Pregnancy Behind Bars Proves Deadly for Women and Their Babies

When Chasity Congious went into labor for the first time, there were no doctors or nurses. No clean blankets to swaddle the coming baby. There were no family members, no friends.

Congious wasn’t even in a hospital. She was alone in a jail cell.

Four months earlier, she suffered a mental health crisis and her mother called 911 for help. Instead, police arrested the 21-year-old.

Now, the contractions were getting stronger, with no way to ease the soaring pain. Bleeding, she said, she pressed the emergency intercom button, but no one came. She tried to get up from the thin, dirty mat, but could not.

She started pushing.

The baby girl was born into the pant leg of Congious’ beige uniform on May 17, 2020, in the Tarrant County, Texas, jail. The newborn struggled to breathe. The umbilical cord was wrapped around her neck — a common problem often resolved with a quick unraveling by a doctor’s hands.

But no one was there to help. Congious’ daughter, named Zenorah, died days later.

Horrific scenes like this are unfolding in jails across the country, according to a yearlong investigation from Bloomberg Law and NBC News that reveals systemic failures. Pregnant women are locked up, often for petty crimes, and say their cries for help go ignored. They are miscarrying or giving birth in excruciating pain into cell toilets or on filthy jail floors. Newborns are suffering infections and long-lasting health issues, their mothers say. Some babies die.

These catastrophes are largely hidden from public view. To bring them to light, this investigation relied on thousands of pages of legal complaints, depositions, police reports, medical and jail records, and body camera and surveillance video. Reporters interviewed more than 60 people including a dozen formerly incarcerated women. Among the tragedies:

• In Kentucky, a woman chewed through her umbilical cord after she gave birth alone on a dank county jail floor.
  
• In Georgia, a woman said she begged for 13 hours to be taken to the hospital before delivering her son in her cell; he died four days later.
  
• In Louisiana, a woman said she gave birth on a toilet after a jail nurse told her to “shut the f--- up. Go back to your corner.”
  
• In Mississippi, a woman died of a ruptured ectopic pregnancy after complaining for days about abdominal pain.
  
• In California, a correctional officer stopped at a Starbucks while driving a woman in premature labor to the hospital, she said. The baby died.

“To deprive someone of that kind of basic access to health care in this country is unfathomable,” said Dr. Theresa Cheng, an assistant professor of emergency medicine at the University of California San Francisco who works with incarcerated patients and reviewed Bloomberg Law and NBC News’ findings.

In a first-of-its-kind analysis of federal civil rights lawsuits from 2017 to 2024, reporters found at least 54 pregnant women or their families have alleged severe mistreatment or medical neglect in jails. And it keeps happening: In September, a Texas woman said she gave birth in her Johnson County Jail cell hours after alerting staff she was in labor.

“What it shows,” Cheng said, “is we don’t see these people as human beings.”

There’s a long history in medicine of not believing women in distress. Yet pregnant women in jail often face another obstacle: They say they are presumed to be unfit mothers. That bias can lead correctional workers to dismiss their medical complaints and regard them with doubt or contempt.

“When staff see their patients as inmates and not as patients and as mothers, this is the result,” said Julia Yoo, a lawyer who has represented incarcerated women for 20 years and is a past president of the National Police Accountability Project, which fights abuses in jails.

“The value of human life in prison and jail is worth less — including for these children, because of who their parents are,” she said. “They are born with a stigma or they are not even born at all because they are viewed as not worthy of life.”

While this investigation offers the most detailed look at the issue to date, experts on incarcerated women’s health said its tally from civil rights cases is a considerable undercount. There is no comprehensive data on pregnancies in jail, even when a baby dies, because the federal government does not require it. At least 22 states said they don’t track pregnancy outcomes in jail. And filing a lawsuit can be costly and challenging.

Most of the women in these cases were arrested on low-level charges that included probation violations, theft and drug possession. They were housed in jails, largely intended for short-term detention as criminal cases unfold, not prisons, which are for punishment after a conviction. Many could have made it to a hospital if they had been able to afford bail; some said they faced fees as low as $125.

Their babies paid the price.

Alyssia Moulton was arrested on suspicion of shoplifting trash bags at a Walmart in August 2023 and taken to Montgomery County Jail in Tennessee. Her son was born into the toilet of her cell, landing in dirty water, she said, as he struggled to take his first breath. He hit his head on the metal seat and contracted blood and eye infections.

Moulton was withdrawing from opioids when she was arrested. The standard of care for pregnant women is treatment with medications such as methadone to avoid complications like preterm labor. A nurse said that Moulton had refused detox medication, but Moulton said in a lawsuit she wasn’t offered any. At least six other women alleged they, too, were deprived of withdrawal treatment while jailed.

Moulton said she begged to go to the hospital when labor pains began, but staff offered her only water and Tylenol.

“It was hell,” Moulton said in an April interview. “Nobody believed me.”

A spokesperson for the Montgomery County Jail said it provides obstetric care and does not plan for women to give birth inside the facility. Moulton sued the jail’s medical provider, Southern Health Partners, which denied the allegations but agreed to a confidential settlement this fall.

Moulton is now sober, and her son, who recently celebrated his second birthday, is one of 21 babies who survived out of the 54 cases reviewed. Twelve suffered infections, diseases or birth defects that mothers believe could have been prevented, the investigation found.

Six women delivered babies who were born alive but died within days. Six endured stillbirths. Sixteen had miscarriages. Four survived ectopic pregnancies, which can be fatal. Some women required liters of blood transfusions after hemorrhaging for days. Some can never have children again. Two women died.

There’s no way to be certain whether these pregnancy complications occurred because of a woman’s time behind bars. About 10% to 20% of known pregnancies end in miscarriage. Stillbirths occur in about 1 out of 175 births.

But unsanitary conditions and limited access to prenatal care, medical providers and critical medication are factors that can affect a healthy birth or contribute to preterm labor.

About half of the lawsuits were settled, according to court documents and interviews, with payouts ranging from $200,000 into the millions. Many were dismissed, sometimes because a judge ruled that they did not meet the legal bar of proving “deliberate indifference” by jail or medical staff. Several cases are still pending.

Most of the jails and health care companies that were sued did not respond to questions. In court filings, they generally denied wrongdoing, defending the care they provided. Some said the women had misstated facts, or they pointed to mothers’ drug use or limited prenatal care before being jailed.

There is a solution to this crisis, offered not just by women’s health advocates but also by some law enforcement officials: Fewer pregnant women should be jailed, particularly for nonviolent offenses.

Some states have taken steps in this direction. Illinois, Maryland and Tennessee have adopted laws that allow shorter sentences or alternatives to jail for pregnant women. In Virginia, a new law makes it easier for pregnant women to be released on bail.

But such reforms remain rare.

“There is no excuse or reason for a woman to have to give birth by herself without any help,” said U.S. Rep. Sydney Kamlager-Dove, a California Democrat who co-sponsored a bill that sought to improve health care for pregnant women behind bars.

She called Bloomberg Law and NBC News’ findings “shocking and horrifying” and said she plans to reintroduce the Pregnant Women in Custody Act, which stalled in a fractured Congress in 2023.

“It’s malfeasance,” she said. “They are akin to human rights violations.”

The Call to Police

The night Chasity Congious got pregnant in the summer of 2019, she was out with friends, “having a good time, growing up,” she said. She had her nicest outfit on and met someone in a hotel room she thought she would like to marry.

Congious has schizoaffective disorder, bipolar disorder and developmental disabilities. She was sick of being called “slow” and yearned for a chance to be like other 20-somethings.

She lived in Fort Worth with her mother, Kim Hammond, a crisis intervention therapist, and shared a room with her younger sister, where butterfly decals adorned the walls and stuffed animals lined her bed. A self-proclaimed “girly girl,” Congious filled her wardrobe with pink and liked dancing to hip-hop and gospel music.

“I wanted to start a new life,” she said. “I’m somebody, too. I get a chance in this world, right?”

Hammond, who has dedicated her life to caring for her daughter, was prepared to do everything she could to help raise her first grandchild.

On Jan. 15, 2020, when Congious was roughly five months pregnant, she became angry and paranoid. As she screamed and kicked, her brother tried to restrain her, and she bit him, according to a police report. Hammond feared that her daughter was in danger of hurting herself. She called 911 for help in committing Congious to a hospital to stabilize her with medication — just what medical providers had advised.

But when Fort Worth police arrived, they arrested her on an assault charge, against her family’s wishes.

The Fort Worth Police Department did not respond to questions about her arrest.

Congious, in the throes of psychosis, was sent to jail.

No Place for a Pregnant Woman

Jailed pregnant women can’t call their OB-GYN for advice. They can’t rush to a hospital when they bleed.

The U.S. incarcerates women at the world’s highest rate; tens of thousands are estimated to be pregnant, and jails are legally required to provide adequate medical care to all. But the reality is the criminal justice system has few safeguards to protect expectant mothers and the babies they’re carrying: There are no uniform regulations for medical care, according to a review of state laws and policies. Standards are often murky or nonexistent, and even when jails have adopted them, they can go ignored.

At least nine states, including Hawaii, Iowa and Maine, said they don’t require any training for jail staff on pregnant women, according to Bloomberg Law and NBC News’ analysis. In states where jail regulations consider pregnancy, the measures rarely go beyond offering pregnancy tests and special diets or barring shackles during birth.

“Most jails in the country are not equipped and are not trained to handle most pregnant women,” said Gabriel Morgan, the sheriff in Newport News, Virginia. “Jail is not the place for them.”

Some jails hire in-house doctors and nurses, but many outsource medical care to for-profit companies. Reproductive health care is often limited. According to a review of jail contracts, companies sometimes pledge to find cheaper treatment options — including by using telehealth and limiting when detainees are sent to hospitals.

Yolanda Huang, an attorney who has represented pregnant women in California jails, said many facilities treat maternal health like a cold or a dislocated shoulder.

“They’re not going to give these women any special treatment,” she said.

But pregnancy requires special treatment. According to the American College of Obstetricians & Gynecologists, pregnant women should have access to healthy food and prenatal vitamins. Routine exams, blood tests and ultrasounds help prevent life-threatening complications.

In Navarro County, Texas, a woman said her requests to go to a hospital were denied until it was too late; EMS arrived at the jail midbirth. She said her twin babies suffered cerebral palsy, kidney failure and respiratory issues after they were born prematurely in her cell. One child later died from health complications.

A medical provider she saw at a hospital noted that her pregnancy was complicated by “late limited prenatal care,” according to her lawsuit. A lawyer representing the county, which was removed from the lawsuit before the mother reached a settlement with the jail’s medical contractor, said she was sent to an outside specialist while incarcerated.

In order to see a medical professional, pregnant women often must repeatedly fill out request forms and demonstrate they’re in medical distress; some jails require a woman to prove she’s bled a certain amount before she can be hospitalized. Some women reported they never saw a doctor; others said they gave birth when health care staff were not on shift — only medically untrained officers.

More than two dozen women said they were placed in isolation after raising concerns about their symptoms. While jail officials said that enables more attentive care, their attorneys say it was a punishment.

Women often describe jail workers as callous. At an Etowah County, Alabama, jail, a woman who had just given birth in her cell said officers posed for photos with the newborn and she could feel the umbilical cord, still attached, tug as she begged, naked, for them to stop. She settled with the county and health care providers, who denied the allegations.

As Lauren Kent was placed on a stretcher after miscarrying into a cell toilet in Collin County Jail in Texas, she said she saw a nurse pull her baby from the water and drop his 5-inch body into a medical waste bag. The memory still haunts her.

Kent, who is now sober, had been jailed on a charge of credit card abuse after she was caught buying groceries with a card she found in a parking lot while homeless and addicted to methamphetamine. When she complained to jail staff about cramping and bleeding, she was told to prove it by collecting two soaked menstrual pads within 30 minutes, according to records filed with her lawsuit.

“Your issue is more of behavoural than medical,” a nurse wrote to her via an internal system in July 2019.

Kent was placed in a single cell with a window so staff could watch her.

“I was just holding my stomach on this concrete bed and I was begging and crying for help,” Kent said. “I told them something is wrong, this feels like I’m in labor.”

Noting Kent’s drug use, Collin County said her pregnancy loss was unrelated to her treatment at the jail. At the time, the county outsourced medical care to Southwest Correctional Medical Group — later acquired by Wellpath, which defended pad counts as standard practice for monitoring bleeding and denied limiting off-site care due to costs. A judge dismissed the county as a defendant in Kent’s lawsuit, and she settled with Wellpath.

Wellpath, one of the largest medical providers behind bars, has faced hundreds of lawsuits alleging poor care, including from roughly a dozen of the women in this investigation. The company said it faces “baseless lawsuits.”

In a statement on Kent’s case and others, Wellpath said its employees are committed to offering prenatal care to jail patients.

“Many of our patients come to us with complex medical and social histories, some even unaware that they are pregnant, and we manage this complicated population within the logistical realities of incarceration,” Chief Clinical Officer Dheeraj Taranath said in a statement.

When she got to the hospital, Kent said, she was finally treated with dignity. Nurses put the baby’s body in a blanket and let her hold him. They took hand and footprints.

She named her son Dakota Lee.

‘Why Won’t You Help Me?’

Babies born in jail enter the world at immediate risk. They are delivered onto blood-slick cell floors, swaddled in soiled sheets or their mothers’ uniforms. Some develop life-threatening bacterial infections, such as MRSA.

Others are saved purely by the instinctive actions of their exhausted and pain-addled mothers.

On May 16, 2017, her third day in a Kentucky jail, Kelsey Love began screaming in her cell. Eight months pregnant, detoxing from meth and deemed a suicide risk, Love had been arrested on suspicion of driving under the influence and receiving stolen property and was put in an observation cell in the Franklin County Regional Jail. Guards were supposed to check on her every 10 minutes, jail logs show. Southern Health Partners, the company providing medical care, didn’t staff the jail overnight.

At 5:11 a.m., a deputy jailer opened Love’s cell door and found her lying naked on the floor, holding her belly, crying.

“What are you doing?” the deputy said.

Love said her legs and back hurt and asked for a doctor.

“Well, I need to know what’s the matter,” the deputy said in an exchange captured by her body camera.

“I don’t know but something’s wrong with him,” Love moaned. “I need to go. He’s coming out. It hurts. I don’t know. Why won’t you help me?”

“Have you had a baby before?”

“Yes.”

“Does it feel like you’re having contractions?”

“Yes.”

The deputy stepped out, leaving Love alone. A second deputy shut the door and said: “If she can’t pass on the information, how are we supposed to help her?”

Deputies reported hearing more screaming and notified an on-call nurse. But there’s no evidence anyone reported a medical emergency, jail records show. Hours later, a nurse and deputy found Love wedged inside her torn sleeping mat, blood smeared across the floor, walls and door.

“Love. What have you done?” a deputy said, calling out for gloves. “Jesus Christ.”

The nurse kneeled at Love’s side and found a newborn baby. Love had given birth, scooped mucus from the baby’s mouth, tied the umbilical cord with a used condom she found under a bench, bit the cord off, then crawled into the mat to keep him warm. Her son, named Xayden, survived.

“You never know what you’re capable of until you are pushed to the limit,” she said in an interview.

Love pleaded guilty to reduced charges and said she received a $200,000 settlement from Franklin County. The jail has since changed its medical contractor and adopted a new policy requiring a protocol for the care of pregnant women. A jail spokesperson said officials pay “special attention” to all medical issues. Southern Health Partners said in court filings that it was not responsible for what happened to Love, and a judge dismissed the company from the case.

Now seven years sober, Love is raising five children, including Xayden, in a southern Indiana apartment. She worries how the circumstances of his birth might affect him.

She recently played some of the body camera footage for him in hopes it will help him understand. “When I went into labor with you, no one came to help,” she told him.

Xayden watched quietly. He said it made him sad that she gave birth to him alone.

“Not alone,” she told him. “We were together.”

Golden Angel Wings

Chasity Congious, whose mother had called 911 for help getting her treated for a psychotic break, ended up locked in a cell, alone, at Tarrant County Jail. Without adequate medication, her mental state deteriorated, according to her lawsuit. She refused meals and stopped speaking.

In jail medical reports, she was described as “child-like.” A nurse warned that she might not recognize that she was in labor.

An OB-GYN who examined Congious in jail four days before she gave birth recommended she be induced so that her labor could be better controlled, according to court documents.

That didn’t happen.

By the time paramedics arrived and found Zenorah with the umbilical cord wrapped around her neck, the baby girl had no pulse. Congious was bleeding out and nearly catatonic.

A spokesperson for Tarrant County Jail said Congious never cried out for help and that staffers were “feet away” from her cell door.

The jail has a brief “pregnancy inmate protocol” that includes access to OB-GYN care and prenatal vitamins.

“Detention staff are not allowed to make any medical decisions,” spokesperson Robbie Hoy said in an email, referring questions to health care providers, which didn’t comment on Congious’ case but said everyone jailed has access to mental health services.

Zenorah was taken to Cook Children’s Medical Center in Fort Worth, where Hammond rushed to care for her first grandchild. Congious was sent to a different hospital, then back to jail.

For 10 days, Zenorah lived in a small plexiglass incubator, connected to tubes that kept her alive. Hammond hired a music therapist to play an acoustic guitar and sing to the baby. A chaplain baptized her.

But she had been without oxygen for too long and never emerged from a coma.

Doctors withdrew life support on May 27, 2020. Hammond held Zenorah skin to skin as the baby took her last breath.

For Zenorah’s funeral, Hammond wrapped golden angel wings around the baby’s back and painted her tiny toes gold to match.

“I tried to make it as special as I could when we had to let her go,” Hammond said through tears. “I didn’t want her to be alone in the way that Chasity was alone.”

Congious never got to hold Zenorah. The jail wouldn’t allow her to visit the hospital or attend the funeral.

Six days after her daughter was buried, five months after she was jailed, Congious was freed. She was hospitalized for inpatient mental health care as her family had originally intended.

The assault charge was dropped.

Disbelieving Women

Even as they heave and scream in agony, women say they are accused of faking symptoms to gain sympathy or get out of jail.

“That’s what they all say,” a jail officer told a pregnant woman in Georgia who worried she’d lose her baby because she was bleeding so heavily, according to her lawsuit. She had been arrested at five months pregnant for an alleged traffic violation. Her short stay in jail ended with a stillbirth. Her lawsuit against health care providers was dismissed after the parties reached an agreement.

Shawna Tanner was about eight months pregnant when she relapsed in 2016. She went to a hospital, panicked, looking to check on her baby after using meth in a moment of weakness. She told her probation officer, hoping to get sent to a rehabilitation program like she had in the past. Instead, she was booked at the Metropolitan Detention Center in Albuquerque, New Mexico, on a probation violation.

Two weeks later, she began cramping. She filled out health care request forms and begged for more than 24 hours to be taken to a hospital as she bled and leaked fluid, according to her lawsuit.

“I’m pregnant need meds,” she wrote in a health care request form.

She said the nurses and officers responded with disdain, as if she were seeking drugs.

“They had no sympathy for me,” Tanner said.

An ambulance was finally on its way when Tanner’s baby started to crown. Paramedics arrived just in time to deliver her son. He was stillborn.

An autopsy later determined that the amniotic sac had ruptured prematurely, causing the bleeding and fluid Tanner had reported, and the umbilical cord was wrapped around the baby’s neck.

Tanner believes he could have survived had she made it to a hospital sooner.

“To get ready to have a child, and then to not have that child,” she said, “it just doesn’t go away, the emptiness.”

Medical care at the jail was handled by Correct Care Solutions, now a part of Wellpath, which denied the allegations in court filings. In statements to police, employees expressed concerns about understaffing. One nurse, Adriana Bustamante, acknowledged that Tanner had asked for a pelvic exam, but “there’s not a licensed person here” to perform one.

In an interview with Bloomberg Law and NBC News, Bustamante said that prenatal care at the jail was “basically nonexistent” at the time. She has since left correctional care.

“It was not sustainable for me as a nurse to be there providing such limited care,” she said.

Tanner sued the jail in 2017 and said she received a settlement. The jail, which declined to comment, now contracts with a nonprofit hospital and requires all pregnancy outcomes be documented.

Tanner, now sober, said she thinks about her baby every day and still wonders what color eyes he had — she never got to see them.

She never had more children.

‘Her Voice Was Not Heard’

Jail staff dismissing pleas for help can be just as dangerous for mothers as it is for their babies.

Lanekia Brown was a few weeks pregnant when she and her boyfriend were arrested in November 2018, accused of marijuana trafficking. From her cell at the Madison County Detention Center in Mississippi, she wrote excitedly to her boyfriend.

“CONGRATS we’re having a baby,” wrote Brown, who was 37 and had two sons from a prior relationship. “All this time we’ve been wanting this and it finally happened and we’re in a MESSED UP position.”

About three weeks after her arrest, Brown complained that she was bleeding and had a sharp pain in her pelvis, records show. Medical staff noted she was vomiting.

The next day, Brown was put in a medical holding cell so staff could check her every 15 minutes. She was given Tylenol for the pain, medical records show.

Just before 2 a.m. on Dec. 23, Brown told officers she was hot and dizzy and asked for water to pour on herself. Brown asked officers to get her to a hospital, according to a law enforcement report, but they did not.

Later, she was brought a tray of food, but she couldn’t eat. She asked for help going to the bathroom, but was too weak to walk.

Jail surveillance video shows Brown writhing on a mat in her final hours, alone in an infirmary cell. Then she went still.

At 9:23 a.m., a guard reported finding Brown unresponsive, records say. Surveillance video shows a jail staffer opening the door, looking down at her, then closing it. Medical staff brought her into the hallway and tried to revive her. Then they covered her body with a blanket.

Brown died from internal bleeding caused by a ruptured ectopic pregnancy, a medical examiner found, a complication that’s uncommon but treatable in which a fertilized egg grows outside the uterus. Symptoms can include bleeding and severe abdominal pain.

Madison County declined to comment. It had a medical services contract with a small local provider called Mississippi Correctional Services. After Brown’s death, the company, which denied the allegations, went out of business, and the county hired a new contractor.

“She had a voice and her voice was not heard,” her brother, Keith Brown, said. Their family sued the Madison County Detention Center and settled. “She was hurting. She told the staff. And they abandoned her.”

Missing Zenorah

Chasity Congious eventually made it back home to her family, medically stable but tormented by the death of her baby. Her mother sued Tarrant County on her behalf. The family received a $1.2 million settlement last year, the largest in county history.

But that’s little comfort to Congious, who struggles to watch her mother play with the granddaughter who came after Zenorah — her younger sister’s toddler, who wears tiny buns with pink barrettes and is adored by the whole family.

One afternoon in early September, Congious wrapped herself in a blanket despite the 101-degree heat and stared down at her daughter’s grave in “Babyland 5,” a plot for the youngest of Fort Worth’s deceased.

The blanket had a picture of Zenorah on it and read, “When you really miss me, hug this blanket tight.”

“I just want to go to heaven already so I can be with her,” Congious said, holding her belly.

As the family pulled away from the grave site, their red SUV abruptly stopped.

Congious ran back toward the grave, to say goodbye one more time.

“I love you, Zenorah,” she said, blowing kisses at the ground.

“I should’ve got to see you. I should’ve got to hold you.”