On the last day of the legislative session, New Jersey lawmakers enacted a measure to limit the use of restraints on women during labor and childbirth. The Assembly voted 75-0, following a 39-0 vote in the Senate earlier in the year. It is now up to Governor Chris Christie to decide whether to sign it.

“Everybody deserves to have a child in a healthy way,” said Assemblywoman Valerie Vainieri Huttle, one of the bill’s primary sponsors, who called the bill “commonsense [and] humane.”

Former Assemblywoman Bonnie Watson Coleman, now a U.S. Congresswoman, first introduced an anti-shackling bill in late 2010. In her role as Majority Leader of the Assembly, Coleman Watson held hearings around the state on criminal justice; women spoke about being pregnant and giving birth while they were incarcerated, planting a seed.

What the bill does

“An Act concerning the restraint of prisoners during childbirth” is narrower in scope than recent legislation in New York and Massachusetts that limits the use of restraints throughout pregnancy and, in the case of New York, eight weeks of postpartum recovery.

The bill does not absolutely ban the use of restraints during labor – although it does ban the use of leg and waist restraints on laboring women. Instead, the bill allows for the least restrictive type of restraint to be used if a woman presents a “substantial flight risk” or “some other extraordinary medical or security circumstance.”

An unusual feature of the bill is the way it groups medical service providers for prisons and jails with staff members of prisons and jails. For example, the bill allows both corrections staff and medical service providers to restrain a pregnant woman if they make an “individualized determination” that she presents a flight or safety risk.

This creates a “conflict of interest,” according to Marc Stern, MD, a consultant, assistant professor of public health at the University of Washington, and former medical director of a state prison system. “Medical providers should never be involved in either the decision to place, or the actual placement of, restraints on patients for non-medical reasons.”

Dr. Stern noted that many individuals who are incarcerated have health conditions that require special attention, from the person with a frozen shoulder who can’t reach behind his or her back to be handcuffed to the person with a broken ankle for whom ankle chains might be harmful. While the bill is “thoughtful in its approach to pregnant women,” Dr. Stern is concerned that “legislation isn’t nimble enough to address all of these situations.”

The bill is somewhat broader than its title suggests. It limits the use of restraints on women who are experiencing “any pregnancy related medical distress” (such as a possible miscarriage) and during “transport to a medical facility.” And medical personnel caring for incarcerated patients in hospitals or outside settings can request the removal of restraints.

A quiet campaign

Unlike campaigns in some states with active lobbying, grassroots mobilization, and media coverage, the advocacy campaign in New Jersey appears to have taken place largely inside the State House. The issue sparked the commitment of policymakers interested in both criminal justice reform and women’s health, who spent five years shepherding a bill to passage.

As Assemblywoman Huttle explained, the trend in courtrooms and legislatures around the country made clear the need to address the problem and “promote humane practices in our prisons.”

Alexander Shalom, Senior Staff Attorney for the ACLU of New Jersey, called shackling women in labor a “barbarous practice” and said that the organization testified in support of outlawing it.

If Governor Christie signs the bill, New Jersey will become the 23rd state with a statute addressing the use of restraints on pregnant women.