. Some women
improve, but some may worsen. Because migraines have a hormonal component, many
women's migraines improve with increasing hormone levels, such as those that occur
during pregnancy. For women whose conditions remain unchanged or worsen, treatment
options are limited, especially in the first trimester. Some physicians suggest
acetaminophen, narcotics, and antiemetics (drugs used to control nausea or vomiting).
Other treatments include relaxation strategies, eliminating stressors, and a good
exercise program. These should be tried before taking drugs.

Is feeling the heart racing a common occurrence during pregnancy?

A significant number of changes occur to your heart and blood vessels during
pregnancy, which may be accompanied by dyspnea (difficulty breathing) and a reduced
tolerance for endurance exercise. Women expand their blood volume by approximately
30-50%. The heart rate may also increase by 10-20 beats per minute. The changes
peak during weeks 20-24 and usually end within 6 weeks of childbirth.

What are the common respiratory system changes during pregnancy?

Pregnant women experience a stuffy nose due to the increase in hormones. Nosebleeds
are also common. The safest treatment of these symptoms is a saline nasal spray.

Is gallbladder disease more common during pregnancy?

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For some, gallbladder disease is more common during pregnancy. Estrogen (a hormone)
increases the concentration of cholesterol in the bile leading to an increased risk of
forming gallstones.

What hair changes are common during pregnancy?

Hair grows in the anagen phase and rests in the telogen phase. About 15-20% of all
hairs are in the telogen phase at any given time. During this resting phase, it is normal
for hair to fall out so a new hair can regrow. During late pregnancy, fewer hairs are in
telogen; immediately after birth, more hairs are in telogen phase. This often results in
loss of hair immediately after giving birth. This may be very disturbing, but it is normal.

What is Rh disease? Why is a pregnant woman's blood type important?

Knowing the blood type of a pregnant woman is an important part of preventing a
potentially deadly disease for the newborn. About 15% of the US population has blood
that is Rh negative. If the mother's blood type is Rh negative and the baby's blood type is
Rh positive (inheriting this type from the father) the mother may make antibodies that can
cross over the placenta into the baby's blood stream and attack the baby's red blood
cells. Sensitization (Immunity) can occur at any time, including after spontaneous
abortion.
The first pregnancy usually poses no problems because sensitization typically occurs at
delivery. Subsequent pregnancies are at risk if the mother was not protected with an
injection of RhoGAM, which prevents the mother from forming antibodies. This condition
eventually leads to fetal anemia and heart failure. Administering RhoGAM (RH
immunoglobulin) to a pregnant woman early in the third trimester (before the baby's
blood type is known) or after miscarriage or abortion can prevent formation of these
attack immunoglobulins. After birth, the newborn's blood type is checked; if the baby is
Rh negative like the mother, no further treatment is necessary. Other antibodies and
incompatibilities can produce similar problems, but they are rare and less likely to cause
severe disease.

How much does the uterus grow during pregnancy?

The uterus grows from an organ that weighs .2 lbs with a cavity space of about .0003
gallons to an organ that weighs more than 2.2 lbs that can accumulate a fluid area of
over 5 gallons. The shape also evolves during pregnancy from the original pearlike
shape to a more round form, and it is almost a sphere by the early third trimester. By full
term, the uterus becomes oval shaped. After 20 weeks' gestation, most women begin to
appear pregnant upon visual examination.

Why do women get varicose veins during pregnancy?

Varicose veins, abnormally dilated or swollen veins, are more common as women age
and/or gain weight. Also, the pressure on major veins in the legs, and family history
increase the risk of developing varicose veins during pregnancy. These can occur in the

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vulvar area and be fairly painful. Rest, leg elevation, acetaminophen, topical heat, and
support stockings typically are all that is necessary.

Why are my breasts larger and more tender than usual?

Your breasts are larger and more tender because of the increased amounts of hormones
that your body is producing. Although the tenderness should decrease after the first
trimester, your breasts will continue to grow in preparation for nursing your baby. Wear a
supportive bra. You might want to have one of your family members buy you a bra that
is one or two sizes larger than your normal size and send it in to you if the prison or jail
permits this.

Is it normal to secrete milk from the breast prior to delivery?

Yes. Each woman is different, and some women notice secretions beginning before the
fifth month of pregnancy. Many women find they spontaneously leak or express some
fluid by the ninth month. The initial milk, may be watery and pale. Bumps that appear to
enlarge around the areola normally appear during mid-pregnancy. Early secretion does
not mean that a woman will produce less milk after delivery.

Can I breast-feed my baby while I am incarcerated?

Breast-feeding is almost impossible to do while you are incarcerated. However, you
should check with the prison or jail OB-GYN about this. There is only one published
court decision in which a woman was permitted to breast-feed her infant. In Berrios-
Berrios v. Thornburg, 716 F.Supp.987 (E.D. Ky. 1989), a federal prisoner was allowed to
breast-feed her child during regular visitation periods. Indeed, the courts have stated
that breast-feeding is a constitutionally protected right and the most elemental form of
parental care. Dike v. School Board, 650 F.2d 783, 787 (5th Cir. 1981). However, the
court in Thornburg decided that storing breast milk in the prison refrigerator and making
arrangements for delivery of the milk to the baby’s caretaker was outweighed by the
government’s interest in preserving the security of the prison.
In the only other published decision about a prisoner’s right to breast-feed her newborn,
the court ruled that the state’s penal interest outweighed the interest of the prisoner’s
infant receiving his mother’s breast milk, even though the baby had special medical
considerations that made breast-feeding even more important than usual. Southerland v.
Thigpen, 784 F. 2d 713 (D. Miss. 1986).

Why is a baby born in the breech position? Can this pose a problem?
Most babies settle into a head down position before labor. At 28 weeks of pregnancy,
about one third of babies remain breech (buttocks down); by term, only 3% are still
breech. The head is the largest part of the baby, and, because it comes down first in the
birth canal, the body usually follows without difficulty. When the baby is in a breech
position, the head is the last to come out, which may pose a risk to successful vaginal
birth. The specific risks of a breech birth include minor stretching of the shoulder area of
the arm or fetal head entrapment (which is fatal in rare cases).

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Many ways exist to detect breech position before birth (sonography and manual
examination). Women should check with their doctors to determine how this delivery will
be handled (vaginal or elective cesarean delivery) and if the doctor would consider trying
to turn the baby before birth. Some physicians perform cesarean deliveries on breech
pregnancies.

How often is a woman put on the fetal monitor in labor?

Once active labor is diagnosed, the baby's heart rate needs to be checked every 15
minutes; during the second stage of labor, the heart rate should be checked every 5
minutes. Continuous fetal monitoring is necessary for all cases in which questions of
fetal health or previous abnormal heart rates exist. Unfortunately, once strapped to the
fetal monitor, walking around in labor is not possible. Many physicians choose to monitor
on a schedule of 15 minutes before and after the hour to allow time for the woman to
move around. This is an individual choice made between a woman and her doctor.

Why do I have to urinate so often?

During the early stage of pregnancy, the blood supply to your pelvis increases, which
makes you need to empty your bladder more frequently. As your uterus grows to
accommodate the baby, it presses more heavily on your bladder causing you to have to
urinate more often. If you Limit your fluid intake in the evening, you will not have to
urinate as much during the night.

Are urinary tract infections (UTIs) more common during pregnancy?

Normal pregnancy-related changes contribute to UTIs. Urinary Tract Infections in
pregnant women usually do not present with typical symptoms and may have no
symptoms at all. Pyelonephritis (inflammation of the kidney or pelvic area) is a serious
complication of UTIs.
Typical symptoms include: Pain or burning when urinating, abdominal pain in the area
over the bladder, a need to urinate immediately as soon as any urine collects in the
bladder, need to urinate extremely frequently, passage of small amounts of urine at a
time, need to get up from sleep to urinate, low back pain, cloudy or bloody urine, bad-
smelling urine.

Are yeast infections more common during pregnancy?

Yes, yeast infections are more common during pregnancy. Symptoms include: Vaginal
itching that is often severe; Vaginal discharge that is usually white, curdlike, and
odorless; Red, irritated skin around the opening to the vagina (labia); Pain while urinating
when urine touches irritated skin. Symptoms of a vaginal yeast infection are more likely
to occur during the week before a menstrual period.

Is heartburn more common during pregnancy?

Heartburn is a burning sensation and discomfort in your digestive system. Heartburn is
more common in pregnancy because as the baby grows there is more pressure on the

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stomach. Small, frequent meals (if possible) may be better than large meals. Try to
avoid:
Bending, lifting or lying down after meals
Excessive consumption of tea, coffee or alcohol, chocolate, peppermint and spicy or
greasy foods.
You may also like to try sleeping with the head of your bed raised a few inches. You can
do this by putting a folded blanket or pillow under your mattress.

Constipation has recently become a problem. What can I do about it?

Eat more fiber, if you can, by increasing your intake of fruits, vegetables and whole
grains. Try including more peas and dried beans in your diet. Also it is very important to
drink more water, at least eight glasses per day. Warm or hot fluids are especially
helpful in the mornings. If you are not physically active, some exercise may also help.

How can stretch marks be prevented?

Unfortunately, striae (stretch marks) cannot be prevented. The degree to which a woman
experiences stretch marks is genetic. Stretch marks usually occur when weight is lost or
gained quickly. Using creams and gels rarely help. Fortunately, stretch marks fade with
time, and the marks become silvery white, but they do not tan. Striae may be considered
the "stripes of motherhood.@

Should newborn boys be circumcised?

Circumcision of male newborns has evolved from a religious and cultural ceremony.
Many women choose circumcision for hygienic reasons. Circumcision has become
commonplace among many American cultural and social groups. Most fathers are
circumcised and want their sons to be the same. The procedure usually is performed in
the hospital 24-48 hours after birth by a pediatrician or obstetrician. Religious
circumcisions in the Jewish faith occur a week after birth. The procedure is not painless,
and anesthesia may or may not be used. Circumcised infants may be at lower risk for
rare penile cancer and some infections. The choice of circumcision is a private and
personal decision and is yours to make.

When will the uterus return to normal size?

The uterus returns to pre-pregnancy size after about 6 weeks. During this process, the
uterus has contractions that women may be able to feel.

What is the purpose of folic acid supplementation during pregnancy?

According to the Cochrane Data Base, folate supplementation, generally recommended
as 400 mg/d, may reduce the incidence of neural problems by 72%. The National
Institutes of Health recommends that this supplementation begin at least 3 months
before conception and continue for the first 3 months of pregnancy. Folic acid has also

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shown to possibly prevent events such as miscarriage, ectopic pregnancy or stillbirth.
(Also see Nutrition section, page 24)

What vaccinations are necessary prior to pregnancy?

Women who are planning to get pregnant should make sure that they have been
properly vaccinated and are immune to certain diseases, such as rubella (also called
German measles), which can be determined by blood testing. Rubella infection during
pregnancy is a serious disease, with the developing fetus at increased risk for a
condition called congenital rubella, which can include deafness, heart problems, eye
problems, and mental retardation. ACOG reports that the fetus has a 50% chance of
being affected if the infection is acquired during the first month of pregnancy but only a
10% chance if the mother is affected in the third month. After vaccination, ACOG
recommends avoiding pregnancy for 1 month. If pregnancy occurs before vaccination or
in a woman without immunity, the vaccine should be administered immediately
postpartum before leaving the hospital.

Chicken pox is caused by the varicella zoster virus, and it can also cause severe fetal
infections. In the recent report on vaccinations, the Advisory Committee on Immunization
Practices (ACIP), part of the Centers for Disease Control and Prevention (CDC),
recommended nonpregnant women of childbearing age be vaccinated against varicella if
they are not yet immune, and the American Academy of Pediatrics and the ACIP also
recommend that women wait at least 1 month after getting vaccinated before trying to
get pregnant.

See pages 12 and 15 for more information about chickenpox and rubella.

What vaccinations are safe during pregnancy?

Getting tetanus and influenza vaccinations during pregnancy is safe. For women with
risks, getting a pneumococcal vaccine during pregnancy is safe. If exposed, women may
safely get specific treatments for measles, hepatitis A or B, tetanus, chickenpox, or
rabies.

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 ALTERNATIVES TO INCARCERATION

Women make up one of the fastest growing groups of prisoners in the United
States and California. Nationwide, the number of incarcerated women has tripled
since 1980. In California the number of women in state prison has risen from
about 1,000 in 1980, to more than 11,000 in 2006. This rise is due in part to the
so-called ‘war on drugs’ that has had a devastating impact on communities of
color and poor communities.

Because more women are finding themselves in prisons, jails and juvenile
detention centers, the number of children affected by the absence of their
mothers has also increased. It is estimated that at least 85% of women prisoners
are mothers and more than half of them have a child who is under the age of
eighteen. In addition, at any given time there are about 200 women who are
pregnant and in state prison in California.

Women who are pregnant or have children under the age of six may be eligible
for one of the programs below where they can serve out their sentences in
community settings and have their children with them. Both programs are
administered by the Women’s and Children’s Services Unit of the CDCR’s Office
of Community Resources. The programs are highly structured residential
treatment facilities.

California Prisoner Mother Program

The Community Prisoner Mother Program (CPMP) was established in 1980 as a
result of 1978 legislation. It is a community treatment program that allows
eligible women prisoners to transfer from state prison to a CPMP facility and
serve their sentences at halfway houses where they can live with and care for
their young children. A woman prisoner qualifies for the CPMP program if:

She has a child or children under the age of six years or she is
pregnant;
She was the primary caretaker of her child before she entered prison;
She is within six years of her release date (calculated after deduction
of any possible good time credit);
The person who is now taking care of her child agrees to the child’s
participation in the program;
She has not been found to be an unfit parent in any court proceeding;
She has more than 60 days until she is released or paroled from
prison;
There are no holds or detainers against her;
She has not been convicted of a violent crime. [However, it is important
to note that women whose crime involved the death of the victim may
still be eligible for CPMP provided that: (1) They were convicted of
manslaughter in response to a physically abusive partner, (2) They

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 have no prior felony convictions, and, (3) They have no prior history of
violence whether convicted or not.

Because of a lawsuit settled in 1985 (Rios v. Rowland), the CDCR must notify
women about the CPMP program within one week of their being taken into
custody and allow pregnant women to submit applications prior to delivery. The
CDCR must also inform recently transferred women by including a copy of the
settlement agreement in their orientation materials, and by posting the
agreement in the areas housing potentially eligible women. The CDCR must
keep regional waiting lists of eligible applicants to the program and must train the
staff in processing the applications.

Family Foundations Program

In 1994, the California Legislature created the Family Foundations Program

(FFP) as an alternative to sending mothers and pregnant women to State prison.
Eligible mothers go from the courtroom directly to a residential correctional facility
similar to those in the CPMP; the difference is that no time is spent in prison.
Since it is an alternative sentencing program, the probation department must
recommend placement in the FFP, with agreement by the district attorney,
sentencing judge, and the CDCR.

Women applying for this program must meet many of the same criteria as
prisoners seeking to enter CPMP. For example, their children must be no more
than six years old, or the woman must be pregnant at the time of sentencing, and
the woman must have been a fit parent and primary caretaker of her children. If
eligible for FFP mothers and pregnant women will spend a minimum of 12
months in residential treatment followed by a 12-month intensive aftercare and
transition period to assure successful completion of parole, and to help the
mother reenter society.

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 CPMP and FFP Programs
Current as of August 2006

Community Prisoner Mother Program (CPMP) & Family Foundations

Program (FFP)
501 J Street, Suite 350, P.O. Box 942883
Sacramento, CA 95814
Office Phone: (916) 323-0125 Office FAX: (916) 445-6029

CPMP FACILITIES- NORTH BED

CAPACITY
EAST BAY COMMUNITY RECOVERY PROJECT - PROJECT PRIDE
2551 San Pablo Avenue 24
Oakland, CA 94612
PHONE: (510) 446-7160;

CPMP FACILITIES- SOUTH BED

CAPACITY
PROTOTYPES
845 East Arrow Highway 24
Pomona, CA 91767
Los Angeles County
PHONE: (951) 624-1233

CPMP FACILITIES- SOUTH BED

CAPACITY
TURNING POINT
4941 David Road 23
Bakersfield, CA 93307
PHONE: (661) 858-2975

FAMILY FOUNDATIONS PROGRAM- SAN DIEGO BED

CAPACITY

FAMILY FOUNDATIONS PROGRAM – SAN DIEGO (Center Point)

3050 Armstrong Street 35
San Diego, CA 92111
PHONE: (858) 874-6599

FAMILY FOUNDATIONS PROGRAM- SANTA FE SPRINGS BED

CAPACITY

FAMILY FOUNDATIONS PROGRAM – SANTA FE SPRINGS (LACADA) 35

11121 Bloomfield Avenue
Santa Fe Springs, CA 90670
PHONE: (562) 946-7675

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-46-
 Appendix 3

The Pregnant Patient’s Bill of Rights

Summary of the Pregnant Patient’s Bill of Rights

The following bill of rights for pregnant women was found on the web site for Lourdes Hospital
(Binghamton, NY; www.lourdes.com). A summary of these rights was found on another web site,
www.allina.com, and is included in this appendix. The pregnant patient’s bill of rights was prepared by
the International Childbirth Education Association.

The Pregnant Patient’s Bill of Rights

The pregnant patient has the right to participate in decisions involving her well-being and that
of her unborn child, unless there is a clear-cut medical emergency that prevents her
participation. In addition to the right set forth in the American Hospital Association’s “Patient’s
Bill Of Rights”, the pregnant patient, because she presents two patients rather than one, should
be recognized as having the additional rights listed below:
The Pregnant Patient Has The Right:
1. Prior to the administration of any drug or procedure, to be informed by health professionals
caring for her, of any potential direct or indirect effects, risks or hazards to herself of her
unborn or newborn infant which may result from the use of a drug or procedure prescribed
for, or administered to her, during pregnancy, labor, birth or lactation.
2. Prior to the proposed therapy, to be informed, not only of the benefits, risks and hazards of
the proposed therapy, but also of known alternative therapy, such as available childbirth
education classes which could help to prepare the pregnant patient physically and mentally
to cope with the discomfort or stress of pregnancy and the experience of childbirth, thereby
reducing or eliminating her need for drugs and obstetric intervention. She should be offered
such information early in her pregnancy, in order that she may make a reasoned decision.

3. Prior to the administration of any drug, to be informed by the health professional who is
prescribing or administering the drug to her, that any drug which she receives during
pregnancy, labor and birth, no matter how or when the drug is taken or administered, may
adversely affect her unborn baby, directly or indirectly, and that there is no drug or IV
chemical which has been proven safe for the unborn child.

4. If cesarean birth is anticipated, to be informed prior to the administration of any drug, and
preferably prior to her hospitalization, that minimizes the intake for her and her baby of
non-essential preoperative medicine, which will benefit her baby.

5. Prior to the administration of a drug or procedure, to be informed of the areas of uncertainty

if there is NO properly controlled follow-up research which has established the safety of the
drug or procedure with regard to its direct and/or indirect effects on the physiological,
mental and neurological development of the child exposed, via the mother, to the drug or
procedure during pregnancy, labor, birth or lactation (this would apply to virtually all drugs
and the vast majority of obstetric procedures).

6. Prior to the administration of any drug, to be informed of the brand name and generic name
of the drug, in order that she may advise the health professional of any past adverse reaction
to the drug.
 7. To determine for herself, without pressure from her attendant, whether she will accept the
risks inherent in the proposed therapy, or refuse a drug or procedure.

8. To know the name and qualifications of the individual administering a medication or

procedure to her during labor or birth.

9. To be informed, prior to the administration of any procedure, whether the procedure is

being administered to her or for her baby’s benefit (medically indicated) or as an elective
procedure (for convenience, teaching purposes or research).

10. To be accompanied during the stress of labor and birth by someone she cares for, and to
whom she looks for emotional comfort and encouragement.

11. After appropriate medical consultation to choose a position for labor and birth which is least
stressful to her baby and herself.

12. To have her baby cared for at her bedside, if her baby is normal, and to feed her baby
according to her baby’s needs, rather than according to hospital regimen.

13. To be informed, in writing, of the name of the person who actually delivered her baby, and
the professional qualifications of that person. This information should also be on the birth
certificate.

14. To be informed if there is any known or indicated aspect of her baby’s care or condition
which may cause her or her baby later difficulty or problems.

15. To have her and her baby’s hospital medical records complete, accurate and legible and to
have their records, including Nurses’ Notes, retained by the hospital until the child reaches
at least the age of majority, or, alternatively, to have the records offered to her before they
are destroyed.

16. Both during and after her hospital stay, has the right to have access to her complete hospital
medical records, including Nurses’ Notes, and to receive a copy, upon payment of a
reasonable fee and without incurring the expense of retaining an attorney.

It is the obstetric patient and her baby, not the health professional, who must sustain any
trauma or injury resulting from the use of a drug or obstetric procedure. The observation of
the rights listed above will not only permit the obstetric patient to participate in the
decisions involving her and her baby’s health care, but will help to protect the health
professional and the hospital against litigation arising from the resentment or
misunderstanding on the part of the mother.
Source: Lourdes Hospital. Binghamton, NY. Retreived: September 10, 2006.
www.lourdes.com/Centers_and_Services/womens_and_childrens/bill_of_rights.aspx
 Summary of the Pregnant Patient’s Bill of Rights

Each pregnant patient has the right:

To be informed of the effects and risks of drugs and procedures on her and her baby
To be told of all possible alternatives and options in treatment and procedures
To choose for herself, without pressure from any health care provider, whether or
not she and her baby will accept drugs, treatments, and procedures
To know the names and qualifications of anyone who treats her
To be accompanied through labor and birth by a friend, partner, or family member
To labor and birth in the position most comfortable to her, if it’s medically sound
If she does not care for or get along with a nurse or staff member, to ask that a
different one be assigned to her
To care for her baby at her bedside, if the baby is healthy

Source: Allina Health System Press, “Beginnings: Pregnancy, Birth and Beyond,” fourth edition,
American College of Obstetricians and Gynecologists. Retreived: September 11, 2006. www.allina.com