An Attorney's Proactive Approach to a Safer Birth

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This is Birth, Baby! Your hosts are Ciarra Morgan and Samantha Kelly. Ciarra is a birth doula, hypnobirthing educator, and pediatric sleep consultant. Samantha is a birth doula, childbirth educator, and lactation counselor. Join us as we guide you through your options for your pregnancy, birth, and postpartum journey. Thank you to our listeners for your continued support. If you enjoy our content, please be sure to like, follow, rate, and review wherever you listen to podcasts. This helps us gain visibility to other people that could benefit from listening in.

All right. Today we have with us Gina Munby. Gina is an attorney, bestselling author, wife and a mother of three children. And today she's here to share her tips with us to avoid becoming somebody who needs an attorney to assist them after their birth. Thank you so much for being here today, Gina. It's really an honor to have you. Ciarra, Samantha, thank you for having me. I enjoyed talking to you guys during the free show a little bit. So I know today is going to be a great conversation. Yeah.

You know, to prepare for today, Samantha was reading your book and I've been listening to your podcasts that you've recorded with other people. And I've learned so much just about kind of the process of you getting into this work. And I really want to focus on, I thought that this was the coolest takeaway was, can you tell us who you work for? Because I heard you say the person, the people you work for is actually not what people think. Yes. So most people think, because I wrote a book to expecting parents, to help them have a healthy baby and avoid the mistakes and complications that can occur during childbirth, that I am the attorney for the families. I am not. For the past 21 years, I am the attorney for the delivery team. So I'm the nurse, the doctor, midwife, residents. I'm their attorney in these cases, which, you know, if anything, provides way more valuable information in my book because I, you know, I have the information from the behind the closed doors to whatnot, but I've traveled all over the country meeting with these, you know, the delivery teams, the experts on the cases, you know, hashing out every aspect of labor and delivery, but definitely from, you know, the side of the case of the, you know, the healthcare professionals. Yeah, and people wouldn't go so hard. Go ahead.

No, I just I was thinking like I think one of the most valuable things that I saw in your book was just talking about like choosing the right team. You know, you call it the dream team for your for, you know, people who are having babies. And I think that's such an important thing that people really overlook. And you have you know, you have so much experience with these different providers. So you obviously have, you know, different kind of insight on it. So I think that's really interesting.

So in your experience, what would you say is the key to finding the right provider for someone's birth? absolutely. So the delivery team is chapter three. The good doctor is chapter four. So those are different, but they all play together because the doctor heads the delivery team. He's captain of the ship. And let me tell you how important our delivery team is. I mean, they're responsible for bringing your baby safely into this world.

When I have a legal case or a childbirth case, it is their care that is at issue and analyzed more than any other aspect of the case. So they are extremely important. Now your delivery team, not your doctor, the delivery team who's at the hospital, at your bedside, those typically consist of people that are scheduled to work that day. So it's very important to understand that going into labor and delivery.

And if you're not a fan of somebody on your team, so you know the different teams, so I have the dream team, those are, you know, that's who you want. They provide good care, they're looking out for your best interest, you're comfortable with them, and I go through what the dream team is. But let's say you have the team, I call it the team with a bad apple. You know, now you don't like somebody on your team, my book goes through, okay, how can you switch them out, or what can you do, you know, in that case.

And then of course, you probably saw earlier my career. So my first case was in February 2003. And back then, there were a lot of baby cases and there are I called the teams sometimes Bush League. And that's when you, you know, there's more than one person that you were not a fan of on your team, I even go through those, which this day and age, 21 years later, very, very uncommon, haven't seen those in a long time. But in case somebody got one of those teams, I wanted to include it.

But basically your doctor heads that team. We've got to realize doctor is most likely not going to be at the hospital unless they're taking a 12 hour shift. Usually they may come in early in the morning before they go to their office. They may come in another time if they need you or sometimes they just really kind of come in to catch the baby. So having that doctor to head the team is absolutely critical because they're not at the bedside. So then if there's a concern about you, there's a concern about baby or things are changing and they have to contact the doctor, hopefully your dream team has to contact the doctor. They communicate and then doctors make recommendation. Your dream team comes back to you and says, well, doctor says this. So having that good doctor that can communicate and whatnot is absolutely huge. But when I start that chapter, chapter four on how to find a good doctor. You know, I point out that OBGYNs, those are the doctors that deliver babies. I have analyzed these doctors for a very long time because ultimately since they do head the teams, it's really their care that's at issue. And, you know, in these cases we'll go to trials sometimes or whatnot, and there'll be doctors on both sides. I mean, there's expert doctors for the families or expert doctors for me. There's the delivery team, whatever, but they all require an analysis because I'll tell you, juries, juries don't like bad doctors. They like good doctors. So from day one, I've had to figure out who are my good doctors. So I have a doctor analysis that I do, which I share in the book. Now, listen, you're not going to do the childbirth analysis, childbirth attorney analysis, but I give you almost like a mom analysis that you need to do. And then I tell you different things like, you know, good.

A good reputation does not equate to good care. I tell a story about a Yoda imposter. Yes, yes. She did. I didn't. It's so cute. Literally, so I have a case. There's a case with the birth of a baby. Something happens. And just so your audience understands, when there's a childbirth case, this means that during the birth of a baby, something went wrong and baby's not born healthy. When I say baby's not born healthy, I mean permanently not healthy.

Some babies pass, some moms pass. So these are big cases. The big ones. Yeah. Yeah. And so basically, in that case, baby was born, there were complications. One of the nurses that were on the delivery team left the hospital system. Two years later now, when we're working up the case and whatnot, I meet with that same nurse. She was now at a different hospital system and she sees the name of a doctor in the records and she goes, the doctor, well, we call him Yoda. And I responded immediately. Do you call him Yoda because he looks like Yoda? I didn't think he looked like Yoda. There's no way we're talking about the same doctor. She clarifies we are talking about the same doctor and goes on to explain that he's a wise old physician that does such great things for his patients. I'm sitting there now jaw dropped going you might want to Google Yoda. Because he was actually accused of doing some pretty bad things to his patients. And it was a lot of patients. I mean, it must have went down right after she left the hospital system. But she thought this doctor was the best thing since sliced bread. And I'm like, what? So it's important to understand that no, good reputation does not equate to good care. Physicians try to build their reputation because they're going to get more referrals. They're going to get more patients and whatnot. So keep that in mind. But, ultimately, I go through following your instincts, watching how they communicate to you. Do they communicate? Do they explain things? Do you ask them anything? If you ask them a question, do they elaborate? Just keep in mind how they communicate with you is likely how they communicate with their delivery team. So if they're short, like don't have time for you, yeah, that's a problem. Yeah. And I teach childbirth education and I tell people,

I want you to ask questions early and often to your provider, whether that's a midwife or a doctor or whoever. And I want you to not only listen to their answers, but how they're receiving your questions. Are they annoyed? Are you like, do they feel like you're wasting their time? You know, the red flag isn't always in the answer. Sometimes it's in the delivery. And something else you said that really sparked something, which is so true. One of them is you saying, you know, the reputation. We have people all the time that choose high intervention, not evidence -based doctors who are like, my gosh, I love them. They saved me and my baby. And I'm like, they put you in a position to need to save you and your baby, but the things that they were doing were not safe. And then therefore they needed to save you and now you think that they're God, you know? And one other thing that you said was about, the nursing team, and then really the doctor is the leader of the ship. And that is so true. You know, these nurses work for many doctors. They work for any practice at the hospital. They have any of those doctors, you know, they can have three rooms with three moms having babies and all three of them have different providers. And that nurse is bound by what that doctor is, quote unquote, allowing or dictating that they do. So some people are like, it doesn't matter. I've heard the nurses there are great.

I'm like, yeah, the nurses are great at that hospital, but all of those providers are not created equally. And each one of them is her boss, depending on which room she's in. absolutely. That's such a great point. And that's why you're a labor and delivery nurse. Now, listen, I love labor and delivery nurses. They are a different breed of people. They really can be just, gosh, you get a good labor and delivery nurse. You're sitting pretty. Absolutely.

You know, because they are so that is absolutely huge. But yeah, they are definitely doctors give them orders. And they must follow the orders. And then once their order is up, then they you know, if it's toasting or something like that, you know, they'll have to call the doctor, the doctor gives them more orders. And they're following the doctor's orders. Yeah, absolutely. But some of you got a good labor and delivery nurse, though they'll stand up to the some of the doctors or they will, you know, they may not be just cut and dry though, with you because they can be a huge advocate as well. If you know, if you have one of those kind of dream team nurses, it's always really nice to walk into a room, you know, for us, we work for the patients, we have no, you know, medical background, we're solely working for our clients and so it's always nice to walk into a room and connect with a nurse and realize we're on the same team here. We can work together to make this the best experience possible for our clients, which is, it's huge. That's awesome. I love it. Yeah. I mean, nurses are supposed to be patient advocates. That's what they are in the cases. They're patient advocates. And if they think a decision or something that the doctor is doing is not right, they're actually...supposed to advocate them for the patient and get their charge nurse involved. And actually in the legal cases, they have the whole chain of command issue, meaning if they believe the patient's being endangered, they're supposed to go up the chain of command. Here's the deal though, labor and delivery nurses might be the busiest people alive because they're running, they run so hard. Like, especially if the delivery, the unit is busy. So another, if you read this in the book, another common issue in my cases is that it's a really busy day on the unit. So yes, yes, she's going to the nurse is always going to try, you know, most nurses, obviously, in every profession, you have your bad apples. But most nurses are going to try to be your patient advocate try to be there. But when they have three patients, when they're running hard, they're thinned out, especially if they have something like two Pitocin inductions. my goodness. Yeah. So yeah, no, they're beaching advocates. Would you believe that we've experienced as doulas, nurses that are so busy that they have told clients to, or our clients, but their patients, just have your doula come in early because I can't really be in here to watch you. Like we're so busy. What? Like, I'm not a nurse. And then also we've had, I've been asked, and I know other doulas that have been asked when in labor,

The nurse is like, I have to run to this other room. Can you watch the monitors for me real quick? Just call me if it gets below this. And I'm like, yeah, my hands are up. Like that is not my job. That's very scary. It's out of my scope. I don't want to be responsible if something happens to this baby, you know? Right. Yeah, but I'll tell you, you know, I love that you guys are doulas. I love that you're there as a childbirth attorney. I don't know if you've seen on my social media, or in my podcast, but I literally am known for saying I love doulas. So I only see the bad stuff, right? Stuff that goes wrong, the complications, sick babies, sick moms. I have never had a doula in 21 years of practice be a fact witness in a case. So if you are, if mom has a doula at any point during labor or even during her prenatal course. So if there was a, she was had a doula that was teaching her, educating her or anything, their doula would be a fact witness in my case. If doula steps foot in the hospital during labor, doula would be a fact witness in my case. I have never had a doula in any of my cases. I am convinced that doulas help bring babies safely into this world. that just like gave me chills all over. Thank you so much for saying that because statistics would say that having a doula reduces your likelihood of a whole slew of things.

So hearing that from somebody who deals with that all the time, my gosh, my heart just grew two sizes. I know, I was going to ask about that. I was curious if you have dealt with doulas a whole lot in your work. So it's really interesting to hear that you don't see this and that's because most of your cases don't have doulas there. So that's a good note.

It is a very good note. I wish I would have realized this before publishing my book. Now I'm going to publish another book and then I'll put more doula stuff in there because what happened is, you know, I just didn't know much about doulas because I don't, you know, and I had C -sections so I wasn't like a labor.

You know, I didn't go into labor. Well, actually I did go into labor long story. We won't get into it, but I just didn't know much about doulas, which everybody, by the way, always found shocking. And I'm like, I just don't know. And it didn't really register why until I published my book. And now I'm on all these podcasts with amazing, amazing doulas. And I'm always like, you guys are just doing such great things because I like it. Because as I said earlier with the delivery teams, you roll up to the hospital. It's scheduled. Who's scheduled to work that day?

I mean, I've had nurses, you know, in cases where there's one nurse born to be a labor and delivery nurse, and I have one nurse who just got out of training, hated her job, was trying to get a different job and whatnot. So that day when the patients rolled up, one patient got the dream nurse, and by the way, she had been a nurse for 20 years and she literally loved her job. And the other patient got the other nurse who hated her job and was just out of training, I'm sure your audience is smart and we don't have to tell them which one was involved in the case. So yeah, when you have, or there's again, busy labor and delivery unit and you have your doula by you, it's just absolutely huge because it's also you guys, I like how you build relationships with your clients beforehand.

So then that way they trust you, they know you, you've had these discussions. I love how doulas educate them. That's huge because that's one of the big lessons in preparing for childbirth is, or lessons from the baby cases is preparing for childbirth. And I know you guys do a great job educating the clients. So I see why doulas and what you do for your patients and patients who have doulas, they're not involved in my cases. And by the way - One of the interesting things, sorry, go ahead.

No, and by the way, so then I had to ask my baby lawyer friends if they have doulas in their cases or ever. No, I still can't find a case where a fact witness was a doula who was present at any point during labor. If I do find one, I'll let you know, but I can't find them. Why? Why can I find them? Obviously, you guys are helping these parents bring babies safely into this world.

And you know what's interesting is I was just teaching a class last night because I'm also a childbirth educator and I teach hypnobirthing. And one of the things that I tell people is, you know, it is beautiful that you trust your provider or that you trust your doula and it's beautiful that you're taking the childbirth education classes. And I understand that a lot of people, you know, we typically as doulas are low intervention births, right? We're trying to get the baby here and the mom safely and the baby safely, but also, honoring some emotional side of this as well and having the least amount of emotional trauma as well. But I said, you know, you have a doula and they're in the room and not everybody who takes my class is our client, that some of them have other doulas or none. And I say, you could be in labor and something is being offered to you or being told that it needs to be done. And because so many people have this really jaded, not so of the hospital world and the doctor world, they automatically think that it's not needed. And sometimes as doulas, the way that we help babies and moms come into the world safely is preventing an unnecessary intervention. But sometimes it's giving parents the confidence to know this is actually something that we have seen before. Like it needs to be, it does safely need to be done. Where, you know, we're not making the decision for them, them because we're not medical them knowing that we have seen this before and it could have a negative outcome. So having this intervention could actually make things safer is really comforting to the parents. And they don't feel like they just need to say no to everything all the time. I think some people go into the hospital system just ready to fight. And because of that, they miss out on some safety things that would have been beneficial. Do you agree, Samantha? Yeah. Yeah, I totally agree. I think that, you know, a lot of our goal as doulas is to help our clients have positive birth experiences, whether that means every intervention in the book or no interventions whatsoever. And it's going to depend very much on them and what they need, as well as what their baby needs and what their labor and birth is progressing. And so sometimes absolutely those interventions are necessary and having a doula there to help educate you on those things is so huge. I know you talk about birth plans later on in the book and you talk about how, I think you say, decision -making before labor versus during labor is really different. And you have to have, before labor, you have the time to think and to research and to read and to do all of these things, take classes, talk to your friends and family. And so you can make evidence -based decisions that are not based on emotion and fear, or whatever else is going on in that moment. Whereas right there in that moment, if you're having to drink from the fire hydrant with all of this information being tossed at you, it's so hard to make a true informed decision. 100%. 100%. Yeah, that chapter, it's funny. I'm doing my audio book and I just finished that chapter like two days ago. So I just went through all of that.

But then you probably saw the testimony from the doctor. I mean, I had a doctor testify that, yeah, you go into labor, you enter a different state of mind. He said he testified, I threw it in the book, that he thinks all decisions should be made before labor, which is impossible to do. But basically, I think he said actually, mom should be given all of her options before labor, because she does enter a different state of mind.

But also in preparing for labor and delivery is also understanding that it's almost impossible to prepare because everything may change or whatnot. So the act of preparing is just absolutely, absolutely huge to help you make those good decisions. And having a partner, whether that's a romantic partner or a sister or an aunt or somebody that's going to be in there with you, but also is educated and knows what you want beforehand so that they can help you navigate or doula. But, you know, also a doula, but really somebody also that's like a family or really close friend, because they're gonna help you be able to navigate those decisions a little bit in the moment. I'm really excited to get into this next question because one of the things that when I was reading a part of your book and that I've heard in the podcast is you said that almost every case you deal with starts with one thing and it may or may not start with a P. Can you talk to us a little bit about that? Of course, the number one most common fact and issue in a childbirth case is the drug Pitocin. Pitocin is used to induce mom's labor. It makes her uterus contract, then the body has its cues and mom's supposed to go into labor. And I like how you guys were talking about the interventions and how, hold on.

Earlier in the podcast, you were talking about interventions and that reminded me of something I think is so incredibly important. And I don't say this enough on podcasts, but while Pitocin is common in most of my cases, and then obviously it's a cascade effect, Pitocin is very strong. So then mom gets an epidural and it's just like this cascade of interventions. What I don't see in a lot of my cases are spontaneous vaginal births with no intervention. I just like to throw that out there. So, you know, sometimes when people, they don't want their interventions, I can tell you, those are the, I don't see a lot of those. My case is really involved, like the ones with a lot of interventions. So when you are offered interventions and whatnot, those are extremely important decisions. And I like how you guys, you understand it, you've seen it. So you can give your clients like the go ahead and whatnot. So basically, Chapter 11 are the reoccurring issues and facts in the baby cases. Unfortunately, because I do see the same ones. So number one is Pitocin. And then I also authored a subsequent chapter, the very last chapter of the book, Chapter 14, how to have a safe Pitocin induction. Pitocin is a very individualized drug, everybody responds differently. However, like we talked about earlier, what happens is a doctor will just make orders for Pitocin and the nurse just follows the orders. But the drug is extremely individualized. Your nurse, you need to have that conversation. You know, if the nurse wants to increase your Pitocin, find out how much are they increasing your Pitocin. Now I go over all of this in the book. So, Pitocin is actually extremely easy to understand. Literally, they typically start at one and they go to 20. They can start at one and they can go up by two.

Some doctors like to go two, four, six, eight. Some doctors like to go one, two, three. So you got to figure out, does your doctor go by one, your doctor go by twos? Personally, as a doctor - When I was first a doula, sometimes it was six by six. I remember having to help advocate to not have six and then six more and then six more, which is crazy to me. Yes. So other countries do that. I have not seen that so much in the, I've seen threes a couple earlier, but they're pretty around, in Michigan, they're pretty one or two. They've set the hospital protocols at that these days, so it's really hard to do that, but other countries do by six. And ACOG, I think, ACOG calls the high dose, the Pitocin dose. You know, they start at six or they go up, but yeah, there's, yeah, no, no, so that's crazy. Anyway, so when you, aren't going to do Pitocin or actually, even if you're just expecting a baby, you should have an understanding of what Pitocin is. Even if you're listening to this podcast and you're like, heck no, I am not doing Pitocin. Here's the deal. You're 38 weeks, you're not in labor, but you go to the hospital because something's up and your team kind of evaluates you and baby and there's concerns for either you or baby and your healthcare provider is like, hey, I think it's time, but you're not in labor. You have two options. You have a Pitocin induction option or you have a C -section option. Which one do you want? So listen, you don't want to be reading chapter 14 if your doctor makes that recommendation. So any parent should really, expecting parents should have a good understanding of that chapter because I've seen the Pitocin induction's gone wrong since February 2003.

I've researched this drug. I've traveled the United States talking about this drug. I know the hospital protocols. I know how it's administered. It's very important to read that chapter. And listen, I don't like Pitocin. I don't. I'm a childbirth attorney. It's in most of my cases. I don't like it. I say to my doctors, I don't like Pitocin. They said, Gina, Pitocin's fine. So the doctors, the nurses, I think they all agree pretty much universally, Pitocin is safe during labor is what they tell me, but what they don't agree on is how to administer it. That's the thing. So you may have your doctor may look at chapter 14 of my book and be like, duh, great, perfect. I hope the doctor agrees with chapter 14. Another doctor is going to look at chapter 14 and be like, no, that's too conservative. Because I am definitely like a slow and steady hit your sweet spot kind of person. And that's chapter 14. But you may have a doctor who wants to be more aggressive. I do not recommend that because how your body responds to Pitocin, nobody knows until you try it. So you do it. And the last thing you want to do is contract too much because that's too much stress on babies.

I'm sure you teach your clients this, and I talk about it in my book, but a contraction, so a contraction is your uterus, so your baby's in your uterus with the placenta and the umbilical cord. And when you contract, it squeezes down on baby, and that cuts off the oxygen to baby. Nobody freak out. Babies are made to handle contractions, completely normal. But when you're on Pitocin and you have artificial contractions and you start contracting too much, it's like, it's like baby going underwater you know, as the contraction comes down, baby's going underwater, contraction comes up, baby can breathe. So, you know, it's very important to understand that when you your Pitocin goes too high, that could stress out baby, listen, baby, yes, they're made to handle contractions, but they can only handle so much when you're artificially making contractions happen. That's when you got to be super, super careful. And that's why I like slow and steady. Yeah. I mean, obviously your doctor's going to go through this or whatever, but I tell you if your doctor has a different opinion, what to talk about with your doctor. Doctors max out at 20, I say in my book, max out at 10. Do you want to know what we've seen? We were talking about this before you hopped on. Ciarra's top number of Pitocin that I've seen, 36. How about you, Samantha? I saw 40 once. I saw 41 so it was a little scary. I believe that. I know we're giving her a heart attack y 'all. She's like, wow. Another thing. Yeah, you guys are going to make me freak out. Something else that you said about the Pitocin thing. You know, yeah, Pitocin is not ideal, right? It's not the enemy in a situation that we actually need it in and we can taper it and use it and try to make it as safe as possible if you go by some of these protocols. But this is exactly why we encourage people to not just get elective inductions for funsies, you know, because my doctor's in that day or because, you know, my doctor's going on vacation and I don't want the other doctor or because, you know, I love this birth date and I want my baby to have this birth date or whatever, right? If we can avoid the Pitocin, great. If we need to use it, we need to educate ourselves on the safety of it. Because the other thing to think about with Pitocin too is with the spontaneous labor, your waves are starting, you know, whatever, 10, 15 minutes apart and then kind of slowly getting closer together. And they're typically in that two to three minute apart range right at the end, right? As we're approaching transition. And then you're looking at a Pitocin delivery and what they would call adequate contractions is when the contractions are coming every two to four minutes and they want that to happen from the beginning because that's what's going to drive labor. So we're having two to four minute apart contractions for the entirety of your labor versus the remaining, whatever it is, three to four hours from transition to delivery. So that's a lot more time for you to spend contracting and for that pressure to be on baby. And most babies do handle Pitocin just fine, but I would say, I'm trying to think of all of the C -sections I've been in. I think in most of the C -sections I've been in because of baby having a hard time, all but maybe one or two was due to Pitocin. Luckily we don't usually get to the point of, you know, it's an emergent cesarean. Usually we have, we're watching closely, nurses are watching closely. If the baby's not tolerating well, we're backing down on Pitocin. It's not like we only can go up, we can come back down. And then sometimes it's like, look, we can't even restart it because this baby's not recovering well. And now we're kind of stuck because we're six centimeters and we aren't having natural waves or contractions. And we can't add anything because the baby's not tolerating it. So we are kind of timed out of ideas here.

And we would much prefer that as a reason for cesarean than we're just going to keep on pressing and going hard until it's an emergency situation. So, you know, you got to make sure that you have providers that are paying attention and aren't just arbitrarily continuing to go up because we've got to have a baby, you know. Right. Or they want to get home for dinner. So, yeah, you know, and then and I'll tell you guys, I don't know if you've read this, but the Pitocin drug inserts.

That is fascinating. First of all, it does not recommend elective inductions at 39 weeks. Number two. Shocker. Yeah. It says, hit up to six is equivalent to spontaneous labor. Don't go over 10. That's the drug insert. That's crazy. Yeah, there was a study. This is one of the last things that made it into my book because it came out and I was like, I like the magic number 10. Like don't go over 10. And not only don't go over 10. So doctor is going to write your Pitocin order up to 20. I say no, doctor, you're going to write the Pitocin order up to 10 maximum. And if I do need more than 10, listen, you might need more than 10. Everybody responds to Pitocin differently. If you require more, that's going to require your nurse to call your doctor, have a discussion about your labor and say, okay, we need a little bit more Pitocin. This is why. Doctor then should look at your monitor strip, make sure baby's heart rate's okay and whatnot. So I like the magic. I like the Pitocin drug insert, by the way. I'm going to tell you, Gina, I don't think I've ever been to an induction that is used Pitocin where we've had a baby with less than 10 pit, except I guess I can think of one time, as I said that statement, my brain found one time where I had a VBAC mama who had like literally a pinch of Pitocin. I think we got two. It helped her body just enough to go. But that is rare. Augmenting I see it lower. Yeah, not so much with induction. And for people listening, augmenting means, you know, we're not starting an induction from zero contractions. We're in labor the way the waves or contractions are pretty far apart, or we just need a little bit of something to help make them stronger. And then that's an augmentation where we add it to an already existing spontaneous labor versus starting it with no spontaneous labor. No, yeah, I still like the fact that they still have to have that discussion. Because so there's a study that came out. So you have your neck, every mom has her natural oxytocin. So if you go into labor naturally, that's like your natural oxytocin. Pitocin, the drug, it's like the synthetic drug of oxytocin. So when you give a mom Pitocin, her body then starts producing oxytocin. And what that study found is that if you go over 10 with the Pitocin, that then your Mom's body is producing too much oxytocin and you have this like the oxytocin overdrive effect. Yeah. So that's a study. I threw that study and as a less thing, I threw it away because I'm like, I've always liked 10 and my cases are usually about 10. Why?

We just had a, I just had a class on Saturday and we, in my last final in -person class, we talk about all of the interventions and different things. And we were talking about Pitocin and how, you know, you might have Pitocin, you know, in your delivery. And then they also give Pitocin after delivery to prevent a hemorrhage. And we talk about, you know, what things might make it more likely that you would have a hemorrhage. And one of those things is that you had Pitocin, if you had an induction, you had Pitocin in labor, then you're more likely to need Pitocin after labor. And it's just this really weird circle. And it is that, it's that oxytocin overload. And we have all of these receptors in our uterus and they do get overloaded with oxytocin when they're being slammed full of pit. And so it's always funny to like try to talk about that. I'm like, well, if you get too much pit, then the answer is more pit is what's going to fix that for you. I know. It's crazy. So I'm like, if you can just stick with spontaneous natural vaginal delivery. That's great. Yeah. You can try that first. There you go. And I think one thing. go ahead. Sorry. Sorry. I think one thing that I just keep thinking as we're talking about all of this is, you know, we talk about the per choosing your provider and having that dream team. And a lot of it is also going to be choosing a hospital system so that your delivery team is going to be supportive of all of these things and able to look at you. I'm thinking of the nurses that are just overloaded. Those are hospital systems. And it happens in even the best ones, but there are certain hospitals that are going to have that happening more often. They have lower staff to patient ratios happening. And so, I think that's also a really important thing to look at. Some of our formerly favorite providers are at hospital systems that are just no longer providing safe care to patients. They have nurses that are just overloaded and all of these things that are happening. And so it's important to look at all of that together. absolutely. I was on a podcast with a nurse and she was a labor and delivery nurse. It was her podcast. And her last day at her job was the day after our podcast. And I'm like, where are you going? And she's like, listen, I love my job, but I cannot do it effectively because we are completely understaffed. It is not safe. Something's going to happen. And I can't let that happen on my watch. So it's so sad because you do, you'll have like these great labor and delivery nurses who are put in these impossible situations. Your hands are tied.

Yeah, it is. But again, if you have a hospital system where you have a great doctor and the nursing staff is short staffed or you're not getting the nursing care you need, especially on Pitocin, I cannot emphasize enough to your audience that you have to have a doula or a baby advocate or somebody there to keep an eye on you. I like doulas, obviously, because you guys also speak the language of the delivery team. You are often, like you just said, you're familiar with these doctors, you're familiar with the teams, you're familiar with the hospital system. So having somebody like you guys, especially in that kind of situation, is so critically important. And let me tell you why. So a busy labor and delivery unit, very common in the cases. I tell this story very in general in my book. I have a mom come into the hospital, the unit is slammed. They put mom on a mat, they get mom in her room. She's getting like the extra room. I don't know if you guys have those happen, but you know, you get the extra room because labor delivery is full. Just again, so important to have a doula present for that. They put the monitor on mom, there's concerns about the baby and they do their tests and they do their interventions and they are reassured enough to leave the room. But then, after they leave the room, the baby's heart rate stops graphing. They don't realize, they don't realize that happened. Families in there, mom, soon to be dad, grandparents, and in that room, nobody understands how important the baby's heart rate is. So think about it, audience. I know you guys know.

So when you, there's a mom and labor, there are two patients, there's mom and there's baby. Mom is the easy patient because you, mom, you can look at mom and say, okay, mom doesn't look good, what's up mom, or you're in pain, you guys, you know, she can communicate, there's usually a diagnosis, and then there's a plan. Baby is completely different, baby's hiding inside mom. So they must use the baby's heart rate a lot of times to figure out how is baby doing. As a childbirth attorney, it is the first thing I learned how to do was to read the baby's heart rate. I put testimony from a doctor in one of my cases in the book because doctors tell me this all the time, Gina, the only way a baby can talk to me is through their heart rate. So basically, I can look at a fetal monitor strip and I can tell you if baby's a rock star or if baby's struggling. But more importantly, going back to that doctor's testimony, a baby can only talk to me through its heart rate. So if you understand - And this is why you have to have monitoring when you have Pitocin. This is not, like that's not an option. Evidence would show, evidence -based birth, all of those things, all of the research would show that it's OK to have intermittent monitoring when you're not having all of these interventions. But like you said, those aren't the cases you see. You see the ones with Pitocin and the ones with Pitocin, you have to be being monitored. And what's supposed to happen is when you don't have a nurse in the room, they still see that monitor from other rooms and from their computer in the hall. If they're so overloaded, they can't see it. Then that's a problem. Parents shouldn't be having to watch those monitors in the room. That should that that is a failure of a system. And neither should do this.

Though we do sometimes, you know, I noticed that baby's not on the monitor. We're getting, you know, we've been off the monitor. It's technically, at least where we are, if they're on Pitocin and we lose baby's heart rate for more than 10 minutes, then we have to turn off the Pitocin no matter what. Even if we get baby back on and, you know, she looks totally fine. We have to turn off the Pitocin and start again. And that doesn't always happen. So if, but if I notice that, you know, baby's falling off the monitor and our nurses, you know, I know dealing with something else or just not there yet, sometimes I'll just go over and put my hand on that monitor to make sure that we are tracing. because it is helpful. That's huge. That's huge. So, right. So I'll finish that because this is, this was a case, but I'll finish that. So basically with the babies, with the bat, with the baby's heart rate, as that doctor testified, that's the only way that baby can talk to doctor. But then whoever understands that heart rate, like you guys, it's like baby can talk to you. So I say in my book, I'm like, parents, you got to understand the baby's heart rate. I wrote a chapter on how to read the baby's heart rate. It's chapter nine. I think that is critically important because if there's any concerns about your baby, it always starts with their heart rate. So to have that understanding is going to help you streamline communication, make decisions because they don't go concern of heart rate to C -section. It doesn't work like that typically. It's concerns about the baby's heart rate. And like I said, that happened in the case, they do tests and interventions. So they're trying to see their other ways, you know, as baby responding, how much amniotic fluids in there. They may do an ultrasound, a BTP, a non -stress test, contraction stress test, blah, blah, blah. Again, all of these interventions, I wrote the chapter on fetal monitoring there's concerns, interventions, I wrote a chapter on interventions and whatnot. But basically, I tell parents in the book, they have to have an understanding of the baby's heart rate that I believe that's incredibly important. So I'll finish that case. So in that case, again, the baby's heart rate stops graphing. When there's concerns about your baby, it is so important to keep that heart rate on so you understand how your baby is doing.

Even if you're not on Pitocin, if there's concerns about baby, that heart rate monitor has to stay on. It didn't. And when the nurse came back a while later, again, busy labor and delivery unit, eyes up the prize. She tried to start the monitor again, and there was no heart rate. They were finally, so the other, you know how this works, the other nurses come in and they're trying to help the nurse, everybody's in there, they get the doctor, the busy doctor finally gets back and he can't find the baby's heart rate, he pulls in the big ultrasound machine and confirms that that day on the unit in that room, surrounded by the family, the baby passed away. So, you know, if you again, like you said, if you were there, especially if there's concerns or if there's Pitocin, you're over there adjusting the monitor or whatnot. So no, I

So I wrote this in the book. I feel like the medical community wants to keep the baby's heart rate to themselves. They want to interpret it. And if you guys start trying to interpret it, you know, they're going to slap you on the hand or something. But to me, I'm like, no, every single parent needs to understand what the baby's heart rate is because baby's inside you. And it is the best way by far to figure out how your baby's doing, especially during something like a Pitocin induction. Yeah, yeah, absolutely. It's important for, and this is why we encourage, you know, not just the birthing person, but also the, you know, partner and anyone else who's going to be in the room to attend childbirth education so that they can have all of this, all of this knowledge as well. And then, you know, one last thing that you, that I want to mention before we wrap up is you have, I forget which chapter it is, but you have a whole chapter on what you call the, the LAD, the labor and delivery plan. And, I think, you know, as doulas, we're a big fan of birth plans or birth preferences of all of these things. But can you just briefly tell us why, as a baby lawyer, you feel that those are really beneficial for people? absolutely. And it just goes back to preparing for childbirth and just being ready for it and in the comfort of your own home. Being able to read a book like my being able to listen to this great podcast that you guys are out there, being able to do a childbirth class, just getting ready so you can make those important decisions. And if you're offered a couple options, you're not deer in the headlights, you are able to communicate, pivot, you understand that that's a possibility, that there are changes in the plan. Sometimes people, I've had a podcast, like the last one I was on, they're like, well, are people gonna be fearful if they read the book? I'm like, fear? Fear is the unknown. The way to overcome fear is by understanding something, using that power of knowledge, learning about it. So if you are, you know, approached with a big decision during childbirth, you can make that using your brain and not fear. So it's so incredibly important. So I go over, then different things that I believe should be included in your plan or that you should think about. One super important thing that I don't think people understand, but it happens a lot in my cases. And again, this goes from Pitocin, Epidural, I'm sure you guys have seen this, and then it'll go possibly C -section or if baby's really close, vaginal operative delivery. So you need to figure out with your doctor, if they decide to do an operative delivery vaginally, that is the use of a vacuum or forceps, which one are they going to use? That is incredibly important. And let me tell you why. So families in my cases are minutes from a healthy baby, one decision from a healthy baby. I say that in almost every podcast. I say that all the time because it is so heartbreaking when you land on the wrong side of a close call. Something like, especially if you're going to do Pitocin, sometimes Pitocin ductions end in this operative vaginal delivery. You need to find out from your doctor, are you going to use a vacuum on me if we get to this point, or are you going to use forceps? And in my cases, when they use forceps, forceps are more effective in delivering the baby. However, there's vaginal trauma involved with that.

But if you have a baby that's in trouble and struggling and needs oxygen, that is the best way to get baby out. In my cases, this is unfortunately what I see a lot, is they do not use forceps. They use the vacuum. And vacuums can pop off three times, but once a vacuum pops off three times, if they cannot get baby delivered with a vacuum, now, not as much vaginal trauma but after three pop -offs, they must convert to a C -section, and they usually can do it pretty quick, but those minutes, that's what I'm talking about in my cases. They have the vacuum pop -off three times, they think that they can get the baby delivered with this, they can't convert to C -section, baby goes too long, too long without the oxygen they need. So you've got to find out from your doctor, especially if you're doing a Pitocin induction, just going over these options. Are you?

The doctors, I know the doctors in my cases, I know the experts, I know if they're a forceps guide and I know if they're vacuum doctors because that's a huge distinction. They always use one or the other. Well, a big piece of that is what are they trained in? So you need to talk to your doctor about what they're trained in because I've been to over 150 births and I have never seen forceps used. I've only seen vacuum used, but not very many times.

But I think it's a little bit of a lost art. If they don't know how to use them properly, it's not safe. So I think asking them what their experience is, what their training is, and using those things that might need to be used in an emergency case like that is important. Absolutely. And it's just because in my cases, I have seen just the times where, and then I'll get an expert in, and the expert's like, why didn't they use forceps? Well, yeah, unfortunately it seems like the older doctors are using forceps and that the younger doctors are not being trained with forceps. They're being trained with vacuums. And it's just scary. So just keep in mind, in vacuum, you know, you're contract, you got to wait for contraction, then you're pulling with the contraction. So it takes a little bit, but those, you know, so those are important discussions. Again, especially if you're having a Pitocin induction.

You're going to have elective induction. You better have an idea if they're going to use forceps or a vacuum if it's needed. Just find out. You just want to make sure. Ask the questions. Just ask the questions. Get those discussions going. People are so afraid. They feel like a confrontation. It doesn't have to be confrontation. It's just a discussion. You're a human being just like they are. And they work for you. You don't work for them. So we tell people that all the time. We're like, you're the boss.

You're the one who gets to make the choices. So we really appreciate that you have come on here and shared your knowledge. We know that it takes an insane amount of work to read a book. We are going to link all of that in the show notes on how people can find you. But will you tell people how to find you and the name again of your book? sure. So the best way to find me is I'm sure it's show notes, but G -I -N -A -M-U -N -D -Y.

The name of my book is A Parent's Guide to a Safer Childbirth, Expecting the Best, How the Power of Knowledge Can Help You Deliver a Healthy Baby. So definitely, and by the way, chapter, I don't think we talked about this in the podcast, but I do have chapter one of my book on my website for free. You don't even have to give me your email address. You just download it and you can look at all of the lessons. So chapter one are all of the lessons from the baby cases. So as a lesson, we're learning from it in order to prevent the mistakes from happening in the future. These are lessons from the delivery team, the families, the medical experts, but it's really, it's a good starting point for families. Awesome. Yeah. I appreciate it so much. Thank you for being here and taking the time out. I know you're quite the busy lady.

Of course. And you know what? I love being on your podcast. I love what you guys are doing for your clients. You guys are definitely helping to bring babies safely into this world. So I likewise thank you for all your work. Thank you so much. We really appreciate it having you on today and can't wait to listen to your audio book when it comes out. You said hopefully next month and we'll look for more from you. Thank you guys. I appreciate it.

Thank you for joining us on Birth, Baby! Thanks again to Longing for Orpheus for our music. You can look him up on Spotify. Remember to leave a review, share and follow wherever you get your podcasts. See you next week.

An Attorney's Proactive Approach to a Safer Birth
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