Caswell v. Horton, et al.

Content warning: The following case summary contains graphic descriptions of a mother almost dying during childbirth.

Ashley Caswell filed a federal civil rights lawsuit in Alabama after her constitutional rights were violated when a notorious county jail restricted her access to necessary medical care during a high-risk pregnancy. Her pleas for help were ignored as she delivered her baby alone in a filthy jail shower, almost losing her life. The Southern Poverty Law Center and Pregnancy Justice represent Caswell.

Caswell was two months into her pregnancy when she was detained at the Etowah County Detention Center in Gadsden, Alabama, in March 2021. Citing her pregnancy, the jail denied her use of a lawfully prescribed psychiatric medication and later restricted her access to recommended, regular prenatal visits, despite her high blood pressure. The jail also denied her basic accommodations, even forcing her to sleep on a thin mat on a concrete floor.

In October 2021, Caswell’s water broke, but her cries to be taken to a hospital were ignored. During nearly 12 hours of labor, medical staff only gave her Tylenol for her pain as she lost amniotic fluid and blood. She was eventually taken to the jail showers, where she delivered her baby alone while standing on the concrete floor. She suffered excruciating pain and experienced a life-threatening placental abruption, which almost caused her to bleed to death.

She handed her newborn to jail staff before passing out, naked and terrified on the shower floor. Instead of offering aid, staff took pictures with her newborn without her consent, even though the baby was still attached to her body via the umbilical cord.

“Giving birth to my son without any medical help in the jail shower was one of the most terrifying experiences of my life,” Caswell said. “My body was falling apart, and no one would listen to me. No one cared. I thought I’d lose my baby, my life and never see my other kids again.”

This first-of-its-kind suit seeks unspecified damages for the jail’s deliberate indifference to Caswell’s medical needs, among other claims.

Caswell’s treatment is part of a disturbing pattern of inhumane treatment at the jail, where most women are held on charges of chemical endangerment of a child for alleged drug use during pregnancy. Over the years, many women who were jailed while pregnant or shortly after giving birth have faced brutal and dehumanizing treatment.

Alabama leads the nation in pregnancy criminalization, and Etowah County is the epicenter, targeting at least 257 pregnant women and new mothers in recent years, according to local media reports. The state consistently ranks near the bottom for maternal and fetal outcomes, in part because criminalization deters pregnant women who use substances from seeking necessary medical care. As a result, the Alabama Maternal Mortality Review Committee recommends that “punitive measures for pregnant women with mental health and substance use disorders must be eliminated in order to create an environment that encourages them to seek assistance during pregnancy.”

The lawsuit was filed in the U.S. District Court for the Northern District of Alabama, Middle Division.