In 2000, Amnesty International published a report describing the treatment and experiences of women behind bars and of women prisoners during the delivery of their baby.   It was reported that jails and prisons around the United States commonly use restraints on incarcerated women when they are being transported, during labor and delivery, and after the birth of their baby.  In some prisons, even chains or leg irons continue to be used during transport. 
Pregnant women in prison constitute about 6.4% of the prison population in the United States and continues to rise ( Amnesty International, 2000; BJOG, 2005).  Pregnant incarcerated women  have been identified as a potentially high risk population ( Amenesty International, 2000; BJOG, 2005; Fogel, 1993; Fogel & Belyae, 2001; Fogel & Harris, 1986; Kubiak, Young, Siefert, & Stewart, 2004; Wismount, 2000).  Typically these women come from impoverished backgrounds with a history of   physical and/or sexual abuse, mental health issues, substance abuse problems, poor nutrition, and little or no prenatal care. (BJOG, 2005;  Egley, Miller, Grandos, Ingram,  & Fogel, 1992; Fogel, 1993; Knight & Plugge, 2005).
The use of any restraints on women who are about to give birth endangers the woman and her baby (Amnesty International, 2000; The Rebecca Project, 2008; van Wormer and Kaplan, 2006).  Complications that have been reported as a result of shackling during labor include hemorrhaging, decrease in fetal heart rate, and brain damage ( Amnesty International, 1999; van Wormer and Kaplan, 2006). Although the use of restraints may not violate criminal laws, this practice does violate internationally recognized human rights standards ( Amnesty International, 2000).   The use of shackels and restraints on pregnant women during labor and delivery is “especially cruel in light of who those mothers are.  They are not violent offenders, guilty of crimes like murder, rape and assault.  Nearly 71% of all arrests of women are for non violent larceny and theft or drug related offenses” (The Rebecca Project, 2008).
Although the majority of states continue to shackle women even during their labor and delivery, California, Vermont and Illinois have established legislation regulating the use of shackles and restraints on pregnant women.   In addition, Departments of Corrections (DOC) in Connecticut, Florida, Rhode Island, Washington, Wyoming, Oregon, Oklahoma and Washington DC  now have written policies stipulating that no restraints be used on inmates during labor and birth (The Rebecca Project, 2008).    

Nurses are in an ideal position to advocate for policies that will provide humane care for pregnant incarcerated women.  We can be the voice for thousands of women  who have  become  invisible.