Nonuse of Restraints for Pregnant and Postpartum Incarcerated Individuals (2025)

This position statement provides guidance regarding the nonuse of custody restraints with pregnant individuals. It does not address the use of medical restraints, as standard clinical and ethical practices apply as they would for nonincarcerated pregnant people.

Pregnancy, birth, and the postpartum period in custody present special concerns for health and well-being. Pregnancy is a medically complex time when neither the pregnant person nor fetus should be exposed to unnecessary risks. Restraints can increase risk of falls or injury throughout pregnancy, cause harm during the processes of labor and delivery, hinder the ability to provide emergency obstetrical care, and interfere with postpartum recovery, including the mother’s ability to safely hold and breastfeed their infant. Obstetrical emergencies during pregnancy, labor, birth, and the postpartum period arise unpredictably, and medical staff must be able to evaluate and treat the pregnant person and fetus without interference from restraints and without delay. For these reasons, multiple health care professional societies, including the American Medical Association, the American College of Obstetricians and Gynecologists, and the American Public Health Association, strongly recommend against the use of restraints in pregnancy and postpartum.

Pregnant individuals should receive medically appropriate prenatal, intrapartum, and postpartum care, including appropriate nutrition; these issues are addressed in the National Commission on Correctional Health Care’s Standards for Health Services.

Restraints must not be used during labor and delivery, including during transport to the hospital for labor. As the default, avoid the application of restraints during all other points of pregnancy and the 12-week postpartum period and use them only when necessary to address a serious security concern. Health care and custody staff must also comply with relevant local, state, and federal laws regarding the application and documentation of restraints during this period.

When restraints must be applied to a pregnant or postpartum person, use the least restrictive means possible. Custody staff should be immediately available and required to remove restraints upon request of health care personnel, whether at the correctional facility or an off-site health care facility. To maintain privacy for the pregnant person, custody staff should be positioned outside the patient’s clinic or hospital room, or, at a minimum, behind a curtain.

Restraints should be avoided during the first 12 weeks of the postpartum period because labor and delivery can result in energy depletion, dehydration, difficulty in urination or defecation, and complications such as hemorrhage. Necessary mobility to reduce the risk of postpartum blood clots and rapid response to medical emergencies should also be taken into account.

For the most successful outcome of a pregnancy and to ensure a dignified birth experience, collaboration among custody staff, facility health care staff, and community clinic or hospital personnel is required. To optimize cooperation, facilities should distribute this position statement and their facility’s policy to partnering clinics and hospitals (especially emergency departments and labor and delivery units) and discuss these protocols with relevant clinic or hospital personnel (e.g., hospital security, labor and delivery leaders). Facilities need to comply with state laws and local statutes addressing this issue. Correctional administrators should have systems to document and review all uses of restraints in pregnant individuals and address instances of inappropriate restraint.