Transcript Pregnancy Issues in Juvenile Detention

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Discuss why pregnant adolescents are considered high risk
Special Considerations in regards to
 Use of force
 Restraints
 Transportation
 Substance Abuse and Detoxification/Withdrawal
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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
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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
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Prone positioning- blunt trauma to abdomen Spontaneous abortion
 Preterm labor
 Placental abruption
 Fetal maternal transfusion
 Still birth
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Supine positioning- supine hypotensive syndrome (8%)
Anxiousness, nauseated
Syncope
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
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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
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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.
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The widespread use of restraints as a risk management
tool for justice-involved women is not supported by the
evidence.
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The use of restraints is only one facet of the need for
system reform regarding pregnant women in custody.
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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
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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.)
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Increased fetal loss
Poor prenatal care
Pre-term labor and delivery (25-40%)
Intrauterine Growth Retardation
 Small baby =small baby brain
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Congenital infections
Perinatal infections(HIV, HBV, GBS, HSV)
Placental abruption (psychostimulants)
Maternal mortality
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.
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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