Chapter 5 – Adult Custody and Security Operations

The California Department of Corrections and Rehabilitation (CDCRCalifornia Department of Corrections and Rehabilitation) shall support the safety, security and the provision of comprehensive health care to all pregnant and postpartum incarcerated persons in CDCRCalifornia Department of Corrections and Rehabilitation custody (including those who have a miscarriage, stillbirth, or abortion, including a termination of the pregnancy) in accordance with law and policy.

The purpose of this policy is to set forth guidance regarding the safety, security, and health care of pregnant and postpartum incarcerated persons.

CDCRCalifornia Department of Corrections and Rehabilitation shall ensure pregnant and postpartum incarcerated persons receive health care services (medical, mental health and dental care), accommodations and protections afforded to all CDCRCalifornia Department of Corrections and Rehabilitation incarcerated persons, as well as the following services, accommodations and protections identified for pregnant and postpartum individuals in program policy documents including, CCHCS Health Care Department Operations Manual (HCDOM), and specifically the following sections and any local operating procedures:

• HCDOM Section 3.3.2.5, Periodontal Disease Program for Pregnant Patients

• HCDOM Section 3.1.16, Patient Care During Pregnancy and Childbirth

• HCDOM 3.1.8 Reception Center

• HCDOM 3.5.20 Medication Continuity with Patient Movement

Appointed guardians of the child and individuals who wish to visit the incarcerated person and child in the hospital shall comply with applicable California Code of Regulations, Article 7, Visiting Rules.

An incarcerated person shall be permitted to breastfeed the newborn while at a hospital. An incarcerated person shall be permitted to pump breast milk to be stored and provided to the child.

Coordination for the milk to be retrieved from the stored location by the child’s care giver shall be arranged prior to pumping and storing the milk.

Pregnant incarcerated persons shall be recommended for placement at or transferred to the California Institution for Women (CIWCalifornia Institution for Women), unless delivery is imminent or there is a medical contraindication to traveling.

Pregnant incarcerated persons housed in a multitier housing unit shall be assigned to lower tier housing. All pregnant incarcerated persons shall be assigned a lower bunk.

Pregnant incarcerated persons shall not be placed in Restricted Housing Units (RHU) during their pregnancy, if known by the department to be pregnant, or for 12 weeks postpartum. This prohibition shall not apply when there is a credible and imminent threat to the safety or security of the pregnant incarcerated person or the institution. If Custody staff determines a pregnant incarcerated person meets the credible and imminent threat to safety and security, then within 24 hours a medical assessment shall occur by the provider or an RNRegistered Nurse with concurrence with the Provider on Call. If the medical assessment identifies clinical contraindications in addition to pregnancy to placement in the RHU, the institution leadership shall be notified. Such placement in the RHU shall not extend beyond five days. Individuals placed in the RHU shall not be unenrolled from work assignments and rehabilitative programs and shall not be subject to other RHU restrictions.

The Facility Captain shall conduct the Restricted Housing Placement Order review for release to appropriate housing and/or a special Institutional Classification Committee shall be completed for appropriate housing.

Staff shall follow standard supervision protocols for pregnant incarcerated persons while adhering to established medical and legal standards that restrict or prohibit the use of restraints and physical force.

Pregnant incarcerated person, if known by the department to be pregnant, shall not be tased, pepper sprayed, or exposed to other chemical weapons.

Pregnant incarcerated persons, if known by the department to be pregnant, shall not be restrained by the use of leg irons, waist chains, or handcuffs behind the body. In the event of transport, the Request for Authorization of Temporary Removal for Medical Treatment Form (CDC Form 7252) shall state in the “Remarks” section, “Application of restraint gear limited to handcuffs in front of incarcerated person only.”

A person who is in labor, delivery, or recovery, shall not be restrained by the wrists, ankles, or both absent extraordinary circumstances. Recovery is the length of time the incarcerated person stays in the hospital after giving birth. If handcuffs are applied, the incarcerated person’s arms shall be brought to the front of their body for application.

Staff shall remove all restraints applied to a pregnant incarcerated person experiencing a medical emergency, labor, delivery or recovery if a professional responsible for the medical care of the pregnant incarcerated person determines that the removal of restraints is medically necessary. Recovery is the length of time the incarcerated person stays in the hospital after giving birth.

An incarcerated pregnant person in labor and delivery shall be given the maximum level of privacy possible during the labor and delivery process. If a custody officer is present, they shall be stationed outside the room rather than in the room, absent extraordinary circumstances. If the custody officer must be present in the room, the custody officer shall stand in a place that grants as much privacy as possible during labor and delivery. A custody officer shall be removed from the room if the professional responsible for the medical care of the person during a medical emergency, labor, delivery or recovery after delivery determines that the removal of the custody officer is medically necessary.

A pregnant incarcerated person shall be allowed to walk during labor as prescribed by the attending doctor. The area used to walk during labor shall be determined based on safety and security needs.

An incarcerated person, when known by the department to be pregnant, shall be advised in writing of the law, regulations, and the institution’s policies governing pregnant incarcerated persons.

A pregnant incarcerated person shall receive extra provisions including two extra cartons of milk, two extra servings of fresh fruit and two extra servings of fresh vegetables daily.

A pregnant incarcerated person shall receive prenatal vitamins, to be taken on a daily basis, in accordance with medical standards of care.

A pregnant incarcerated person shall receive a minimum of 120 ounces of bottled water daily.

pregnant incarcerated person shall be allowed one additional larger pair of shoes to accommodate the swelling of their feet.

Within seven days of arriving at an institution, a pregnant incarcerated person shall be referred to a Licensed Clinical Social Worker for Case Management. The social worker shall discuss with the pregnant incarcerated person available options for feeding, caring for, and visiting with the child after birth. The social worker shall discuss the options to establish future placement for the child and shall oversee placement for the child. The social worker shall assist the pregnant incarcerated person with access to a phone to contact relatives regarding newborn placement even during their unclassified status. The social worker shall discuss with the incarcerated person options for parenting classes and other classes relevant to caring for newborns and options for visiting with the newborn.

A pregnant incarcerated person shall be provided notice of, access to, and written application for community-based programs serving pregnant, birthing, or lactating incarcerated persons, including the Community Participant Mother Program (CPMP). The notice shall contain guidelines for qualification, the timeframe for application, and the process for appealing a denial of admittance. If a community-based program is denied access to the institution, the reason for the denial shall be provided in writing to the incarcerated person within five working days of receipt of the request. The written denial shall address the safety or security concerns for the incarcerated person, infant, public, or staff.

A pregnant incarcerated person in labor or presumed to be in labor shall be treated as an emergency and shall be transported in the least restrictive way to a hospital outside the institution. A pregnant incarcerated person shall not be shackled to anyone else during transport.

A pregnant incarcerated person may elect to have a support person present during labor, childbirth, and recovery. Recovery is the length of time the incarcerated person stays in the hospital after giving birth. The support person may be an approved visitor or the institution staff designated to assist with prenatal care, labor, childbirth, lactation, and postpartum care. The approval for the support person shall rest with the Warden, or designee, and shall be on a case-by-case basis. Within five working days of receipt of a request, any reason for denial shall be provided to the pregnant incarcerated person in writing and shall address the safety and security concerns for the incarcerated person, infant, public, and staff. Upon receipt of a written denial, the pregnant incarcerated person may choose the approved institution staff as the support person.

The Watch Commander shall notify the AODAdministrative Officer of the Day of a child’s birth. Notification shall include the name and CDCRCalifornia Department of Corrections and Rehabilitation number of the incarcerated person, time of departure, location of transport, and time of delivery. The medical department shall notify the Watch Commander of any non-routine deliveries.

The Associate Director, Region II or designee shall ensure that the contents of this article are current.