PREGNANT INCARCERATED PEOPLE D-150 FRESNO COUNTY SHERIFF'S OFFICE
CUSTODY DIVISION POLICIES AND PROCEDURES
TITLE: INCARCERATED PREGNANT PEOPLE NO: D-150
FILE: INCARCERATED PREGNANT PEOPLE
EFFECTIVE DATE: 12-16-19 REVISED: 12-16-20, 06-08-23
AUTHORITY: Sheriff J. Zanoni APPROVED BY: Assistant Sheriff G. Gularte
REFERENCE: Penal Code Sections 3407, 3440, 4002.5, 4023.5, 4023.6, 4023.8, 4028,
and 6030; Health and Safety Code Sections 125107, 120685, 120690,
125085, and 125090; and California Code of Regulations, Title 15, Sections
10297 1058.57 12067 1241, and 1248.
PURPOSE:
The purpose of this policy is to ensure medical care and custody concerns are met
regarding pregnant people.
POLICY:
It is the policy of the Fresno County Sheriffs Office Custody Division to ensure the safety
of pregnant people and the unborn child during pregnancy.
PROCEDURES:
I. INTAKE
A. At intake, all individuals capable of becoming pregnant are queried during
the initial screening process regarding pregnancy. People may choose to
have a pregnancy assessment and urine pregnancy test performed
within 24-hours of booking. The pregnant person's medical care is
initiated at the time of intake upon self-report or physical appearance,
confirmed by physical examination and laboratory test results.
B. Body scanners that use radiation shall not be used to scan a person who
is known or alleged to be pregnant. Any statement made by an arrestee
identifying themselves as pregnant is sufficient to exempt the individual
from a body scan at the time of booking, unless otherwise refuted by
Medical staff.
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FRESNO COUNTY SHERIFF'S OFFICE
CUSTODY DIVISION POLICIES AND PROCEDURES
TITLE: INCARCERATED PREGNANT PEOPLE NO: D-150
FILE: INCARCERATED PREGNANT PEOPLE
II. PREGNANT PEOPLE — SPECIAL ACCOMMODATIONS & EXTRA ISSUE
A. Pregnant incarcerated people will have a "Pregnant" ALERT created by
Medical staff.
B. All pregnant people shall be issued maternity smocks.
C. Pregnant people are to be issued two (2) mattresses.
D. Pregnant people housed in a multi-tier housing unit are to be assigned to
lower tier housing. ALERTs are to be made for "Low Bunk Needed" and
"Low Tier Needed" by Medical staff.
E. Pregnant and lactating people are to receive an 8-ounce container of milk
with each meal, as well as a protein snack and an additional serving of
milk.
F. To facilitate breast milk feeding, lactating people are permitted to retain
the following supplies in their housing unit (absent misuse).
1. A manual breast pump and a storage container for the breast pump
(e.g., the packaging box, or issued storage bag).
2. A supply of pre-labeled plastic storage bags to store the breast milk.
3. A small supply of dish soap and paper towels for cleaning the breast
pump.
4. An extra sheet (to use as a temporary privacy screen when pumping).
[Refer also to policy E-490/1-actation Program (FILE: LACTATION)]
III. EDUCATION
A. Upon confirmation of a person's pregnancy, they must be advised orally
or in writing of the standards and policies governing pregnant people.
The Pregnancy Services pamphlet explains the standards and policies
governing pregnant people. The pamphlets are issued by Medical staff,
but are also available on female housing floors.
B. Medical staff will provide pregnant people with educational information
and counseling that is nondirective, unbiased, and noncoercive, to
include exercise, nutrition, personal hygiene, safety precautions, and
other appropriate health education materials, as well as information
pertaining to childbirth education and infant care.
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FRESNO COUNTY SHERIFF'S OFFICE
CUSTODY DIVISION POLICIES AND PROCEDURES
TITLE: INCARCERATED PREGNANT PEOPLE NO: D-150
FILE: INCARCERATED PREGNANT PEOPLE
C. Incarcerated pregnant people are provided with a copy of "What to
Expect When You're Expecting." The book helps to explain everything
about pregnancy, childbirth, postpartum, managing complications and
breastfeeding. Pregnant individuals are encouraged to read the book and
ask questions during their health appointments.
D. Parenting classes and a variety of pregnancy-related pamphlets are
available to all incarcerated people through the Jail Programs Unit.
IV. MEDICAL CARE
A. Medical Services will provide timely and appropriate prenatal, pregnancy
and postpartum information and health care, and specialized obstetrical
services (when Indicated). [Refer to Medical Service's policies and procedures.]
B. Nondirective, unbiased, and noncoercive counseling and assistance are
provided in accordance with the pregnant person's expressed desires
regarding their pregnancy, whether they elect to keep the child, terminate
the pregnancy, or use adoption services. Pregnant people desiring
abortions shall be permitted to determine their eligibility for an abortion
pursuant to state and federal law, and if determined to be eligible, shall
be permitted to obtain an abortion, after providing informed consent.
Impermissible restrictions include, but are not limited to:
1. Imposing gestational limits inconsistent with state law
2. Unreasonably delaying access to the procedure
3. Requiring court-ordered transportation
D. Sterilization for the purpose of birth control, including, but not limited to,
during labor and delivery is prohibited by law.
V. SECURITY AND RESTRAINTS
A. Staff shall supervise pregnant individuals in the same manner as other
incarcerated people, with the exception of application of restraints and
physical restraint of pregnant people with force. Restraint equipment
(handcuffs) and physical restraint shall only be utilized when a pregnant
incarcerated person poses a threat to the physical safety of themself or
others (including the unborn child), threat of substantial damage to
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FRESNO COUNTY SHERIFF'S OFFICE
CUSTODY DIVISION POLICIES AND PROCEDURES
TITLE: INCARCERATED PREGNANT PEOPLE NO: D-150
FILE: INCARCERATED PREGNANT PEOPLE
county property, or attempted escape. Shackles and waist/belly chains
shall not be applied. In every instance, special effort shall be made to
avoid harm to the unborn child. If handcuffs are applied, the person's
arms are to be brought to the front of their body for application.
B. When transporting a pregnant person off grounds for medical care and
treatment, the application of restraints shall be the least restrictive means
possible (e.g., handcuffs to the front of the person only).
C. A pregnant individual in labor, during delivery, or in recovery after
delivery, shall not be restrained by the wrists, ankles, or both, unless
deemed necessary for the safety and security of the incarcerated person,
the staff, or the public. (Recovery is the length of time the individual stays
in the hospital after giving birth.)
D. Restraints shall be removed when a professional who is currently
responsible for the medical care of a pregnant person during a medical
emergency, labor, delivery, or recovery after delivery determines that the
removal of restraints is medically necessary.
VI. NUTRITION
A. Pregnant incarcerated people shall be provided a balanced, nutritious
diet and necessary vitamins approved by a doctor.
B. Pregnant and lactating people are required to receive four 8-ounce
servings of milk or milk products and a protein snack each day.
VI I. SUPPORT PERSON
A. Pregnant individuals may request to have one support person present
during labor and childbirth. Incarcerated people are encouraged to
submit the name of at least one alternative support person (should the
primary support person be denied, or is unable to be contacted at the
time of labor). Pregnant people may submit up to three (3) names for
approval by completing a Childbirth Support Person form (Addendum A).
B. The approval for the support person will be made on a case-by-case
review by the Compliance Lieutenant (or on-duty Watch Commander in
cases of emergency). The lieutenant is responsible to ensure:
1. The form is scanned into the incarcerated person's records in
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FRESNO COUNTY SHERIFF'S OFFICE
CUSTODY DIVISION POLICIES AND PROCEDURES
TITLE: INCARCERATED PREGNANT PEOPLE NO: D-150
FILE: INCARCERATED PREGNANT PEOPLE
Laserfiche (under Pregnant/Lactation).
2. The name and contact information for the primary and any alternative
support person Is logged In Offendertrak. [PERSON—.REQUEST (REQUEST
TYPE=Writing;SUBMITTER=(Name of lieutenant who approved); STATUS=Approved; REQUEST
DETAILS=name and contact information of support person in order of preference.]
3. A copy of the form is returned to the individual, notifying them of the
results. If a support person is denied, the reason for denial must be
provided in writing within fifteen (15) working days of receipt of the
request. Reason for denial must address the safety/security
concerns for the incarcerated person, infant, public and/or staff.
C. If an incarcerated person does not have a support person available, or
their support person is denied, they may elect to have an approved
"doula" accompany them and assist during labor and childbirth. A doula
is a birth companion who can provide emotional, physical, and
informational support during labor and childbirth. The doula may be a
professionally trained volunteer from within the community, or a
designated Jail staff member.
D. The on-duty Watch Commander shall ensure that the support person is
notified at the time the pregnant individual is transported to the hospital.
Vill. CHILDBIRTH
A. A pregnant person in labor or presumed to be in labor shall be treated as
an emergency and shall be transported in the least restrictive way
possible.
B. Pregnant people will be transported to Community Regional Medical
Center (CRMC) for labor and delivery whenever possible. A pregnant
person away from the facility who requires transport due to imminent
delivery or other emergent condition will be taken to the nearest
emergency department with obstetrical services.
C. After giving birth, the appointed guardian of the infant and/or family
members may be permitted to visit the incarcerated person in the hospital
with the approval of the on-duty Watch Commander.
D. Upon return to the Jail, anyone who delivers a child via caesarean section
(C-section) will be admitted to the Outpatient Hospital Unit (OHU).
Anyone who delivers a child vaginally will be assessed to determine the
appropriate housing and to initiate postpartum care.
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FRESNO COUNTY SHERIFF'S OFFICE
CUSTODY DIVISION POLICIES AND PROCEDURES
TITLE: INCARCERATED PREGNANT PEOPLE NO: D-150
FILE: INCARCERATED PREGNANT PEOPLE
IX. BREAST MILK FEEDING
A. Pregnant people shall be informed of the benefits of breastfeeding by
Medical staff. In addition to the benefits, incarcerated people will be
educated about breastfeeding with active tuberculosis; Hepatitis B,
Hepatitis C, HIV, syphilis, and other infections which can transmit from
mother to child; illicit drug use; alcohol, tobacco and marijuana use; and
while on certain prescribed medications.
B. After giving birth, they will be issued a manual breast pump by the
hospital. They may be permitted to retain possession of the breast pump
during the duration of need. "Need" considerations include maintaining
the milk supply, relieving discomfort, and preventing infection.
C. Medical staff will be responsible to modify the incarcerated person's
"Pregnant"ALERT, noting the issuance of the breast pump in the Remark
section. Upon cessation of lactation, the breast pump is to be retrieved
and the ALERT is to be inactivated.
[Refer to policy E-490/1-actation Program (FILE: LACTATION) for breast milk
expression, storage, and transfer procedures.]
X. REQUIRED POSTINGS AND NOTIFICATIONS
California law requires that incarcerated people be advised of their rights
involving pregnancy, abortion, breastfeeding, and sterilization. The required
information and supporting laws are contained in the Pregnancy Services
pamphlet. [Refer to Addendum B.]
Penal Code Section 3407 addresses the use of restraints on pregnant
incarcerated people and requires that upon confirmation of an individual's
pregnancy that they be advised, orally or in writing, of the standards and
policies governing pregnant people, including the relevant regulations and
the correctional facility policies.
Penal Code Section 3440 prohibits sterilization for the purpose of birth
control and requires that notification be provided to all incarcerated people.
The required information is also included in the Jail Orientation Handbook.
Penal Code Section 4002.5 requires an infant and toddler breast milk
feeding policy and requires that the policy be posted in all locations where
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FRESNO COUNTY SHERIFF'S OFFICE
CUSTODY DIVISION POLICIES AND PROCEDURES
TITLE: INCARCERATED PREGNANT PEOPLE NO: D-150
FILE: INCARCERATED PREGNANT PEOPLE
medical care is provided and the provisions of the policy are communicated
to all staff who interact or oversee pregnant or lactating people. [Refer to policy
E-490/Lactation Program (FILE: LACTATION).]
Penal Code Section 4023.5 requires that every person, upon request, be
furnished with information and education regarding the availability of family
planning services, and upon request, shall be furnished with services
necessary to meet their family planning needs at the time of release. This
advisement is included in the Jail Orientation Handbook, and the information
concerning available community care services is provided on the Medical
Discharge Summary supplied to all individuals at the time of release.
Penal Code Section 4023.6 advises that incarcerated people have the right
to summon and receive the services of any physician and surgeon, which
must be posted in at least one conspicuous place to which all incarcerated
persons capable of becoming pregnant have access. The information is
posted in the gymnasiums and included in the Jail Orientation Handbook.
[Refer to Addendum C.]
Penal Code Section 4023.8 addresses all aspects of pregnancy care within
jail facilities. Must be posted in at least one conspicuous place to which all
incarcerated persons have access. The information is posted in the
gymnasiums. [Refer to Addendum D.]
Penal Code Section 4028 requires that the right to abortion be posted in at
least one conspicuous place to which all incarcerated persons capable of
becoming pregnant have access. The information is posted in the
gymnasiums and included in the Jail Orientation Handbook. [Refer to
Addendum E.]
Penal Code Section 6030 requires that pregnant individuals be advised,
orally or in writing, and provided all of the following:
• A balanced, nutritious diet approved by a doctor.
• Prenatal and postpartum information and health care, including, but not
limited to, access to necessary vitamins as recommended by a doctor.
• Information pertaining to childbirth education and infant care.
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