The volunteer instructors at Helms Facility pass out photocopied diagrams of the female reproductive system as the women settle into a tiny classroom.
The group comprises 11 tired women, ages 20-32, in tan scrubs and bright orange Crocs shoes.
Abigail Vaaler, a volunteer instructor with the organization Motherhood Beyond Bars, introduces herself to some of the new faces. The group hasn’t met since before the holidays.
“There was somebody who was due super soon right? Who’s due in January?” Vaaler asks. “OK, that’s a lot of people. Who thinks they might give birth in the next week?”
Of the four hands that go up, Sheamante Shields keeps her hand raised. She has been at Helms since late July. Like the majority of the women around her, she is not going through her first pregnancy.
Fridays are the childbirth education class at Helms. Shields has already been over most of what’s getting covered.
“It’s hard to stay on topic in here, which is a good thing, because we get to express ourselves more than even with our counselors," Shields says. "When we come into parenting class, it helps us express ourselves. It always does. That’s fine. That’s what we need.”
One woman can’t hold back tears as she talks about the prospect of having to say goodbye to her baby hours after giving birth. She says right now, the other inmates are the only ones who know what she’s going through. Right when you walk in the building, she says, you feel the pressure.
The classes try to cover basic anatomy, what to expect during and after delivery as inmates and strategies for how to parent from prison. But, more often than not, a whole range of other issues are on the table.
“A lot of these women are just at the end of their ropes emotionally and physically,” said Bethany Kotlar, the program director of Motherhood Beyond Bars.
"I mean -- just imagine, all of the risk factors for postpartum depression are there, plus a couple more thrown in for good measure,” she said.
About three years ago, Kotlar began working with Georgia’s Department of Corrections to bring classes like this one to expecting and new mothers in state prisons. She says agency officials told her the level of inmate’s health education was a concern.
“One of the things that stuck out to me was them saying that a lot of the women didn’t really know the difference between just normal discomforts and warning signs of serious issues,” Kotlar said.
The staff at Helms says that confusion can lead to tense relations if the women think something is a sign of a problem with the pregnancy, or if they don’t communicate when there is a problem.
“Yeah sometimes, unfortunately there is some fetal demise,” said Dr. Adel Mikhail, the facility’s medical director. "It doesn’t happen often, but most of the time it happens early after their arrival, before they start prenatal care."
He says, though the women get weekly check-ups, the potential for complications is heightened because the inmates often arrive in the middle or toward the end of their pregnancies.
“Imagine someone came in five, six months [pregnant], but you didn’t have any work-ups, any prenatal care,” Mikhail said. "It’s not like the free world once you get pregnant and you start from zero. So we start from scratch sometimes in the middle."
He says addictions to drugs or alcohol are common problems in the women he sees. And many don’t necessarily know they’re pregnant until they’re sentenced. An estimated 60 percent of pregnancies in Georgia are unplanned.
Some of the women have spent months in county jails, where the level of care ranges widely. In 2012, two separate women sued jails in Georgia for care they said was inadequate and led to miscarriages.
“At Douglass County jail, I was there until I was about 8 months pregnant,” said Liesa Brooks, who was released in September. "And I went to two doctor's appointments for my pregnancy."
She was homeless when she was locked up for not reporting to her probation officer.
“And there’s nothing that I could do, because I’m in jail ... ,” Brooks said. "If you don’t have anybody on the outside that can call and harass these people, they don’t care."
The American jail and prison system was not designed with women in mind. Though the population of incarcerated women is now more than six times the number in 1980, very little data exists on how many are pregnant and what becomes of those pregnancies. The last Bureau of Justice Statistics count, which found that about 4 percent of women in federal prison were pregnant, comes from 2004.
About 100 pregnant women move through Georgia state correctional facilities each year.
“We have a population of about 100 women, and that’s it,” Kotlar said. “And trying to communicate the ripple effects of working with that small amount of people can sometimes be difficult. They go back to their communities. They go back to their families, and we really do want to see those ripple effects keep going.”
Along with better data, Kotlar says she has a long list of improvements she’d like to see for the expecting and new mothers, including a dedicated doula program, more counseling of every kind, more activities and fresh fruits and vegetables. All that would take funding.
“We’re running on the steam and energy of a lot of very idealistic people, but as a program director, I am always afraid that that steam and energy may someday run out.” Kotlar said. She says, right now, up to about 30 volunteers operate on about $4,000 a year. That’s not enough to hire even a single, full time staff person, which she says they desperately need.
“This matters because of human dignity,” Kotlar said. "Everybody deserves the right to have access to their family and have a birth process be as respectful as possible, and to get the education, the health care and the support that they need to build a good family."
She says one of the biggest impacts the program can have is just to recognize these women as people and mothers.
One woman in particular comes to mind.
“Just the most loving, devoted mother," Kotlar recalled. "And you can see in her eyes every single day how devastated she was not to be with her youngest."
Parenting from prison for this woman meant playing tic-tac-toe through the mail.
“She would write out the tic-tac-toe board and she would send it back and forth through the mail, and she would do an X, send it back," Kotlar said. "Her older kids would do an O, send it back."
Kotlar said the woman thanked her in a note after one of the classes had run its course, for giving her the chance to remember her own humanity.
“That’s not something that she had experienced before in prison and that just brought that dignity back to her," Kotlar said, "and made her believe in herself again because that experience had stripped away her good feelings about herself and her power of -- ‘Yes, I can be a good mother.'"