Staying connected: Moms who pump in prison

An innovative lactation program encourages incarcerated new moms to maintain their breast milk supply, reinforcing maternal bonds and providing health benefits to newborns.

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Theresa Reid feeds her five-month-old niece, Ummayyah, a bottle of breast milk that was pumped by Ummayyah's mother, Cierra Jackson, who is serving a 6-to-23-month sentence at Riverside Correctional Facility, in Philadelphia. (Kriston Jae Bethel/Next City)

Theresa Reid feeds her five-month-old niece, Ummayyah, a bottle of breast milk that was pumped by Ummayyah's mother, Cierra Jackson, who is serving a 6-to-23-month sentence at Riverside Correctional Facility, in Philadelphia. (Kriston Jae Bethel/Next City)

This story originally appeared on Next City.

Warden Nancy Giannetta, clutching a dense ring of keys, gets buzzed through a series of security doors and into Unit G of Riverside Correctional Facility, a county jail for women in Philadelphia. It’s a Thursday afternoon in January when Giannetta greets three uniformed guards on her way to the back of the unit, where there’s a room with a turquoise door and windows shielded from the inside by a curtain.

“Ladies, you can resume your activities, just try to stay out of the way,” says Giannetta, who untangles a key to unlock a room no bigger than a few standard cells.

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Inside are folding tables, plastic chairs, a cooler, and the low-pitched, electrical hum of a hospital-grade breast pump. It’s where Cierra Jackson pumps according to her specifications, three times a day, under the direction of a doula and a nurse. “They gave me a book on breast-pumping and it was telling me that the breast milk has antibodies,” Jackson says. “It’s very helpful for the baby, keeping them smart and healthy. I did not know until I read the book. I never breastfed before — I never wanted to.”

Jackson is one of six mothers at Riverside who are currently participating in the lactation program, one of the first of its kind inside an American jail. Women who give birth just before or during their time here are given access to breastfeeding education and the facilities of the lactation room, plus additional hand pumps and milk storage bags to keep within their cells. Case managers from a local nonprofit transport the mothers’ milk directly to their babies on the outside, returning to jail with pictures and updates.

While a woman’s right to pump her breast milk is legally protected in the United States, the privilege doesn’t extend to incarcerated moms. Unlike men, the majority of whom are incarcerated in state and federal prisons, the majority of women in custody in the U.S. are locked up in local or county jails. And the majority of these women have yet to be convicted of a crime. Most are being held in custody pre-trial because they can’t afford to post bail, or they’re waiting on overburdened criminal courts to try their case. (Of those women already convicted, most are serving time for misdemeanors or lesser offenses.) On any given day, 70 percent of all people in American jails haven’t been convicted of a crime. In Philadelphia, the duration of pre-trial stays have been considerably longer than in most big-city jurisdictions; more than a quarter of pre-trial detainees stay in jail for a month or longer.

One month (or less) spent in lockup is plenty of time to lose a job, to get evicted, or in the case of a nursing mother, to lose the ability to produce and provide breast milk for a newborn — a loss that carries potential health consequences for both the child and the mom. Those consequences are exacerbated by the fact that people in jail make even less money than those imprisoned in state or federal facilities. Given that the cost of infant formula can run upwards of $1,500 per year, the most at-risk mothers — and their children — are also being economically penalized by revoking their right to pump. Unless they happen to be sent to a jail such as Riverside.

While it’s not skin-to-skin contact between mother and child, the lactation program aims to achieve some of the same psychological and health benefits ascribed to breastfeeding. The medical consensus is that babies who consume breast milk are at lower risk of asthma, diabetes, and sudden infant death syndrome, while mothers are less likely to develop breast and ovarian cancers. But the practice also promotes more stable family units, strengthening an emotional bond between child and caretaker.

Among the women at Riverside who participate in the lactation program are (from left): Cierra Jackson, Tynette and Germaine Opher. (Kriston Jae Bethel/Next City)

“I get to have a clear mind, three times a day”

That bond can be strengthened even when mom is behind bars. “I can still have some type of connection with my daughter, a connection through the milk,” Jackson says. “I never wanted to breast pump before. All my other kids had formula.”

Jackson, 27, was arrested last fall one day after giving birth to her youngest daughter, Ummayyah. There was a bench warrant out for her arrest stemming from a missed court appearance, which was part of Jackson’s house arrest for an assault charge she picked up in 2017.

“I knew they had the bench warrant out for me, I just didn’t know when they’d serve it,” Jackson says. Once over with the delivery, she knew she was headed back in jail. “When I was at the hospital I was so depressed. I didn’t want to eat or sleep because they told me I was being taken away from her.”

Bridget Biddle (right), from the Maternity Care Coalition, assists Cierra Jackson (left) as she pumps her breast milk. (Kriston Jae Bethel/Next City)

Jackson, a mother of four, says the last six months have been the longest period of time she’s spent away from her kids, although, by pumping for her new baby for the first time in her life, she hasn’t felt entirely lost. She also is taking parenting classes at the correctional facility. The nonprofit Maternity Care Coalition runs the classes and the lactation program, through an initiative it calls MOMobile.

“I thought I would be up here stressed out because I just had a baby and I knew how long I would have to be here,” Jackson says. “Being in the lactation program, I’ve been happy ever since” — she pauses, as if made aware again of her surroundings — “being in the lactation program, coming here, it’s like I get to have a clear mind three times a day.”

An idea whose time has not quite come (yet)

Jails are not just “mass incarceration’s front door,” as the Prison Policy Initiative wrote in a 2017 report, they are ground zero for family separation in the criminal justice system. Given the greater likelihood of family reunification because of shorter jail sentences, there’s a powerful argument for allowing a newborn contact with her jailed mother.

The lactation program at Riverside is one of a handful of similar restorative programs happening for mothers inside U.S. correctional centers, although no official census exists for these programs. Tracking by the New Mexico Breastfeeding Task Force, a nonprofit advocacy organization, suggests there are more than 10 but fewer than 20 lactation programs in jails across the nation which allow moms in custody to pump for their kids. While prison nurseries exist in nine U.S. states — permitting women who’ve given birth on the inside a chance to effectively live with their babies behind bars for a finite period of time — and mothering from jail is a common sight around the world, the unique plight of jailed mothers is less popularly known, despite the fact that the population of women in jails has grown more than 1,000 percent since 1978, according to data by the Prison Policy Initiative.

As the mysterious death in 2015 of Sandra Bland— who died of strangulation inside a jail, not a prison — revealed, there’s also less accountability and attention paid to jails. This includes issues relating to maternal and infant care.

What little progress has been made nationally on pumping in prison has happened mostly at the state level. Some departments of corrections (DOCs) continue to ban breastfeeding altogether, but others have begun to retool approaches. In 2017, Monique Hidalgo, a prisoner serving a three-year sentence in New Mexico, sued for her right to breastfeed her child during visits, winning a court order that shook up that state’s DOC. Then, Hidalgo’s subsequent positive drug test put the breastfeeding pilot program at her facility on hold. (The prison suggested that Hidalgo could spread Hepatitis C to her child, which raised health concerns about the lactation pilot program more broadly.) This year, the New Mexico state senate recommended passage of two pieces of legislation that would require all jails and prisons in the state to provide access to electrical pumps and storage for lactation, among other breastfeeding implementations. Advocates are optimistic that the bills will be signed by a newly elected governor this year.

“It was devastating to watch women go in [to Riverside] with their babies and then come back [from the hospital] without their babies, crying and sad. The only time some of them was really happy was when they’d go to the lactating room and pump for their babies.”

Most DOCs lack clear policies around breastfeeding or pumping, leaving regulations up to individual facilities. It’s an issue more jurisdictions will be forced to consider. An estimated 6 to 10 percent of the female prison population is pregnant upon incarceration. Not only do breastfeeding programs aim to preserve and strengthen the early-childhood bond with a parent, but they’re also advancing an important public health goal among populations of women who are less likely to pump.

The breastfeeding initiation rates in Philadelphia, particularly among African-American mothers, have historically lagged considerably behind national averages. Between 1999 and 2005, Philadelphia ranked 10th out of 10 major American cities in breastfeeding initiation rates, at 57 percent, according to data by the Pennsylvania Department of Health, although it’s since increased to 80 percent as of 2016. (83 percent is the national average.)

A lifeline during the trauma of separation

Last year, when Tysheen Robinson gave birth at Temple University Hospital, the delivery took almost 24 hours. No family members were permitted in the obstetrics unit. Security guards flanked her bedside. Although she wasn’t handcuffed to the bed, Robinson was treated like any incarcerated mom: as a security risk. If not for the prison doula who accompanied her, she’d have given birth amid a crowd of strangers.

After cradling her healthy newborn for the first time, the clock immediately began ticking. “You only have two days. Then someone comes right up, gets ‘em, and you’re right back to the prison. If you don’t have no one to get ‘em, they will be going into the system,” Robinson said in December, sharing her story as part of a public speaking series at Eastern State Penitentiary, Philadelphia’s famous jail-turned-museum that has used recent exhibits to explore the impact of mass incarceration.

“It was devastating to watch women go in [to Riverside] with their babies and then come back [from the hospital] without their babies, crying and sad,” said Robinson, who finished her sentence on a drug possession charge shortly after her pregnancy. “The only time some of them was really happy was when they’d go to the lactating room and pump for their babies.”

It’s five times more common for children with incarcerated mothers to end up in foster care, when compared to those with incarcerated fathers, making the severance of the mother-child bond a commonplace feature of the criminal justice system. It was a harsh introduction for Tynette (who preferred to not use her last name), 20, who arrived at Riverside when she was 39 weeks pregnant. “I was scared. This was my first time being arrested or first time anything, being in any kind of trouble,” she says, before mustering a few words about her case. “One of my children fell. I took him to the hospital — he was fine — and I let them know that I wasn’t in the same room; I was in the living room. Then they took him from me.”

“It was a shock because I thought that maybe if I had left the house it would be endangering his welfare, but I didn’t think that me stepping into another room was, you know, putting him in danger, otherwise I would have never left,” she says. “It’s a big adjustment in here.”

Colette Green, the director of behavioral health at Maternity Care Coalition, says that the rate of psychological stress in jails is much higher than in prisons. Many factors contribute to this, including challenges from within jail that prevent communicating with families, and availability of fewer services on the whole. All that toxic stress can affect a child’s neurological development, either during the pregnancy or after mom and baby are reunited on the outside.

“Studies have shown that maternal psychological stress can impact the fetus. So a woman experiencing stress, depression — that can have a long-lasting impact on a child,” says Green. “Even a short stay in prison can have a serious long-term consequence.”

Stress can also curtail a mother’s milk production; few situations are more stressful than living in penal custody. That’s why with any lactation program, designing the room is as important as crafting the policies and securing the bureaucratic buy-in that affords jailed moms “the right” to pump.

Conversely, without pumping consistently, new mothers can become painfully engorged, develop infections or witness a rapid depletion of milk supply. Even so, some women enrolled in the lactation program admit that they would not have given pumping much thought if not for the intervention of Maternity Care Coalition.

“I knew it was healthy for my baby and the best thing for me, but I just thought it would hurt. I didn’t want to go through that, traveling with her and breastfeeding, so I had just chosen formula,” Robinson says, recalling her thinking before being introduced to MCC.

Others, such as Windy Fortune, knew how much they wanted to breastfeed when they got to Riverside and have been thrown an unexpected lifeline through the lactation program.

“I have eight children. I breastfed all of them. This was the first time I’ve been away from any of them. This is pretty rough,” says Fortune. “I think if it wasn’t for this program, I would have lost it a long time ago. This is the only way I can still be involved.”

“We’ve found that most of the women who’re in here going through this very similar experience are really bonded. It’s this rare space that feels separate, where they can talk about being parents and their kids,” says Bridget Biddle, an MCC advocate based at Riverside, who oversees the lactation program.

Working moms face their own struggle. Passage of the 2010 Affordable Care Act guaranteed women the right to pump at work and a “reasonable break time” to do so. But the law’s many loopholes have resulted in working women using lactation “spaces” that range from cramped to uncomfortable to downright hostile — think storage rooms, filing closets, even, in an open-office culture, moms “perched delicately atop toilets,” as one woman wrote in Philadelphia magazine.

One step along the road to greater reform

The importance of having the support of Riverside’s administration can’t be understated. If not for buy-in from warden Nancy Giannetta, the lactation program would never have launched. “I’ve been in this business for so long that I’ve seen a point when they used to just take the baby away with no communication — to now, when the mother is still able to have an active role in the child’s health and growth while still incarcerated,” Giannetta said during an interview in December. “I think being one of the first in the country to do this, it’s something to be proud of.”

Viewed through the lens of recidivism, the lactation program — and the work of MCC more largely at Riverside — also pays dividends. One recent study looking at a prison nursery program found that mothers who were allowed to care of their children while in custody had 50 percent lower recidivism rates for up to three years after release.

Giannetta, who has a placard on her desk that reads “I’m not bossy, I’m the boss,” has witnessed the transformative potential of promoting motherhood behind bars. “I was here, when it first started, as a captain, so I’ve seen the program grow since its inception,” she says. Since 2006, MCC has run motherhood- and health-education programs within Riverside. As the relationship has grown over time, MCC has grown its physical footprint inside the facility, expanded into doula services and other forms of assistance.

Theresa Reid, Cierra Jackson’s aunt, receives a delivery of frozen breast milk for Cierra’s daughter, Ummayyah. (Kriston Jae Bethel/Next City)

The lactation program aligns with the broader climate of reform within the Philadelphia Department of Prisons. Led by $7.65 million in grants from the MacArthur Foundation, city officials have committed to the goal of reducing the prison population while lessening the impact of the criminal justice system on racial minorities and people struggling with poverty.

The population at Riverside has decreased from roughly 750 women per day in 2015 to just over 400 today. Giannetta points to programs such as early bail reviews that have made a difference. “I think the administration is more into reducing recidivism or into diversionary programs, due to the MacArthur grant,” says Giannetta. “A lot of the programs done here in the prison system itself are geared toward living outside the walls.”

It also doesn’t hurt that from the facility’s perspective, the lactation program is a relatively low-maintenance enterprise, once up and running. The lactation room itself is tiny — small enough that the prison staff once moved it from another location in only a few hours last year — and requires little more than the chest freezer, a storage-filing system, pumping equipment, and supervision.

Going the extra mile to deliver the milk

The creation of a safe, comfortable environment at Riverside had to be a prerequisite for the program to succeed. It also had to be convenient.

“Initially, the idea was that the caregivers would pick up the milk for their child. [But] it’s not really practical,” says MCC’s Green. Expecting families who live miles away, often with low incomes, to carry the weight of the program didn’t work. Another hurdle was Riverside’s location, in the relatively inaccessible Northeast section of the city. “Often, [visiting caregivers] are taking a bus, and then the milk is going to thaw,” says Green, who notes that once thawed, breast milk cannot be refrozen and used effectively.

Instead, MCC takes the milk directly to the children, whether they’ve been living with a relative or have been brought into foster care. Over the last two years, the lactation program at Riverside has transported more than 4,000 ounces of milk to families on the outside, using boxy red insulated containers that could easily be mistaken for pizza delivery bags.

A lot of those bags are delivered by Bridget Biddle, who says there’s more milk being pumped each day. “Three women gave birth two weeks ago — a Sunday, a Wednesday, and a Friday birth — and luckily they all want to be in the program,” she said in mid-January. “It’s something when the trauma of separation is happening to stay connected.”

Particularly in jails, which house women who await trial (who haven’t been convicted but who can’t post bail) or who serve time for minor crimes (mostly drug offenses), the lactation program represents a light at the end of the tunnel. For these women, the promise of getting out is real, which offers the chance to continue what the lactation programs begin to instill.

“Here, at least there’s the idea that the mothers are going to reunify with their kids, so they’ll be able to continue to breastfeed. That’s what’s amazing — they can go back home and continue to breastfeed. Otherwise, they wouldn’t be able to.” Green says. “We take advantage of a captive audience. They want to learn.”

Over time, scheduling milk deliveries have become an integrated piece of the continuum of early-childhood care provided by MCC to families affected by incarceration. As part of its other services, MCC case managers already serve as a conduit between the mothers at Riverside and the homes where children are staying. In addition to supplying resources such as diapers, clothing and school supplies to the children of incarcerated mothers, MCC does home visitations and works to prepare the household for mom’s reentry. After release, they continue to work with mothers and children.

These days, Robinson nurses her baby, skin to skin, as a working mom. “I wish a lot of places could have this MOMobile program. I knew nothing before this,” Robinson said at the Eastern State event. “[Jail] was one of the worst experiences of my life … There were times when I didn’t want to have a baby in jail. My goal, for now, is to make a career, have a career for me and my baby.”

Next City is one of 22 news organizations producing Broke in Philly, a collaborative reporting project on solutions to poverty and the city’s push toward economic justice. Follow us on Twitter: @BrokeinPhilly.

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