Minnesota has joined a number of states that ban the use of restraints while inmates are giving birth and guarantees that incarcerated moms-to-be have access to a birthing coach during delivery.

The change makes Minnesota part of a larger national trend in which state leaders are insisting on better care of incarcerated mothers and their newborns. Advocates consider this the first law in Minnesota that directly targets the needs of pregnant inmates and their babies.

"It's not about these women as much as it is the future citizens of our society," said state Rep. Carolyn Laine, a Columbia Heights DFLer who sponsored the measure. "We want them to have a good foundation, because everything builds on that."

Minnesota became the 20th state to outlaw restraints during childbirth and the first in the nation to include a provision that specifically guarantees access to birthing coaches, known as doulas. Minnesota legislators passed the measure unanimously this spring, and the law took effect July 1.

The measure prohibits county jails and state prisons from shackling women during pregnancy and up to three days after childbirth. The law says that if restraints are absolutely necessary for the safety of the woman, prison staff or public, they must be "the least restrictive available and the most reasonable under the circumstances." It also requires mandatory pregnancy testing when female prisoners enter the facility, along with free newborn care education for expectant mothers.

"It makes sense to help nurture them to be good mothers to their children, instead of letting them go through this heartbreaking process alone," said Rae Baker, program coordinator at Isis Rising, a doula program that provides parenting and birthing services for expectant mothers in state facilities.

Baker's group pays for the doulas through grants and private donations, without any taxpayer money. Right now they are trying to raise money to expand the program into county jails. Isis has a budget of about $110,000 a year.

Prison officials say the birthing coaches are already saving taxpayers money. Statistics show that pregnant inmates who use a birthing coach were far less likely to need Caesarean section births, which cost roughly $15,000 each compared with $7,000 for vaginal births.

Birth coaches first became available four years ago at Minnesota Correctional Facility-Shakopee, the state's only women's prison. Before that, seven out of 11 inmate births were delivered by C-section. Within the first two years after the doulas arrived, 29 babies were born and only one by C-section. Overall, the C-section rate plummeted to 3 percent, down from 63 percent.

Explosive growth in the prison populations has resulted in more issues surrounding pregnant inmates.

At Shakopee, tougher drug sentencing laws are largely to blame for a prison population that soared 825 percent since 1973. While the prison does house violent offenders, almost all of the women the doula program serves are convicted on low-level drug and property charges.

Shakopee currently houses nine pregnant inmates, but usually has 12 to 15 at any one time. The Minnesota chapter of the Children's Defense Fund, however, estimates that 4,200 women per year in the state are pregnant at the time of their arrests.

With growing scrutiny of over the treatment of inmates around the country, child welfare advocates in Minnesota and nationally have stepped up pressure to stop the practice of shackling inmates during childbirth. Despite occasional complaints and lawsuits, the practice of restraining prisoners in labor continues in 30 states.

"It just felt so unnecessary," said Baker, who watched a mother being shackled after delivery. "This mom wasn't going to be running [away]."

When inmates go into labor at the Shakopee prison, they are taken to St. Francis Regional Medical Center, where only medical staff, a doula and two correctional officers can be in the room. No family or other loved ones are allowed.

More time with newborns

Before the new law, inmates were routinely shackled immediately after delivery and restrained as they were driven back to the prison.

Now women are allowed to stay with their newborns unrestrained for 48 hours — or 72 if they have a C-section. Once it is time to return to prison, the doula delivers the baby to a family member or social service worker. There can be no contact between the family and the inmate.

Prison officials say they have to strike a balance between providing needed security and ensuring the well-being of the mother and the newborn. Pregnant inmates can have violent histories, and other states have reported women trying to hurt medical staff during delivery.

Shakopee officials said they had to make few changes when the new law took effect, and are proud of the level of care pregnant inmates receive.

"Offenders receive the same standard of care as pregnant women receive in the community," corrections spokeswoman Sarah Latuseck said.

Health advocates say the new law ensures a more humane experience for mothers and their newborns.

"Childbirth is a humbling and overwhelming experience for everyone," said Katy Kozhimannil, an assistant professor at University of Minnesota. "Having a doula helps make this transition easier."

An advisory committee will convene to consider additional treatment and education options for incarcerated women who are pregnant or recently gave birth and present a report to the Legislature in January.

"The reality is that these infants are completely innocent in all of this," said Rebecca Shlafer, an assistant professor of pediatrics at the University of Minnesota and chair of the advisory committee. "Only good can come of having women be supported to have healthy pregnancies and births — regardless of what got them into prison in the first place."