Pregnancy Issues in Juvenile Detention

Objectives Discuss why pregnant adolescents are considered

high risk Special Considerations in regards to

Use of force Restraints Transportation Substance Abuse and Detoxification/Withdrawal

Pregnant Adolescents: High Risk Pregnancy In best circumstances, teen pregnancy is high

risk. Risk significantly increased in juvenile justice population

Conditions more likely to be encountered in the juvenile justice female More likely to live in poverty Poor quality of health Substance Use Disorders Mental Health Issues / Trauma Sexually Transmitted Infections

General issues with teen pregnancy

Late prenatal care Outcomes are generally good but very young

mothers <16 are at increased risk for Pre-eclampsia Anemia Placenta Previa Pre-term labor Small for gestational age infants (SGA) Infant death

Outcomes are influenced by socioeconomic status and age

Use of Force- Positioning matters Prone positioning- blunt trauma to

abdomen- Spontaneous abortion Preterm labor Placental abruption Fetal maternal transfusion Still birth

Placental Abruption

Use of Force- Positioning matters Supine positioning- supine hypotensive syndrome

(8%) Anxiousness, nauseated Syncope

Restraint use in pregnancy National Symposium on the Use of Restraints on

Pregnant Women Behind Bars (11/22/10). American College of Obstetrics and Gynecology-

Shackling Pregnant Inmates (2005) 2010- NCCHC Position Statement on Restraint in

pregnant inmates AB568 –vetoed by governor (2011) AB2530- delivered to governors desk 9/11/12

National Symposium on the Use of Restraints on Pregnant women behind bars – November 22, 2010 Identified Concerns:

The use of restraints can pose health risks for mother and child and can interfere with healthcare during pregnancy, labor and delivery

Adjustment and emotional difficulties may be induced or exacerbated by the use of restraints.

Restricted physical contact between newborns and their mothers- in part a function of the use of restraints following delivery-can be detrimental to the wellness of the child

National Symposium on the Use of Restraints on Pregnant women behind bars – November 22, 2010

Policies, operating procedures, and practices pertaining to the use of restraints on women in custody vary considerably within and across federal, state, and local jurisdictions and agencies.

The widespread use of restraints as a risk management tool for justice-involved women is not supported by the evidence.

The use of restraints is only one facet of the need for system reform regarding pregnant women in custody.

Poses health risks for mother and child Balance issues especially in the second and third

trimester. Increase falls/trips

▪ Preterm labor, placental abruption, injury to fetus Pregnant females need to be able to break the fall

Restraints interfere with the performance of routine examinations

and procedures during the course of the pregnancy limit the mobility that is important to the progression of

labor, the management of pain and discomfort during labor, and the process of delivery

Hinder the ability to respond to an emergency situation or acute complications with mother (pre-eclampsia, fetal distress, placental abruptions, etc.)

Substance use in pregnancy

Maternal and obstetric complications of perinatal substance abuse

Increased fetal loss Poor prenatal care Pre-term labor and delivery (25-40%) Intrauterine Growth Retardation

Small baby =small baby brain Congenital infections Perinatal infections(HIV, HBV, GBS,

HSV) Placental abruption

(psychostimulants) Maternal mortality

Detoxification/Withdrawal Withdrawal in mother= Withdrawal in fetus Medical withdrawal of the pregnant opioid dependent

youth is not recommended because of high rates of relapse and the increased risk of fetal death.

Opioid withdrawal syndrome during pregnancy can lead to fetal demise and premature labor. Even minimal symptoms in mom may mean fetal distress, as the fetus is more susceptible to withdrawal symptoms than the mother.

Methadone or Buprenorphine Naloxone should not be given to pregnant women

except as last resort in life-threatening overdose because it precipitates withdrawal and can lead to spontaneous abortion, premature labor or stillbirth.

Key for pregnant youth

Early identification Entry or Continuation of prenatal

services Nutrition STI testing Medically assisted detoxification and

SUD services Minimize restraint use to avoid injury Positioning matters