In 2010, Pennsylvania passed a law prohibiting the shackling of pregnant inmates after their second trimester, but as reporter Audrey Quinn discovered, enforcing it has proved challenging.

Danyell Williams still remembers the first prisoner birth she attended back in 2008. Williams had just created a doula program for Philadelphia prisoners. She was one of the first outsiders to see what an inmate birth looked like.

"The whole time," Williams says of that first inmate, "her left wrist was handcuffed to the railing of the side of the bed. And it stayed that way the entire time that she was going through labor and giving birth.

"And then after she had the baby she wanted to breastfeed," she said. "And so the correctional officer took the handcuff off her and put it on one of her ankles, so that she could hold her baby."

Williams says the woman's ankle was clamped to the sidebar of the bed. Breastfeeding was not happening.

"So her correctional officer," she continues, "created this longer extension by combining two handcuffs together and the chains that she had came to the hospital with, so that she could have more length in the restraint while she breastfed her baby.

"And I'm sitting here watching this whole process and I'm thinking, this is just totally ridiculous. And it's just something very barbaric, and as an African American woman watching another African American woman, I was just thinking about all sorts of things."

Williams figured that if other people – people outside the prison system or hospital staff - knew this kind of shackling was happening in Pennsylvania, it wouldn't be legal anymore.

And in a way, that was true. She got word out about what she'd seen. By 2010, a whole crew of advocates and legislators were speaking out against shackling during labor. Their bill to prohibit the practice, the Healthy Birth for Incarcerated Women Act, became law. The shackling of Pennsylvania inmates any time past their second trimester of pregnancy is no longer legal. 

But it turns out, in Pennsylvania, there's a difference between a practice being illegal, and a practice ending.

Earlier this year the Pennsylvania ACLU reported hospital staff across the state still saying they see inmates coming in to give birth with handcuffs on. Pennsylvania Corrections' own records show pregnant women were shackled 109 times in the 2012- 2013 fiscal year. And that's just in jails that report it.

"Now we're just working to get it implemented effectively," says Pennsylvania state senator Daylin Leach, the primary author of the anti-shackling bill.

But doesn't the passage of a law mean that progress will be made?

Leach gives a tired laugh. "The fact is, he says, "when you do pass new legislation you do have to notify people as to the requirements of that legislation. Particularly the people who are going to be dealing with that legislation."

To some people, not shackling pregnant women seems like a no-brainer. But to many corrections workers, this goes against a very basic tenet of prison life: when an inmate gets escorted off prison grounds, they get shackled.

Addressing key security concerns for officers, inmates and the public 

I talked with Shawn Cooper, the warden at Snyder County Prison. He says they still sometimes shackle pregnant inmates who go on doctors visits.

"I don't want to have to explain to the public," he says, "why I let an inmate overtake one of the officers because they weren't restrained."

He worries inmates could see someone they know in a doctor's waiting room, and try to make a run for it. Cooper says he would never shackle a woman in her third trimester or a woman in labor. But he doesn't think the public realizes how dangerous some pregnant women can be.

"So there could potentially be a time," he says, "when there's going to be an exception made and we may be forced to put handcuffs on a female during a transport just because we've got officer safety, we've got inmate safety, we've got the community safety-- we've got a lot of factors that go into making that decision."

When Senator Leach and his collaborators wrote Pennsylvania's anti-shackling law, they made sure to allow for exceptions. If corrections officers think a woman's dangerous to herself or others, they can still use the restraints. But in some jails, it seems like this exception gets used pretty liberally.

I submitted a Freedom of Information Act request for records of pregnant inmate shackling at Blair County Prison. It's about 90 miles east of Pittsburgh, in the middle of the state. The county sent me records of more than a hundred incidences where pregnant Blair County inmates were shackled over a year and a half. This is a prison that only handles about 55 women at a time.

On each record sheet the warden gets a space to explain why each pregnant woman needed to be shackled. There's fifteen lines of blank space, and the form says the warden can use the back side of the page if necessary. I lined up all the record sheets by the dates they got filled out. The reasons why each woman was shackled followed a pattern. For the first couple months of reports, the records said restraints were used for "safety reasons." The next few months, the excuse is "sec­urity reasons." After that, officers simply stated "security" as the reason for shackling. There's barely any reference to the women's own behavior. Just the phrasing du jour for why shackles were needed.

'No uniform accountability' 

I called up Blair County Warden Matt Johnston. I was curious to ask why so much shackling was happening during pregnancies.

"I'm not interested in talking about that," he told me. Neither was the Blair County Commissioner. I got no comment from the Office of County Inspection and Services. And the Pennsylvania Attorney General's office told me they couldn't talk to me about shackling by the Department of Corrections. The department is their client. No one would claim responsibility for shackling oversight.

"You have the individual correctional facilities policing themselves, says Danyell Williams, the prison doula who helped spark the anti-shackling law, "there's no uniform accountability. I think if there was an identified body that could really be held accountable, and there were some concrete consequences to violating the bill, it wouldn't be violated as much."

Support for pregnant inmates 

One place advocates say the law against shackling pregnant women has worked is in Philadelphia.  At the county's women's jail, Riverside Correctional Facility.  I visited the facility earlier this month.

The Philadelphia Prison System invited the Maternity Care Coalition's Momobile program to set up an outpost here in 2008. They offer support for pregnant inmates and inmates with kids.

One place advocates say the law against shackling pregnant women has worked is in Philadelphia.  At the county's women's jail, Riverside Correctional Facility.  I visited the facility earlier this month. 

Today, inmate Kenisha Tyler's visiting with caseworker Rosalyn Washington. The women greet each other warmly, and Tyler talks about her two-month-old baby girl.

"My daughter's thirteen pounds," she tells Washington, "when I left she was ten pounds. I want to see her, I miss her so much."

Tyler did get released after almost five weeks of being separated from her baby. Her MOMobile case manager reached out to the father of the baby in order to assist him with developing a plan to find someone to be home when the house arrest representative came.

Tyler's MOMobile case manager was able to teach her hand expression while she was incarcerated so that she could maintain her milk supply during the time she was separated from her baby and it worked. Tyler has now returned to exclusively breastfeeding her baby. 

The Momobile program offers parenting classes. And caseworkers like Washington meets with women to talk about motherhood both during and after their time at Riverside. They also offer doula services for pregnant inmates. It's actually the doula program that Danyell Williams had helped start back in 2008.

LaToya Myers now runs the program. She says Riverside doulas serve an extra role when they attend inmate births. They support the prisoner, but they're also a third party to make sure corrections officers are kept accountable for not shackling pregnant inmates.

"I actually think that this really works," she says, "having a nonprofit agency come in. We want to make sure that – and I think that the jail here wants to make sure that – the woman has a safe birth experience. So if anything seems a little bit off, I can call one of the majors in the middle of the night. And they will make sure that it gets handled."

Myers thinks the success of the anti-shackling law at Riverside jail offers hope that the anti-shackling law can be followed elsewhere. But the state correctional system has yet to take action. 

This story was reported in partnership with the Investigative Fund at the Nation Institute.