A recent article in the Toronto Sun drew attention to an inmate in an Ontario prison who is pregnant and alleges she is being mistreated for refusing an early induction. Eva Okello is serving an eight month sentence for practicing nursing without a license, and happens to be pregnant.
Eva’s husband stated that, since refusing an early induction of labour (she is due Dec. 15th), she has been put in solitary confinement and fed a restricted diet.
Whether Eva is indeed in solitary because she has refused an induction, or if she is there because of an unknown medical condition is unclear. Whether her diet is actually restricted or simply different because she is under medical observation is unclear as well. It is also unknown why an early induction was recommended–there is a possibility this recommendation was made for a medical reason such as IUGR (intrauterine growth restriction–baby is not growing well) or high blood pressure. Eva does have the right to information that would help her make an informed decision about her care–and the
evidence regarding early induction in these circumstances is controversial.
Induction for IUGR is not supported by the research, and the studies about induction for high blood pressure are too small to show significant differences in severe outcomes (such as seizure and postpartum hemorrhage) and show only small differences in other outcomes
(Childbirth Connection-Induction Best Evidence Summary).
The way that Eva’s story is presented in the Toronto Sun article lead me to believe that Eva most likely does not understand why the induction was recommended.
Regardless of whether Eva’s claims about mistreatment are true or not, it is very likely that her ability to engage in a collaborative informed decision-making process about pregnancy and birth issues is compromised.
I know that pregnant women who are well-educated, financially and emotionally stable, and not in prison often have a compromised informed decision-making process, and there are many cases where even if all of the health care professionals’ intentions are good, there is a lack of communication or miscommunication between health care professionals and the pregnant woman, leading to a break-down in trust and a situation where the woman feels unsafe with the care provider.
Regardless of whether those in power are actually punishing Eva for refusing a recommended procedure, the fact is that Eva believes they are. Regardless of her crimes, she is a pregnant woman who, in Canada, maintains the right to be in an environment and with people that she feels are safe when she receives prenatal, intrapartum, and postpartum care. As a woman who has chosen to continue her pregnancy despite recommendations otherwise, the well-being of the fetus also needs to be considered .
The fetus has no rights, in the Canadian legal system, so the fetus’ only rights are conferred by the mother who chooses to continue the pregnancy, and in this case the health of the fetus should be considered and promoted, but not above the mother’s health. The mother’s optimal mental health may involve putting the health of the fetus above her own health, if that is what she chooses.
While Eva’s claims may or may not be legitimate, her feelings are.
I think that another care provider should be assigned to Eva regardless of the actual circumstances, and the care provider that made the original recommendations should discontinue working with Eva. Every effort should be made to find a care provider that Eva feels she can trust, so that the original recommendations for induction can be discussed in good faith, especially if there is any merit to the original recommendations. If Eva was segregated for her own safety, the new care provider should discuss this with her as well.
While there is of course a possibility that Eva is misrepresenting her situation purposely to gain media attention and manipulate the system, the reality is that informed decision-making about maternity care is difficult for most Canadian women, who are vulnerable because they are pregnant and because medical authority can be very intimidating. Whether this is a ploy by Eva or not, she is in an increased position of vulnerability due to her incarceration, and if being a ‘squeaky wheel’ helps her to get some ‘grease’ and a little more power and autonomy about her maternity care, I have no problem with that.
We know that women who feel the most positive about their birth experience are those who felt that they were able to make decisions about their care and who felt cared for and supported by those around them, regardless of the level of pain they experienced, interventions, or emergencies or complications that arose (
Hodnett et. al. 2002).
Eva’s sentence is eight months. This means that when she is released from prison, her baby will be about 5-6 months old. The plan is for the baby to stay with the father while Eva is in prison, as babies are not kept with their mothers in prison. The separation of mothers and babies is another issue that I plan to look into, and to try to find solutions for. If the mother will be caring for the child after she is released from prison (i.e. social services is not placing the baby in foster care or removing the child from the mother because the mother is a threat to the well-being of the baby) then it makes absolutely no sense for the mother and baby to be separated during her incarceration, in terms of physiological and emotional well-being for both mother and baby. Breastfeeding is of course a huge long term health benefit that the baby will be deprived of, and while it is possible to bond with a baby after separation, it is much easier to bond during the newborn stage.
In any case, if Eva has a positive birth experience where she feels she can make decisions and is well cared for, she will be much more likely to be in good mental health and not suffering from postpartum depression or post traumatic stress disorder when she is released from prison and has the opportunity to bond with her baby. It is in the best interest of both Eva and her child for Eva to have an empowering birth experience, with people she feels safe with. For this reason, I believe it is imperative that the option of a different maternity care provider be available for Eva.
Mothers of Change will investigate this as best we can–both myself and Kalina have left messages for Eva to call us collect, and we hope that we can hear directly from her what her concerns are and what kind of care she hopes she can receive. I have contacted the Elizabeth Fry Society, a Canadian organization that works with and for women in the justice system, in hopes of collaboration. I have also contacted Ellen Osler Home in Ontario, a federally funded home for incarcerated women who have given birth, which allows them to still serve their sentence but stay with their babies. Unfortunately, since Eva has a provincial sentence, she does not qualify to be transferred to this home.
If you have any experience with the justice system, incarcerated women, or anything else relating to this case, please contact us to get involved. info@mothersofchange.com
{ 4 comments… read them below or add one }
I am disgusted with the system for allowing women and their infants, regardless of the reason, be forced into non-consented prenatal care and birth choices, and separation after birth. It is inhumane. I really hope that this is a situation that more women become aware of and fight to protect their birthing rights. How can the average woman help?
She is a convicted impersonator and as such put peoples' lives at significant risk.
She is completely responsible for being in jail while pregnant.
She is treated well and properly fed in in jail.
Save your sympathies to someone who needs and deserves them, not convicted criminals who don't care for others' health.
@anonymous: Despite whatever brought that woman to be in jail, she does not lose her rights as a human being and what is happening to her and her child is dehumanizing and immoral. A woman's birthing rights should never be violated. It is a travesty. Perhaps an exercise in compassion and empathy is in store. If you were in her shoes, would you be singing the same tune? I highly doubt it.
It was prior to sentencing that she and her husband had made the decision to have a child. This did not simply “happen” but was planned despite her pending sentence. They put the child at risk as prison is not conducive to the emotional well being of a pregnant mother which affects one’s physical well being.
As to her medical condition, that is a matter of privacy and her right to it. The reported reasons of her birth being induced is pure speculation and cannot be disclosed unless she wishes to make such disclosures public.
If anything, based on reports of her public record, her claims are suspect. Ms. Okello is a repeat offender. This was her second conviction/offense. Not long ago, she has been charged with a third alleged offense (she was arrested again on Saturday March 17, 2012 for the same type of offenses with a few new ones). It’s public information and a Google search reveals reports on those published past offenses. One who commits such offenses must make many false statements to support their claims (she is not and was not a RN but must lie to attain and retain the position). Having lied so often, one’s credibility is suspect and more so given the short time between her release and subsequent arrest.
Choose your battles carefully as the public good will is eroded when such egregious errors in analysis are made. That Toronto Sun article, written by Mr. Warmington, was adequately researched but poorly reported with a heavy bias of being soft on the couple’s viewpoint and hard on the penal system.
Mothers of change may have to change their mandate to include advising mothers of changing their ways for the better as some do not behave with the best interests of their child in mind. This child may not see her mother for some time and worse yet, may not get that care and bonding that a child yearns for and only a mother can best offer in those pivotal first couple of years. The likelihood that the child does not even recognize the mother if she is imprisoned this time is great. Perhaps it is best that her influence is not passed on and whoever is looking after the child is the better care giver.
Shame on all of you for feeling sorry for this mother and falling for her lies. The only victim is the child and having to experience such instability at only a few months old.
What a shameless conniving mother! And the father …