While the debate over health care rages in most corners of the nation, prison inmates are dealing with a unique set of issues.

“It’s the one population of the United States that has guaranteed health care,” notes Pam Sprey, a certified nurse midwife in Colorado. But that doesn’t mean there aren’t problems. Sprey specifically works with incarcerated pregnant women, many inside the Denver Women’s Correctional Facility.

As the Boulder Weekly reports, this year alone 50-60 women held by the Colorado Department of Corrections will give birth, and while they may receive some of the best prenatal care available, there is reason for complaint: Most of the women will be restrained with some kind of shackle during labor. That’s because in Colorado—unlike some other states—DOC policy “requires that women be kept within sight or sound of an armed guard and that they remain shackled to the hospital bed by one extremity.”

Currently, nothing is being done within the DOC or state legislature to alter the practice, although “pressure is mounting across the nation.” Among the many advocacy groups in favor of banning shackles during childbirth is Prison Fellowship