That's how we do things here . . .

Courtney Fortin is, like me, the mother of a bouncy toddler. Both our children were born in the month of June. Courtney and I both suffer from lack of sleep, but we agree that it's worth it—the bags under our eyes and the applesauce on our blouses, not to mention the nausea in our bellies because both of us have another baby on the way (me any day now; Courtney's due in February). Both of us are expecting girls.

Here is what Courtney and I don't have in common: During my last pregnancy, I had prenatal care. I had regular trips to my obstetrician, what felt like too many near the end (one per week), but they were pleasant and necessary. I had about four extra pillows on my bed—two under my legs, one between my thighs, and one to rest my giant belly on. I also had plenty of prenatal vitamins and folic acid tablets for the baby to grow big, and compression socks for swelling. I owned comfortable maternity clothes, stretchy leggings that made it easier to waddle to and from my car. My only complaints were the water-retention in my face and the fact that all pregnant women weren't issued handicap-parking stickers the minute their test read "positive."

There was always a male correction officer from York County Jail in the examination room, and she was handcuffed and chained throughout every visit.

During Courtney's last pregnancy, there were no prenatal vitamins, no folic acid. There were no compression socks for the swelling nor was there a body-pillow for extra support. Instead, Courtney had a stone-hard bunk and one flaccid pillow, just like everyone else around her. Instead of maternity clothes to accommodate her ever-growing stomach, she was given an orange jumpsuit. And it wasn't until five months into her pregnancy that she was granted her first prenatal appointment—one of just three. During the appointments, she had zero discretion, privacy, or confidentiality. There was always a male correction officer from York County Jail, where she was an inmate at the time, in the examination room, and she was handcuffed and chained throughout every visit. To get to the obstetrician's office, Courtney says she sat shackled in the back of a van. When she arrived at the doctor's office, she asked the correction officers to remove her handcuffs and leg shackles (which were cutting off circulation in her swollen ankles) so she'd be less likely to trip and fall as she lowered herself out of the van. Her balance was compromised, she explained, and she'd be unable to catch herself with her chained hands. Their only response: That's how we do things here . . .

"I just one time tried an Oxy and just kind of spiraled out from there."

I first heard of Courtney's story through the Family Crisis Services Incarcerated Women's Program, a project that offers representation, support groups, and advocacy to the incarcerated women in the jails (and the prison) of Cumberland County, Maine. We met in late October in a café in Biddeford, Maine, a battered old mill town just south of Portland. "I didn't start using until I was 28," she tells me. "Before that I had my own apartment. I was doing pretty well. I just one time tried an Oxy and just kind of spiraled out from there." Courtney is striking in appearance, almost raven-like: shiny dark hair, sharp facial features, long nails, vigilant eyes. She reads tough, hiding herself under a modest black hoodie and everyday jeans, but she is quite beautiful. Her toddler sits on her lap, syncopating the rhythm of our dialogue with toddleresque interruptions, and her Courtney apologizes, an unnecessary gesture—I have already fallen in love with Ali, a girl with the juiciest cheeks I've ever seen. "That's what led up to me getting arrested. It was for drug charges. It was over one Oxy 15 that I'd forgotten I had in my purse."

Courtney Fortin and her daughter Courtesy

Right before her arrest, Courtney found out she was pregnant. She immediately checked herself into Mercy Recovery, at the time the state's largest free substance abuse recovery program. (It has since ran out of funding and closed its doors.) While there, she was prescribed a withdrawal drug called Subutex, which ameliorates the worst effects of quitting cold-turkey (difficulty breathing, nausea and vomiting, hypothermia) and also, crucially, prevents the negative effects of withdrawal from dramatically harming the fetus. Withdrawal in a fetus can lead to premature birth, even death and spontaneous abortion. "I was…on the road to recovery," she told me, "but then I was arrested…I wasn't even using at the time. I had like 5 different purses…I didn't even know it was in there."

When Courtney arrived to do her time in county jail, she was still in the first stages of withdrawal from opiate use, as was the growing child in her womb. She asked for the Subutex, but was denied. "The nurse didn't want to deal with it," Courtney told me. "She didn't want to be bothered…They don't like it when you stick up for yourself." Over 24 hours after her initial incarceration, Courtney was finally given the medication. The pattern continued: She had to carefully badger to get the medical attention she knew she needed. Months passed before she was granted her first prenatal doctor's appointment. Unable to make bail, she waited three months in York County Jail to get a court date. "I was 8 weeks pregnant when I went in with her and nearly six months when I got out."

Handcuffs over healthcare

While the United States accounts for only 5 percent of the world's women, it has 33 percent of the world's women prisoners, a number that continues to rise. Maine has one of the lowest incarceration rates in the United States, but the number of women in prison and jail has been following the wider trend, and growing steadily for the past 15 years; this means that the number of women pregnant or giving birth while imprisoned continues to rise each year as well. According to The Sentencing Project, "1 out of every 25 women in state prisons is pregnant and 1 out of every 33 women in federal prisons are pregnant when admitted to prison."

While Courtney's treatment, and in particular the practice of shackling pregnant women, sounds draconian, her experience is quite common. Most states—all but 18—still allow pregnant prisoners to be shackled before, during, and after birth despite overwhelming consensus from the medical community that this practice is, as the American Medical Association puts it, out of line with the "ethics of the medical profession." (The American Public Health Association, American College of Nurse Midwives, the American Medical Association, and the American College of Obstetricians and Gynecologists all directly oppose shackling during childbirth, as do The National Commission on Correctional Health Care and The American Correctional Association, two of the country's primary prison accreditation organizations.) Shackling heightens the risk of blood clots, limits the mobility needed for a safe pregnancy and delivery, increases the risk of falling, causes discomfort and humiliation, and can get in the way of administering medical care in emergencies.

Shackling not only poses a physical danger to pregnant women, it may also impose psychological stresses that are particularly acute for inmates—many of whom have been in abusive, intimate relationships. (In 2002, Family Crisis Services conducted a study which found that approximately 95 percent of incarcerated women were previously victims of sexual trauma.) Shackling most likely triggers past trauma and fear, erasing the critical step of establishing trust between the mother and her doctor, replacing it with dread, punishment, and pain during one of the most intimate moments of a mother's life.

So why shackle? "The prison system is geared towards men," says Amy Fettig, senior staff counsel of the National Prison Project at the ACLU. "Men are always shackled when they are transported out of a correctional facility to receive medical care, and that policy has been applied across the board without considering the unique needs of women." And most correction officers likely haven't been given any training or education to develop sensitivity on the issue; they are simply following protocol.

The practice sometimes continues even in the 22 states (and Washington D.C.) that currently have laws banning this practice. A recent study published earlier this year by the Correctional Association of New York, a nonprofit organization with the authority to inspect prisons, found that 23 of the 27 inmates who'd given birth while incarcerated in New York had been shackled in violation of the law, and this is not uncommon elsewhere. "You comply when you're in prison," says Amanda Edgar, an advocate with the Incarcerated Women's Project. "One woman [told me] that if she didn't keep her shackles on, she wouldn't be able to go to her appointment and [that] other women have been denied access to prenatal vitamins."

So shackles—belly chains around a baby bump during transport, chains around ankles during active labor—continue to be routinely used on inmates during pregnancy, even where they are technically banned, and even though there have been zero documented cases of pregnant inmates attempting to escape during prenatal checkups, labor, or postpartum recovery. Nor is there any documentation of a pregnant inmate attempting to cause harm to herself, security guards, or medical staff. The vast majority of female prisoners are non-violent offenders who pose a low security risk.

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A Silent Victory

Not long after Courtney gave birth to her daughter, Edgar got in touch with Courtney through My Sister's Keeper, an action-based ministry in Cape Elizabeth, Maine, that helps women transition from jail or prison back into their communities. Unsurprisingly, Courtney's story, as well as her drive and transparency moved Edgar. Courtney was asked if she would testify on behalf of a billthat would make the shackling of pregnant women in prison in Maine illegal.

On April 17, 2015, Courtney and Ali drove to Augusta to testify alongside women's health and social service organizations and the Christian Civic League. At the hearing, there was consensus that the policy needed to be changed. Even Gary LaPlante of the Maine Department of Corrections agreed that women "in labor, delivery, or postpartum recovery after giving birth should not be shackled." (He did, however, contradict advocates, claiming, "this has never been an issue in Maine.") In fact, the only public opposition came from criminal law officials.

"I believe no woman should have to feel the fear and humiliation I felt."

When it was time for Courtney to testify, she handed her diaper bag and purse to a friend, and, with her newborn Ali asleep in her arms, stood up. "I am here today to share my story so that no other woman has to go through what I went through," Courtney said. "I believe no woman should have to feel the fear and humiliation I felt."

The bill was approved in the state senate. And then in the house. But once it came across the desk of Maine Governor Paul LePage, he refused to sign it. The governor was on a "strike" against the legislature, and wouldn't sign or veto any legislation. And so, LD 1013, "An Act to Prevent the Shackling of Pregnant Prisoner," became law by default. "It was a victory, but a silent one. Now we just have to figure out what to do with it," says Edgar. "How to enforce it. How to educate women if they've been violated." Oamshri Amarasingham, the ACLU architect behind the bill, concurs. "Implementation is always another story, how to make sure these statutes are being followed is always another issue. That's why our organization is still around."

Nobody says, 'I want to be an addict' as a child

Courtney is due to give birth to her next child in February, which will also mark the two-year anniversary of her sobriety. "You're going to have to share mommy," she tells Ali, which will be tricky because the two are inseparable. "I'm giving my kids a way better life than I had. Making sure that they're loved. And I love everything about this child. She is my world. She is my angel. She is a superstar."

Ali and Courtney attend church every Sunday, St. Joseph's on Elm Street, just down the street from the café where we are seated. Courtney is becoming more and more involved with incarcerated women's activism; her daughter is adored by the church family. Courtney is engaged to a good man, hardworking, treats her like a queen, and she shows me the ring. It sparkles strongly, untarnished. In many ways, her story is a happy one, but many incarcerated women in Maine and beyond aren't as fortunate, and it remains to be seen if this new law will change much about the way they are treated in prison.

As we sip the last of our drinks, Ali begins to show signs that it's time for her nap so we wrap things up. I ask Courtney how, considering everything, she turned out on top? "If there was no Mercy Recovery, I may not have made it," she says. "And now it's gone. There's nothing. Nowhere. We need recovery centers, a place for addicts to turn to. There is not enough help out there."

She pulls on her jacket while balancing the bottle in one hand and lowering her daughter into the stroller. "People say things like 'just don't get arrested,' but it needs to be the other way around. Nobody grows up as a child and says, 'I want to be an addict.'" Her voice shakes for a moment. "Don't assume the worst about somebody just because they're in jail or have an addiction, because you never know the real reason behind it. People assume that you must be a scumbag, but there's just so much more to it. Maybe we're more alike than you think."

Mira Ptacin is the author of the forthcoming memoir (Soho Press, January 12, 2016). She lives on Peaks Island, Maine, with her family and teaches at the Maine Correction Center. www.MiraMptacin.com; @MiraPtacin.

This piece has been updated to more accurately reflect the passage of the Maine bill that banned shackling.

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