Every year approximately 2,000 incarcerated women give birth in the U.S. This means the women go into labor basically alone, with a prison guard watching the entire time and a nurse going in and out of the room. No family, no phone calls. Sometimes the prisoners are shackled: A heavy chain and lock are placed around the belly, with cuffs at the legs and arms, a practice the American Medical Association has deemed unsafe. It’s a grim reality. But into this scene enters the prison doula.

A doula provides nonmedical assistance to a woman in labor. Prison doulas offer massage, a cool washcloth on the forehead and general coaching and support. All over the country, grassroots organizations of prison doulas have popped up. Most of them don’t have a strong presence because of lack of funding, but many organizations try to pay the doulas, who have a tough job. Prison doulas come face to face with corruption: There are reported cases of guards verbally or otherwise abusing women in labor, and some doulas report shackling even when the practice isn’t legally required. One can only imagine the situation when there is no doula present.

“This is one of the biggest public-health issues of our time, and no one wants to look at it,” says Rae Baker, coordinator of Isis Rising, a prison-doula program in Minnesota. Isis Rising offers birthing and child-rearing classes for prisoners, as well as a doula practice. When the program started, prisoners had a 63 percent rate of cesarean births, which is now down to three percent. (The national average is about 30 percent.) Baker calculates that keeping prisoners from having C-sections saves the state $50,000 per childbirth. Half the prisoners have natural births, without drugs, thanks to the classes and doulas’ assistance. “Some of the women who have had children before told us this was their best birth experience,” says Baker. “I think it translates to being a more connected mother.” For Baker, it’s about helping the children as well as the mothers. “These babies never committed a crime, and they deserve a fair shot at a fair life,” she says. “I want these women to have healthy babies.” Isis Rising is working on forming a national coalition for prison doulas. Baker is hopeful that together the organizations can find more funding from grants and private donors.