2.  Discuss why pregnant adolescents are considered high risk  Special Considerations in regards to  Use of force  Restraints  Transportation  Substance Abuse and Detoxification/Withdrawal

3.  In best circumstances, teen pregnancy is high risk. Risk significantly increased in juvenile justice population  Conditions more likely to be encountered in the juvenile justice female  More likely to live in poverty  Poor quality of health  Substance Use Disorders  Mental Health Issues / Trauma  Sexually Transmitted Infections

4.  Late prenatal care  Outcomes are generally good but very young mothers <16 are at increased risk for  Pre-eclampsia  Anemia  Placenta Previa  Pre-term labor  Small for gestational age infants (SGA)  Infant death  Outcomes are influenced by socioeconomic status and age

5.  Prone positioning- blunt trauma to abdomen-  Spontaneous abortion  Preterm labor  Placental abruption  Fetal maternal transfusion  Still birth

7.  Supine positioning- supine hypotensive syndrome (8%)  Anxiousness, nauseated  Syncope

8.  National Symposium on the Use of Restraints on Pregnant Women Behind Bars (11/22/10).  American College of Obstetrics and Gynecology- Shackling Pregnant Inmates (2005)  2010- NCCHC Position Statement on Restraint in pregnant inmates  AB568 –vetoed by governor (2011)  AB2530- delivered to governors desk 9/11/12

9.  Identified Concerns:  The use of restraints can pose health risks for mother and child and can interfere with healthcare during pregnancy, labor and delivery  Adjustment and emotional difficulties may be induced or exacerbated by the use of restraints.  Restricted physical contact between newborns and their mothers- in part a function of the use of restraints following delivery-can be detrimental to the wellness of the child

10.  Policies, operating procedures, and practices pertaining to the use of restraints on women in custody vary considerably within and across federal, state, and local jurisdictions and agencies.  The widespread use of restraints as a risk management tool for justice-involved women is not supported by the evidence.  The use of restraints is only one facet of the need for system reform regarding pregnant women in custody.

11.  Balance issues especially in the second and third trimester.  Increase falls/trips ▪ Preterm labor, placental abruption, injury to fetus  Pregnant females need to be able to break the fall  Restraints  interfere with the performance of routine examinations and procedures during the course of the pregnancy  limit the mobility that is important to the progression of labor, the management of pain and discomfort during labor, and the process of delivery  Hinder the ability to respond to an emergency situation or acute complications with mother (pre-eclampsia, fetal distress, placental abruptions, etc.)

13.  Increased fetal loss  Poor prenatal care  Pre-term labor and delivery (25-40%)  Intrauterine Growth Retardation  Small baby =small baby brain  Congenital infections  Perinatal infections(HIV, HBV, GBS, HSV)  Placental abruption (psychostimulants)  Maternal mortality

14.  Withdrawal in mother= Withdrawal in fetus  Medical withdrawal of the pregnant opioid dependent youth is not recommended because of high rates of relapse and the increased risk of fetal death.  Opioid withdrawal syndrome during pregnancy can lead to fetal demise and premature labor. Even minimal symptoms in mom may mean fetal distress, as the fetus is more susceptible to withdrawal symptoms than the mother.  Methadone or Buprenorphine  Naloxone should not be given to pregnant women except as last resort in life-threatening overdose because it precipitates withdrawal and can lead to spontaneous abortion, premature labor or stillbirth.

15.  Early identification  Entry or Continuation of prenatal services  Nutrition  STI testing  Medically assisted detoxification and SUD services  Minimize restraint use to avoid injury  Positioning matters