The American Academy of Family Physicians recommends that state and federal governments adopt policies that limit the use of restraints, often called shackling, among incarcerated or detained pregnant people to situations where there is immediate risk of harm to others or of escape. Restraints can negatively impact pregnant person and fetal outcomes. Restraints can include any physical or pharmacological restraint, including any mechanical device to control the movement of a pregnant person’s body or limbs, such as handcuffs, leg shackles, and belly chains. When restraints are determined to be necessary for public safety, the least restrictive approach should be utilized and should never interfere with leg movement or the pregnant person’s ability to break a fall. Limitations of such restraints should be considered during pregnancy, labor and delivery, as well as the immediate postpartum period. (2019) (October 2025 COD)