3. INCIDENT PREVENTION AND RESPONSE 3 The use of restraints during pregnancy and childbirth 86 35 The use of restraints during labour, during childbirth or immediately after childbirth is prohibited by the Bangkok Rules and the Mandela Rules, because it is degrading, humiliating and dangerous for both the mother and the child. The commentary to Bangkok Rule 24 explains that “shackling during labour may cause complications during delivery such as haemorrhage or decreased foetal heart rate. If a caesarean section is needed, a delay of even five minutes may result in permanent brain damage to the baby.”185 36 There are also medical concerns during pregnancy itself. It has been noted, for example, by the American Civil Liberties Union (ACLU), that “restraining pregnant prisoners at any time increases their potential for physical harm from an accidental trip or fall. This also poses a risk of serious harm to the woman’s foetus, including the potential for miscarriage (…) Shackling pregnant prisoners endangers the health and safety of both the mother and the foetus, and is almost never justified by the need for safety and security for medical staff, the public or correctional officers.”186 37 The CPT has expressed the view that shackling or otherwise restraining pregnant women to beds or other items of furniture during gynaecological examinations and/or delivery, is “completely unacceptable, and could certainly be qualified as inhuman and degrading treatment”.187 38 The use of restraints at any other time of pregnancy, including during transport to hospital should be used as a measure of last resort when no other measures are possible, and should be based on individual risk assessments. Children in prison 39 Particular caution must be exercised when considering the use of restraints on children, due to their vulnerability. The UNCRC has stated that restraints applied on children must be “used only as a last resort and exclusively to prevent harm to the child or others and that all methods of physical restraint for disciplinary purposes should be abolished”.188 40 Rule 64 of the Havana Rules stipulates that in the case of juveniles, “[i]nstruments of restraint and force can only be used in exceptional cases, where all other control methods have been exhausted and failed, and only as explicitly authorized and specified by law and regulation. They should not cause humiliation or degradation, and should be used restrictively and only for the shortest possible period of time. By order of the director of the administration, such instruments might be resorted to in order to prevent the juvenile from inflicting self-injury, injuries to others or serious destruction of property. In such instances, the director should at once consult medical and other relevant personnel and report to the higher administrative authority.” 185. Commentary to the Draft United Nations Rules for the treatment of Women Prisoners and non-custodial Measures for Women offenders, DOC E/CN.15/2009/CRP.8, 2009, op. cit., 139, p. 25. 186. Briefing Paper: The Shackling of Pregnant Women & Girls in U.S. Prisons, Jails & Youth Detention Centers, American Civil Liberties Union, 2013, p. 1. 187. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), 10th General Report on the CPT’s activities, 18 August 2000, CPT/Inf (2000) 13, para. 27. 188. Concluding observations on United Kingdom and Northern Ireland, Committee on the Rights of the Child, 20 October 2008, CRC/C/GBR/CO/4, para. 39; see also: United Nations Rules for the Protection of Juveniles Deprived of their Liberty, General Assembly resolution A/RES/45/113, 14 December 1990, Rule 64; and Concluding observations on the United Kingdom of Great Britain and Northern Ireland, 6-31 May 2013, UN CAT, 24 June 2013, para. 28. Guidance document on the Nelson Mandela Rules