Master's Project Title:

Minnesota Prison Doula Project

MCH Student:

Samantha Lo

Date of Defense:

April 1, 2016


Executive Summary

Introduction: Over the past several decades, the number of women incarcerated in the United States has increased nearly 650%, with over 200,000 women currently in a correctional facility.[i] While most facilities do not systematically collect data on pregnancy status, the Department of Justice (DOJ) estimates that 5-10% of female inmates are pregnant at the time of admission.[ii]  Upwards of 25% of all incarcerated women are pregnant or have given birth in the past year.[iii]


Compared to women in the general population, pregnant incarcerated women have a higher risk of poor birth outcomes, such as preterm birth (birth prior to 37 weeks gestation) and small for gestational age babies (below the 10th percentile for babies born at the same gestational age).[iv] These outcomes likely stem from multiple risk factors, including: substance use[v], violence exposure[vi], poor nutrition[vii], mental illness[viii], and sexually transmitted infections.[ix]  The success or failure of the criminal justice system to adequately respond to these conditions in incarcerated women has important implications for their health and the health of their offspring.  


Incarceration impacts more than a mother’s pregnancy.  The separation causes a disruption in the parent-child bond, which can lead to insecure attachment and cause a variety of adverse outcomes. As many as 70% of young children with incarcerated mothers have emotional or psychological problems.[x] This impact can extend far into adulthood.  Parental incarceration has been deemed an “adverse childhood experience” (ACE), a set of experiences that has been found to cause high levels of stress.  The stress can become toxic when it is “strong, frequent, or prolonged activation of the body’s stress response systems in the absence of the buffering protection of a supportive, adult relationship.  The biological response to this toxic stress can be incredibly destructive and last a lifetime.”[xi]


This all translates to a system built for men needing to provide services and support for pregnant, postpartum, and parenting women.  Unfortunately, research is only beginning to show the impact incarceration can have on families, and policy change to mitigate that damage is slow.  That is where organizations such as the Minnesota Prison Doula Project come in.


Organization: The Minnesota Prison Doula Project (MNPDP) is a non-profit organization, with a mission to “work in solidarity with incarcerated mothers to create community, opportunity, and change.”[xii]  The goal is to mitigate how the cycle of incarceration and poverty negatively impacts the parent-child relationship, by improving parental skills and knowledge to create healthier families. They support mothers throughout their pregnancy and parenting journeys with a multi-disciplinary team of mental health practitioners, doulas, and prenatal and parent educators.  Services include doula support, individual counseling, and multiple types of facilitated groups.


Experience: My involvement with the MNPDP began by approaching them and stating I have a unique background (law degree and maternal health) that would be uniquely suited to their work – what can I do? How can I help?  Fortuitously, I arrived soon after Minnesota passed a law relating directly to the needs of pregnant incarcerated women.  One piece of the law requires each pregnant or postpartum woman receive “appropriate educational materials and resources related to pregnancy, child birth, breast feeding, and parenting.”[xiii]


These educational materials became my first project for the organization.  While it was a collaborative effort, I was the lead researcher and writer.  I wrote about subjects I was very familiar with, such as doulas and the stages of labor, as well as more difficult subjects like substance abuse and separation.  It was a trial by fire, and I learned how much more pressure there is when your projects have real world implications.  Recently, it has been printed and bound into a full 70-page book to be distributed to pregnant mothers.


Once the book was passed off to editors and graphic designers, I began working on smaller projects.  I helped to coordinate an educational retreat for MNPDP doulas.  This stemmed from another piece of the Minnesota law[xiv], which requires pregnant women to have access to doulas at any correctional facility. This meant we needed trained doulas throughout the state.  It was a 24-hour intensive retreat with speakers on multiple issues, including: human subjects research, intergenerational trauma, sexual violence, and the “nuts and bolts” of being a doula for an incarcerated mother.  It also allowed the current doulas to connect and share their experiences with new doulas.


My other major role was to focus on grant writing. This provided a different, hands-on experience in the managing of a non-profit. Grant writing requires a strong understanding of the goals and desires of your program, as well as the problems you are attempting to address.  It also requires the ability to argue persuasively in writing, to convince the funder to fund your program.  All of these skills were honed with every grant application I contributed to.


Lessons Learned: My experience within the MNPDP gave me a deeper understanding of the inner workings of a public health non-profit.  I took on many different tasks and projects, rather than having one job with one specific role. There are too many things to be done and not enough hands, so you “wear many hats” – writer, coordinator, editor, etc. However, this fit with my learning objectives for the field experience. I sought to understand and participate in a maternal-child health program, and now have a much better understanding of the inner workings of a maternal-child health focused non-profit.  I improved many skills I originally developed in school, but needed the “real world” to see how the pieces all came together to run an organization.


This field experience also gave me a unique perspective on women’s experiences within the criminal justice system. I heard numerous birth stories and how being an inmate can impact a birth. I became aware of the challenges of having so many different systems to work with inside just Minnesota – each county has its own independent jail system, the state prison system, the federal system, and the juvenile justice system.  Each of those systems has women who are potentially pregnant or postpartum and in need of services.  Each system also has their own capacity level for providing support services, which you only grasp once you become familiar with the facilities.


Recommendations: I recommend that organizations like the MNPDP continue to provide services and support, expanding to reach as many women as possible, while advocating for larger systems change. Building collaborative efforts across other providers (substance use, mental health, etc.) should be a short-term goal, to make the system more efficient and effective.  However, the ultimate goal should be to work ourselves into redundancy – become so effective at improving the system for pregnant women that the original mission is no longer necessary.  Jails and prisons are not an appropriate place for pregnant or postpartum women, so creating alternative to incarceration programs should be the long-term goal.


Conclusion: The MNPDP has exposed me to the realities of running a small non-profit organization. But beyond the challenges, it has shown me the impact a small number of dedicated people can have to change even the most intimidating of systems. Incarcerated women need advocates to continue working towards changing the system to improve their health and the wellbeing of their families.

[i] The Sentencing Project (2012). Incarcerated Women.  Washington, DC.

[ii] Sutherland, M. A. (2013). Incarceration During Pregnancy. Nursing for Women’s Health, 17(3), 225-230.

[iii] Urbina, M. G. (2008). A comprehensive study of female offenders: Life before, during, and after incarceration. Springfield, IL: Charles C. Thomas.

[iv] Knight, M., & Plugge, E. (2005). The outcomes of pregnancy among imprisoned women: A systematic review. BJOG: An International Journal of Obstetrics and Gynaecology, 112(11), 1467-1474.

[v] Hutchinson, K. C., Moore, G. A., Propper, C. B., & Mariaskin, A. (2008). Incarcerated Women’s Psychological Functioning During Pregnancy. Psychology of Women Quarterly, 32(4), 440-453.

[vi] Dehart, D. D. (2008). Pathways to Prison: Impact of Victimization in the Lives of Incarcerated Women. Violence Against Women, 14(12), 1362-1381.

[vii] Ferszt, G. G., & Clarke, J. G. (2012). Health Care of Pregnant Women in U.S. State Prisons. Journal of Health Care for the Poor and Underserved, 23(2), 557-569.

[viii] Urbina, M. G. (2008). A comprehensive study of female offenders: Life before, during, and after incarceration. Springfield, IL: Charles C. Thomas.

[ix] Clarke, J. G., Hebert, M. R., Rosengard, C., Rose, J. S., Dasilva, K. M., & Stein, M. D. (2006). Reproductive Health Care and Family Planning Needs Among Incarcerated Women. Am J Public Health American Journal of Public Health, 96(5), 834-839.

[x] Parke, R. D., & Clarke-Stewart, A. (2001). From Prison to Home: The Effect of Incarceration and Reentry on Children, Families, and Communities (US, Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation).

[xi] American Academy of Pediatrics. (2104). Adverse Childhood Experiences and the Lifelong Consequences of Trauma. Accessed on January 27, 2016.

[xii] Minnesota Prison Doula Project. (n.d.). Our Mission. Retrieved March 16, 2016, from

[xiii] Minn. Stat. § 241.89 Subd. 2(3).

[xiv] Minn. Stat. § 241.89 Subd. 2(4).