Imagine being pregnant and going into labor. Now imagine having handcuffs around your wrists attached to a chain, leading to a chain wrapped around your waist. Another chain leads from your waist to your feet, where cuffs keep them only inches apart. This is a practice known as shackling.

Across the United States, prison policy dictates that people be shackled whenever they are transported outside the prison. Many states make no exceptions for women in labor, childbirth or postpartum recovery.

In 2009, after extended advocacy and lobbying from prisoner rights organizations, New York passed legislation that bans the use of restraints on women during labor, delivery, and postpartum recovery. It largely bans the use of shackles on women who are taken to the hospital for a caesarean section or to be induced, as well as when women are returning to the prison from the hospital. But shackling continues to be a common reality for mothers who give birth while in New York state’s prison system.

Maria Caraballo was five months pregnant when she arrived at Bedford Hills, New York’s maximum-security prison for women. In February 2010, nine days after her due date, she was taken to Westchester Medical to be induced. She had learned about the anti-shackling law the month before and, as officers prepared to place her in the van, she told them it was against the law to shackle her. “You have no choice,” she said the officers told her. “If you refuse we’re going to write you up.”

Writing her up meant receiving a disciplinary ticket, which would jeopardize her placement in the prison’s nursery program, where mothers could live with their newborns for 12 to 18 months, and her opportunity for an earlier release. So, despite the law, Maria was shackled with handcuffs and ankle cuffs.

At the hospital, after changing into a hospital gown, the accompanying officers cuffed her right hand to the hospital bed. “The doctor told the officers to take the cuff off, but they refused,” she recalled. “The line to the cuff is short, so you can’t move your arm without the cuff twisting or cutting into you. I couldn’t even sit up.” Despite the doctor’s repeated requests, her hand remained cuffed to the bed the entire time. She gave birth, delivered the placenta and even held her daughter for the first time while handcuffed. Even when hospital staff stitched her up, she remained handcuffed. “I was only unshackled after being taken to the prison ward,” she recalled.

Not a unique experience

Maria’s experience is not unusual. This Thursday, the Correctional Association of New York, a criminal justice policy advocacy organization, released a report detailing the findings of its five-year study of the state’s women’s prisons. New York state incarcerates nearly 4,000 women each year. Although the New York State Department of Corrections and Community Supervision (DOCCS) could not give concrete figures on the number of pregnancies behind their walls, the Correctional Association estimates that approximately 40 women are pregnant each year, and that 12 to 15 pregnant women are in custody on any given day.

As part of its study, the Correctional Association interviewed over 950 women in prison, including 27 who gave birth after the anti-shackling law went into effect. Nearly half had been shackled while being transported to the hospital to give birth, and nearly all had been shackled at some point in their pregnancy. But pregnancy in prison falls between the cracks, remaining an issue largely ignored by the broader reproductive rights movement and neglected by prisoner rights organizing. This means that experiences like Maria’s are allowed to continue despite laws meant to protect them.

Tina Tinen and her son. Photograph: James Trory

Tina Tinen had no idea that she wasn’t supposed to be shackled. She was five months pregnant when she arrived at Bedford Hills in 2011. But even before she went into labor, she had to navigate her way through a system that held little concern over her or her baby’s health.

When Tina went into labor, the nurses dismissed her concerns. “The nurses were discussing the fact that I had no idea what I was talking about because it was my first child,” Tina recalled. Only after placing a fetal monitor on her did the nurses called an ambulance. More than half of the women who spoke with the Correctional Association had similar experiences of nurses dismissing their symptoms or conducting superficial exams when they reported being in labor.

When the ambulance arrived, Tina was handcuffed to the gurney. When she reached the hospital, officers removed the handcuffs so that she could change into a hospital gown. Nineteen minutes later, her son was born. “I gave birth so fast that I was still wearing my prison shirt,” Tina recalled. Unlike Maria, Tina was able to hold her newborn son for the first time unfettered. “He was screaming his little head off and stretching his toes,” she recalled. “I told him, ‘I feel the same way right now. I just gave natural childbirth.’”

Shackled five hours after giving birth

Although the 2009 law bans the use of restraints during postpartum recovery, both Maria and Tina were shackled at various times throughout their hospital stay. This experience seems to be the rule rather than the exception: nearly half of the women interviewed told the Correctional Association that they were shackled while recovering in the hospital, sometimes for long periods of time. One woman told the Correctional Association that she was kept in handcuffs and ankle shackles for over five hours after giving birth. “I shouldn’t have been shackled,” she wrote in a letter from prison. “I was way too sore to run.”

At Westchester Medical Center, which contracts with the prison for routine deliveries, women are placed in a prison unit called Ward 29. They are not allowed to keep their babies with them. Instead, they must wait for officers to escort them to the hospital nursery.

After giving birth, Maria held her daughter with her free arm for less than two minutes before the doctors took the newborn, cleaned her up and whisked her away to the hospital nursery. She was not allowed to see her baby until the following day. When she was taken to the nursery, she was placed in a wheelchair with her hands and ankles cuffed, then wheeled through two hallways to reach the nursery. “Everyone sees your ankles and hands shackled,” she said. “People were staring. It was very humiliating.”

Officers took the handcuffs off so that she could hold her baby, but her ankles remained chained together. “I was scared to get out of my wheelchair with my baby and fall,” she recalled. But Maria notes that she was luckier than some of the other new mothers. “I had good officers on the first shift who let me see my baby every day. I got to stay with my baby for the whole eight hour shift,” she said. When the shift ended, she was handcuffed and brought back to Ward 29. She did not see her baby again until the following day. “Some other girls were only allowed to see their baby for two or three hours a day,” she pointed out.

Like Maria, Tina was placed in a wheelchair and ankle cuffed before being brought to the nursery. The officer draped a sheet over her so she was spared the stares from others throughout the hospital hallways. But, unlike Maria, Tina had a shorter period of time with her baby. She also remembered officers making remarks like, “Don’t drop your baby” and “You’re not holding him right.” These comments made her even more nervous about handling her son. “My baby has a birthmark on the back of his head, but I didn’t find out [for a few weeks] because the officers made me feel like I wasn’t worthy of touching my own child,” she recalled.

Bedford Hills has a nursery program where mothers have the opportunity to live with their children for up to 12 to 18 months. Fortunately for Maria and Tina, both were accepted to the nursery program and did not have to endure an abrupt separation from their newborns. But bringing their new babies back to the prison required mothers to navigate not only handcuffs, waist chains and ankle cuffs, but also carrying a three-day-old in a car seat to the prison van.

“You’re fully shackled with a black box,” Tina described. “They put you in a wheelchair. They put your baby in a car seat and they hand you the car seat. They wheel you to the parking lot. Then they tell you to get out of the wheelchair and they tell you to carry the car seat.”

Maria and another new mother were returned to the prison on the same day. “Our babies were in their car seats, only three days old. We had to help each other try to give them a pacifier or a bottle,” she described. But being handcuffed and waist chained meant that she could only lift her hands a few inches away from her waist. Maria recalled standing up during the entire 15 minute ride to hold the pacifier to her daughter’s mouth.

Tina’s voice cracked as she recalled the drive from the hospital to the prison. “I can remember the sun shining on his face and I’m next to him handcuffed, telling him, ‘You’re with mommy now’”, she says. During the ride, her son’s pacifier began slipping out of his mouth and, unable to move her hands to his face, Tina used her nose to nudge it back in.

Substandard reproductive healthcare

While shackling women during childbirth is the most visibly egregious violation, it’s symptomatic of how pregnancy and reproductive health are treated behind bars. “Reproductive health care for women in New York State prisons is woefully substandard, with women routinely facing poor-quality care and assaults on their basic human dignity and reproductive rights,” the Correctional Association found.

In addition to the extensive use of shackling in violation of the 2009 law, it also found a lack of oversight of reproductive health care, poor conditions of confinement for pregnant women, unfair rejections of women from the prison’s nursery program, inadequate access to gynecological care, substandard medical treatment, insufficient supplies of feminine hygiene products and toilet paper, severely limited access to contraception, and poor access to gynecological care, including privacy violations for women placed in solitary confinement.

The Correctional Association is using the report and its findings to launch the Campaign to End Reproductive Injustice to raise the standard of reproductive health in prison, end the shackling of pregnant women and push New York to continue to shift away from relying on incarceration, a shift that includes an end to criminalizing issues that are social and economic, as well as utilizing more alternatives to incarceration.

Tina and Maria, now both out of prison, are two of the women working with the Correctional Association. Both are sharing their stories to illustrate the horrors of pregnancy behind bars. “I don’t want other pregnant women to go through this,” said Maria. “People make mistakes in life, but they don’t have to be humiliated.”

Correction, 16 February 2015 at 9:55am. An earlier version of this article stated that Maria Caraballo was placed in a waist chain on the way to the hospital; she was only cuffed at the ankles and wrists. She was cuffed by one hand throughout the delivery of her baby and, when returned to the prison, placed in full shackles (handcuffs, ankle cuffs, waist chain and black box).