Ep 244: How to Have a Safer Childbirth with Attorney Gina Mundy

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What can an attorney teach you about your labor and delivery? A lot, it turns out! Gina Mundy specializes in childbirth cases defending medical professionals. Over the course of her 20+ year career, she has learned about the mistakes that can happen in hospitals and she’s here to share those insights with us. Her book, "A Parent's Guide to a Safer Childbirth," helps parents prevent errors and have a healthy baby. In today’s episode we are going to go through the 12 lessons covered in her book.

In this Episode, You’ll Learn About:

  • Lesson 1 - Learning About Labor and Delivery
  • Lesson 2 - The Delivery Team
  • Lesson 3 - The Good Doctor
  • Lesson 4 - Know Your Hospital
  • Lesson 5 - Having a Plan
  • Lesson 6 - Having an Advocate
  • Lesson 7 - Knowing the Types of Fetal Monitors
  • Lesson 8 - Knowing What Your Baby’s Heart Rate Means
  • Lesson 9 - Understanding Tests and Interventions
  • Lesson 10 - Common Facts and Issues in Legal Baby Cases
  • Lesson 11 - Safety and Epidurals
  • Lesson 12 - Understanding C-Sections

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Transcript

Dr. Nicole (00:00:00): What would an attorney who specializes in childbirth cases want you to know so that you can have a great birth experience? Well, that is what you are going to learn today in this episode with attorney Gina Mundy.

(00:00:20): Welcome to the All about Pregnancy and birth podcast. If you're having a baby in the hospital, you are giving birth in a system that too often takes away power from women over what happens in their own bodies. I'm Dr. Nicole Calloway Rankins, a practicing board certified OB GYN, who's had the privilege of helping well over a thousand babies into this world. I've been a doctor for over 20 years, and I'm here to help you take back your power, advocate for yourself, and have the beautiful pregnancy and birth that you deserve. This podcast is for educational purposes only, and it's not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now, let's get to it. Hello there. Welcome to another episode of the podcast. This is episode number 244. Whether this is your first time listening or you have listened to before, I'm so grateful you're spending some time with me today.

(00:01:15): In this episode, we have Gina Mundy. Gina is an attorney who specializes in childbirth cases For over two decades, she has analyzed the mistakes that are made during labor and delivery. Drawing on this knowledge, she has authored the book, A Parent's Guide to a Safer Childbirth to help parents prevent these mistakes and Have a healthy baby rather than merely getting involved after an unfortunate incident occurred. Gina has taken a proactive approach by getting involved before childbirth. The book has been selling around the world since it was published in June of 2023, and it became an bestseller on Amazon in less than three months. Now, Gina's book is divided into 12 lessons, and we're going to briefly touch upon each of those lessons and her recommendations for each, and you can dive into the book to learn more. So those lessons are learning about labor and delivery.

(00:02:15): The delivery team, the good doctor, know your hospital, having a plan, have an advocate. Know the types of fetal monitors, know what your baby's heart rate means, understanding test and interventions, common facts and issues in legal baby cases, safety and epidurals, and understanding c-sections. Now, these are many of the same topics that I cover inside my online childbirth education class. The birth preparation course. The birth preparation course is my signature program that will get you calm, confident, and empowered to have a beautiful birth with focus on helping you get ready for a hospital birth. Thousands of women have taken the class, and I would love to have you inside the birth preparation course too. You can check out all the details of the birth preparation course at drnicolerankins.com/enroll. All right, let's get into the conversation with attorney Gina Mundy. Thank you so much, Gina, for agreeing to come onto the podcast. I'm really excited to talk to you about this important topic and that how you come came to this and approach it, all of that. Good. Great stuff.

Gina Mundy (00:03:38): Thank you for having me. I'm so excited to talk to you a little bit more today.

Dr. Nicole (00:03:42): Yeah. So why don't you start off by telling us a bit about yourself and your work and your family if you'd like.

Gina Mundy (00:03:47): Oh, got to include my family. That's the most important job I have. So I have three kids, 19-year-old girl, 15-year-old girl, and then I got my little Liam.

Dr. Nicole (00:04:00): Alright.

Gina Mundy (00:04:01): He keeps everybody happy. Yes. So I have also been an attorney for over 20 years, and I specialize in childbirth cases. So for your audience, I did no idea this existed even throughout law school. I took the bar exam, had no idea that there was something called a childbirth attorney. But basically when something goes wrong during the birth of a child and the baby's not born healthy, or sometimes I've had some sad cases where mom's passed away, then I'll be one of the attorneys on the case, and my job is to come in and find out what happened, what went wrong, and probably more importantly, what should have been done. So baby was born healthy or mom was around to raise her baby. Sure. So those questions have taken me across the United States more than once. I've been in every state, every hospital system, basically hashing out labor and delivery with people like yourself, midwives, nurses, past residents, you name it, I've talked to 'em, if you're ever part of a delivery team. Gotcha. So I've done that, yes, many, many years. So I took that experience and then I wrote a book, and the book is A Parents' Guide to a Safer Childbirth. So the purpose of my book is to help expecting parents make sure that these mistakes and complications that I've seen for over 20 years don't happen during the birth of their baby. So instead of getting involved in the aftermath of something bad happening, I'm trying to get involved before childbirth just to help have more healthy babies.

Dr. Nicole (00:05:47): Sure, absolutely.

Gina Mundy (00:05:48): That's the whole goal of the book.

Dr. Nicole (00:05:49): So what made you decide to take your knowledge and write a book? Because the vast majority of folks don't do that. And then specifically for expectant parents.

Gina Mundy (00:06:01): So we had a near family, very close family, tragedy, everybody's okay, but for about 20 minutes, we didn't know what had happened. So basically my niece was in labor and she was giving birth to the first baby of our next generation. So we were very excited, we're very close family, and I answered the phone that day expecting to hear the good news that my niece Sam had her baby, and instead it was my sister. Her mom hysterically crying and screaming, oh my God. And it was right. So I ran outside, my whole family was around me. I ran outside where I sat and I listened to her cry, and we just waited. That's all you can do. But I'd been involved that day with the labor and I knew what was going on, and I had this, of course legal analysis going on in my head.

(00:06:59): But as I sat and I listened to my sister cry, I went from this legal analysis to this human analysis, and I for once felt, I'm like, this is how the families feel right now. It's this feeling of helplessness. No, right now, at that moment in time, there is no decision now that's going to change the past and all you can do is sit and hope and pray. And for me, that included just listening to soon to be grandma. So finally we got word that the baby, everything was going to be okay, and today we have a very healthy baby. But it was just that connection because the hardest part of my job has always been to this day talking to the families about the day their baby was born because if there's a case, unfortunately baby was not born healthy. And especially if it's a mistake, if a mistake takes the life of a little one, it's like the parents almost. They can't, it's hard for them to, I don't know how they ever move on. I've talked to them over the years and it's very, very difficult.

Dr. Nicole (00:08:10): Sure, sure, sure. And then what made you even decide to focus on childbirth cases?

Gina Mundy (00:08:16): So yeah, actually I'm like, hold on, I'll keep talking about the keep on the same story. I didn't really come full circle on that one. So that day that I listened to my sister cry, that human experience just stayed with me. I couldn't shake it, and all of a sudden I'm like, wait a minute, what if I'm not around for the birth of my grandkids? Like I said, I have teenage girls and they're getting older, and I'm like, maybe I know some stuff. I know things that people don't know because of what I've specialized in with childbirth. So I am like, you know what? I'm going to start writing this stuff down, especially from not around for my grandkids. Now, Sam, my niece, her story is the introduction to the book. So if you want all of the details, just put the introduction to the book and you can check it out.

(00:09:07): But then as it pertained to my kids and then the rest of my nieces and nephews, I'm like, I got to write this down. So that's kind of where it started. But then the minute I went from attorney to author, I mean the information that was in my head just came out. I can tell you how I prepare my kids for childbirth. It is or will be way different than how a family traditionally prepares, particularly given what I've seen or whatnot. So this is, I wrote it every day I was talking to my kids, so they're still in our teenage years. So I still feel this, here's an issue or here's something you really need to know, and if it happens during, and then I have to solve every single problem because it's my kids now. I'm sure as they age and they get in their twenties, they're going to be more independent, but right now they're not. So every problem has a solution, and I would even call it a problem. This is just what you need to know, and if it happens during your labor, this is what you need to do to make sure these mistakes or complications don't happen, especially during the birth of my grandkids. Right,

Dr. Nicole (00:10:18): Right. Well, let's hop into it because the book you have for everybody who's out there, the first chapter of the book is available on her website and it's very easy to read, very straightforward, clear, easy to understand, and great lessons. So I want to touch upon each of the lessons just briefly a little tiny bit about why you think this is important, especially from your perspective as a attorney. And then folks can go to the book obviously to get more. But I thought we would just go through and talk about each one of the things.

Gina Mundy (00:10:49): That sounds perfect. Okay. Because I'll tell you, chapter one probably was the longest part. That was the longest chapter that took to write because these were all of the lessons, whether it's from the medical experts, whether it's from the delivery team, something I learned from them, or more importantly, whether it's from the families that are involved in these cases. Absolutely. These are the lessons every single parent should understand before childbirth. It will help to guide them even if they don't read the rest of the book, it will help guide them on a good foundation of what they need to know before the big day. That is why it's on my website for free. And you could download it, you can share it, you can do whatever you want with it. But lesson number one is from the families, and that is you have to prepare and learn about childbirth before you get to the hospital.

Dr. Nicole (00:11:46): Thank you for saying this.

Gina Mundy (00:11:48): Yes. I'll tell you, it's funny. I had a labor and delivery nurse go through my book. I published it and she called me. The first thing she said is, if every parent knew what was in your book, my job would be so much easier. But I found that the families in the cases, they're kind of guilty of something we're all guilty of, and that is bad. Things only happen to other people, and unfortunately that leaves you in a very vulnerable state, and I wouldn't recommend it on one of the biggest days of your life. So just preparing and learning, it's not about just everyone, new baby. It's like, oh, great, nursery, baby clothes, stroller, all that fun stuff. And of course the childbirth attorney's like, no, we have to get ready for the big day. That's the most important part to make sure we can get baby and all the cute clothes after that. Absolutely. So just learning about it. But each lesson is a subsequent chapter of the book. So learning about, so then chapter two is the basics of labor and delivery, but they're different basics. These are not the basics that you're going to read about in a normal childbirth book. These are the basics of the childbirth attorney. These are the facts that I find to be important when either I'm assessing a case as a childbirth attorney, I do get phone calls and text messages from family and friends and labor and delivery.

(00:13:14): These are my core facts that I rely on that have really given me a good understanding of childbirth, but again, much different. Lesson two, delivery team, your delivery team. Yes.

Dr. Nicole (00:13:27): Let's talk about what is the importance of the delivery team. This is something I talk about a lot as well.

Gina Mundy (00:13:34): Yes. So the delivery team is responsible for bringing baby safely into this world. When there is a legal baby case, a childbirth case I'm involved in, it is the delivery team's actions or inactions that are the center of the case. It is the part of the case that is talked about more than anything else. So it is important to have an understanding of the roles, the people who will be on your delivery team. For instance, do you have residents? Do you just have a nurse? Do you have midwives? Where's your doctor? Is doctor just calling in? Does doctor come visit you?

Dr. Nicole (00:14:16): So not just necessarily because it's hard sometimes, especially with who's on call, you may not necessarily know who is going to be there, which I think goes back to lesson number one, the importance of understanding what happens during labor and birth. But you're saying you need to know all the players who are the potential people, which a lot of people don't necessarily know. Oh,

Gina Mundy (00:14:38): A hundred percent. Because just like you pointed out, listen, the people who are on your delivery team are people who are scheduled to work that day. It is what it is. Whether the doctor's on call the nurse, I mean, I've had cases where one case, actually it's in the book, but I had two nurses, one 20 years experience, literally born to be a labor and delivery nurse. She was amazing. That was my first nurse. My second nurse had just gotten out of training, had decided she did not want to be a labor and delivery nurse and did not like the whole childbirth thing that day when the patients walked in, it was luck of the draw, who got which nurse? So in my book, I go over not only the importance of understanding your delivery team, but listen, if you get the nurse who doesn't like her job and you don't have a good feeling about the nurse, then you got to step in and say something or have someone else say something.

(00:15:39): But in that case, for instance, at that hospital, everybody knew that an experienced nurse did not like her job and she was leaving the unit. So if the patient would've said, Hey, can I get a new nurse? Listen, everybody on labor and delivery that day would've been on the same page as that patient they already knew. But that very experienced nurse also from that day, she can't just tick her head in your room and say, Hey, if you don't like your nurse, let me know. It doesn't work like that. But once you say something, that nurse can do what she does best and help you. Gotcha.

Dr. Nicole (00:16:16): So let's go to the next lesson, which I thought was interesting, is the Good Doctor, and you pointed out that it seems like in your experience, most are caring, most want to do the right thing. So then what do you mean about the good doctor?

Gina Mundy (00:16:32): Oh, yeah. So I know this is creepy, one of the doctors, but I have been analyzing doctors for over 20 years, specifically ob gyn, and I have to analyze you when you talk, I have to say, okay, you can get in front of a jury. And then I read huge reports, literally taking all of my thoughts and my analysis and writing it down. So yes, I have traveled, like I said, the country, and I have found that most of the doctors that once I represent most OBGYNs are amazing. And yes, I do say in my book, some do irritate me, but they're still good doctors. So what I do though when I see a doctor is I do a doctor analysis. So I go over that under chapter one a little bit. And then there's also some other things that have happened with doctors that have been interesting that I included in the book. One of them, the Yoda Imposter. Yeah, what is that?

(00:17:24): Okay, so I'm meeting with a nurse on a case right after the birth of that baby. In that case, the nurse had left the hospital system and she went to a different one. So she was not really familiar with the players at the old hospital anymore. So I meet with the nurse and I mention a doctor's name and she goes, oh, Yoda. And I'm like, Yoda. I'm like, are you calling him Yoda because he looks like Yoda? I don't think he looks like Yoda. There's no way we're referring to the same doctor. Well, she clarified that we actually were talking about the same doctor where I'm like, you better Google his name. It's not good. But the doctor had done some pretty bad things to a lot of his patients and it had just been coming out. But she told me why she called him Yoda, that he was known as this amazing wise doctor that no one ever really saw, but he did these amazing things for his patients.

(00:18:24): That was his reputation when she left the hospital. I'm sure his reputation now is far from that. But the whole point of the Yoda imposter is just because they have a good reputation, it does not equate to good care. So don't be careful with that. You really, when I do my doctor analysis, I really fall back on my instincts. Intuition and how do they communicate to me is probably the big thing. So same thing, just make sure if you read the chapter, chapter four on Good doctor, and then I also list 20 questions to ask your doctor, your ob, GYN, and I don't know if you went through all the questions, but those are the questions we literally, we ask in deposition or at trial. So if we're trying to establish credibility with a doctor in front of a jury or whatnot, we're trying to get into who they are and whatnot. These are kind of the questions that we ask, but I'm like, these are great questions that patients should know. So I kind guide them on what to ask. That

Dr. Nicole (00:19:26): Is so important because it's easy. Nice is not the same as competent, and people can let things go by because someone's nice. But like you said, listen to that instinct that something's not quite adding up. Really, really important. Okay, let's move on to the next lesson. Also, these lessons are all great, so I'm just so excited about all of them. But this one, know your hospital and you made the interesting point that your hospital can even be more important potentially than your doctor. It kind of depends. So what are your thoughts on knowing the hospital?

Gina Mundy (00:20:04): Right, that's super important. So listen, I delivered my first baby at a huge hospital, but really I'll just say I'm a C-section, 39 weeks elective, whatever. So my last baby was born at a small community hospital because that's very low risk to baby. All of 'em are good options depending on the risks or your individual pregnancy. But if you have maybe a higher risk delivery, like a vbac, a vaginal birth after c-section, a small community hospital, if you're going to use them, you got to be asking some questions because there's some hospitals with policies. So the risk, I'm sure your audience probably knows this, but if not, or you could tell us, the risk of a VBAC is that if you have a vaginal birth after C-section during labor, then there's a risk of that old incision kind of opening, and that's called a uterine rupture.

(00:21:02): That's where the uterus ruptures, and it is very bad for mom and baby when that happens, obviously. So if you have a higher risk delivery, it's just like, okay, we may want to make sure that the after birth care of baby is good. There's different levels of hospital. But then also going back to the vbac, if you're doing a smaller community hospital, find out does your OB GYN need to stay at the hospital? Usually VBACs they've been lately they've been having the doctor stay at the hospital. But here's the trick, the anesthesiologist can be 30 minutes away. I'm like, wait a minute to do a C-section. We need a doctor. We GYN, we need the surgeon and we need an anesthesiologist. I mean, I've had an OB GYN with a vbac, and they couldn't wait. And she did local,

Dr. Nicole (00:21:50): Which is every OBGYN's worst nightmare to have to do that.

Gina Mundy (00:21:53): Yeah, you don't want to, so you know what? Make sure you're at a hospital. If you're, for instance, a vbac, just make sure you're at a hospital where everybody's going to be there, because I can tell you if your old incision opens and depending on how it happens and what happens, that can be very, very bad for babies. So it's just important that everybody is there because a lot of these bigger hospitals, I mean, they've tested, they can do, they're doing C-sections in five to seven minutes, which is crazy. So it can be very fast, and they'll get your baby safely out of that environment at the speed of life, which may is very important. So if you're first time mom, you're going into natural childbirth, no Pitocin, you're not being induced. You probably have some more options, but if you have more of a high risk type delivery, like a VBAC or whatnot, I would be researching your hospitals and make sure there's the criteria which is in the book, and then finding your doctor.

Dr. Nicole (00:22:56): Absolutely. So important. So important. All right. Next lesson is having a plan.

Gina Mundy (00:23:00): So the ultimate birth plan, so I know some people are like a birth plan. Listen, it's not so much rolling up to the hospital with a whole detailed plan. That's not how I think it is the act of preparing for childbirth. It is looking at all of these possible decisions that you may have to make marinating in them thinking about 'em. Go online, Google 'em, make a phone call, text. Because remember, once you get to the hospital, it is all about physically and mentally trying to deliver baby. And it's the only time I feel like in a woman's life where it's okay to be an incredible amount pain, but that incredible amount of pain is also going to kind of alter your state of mind. So it's just important that you have a good understanding. Reading my book, reading a book just about childbirth, it's huge because you're going to read this and you're just going to think and marinate.

(00:24:01): What if they do offer me a c-section? Because the problem is if you don't just prepare for childbirth, then there's a doctor maybe offers you something like a C-section or maybe you do need it, or let's start Pitocin, whatever it is. And there's almost like an element of surprise, wait a minute, I'm not ready for this. What did you just say? And then it can kind of inhibit your ability to focus. Absolutely. It's almost like deer in the headlights. In my book, I use an analogy when I got to do a big cross exam of an expert of an ob, GYN, like yourself, I get ready, I meticulously go through my case, I write down my questions, I read through my outline three times. I put it down and I never look at it again, and I don't have to because I'm ready. And that allows me to pivot and that it allows me to do what I need to do for an effective cross exam. But my walking up reading my questions, no, do you need to walk into the hospital with your birth plan? No. Can you absolutely give it to your delivery team if that's what you choose to do? A hundred percent. But my chapter on this is more about helping you prepare and then when you're doing a plan, you can do a plan for two months and just, again, you're just slowly building a plan and marinating in it and different things. So it's good. And

Dr. Nicole (00:25:22): Exactly. Again, another important point, actually birth can't be planned. It's so unpredictable. There's so many things that are out of our control, but the thing that you can control is how prepared you come into the process that is absolutely within your control. So it's not like you're saying, oh, make this detailed birth plan. You're saying be prepared. That's going to be the best thing that you can do in order to help have a good experience.

Gina Mundy (00:25:48): Oh, a hundred percent.

Dr. Nicole (00:25:49): Yeah. And speaking of which, another thing, because you just mentioned how when you're in the throes of labor and that pain and how your mind is being altered, the next lesson is also super important, and that is have an advocate. So tell us about that.

Gina Mundy (00:26:03): Oh, absolutely. Again, like you just said, you're in this altered state of mind. You need to focus on delivering your baby mentally and physically. So for instance, let's say you're not a fan of your nurse. For you laboring mom to now, okay, I need to talk to a charge nurse, I'm going to follow genus instructions. No, just if a baby advocate can be anybody, lemme back up a little bit. It can be husband if he's a good advocate, if he's going to step in, it can be grandma soon to be grandmas are the best advocates ever. And it could be a really good close family friend. It could be somebody who maybe has a job in labor and delivery type thing, but you just kind of look at them and you say, Hey, I'm not a fan of my nurse. Or give him the look if it's your husband and have him fix it.

(00:26:52): And that allows you to continue to do what you need to do. And you now your advocate's on it and there's no reason to worry about anything. But in the baby advocate chapter, I write right at the end, I'm like, you know what? Your family and friends are there anyway. Just give 'em a little fancy job and any type of job you have a little bit of training. I give seriously just the five things they need to know. I'm like, if they have no, these five things, I'm like, they're going to be doing okay. Awesome. And then they can step in and that will help keep your worry down. And also if you're not worried, then that whole natural process of giving birth is going to be so much easier. You want to avoid the fight or flight mentality. So if you're getting stressed out during birth, you don't want to do that. You want to stay calm and let that process do its thing. Absolutely. So that's why it's important to have a baby advocate, someone that's going to sit and advocate for you and baby. Definitely,

Dr. Nicole (00:27:53): Definitely. Now the next two, I'm curious to hear about these because part of me is like, wait, can people really know these for sure before labor or is this something that just OBGYNs and nurses know? So let's talk about them and we can maybe talk about them together, but the types of fetal monitors and then what your baby's heart rate means. So how much can people really learn or know about that? What do you mean by those?

Gina Mundy (00:28:19): So do you use the Monaco wireless? We

Dr. Nicole (00:28:21): Do.

Gina Mundy (00:28:22): Do you? Okay. So that chapter probably was written because of that. We've had quite a few cases in Michigan, unfortunately, where the Monaco wireless was being used, and I don't know if you've experienced this yet, but basically if something happens in utero, so we've had water break, uterine rupture, those monitors, I'm sorry. So the water breaks and the heart rate goes away because something the placenta detached. So placenta abruption after the water breaks and then uterine rupture. But the problem with the wireless monitor, while it's awesome, mom can walk around, she walked a hundred feet away. It's great unless something happens, because what we found in the cases is that those will just drop the baby's heart rate, but because they're wireless, there's the whole troubleshooting thing that starts, so baby's in trouble and everybody's troubleshooting. Now, we've had other cases with very similar facts, and an internal monitor has been used and as you know, way more invasive.

(00:29:31): It's getting screwed to the baby's head, whatnot. But listen, there's water breaks and something happens to the placenta, your uterus ruptures and baby gets in trouble. Boom. You can see that and the delivery team can respond immediately. And then again, another common fact in my baby cases is that an internal monitor was not placed timely. IE babies showing some signs of not being happy, either they kept the monitor on or just the whole external and whatnot. So you just have to decide, again, if you're low risk having a Monica on and it's your first baby and everything's fine, maybe that's a great option for you. But I think more importantly is one of the harder cases I had involved that, and really I had to take the testimony of the mom, and it was probably one of the hardest things because in all the cases with the Monica where they lost the baby's heart rate, it did take too long and none of those babies ever survived.

(00:30:36): So it's very difficult. So that's where that whole chapter came into play. And again, this is childbirth attorney, this is what I see. But again, it is just telling. I think I just went into a little bit more detail than I do in my book. My book's a little bit more fluffy, but it just gives them the options like, Hey, there is this wireless, but be careful folks of this. But then there's internal, which is like, I call it the gold standard, but it's very invasive and there's a wire between your legs and you're hooked to a machine and it stuck to your baby's head. But if baby gets in trouble, we can move or you guys can move quick. So I just kind of go through just so they have this basic, and actually that one's my shortest chapter because it's like, here's your three monitors. So that's the Monica and the internal, and then there is the old traditional one. People probably see more in the pictures, the pictures of the big strap around your belly, and that's the external monitor. So

Dr. Nicole (00:31:34): Again, it's just about knowing what to expect and what your options are. Yeah,

Gina Mundy (00:31:37): Absolutely. Because some doctors are, I've noticed, would love to place that internal pretty quick, and some doctors don't. So that's a really big thing. I missed this in the doctor's chapter, but you guys, your profession has always a lot of different opinions or the way you guys manage things. It really varies from one doctor to another. Definitely

Dr. Nicole (00:31:59): It does. So what do you want folks to know about knowing what the baby's heart rate means?

Gina Mundy (00:32:07): So I had a doctor one time testify, and I quoted his testimony in my book. He said, the only way a baby can talk to their doctor is through their heart rate.

(00:32:17): And I'm like, Bing, bing, bing, bing. That's true. Okay, so if mom knows the baby's heart rate, then baby can talk to mom or baby advocate or whatnot. But I mean, this is your bread and butter, but baby is inside mom, inside the uterus. It's not like assessing mom. You can look at and mom is swollen or not doing good. You look at her and you are like, whoa, what's up? You ask her some questions together. You guys almost make a treatment plan or diagnosis. Everything's great. Baby's a lot harder, right? This, I'm telling you stuff you already know, but this is for your audience. Yeah, absolutely. Yeah. But baby's inside you, so it's not that your doctor can just assess baby. So the best way to figure out how baby's doing is their heart rate, because if their heart rate, there's almost like a normal heart rate.

(00:33:11): They call it reassuring. And then there's some other stuff. But, and I really try to keep this basic in the book and just understanding what a good heart rate looks like. And then if there's any changes, listen, you can go notify your delivery team. Because my book is also about working with your delivery team, having an understanding or your baby advocate. I do tell them they need to have the basic understanding of the baby's heart rate. Also, if you have a good understanding of the baby's heart rate or exactly what that means, or even just a basic understanding. But that way, if your delivery team comes in or the doctor comes in and says, Hey, we're concerned about the baby's heart rate, you're going to know what they mean. And they may say, Hey, we're concerned about the baby's heart rate. We can either continue to do, go for a vaginal natural delivery, or we may want to start talking about C-section. So here's your two options because we're not really a fan of the baby's heart rate right now, but you decide. Gotcha. So that happens a lot in cases too. And now it's on mom, and it's like really? Mom's typically like, okay, doctor, what do you think?

(00:34:17): So if it's an early, but it's good for parents to know this, sometimes I feel like the medical community always wants to keep the heart rate to themselves. But listen, I'm a non-medical person and I can look at a baby's heart rate, and I've done this many, many cases, but I can look and be like, oh, baby's a rockstar. Oh, baby is in big trouble. I can look at a strip and see that. So it's like, why don't moms and dads don't have this? So hopefully my book changes that a little bit.

Dr. Nicole (00:34:47): Do you ever see, I think the part that's hard for me, it sounds like, and this is unfortunate, but sometimes you see cases where it looks like for extended periods of time it was obvious that this baby was in distress and nobody did anything. Is that fair to say that that happens?

Gina Mundy (00:35:05): Sometimes? I think it's, well, as you know, so the heart rate, this is going to cover it, maybe even one of our next chapters, actually, this is going to go right segue right into chapter 10 tests and interventions. So as you know, if the baby's heart rate's not looking great, there's a process. It's not baby's heart rate doesn't look good. C-section, right? No, it's chapter 10. It's the tests and interventions. So baby's heart rate's not looking good, let's turn mom as baby on the court is, I dunno if you guys do oxygen, I think oxygen's out now.

Dr. Nicole (00:35:43): I think it's just a habit. We still, yeah,

Gina Mundy (00:35:46): But there's, or you may bolus the patient or whatnot. So there's certain tests and interventions where they tried to get whatever's wrong. They tried to fix it in hopes that mom can deliver naturally. So it's that process, okay, how fast is the delivery team noticing that something's up with the baby's heart rate? Okay, now we've noticed, okay, now we have our process, we have the nurse there. Okay, nurse is going to start her interventions, and then we got to contact the doctor. Okay, let's have the doctor get there. But there's a process and then at some point it's like C-section. So it's how fast that process goes a lot of times in the cases.

Dr. Nicole (00:36:31): Gotcha, gotcha. Now one of the things that I think a lot of people don't realize, I think even obstetricians don't realize one of the most common issues or the most common, I'm just going to spoil it, medications that is part of legal cases is what? Share that with us please.

Gina Mundy (00:36:50): So when I get a new baby case, in the first words, I typically read in almost all of my cases, mom is being induced with Pitocin. So Pitocin is definitely by far the number one fact in a legal baby case. It's actually so important that I wrote chapter 14 is all about how to have a safe Pitocin induction. And that's based upon, I've watched Pitocin inductions gone wrong since February, 2003. So my experience with what could have been done better, or my advice, again, my kids were expecting parents, it's laid out there.

Dr. Nicole (00:37:34): Is it just that it's overused and not turned off when it should be turned off or back? Is that what you see

Gina Mundy (00:37:42): Sometimes? Okay, so you know this, everybody responds to Pitocin differently. So I call it in my book, dude, you want slow and steady, your ob, I don't know if you go by, you up it by twos. I like ones. Okay. So yeah. So I don't know if you're 2, 4, 6, 8, 10. I like one, two real slow three, watch how mom's body is responding to it. But something else I noticed already in this book, and obviously some of the cases is that the drug insert for Pitocin caps them out at like 10, but in a lot of illegal baby cases. Yeah, read chapter on pit. And I know because you guys typically have an order to 20 and then you'll hit 30 if you need to, but no, they're like 10. And then there was a study that came out right before I published my book. It was one of the very last things I went and added it in just because I liked it so much. But basically, so your Pitocin is like, it artificially stimulates your contractions. It's a synthetic drug, but you have your natural oxytocin, same thing as Pitocin in your body. So they say in this study when you go over 10 and then your natural oxytocin levels are kicking in, you actually go on oxytocin. Pitocin overload.

(00:39:10): So again, they warn after 10. And again, everyone reacts to Pitocin differently. This is a huge, it's hard to almost, it's like the hospital and doctors need protocols, but it really needs to be very patient specific when it's administered because some patients require way more than 10. It is what it is and some patients don't. So I just kind of go over that. The studies, the drug insert for Pitocin, it's a high alert medication. There's what if it's in the book?

Dr. Nicole (00:39:43): Okay,

Gina Mundy (00:39:44): 14 of those or something. Yeah, 10, 14, yeah, high alert medication. So those are worldwide considered one of the most dangerous drugs. Okay,

Dr. Nicole (00:39:53): That's good to know. And then the last couple things we'll touch on, which I hadn't even thought about probably because I guess I'm not an anesthesiologist, but safety and epidurals. How often do you see issues surrounding epidurals?

Gina Mundy (00:40:07): Well, so that chapter came after just a very difficult case for me as a mom, a wife, a human basically. So in these cases, I don't know if your audience understands this, but I am the attorney for the hospital and the doctors and the nurses and the midwives when there's a case and something happened to either mom or baby, but I had one case that came in and mom had passed away and it was because of the epidural, but the family didn't know that, and that's not something that was in her medical record. The family had then probably the biggest mistake was retaining an attorney who's not a childbirth attorney.

(00:40:55): So they just didn't have the case. And so I knew what happened to mom that she had died during this epidural, but the family didn't and they needed closure and I knew it, but I couldn't, as the attorney, my confidentiality with the hospital doctors and everybody, I can't ever disclose it to the family. So it just always weighed on me because I knew, I don't know, they needed closure and I could never deliver that. So basically what I did then was write that chapter to say, Hey, this is how you have a safe epidural experience and make sure that none of this ever happens again. If it's the only ever good thing that came out of that, hopefully we can prevent future wise. But epidurals tend to be, it's just hard. Everyone gets epidurals, especially if they're on Pitocin. I feel like Pitocin and epidurals go hand in hand. It is literally borderline one of the most common facts too in a case. But since everyone gets them, it was hard for me to make that connection. But I think your combo of epidural and Pitocin really needs to be monitored carefully. So I go over stuff like that in that chapter. Gotcha,

Dr. Nicole (00:42:02): Gotcha. And then the final one is C-sections. My question about C-sections is do you find that most often folks are being sued or litigation surrounds not doing a C-section soon enough?

Gina Mundy (00:42:18): Yes, a hundred percent. Okay. That's probably the main issue in all of my cases is that whole baby's heart rate. There's a concerning that whole procedure to c-section. Now listen too, it could be, this is why it's important to have knowledge and work with your delivery team. Because if you know something's wrong with the baby's heart rate or now the importance that it has to continue graphing because maybe they were concerns about the baby's heart rate, you can alert your delivery team. I had a really sad case, and actually let me back up two seconds, but another one of the most common facts in a legal baby case is a busy labor and delivery unit. It's when the delivery teams are running hard, you guys are running thin and eyes off the prize so that I get a case in. And so many times I call that first witness and they're like, oh, I remember that day it was so busy.

(00:43:16): And I'm like, oh, again, why? You have to be ready. And so going on to my case, I had mom get to labor and delivery and it was extremely busy. They started the baby's heart rate, what it was kind of concerning. And so they did the interventions, but they were in a hurry and they were like, you know what? We think baby's going to be okay and baby's okay. So she had an external monitor on and they left and the nurse and the doctor, and they had to go all their patients. It was the in-house doctor, it wasn't even her private doctor. The private doctor was trying to get to the hospital. But rush hour in Michigan, it was a little bit challenging. And anyway, so baby's heart rate stops graphing, and the family doesn't understand the importance of why that needed to be graphing.

(00:44:10): The delivery team's running hard, seeing the other patients. And finally a nurse comes back and is like, oh, the baby's heart rate stopped graphing. Well, they put the external back on and they're like, uhoh baby's heart rate. And then they brought in the ultrasound and the baby had actually passed away on labor and delivery and the family's in the room. Mom, dad, grandma, grandma, just, she was beside herself. So there's just these important parts about if the family can help come in and be those eyes or the baby advocate. That's why I am like baby advocate, you're learning the basics of fetal monitoring. I know it's kind of scary, but it actually doesn't take too long if you take the time. And I try to do it in my book as simple as possible. I had six pregnant beta readers go over my book and I'm like, can you just read that part on fetal monitoring?

(00:45:08): Do you get it? And they're like, I had to rewrite it, make it even more simple for 'em. But just having a good understanding. And then that way you get that if the family that day would've gone and said, Hey, I know there were concerns about the baby's heart rate. So it's really important that it continued to graph, which they would know if they had a, Boca obviously wasn't around the delivery team would've came in known how important it was to keep that baby on the monitor. But not only that, if they put the monitor back on or they adjusted it and they could see that baby was in trouble, that you know this patient would've been their priority all day long. Not mom who stalled out in labor and now needs a C-section. No. If they know baby is in trouble, the delivery teams are going to move at the speed of light to fix it.

Dr. Nicole (00:45:57): Right. Gotcha, gotcha, gotcha. Then the final question I'll ask is how often do you see that an unfortunate event happened? And it's not necessarily that anybody did anything overtly wrong, it's just that sadly something happened.

Gina Mundy (00:46:18): Yeah, we definitely have those cases. It's hard for me to quantify, especially when you throw in the confidentiality with the hospital. But absolutely. And the good doctor, I talk about the doctor at trial that I had, unfortunately, this was a mom who came to the labor and delivery unit and she had no prenatal care, she had no amniotic fluid. She was smoking well, she had positive for marijuana vaginal bleeding. They start the baby's heart rate. It's not great. But the way it played out in labor and delivery, obviously baby was born very, very sick. And the family then filed a lawsuit and sued the doctor for the injuries to the child, that doctor. So we took that one to trial. And even in the book I talk about it, she was so upset from that trial, she couldn't drive her car to trial for weeks. It was weeks. Her husband would come and get her and drop her off. And then as the attorneys, we would take our turns and drive the doctor. So these really, especially something like that where it impacted the doctor so much. And you know what? She was excellent. She was an excellent, and you know what she was, she was an MFM.

(00:47:36): She was in the trenches every single day. She was at staff MFM. So she was in those trenches delivering babies every day when she worked and whatnot. But no, she was absolutely amazing. So something like that, yeah, we're going to take it to trial. And it wasn't her fault, and actually, I don't want to ruin the story in the book, but the jury being fully advised of what I told you, five, six days before Christmas actually did render a verdict against the doctor in favor of the family.

Dr. Nicole (00:48:06): That's really challenging because it's like what personal responsibility does that person have not having gotten any prenatal care. And then that's, for us, it's very frustrating on our side,

Gina Mundy (00:48:20): We were shocked. We were beyond shocked. The best thing we could think of is you have an injured baby in a wheelchair, you have a family. You're days before Christmas. And I'll tell you, we walked home, we walked home, we walked back to the office, which was just across the street at the time, and doctor walks in and she's like, we sat down at the conference room. She hadn't said a word, and she just looked at us and she's like, I quit. And she was done. She's like, I'm not delivering babies anymore. And it was very emotional. It's one of those times where the attorneys go from attorney to psychologist real quick. So we gave her some time and whatnot. She never did quit. She promised not to quit until we appealed the verdict and that we got a result from the appeal. So she did continue to deliver babies, and then finally many years later, we were successful in the appeal and the verdict was overturned in favor of the doctor. It's

Dr. Nicole (00:49:17): Just hard. It's a long time.

Gina Mundy (00:49:19): It is. And it was very rough on her, but in the end, I think justice was served. It was just a long path. Sure.

Dr. Nicole (00:49:26): So then as we wrap up, what is the most frustrating part of your work?

Gina Mundy (00:49:31): Oh my goodness. You guys, in your different opinions. Seriously, I remember when it first started in this, and again, it goes back to why it's so important for moms to pick their good doctor to have an understanding because you guys have just, I will, this is in the book. I mean, I'll talk to one doctor and they'll be like, maybe I shouldn't be saying this online, but they'll be way too much Pitocin. And it's like they rocketed the baby out of the uterus, and then another doctor will look at that same care and be like, everything was done perfectly. So earlier in my career, I would get very frustrated and I'm like, how? And I started asking in middle of depositions, I'm like, why does this doctor think this? And you think this? And even the doctor's like, I don't know, but you guys do. You have very, very different opinions, which definitely is one of the reasons why it's important absolutely. For you guys to, for the families to know what's going on. Because one Dr. May give one recommendation and another Dr. May give a completely different recommendation.

Dr. Nicole (00:50:43): That's so true. So true. Then on the flip side, what's the most rewarding part of your work?

Gina Mundy (00:50:48): Probably the doctor from the trial when years later that verdict was overturned. But also nurses. Nurses are amazing humans.

Dr. Nicole (00:50:59): 1000%. Yeah,

Gina Mundy (00:51:01): They are. And especially the ones that really enjoy being a labor and delivery nurse, and you'll know if you get one of those or not, but in my cases, so I'll meet with a nurse and they show more human emotion than any other witness in a case. So typically I sit down and they just start crying, and I feel bad because a lot of times something bad happens, but they don't have the resources at the hospital or anywhere to go see something bad happens and they just live with it. And when they cry, it's not because they think they did something wrong or anything like that. They're just genuinely upset that something bad happened to a baby or a mom. So I tend to try to rehabilitate them and get 'em through the process, and I've become friends with some amazing nurses, but I just think they're just such a special breed of people who are so caring and so kind and just dedicate their lives to being They're the ones that are at your bedside. Absolutely. They're the ones right there all the time. They're the ones usually communicating with your doctor, unless you have residents, they have such an important job, and so many of 'em take it to heart. So when I can help 'em in my cases and whatnot, that's probably definitely the most rewarding.

Dr. Nicole (00:52:19): Yeah. So then where can people find you, find your book?

Gina Mundy (00:52:23): So the best place to find me is gina muy.com, G-I-N-A-M-U-N-D-Y. And it'll have links then to where you can find my book. But my book is actually, my book was one big book and then I cut it into two. Okay, now I'm just going to confuse your juror. No, I'm going to confuse your audience. So here we go. I have super confusing Gina, but basically I was trying to get my book published and I divided it into two childbirth, which is currently out right now, and that was released June, 2023. But the book on pregnancy and the stuff that I've seen as a childbirth attorney that first during pregnancy, that is set to come out later in 2024, hopefully. Got it. But I'll tell you, publishing a book, being a partner in a law firm, raising three kids, wife to a very busy business owner, hard, so hopefully, so I started taking some of the content and I actually started a childbirth blog.

(00:53:30): So it's kind of everything that I would tell again, my kids is what I need to know, or if I am like, oh, why didn't I include that in the childbirth book blog. And then same thing. So the pregnancy stuff, I've been dumping it into the blog because listen, ultimately I want to make sure parents have a healthy baby. So if I don't have time to publish it, then I'm just going to keep this blog going. So if there's a question or different, and it's definitely a different twist, and you have a childbirth attorney, remember I have no medical experience. So you have the childbirth attorney that's writing everything. It's interesting. And then also, like you said, chapter one of my book with all of the lessons is on my website, download it for free, do what you want. And then my niece's story, the one that kind of triggered me to wait a minute, I may know something about childbirth that would help families, her story's introduction, and I do have that on my website also.

Dr. Nicole (00:54:26): Okay, awesome. Well, thank you so much. This was incredibly helpful. We could easily have you come back and talk about pregnancy things

Gina Mundy (00:54:32): Also,

Dr. Nicole (00:54:33): But this was so helpful and so not just for the listeners, but for me it's an obstetrician also. So I appreciate your time,

Gina Mundy (00:54:42): Dr. Rankins. You are awesome. And you know what? I went and researched you and looked you up, and you definitely would be one of the doctors that everybody, everyone should want. Oh, well thank you. So thank you very much, and thank you for doing this podcast for all of the patients, because what I talk about with preparing and learning, you're giving them that information that I so want everybody to learn. So thank you very much.

Dr. Nicole (00:55:15): Wasn't that a great conversation? Gina is obviously very passionate about her work, and I appreciate how she has taken her knowledge and expertise and experience and turned it into something to help folks have a great experience giving birth. Now, after every episode when I have a guest on, I do something called Dr. Nicole's notes where I talk about my top takeaways from the conversation. Here are my Dr. Nicole's notes from my conversation with Gina. One, you can always ask for a new nurse or even a new doctor. You can definitely ask for a new nurse if your nurse is not connecting with you. Sometimes people don't realize that. Just ask to speak to the charge nurse. The charge nurse is the nurse who is on the unit who doesn't typically have patient care responsibility. She's just responsible, not just, but she is responsible for managing everyone on the unit and making patient care assignments and just keeping an eye on things and making sure things are running smoothly.

(00:56:16): So if you're not happy with your nurse, just ask to speak to the charge nurse to be assigned a new nurse. You can even ask a different doctor. I've had some birth story episodes and guest interviews where people have fired their doctor during the course of labor. That's not easy, and it may not always be straightforward to find a replacement, but you can certainly try if you're really having a bad experience with the doctor and you want something different. Number two, I appreciate her frustration about doctors having different opinions about things. This is really a reflection of the art part of medicine. Not every decision, not everything is necessarily straightforward. I will say that I do genuinely believe that most doctors are caring people who want to do the right thing. We go into medicine wanting to take great care of people. Sometimes clinical situations though, arise where everyone's definition of what is right varies.

(00:57:24): You may have one person who sees that things should have gone one way, and another person who sees that things should have gone a different way, and neither one is necessarily wrong. So just know that it's not always as straightforward or easy or as simple as sometimes people make things out to be. The third thing I'll say is that you heard how she said she's never seen a lawsuit where a doctor was sued for doing a C-section. Doctors are typically sued for not doing a C-section, and I say that to let you know that. Not that it's right, that our c-section rate is so high, but you can see how if you are a doctor and you have that in the back of your mind that you could potentially be sued for not doing a c-section, but not sued for doing a c-section, then you can see how that may influence your decision-making process.

(00:58:29): Again, not saying that it's right, but that's the reality of where medicine and malpractice is. And malpractice isn't something that's necessarily or isn't something that's easy or straightforward. As she mentioned in the case about the doctor who was a maternal fetal medicine doctor who she was defending. It can be very emotionally difficult. So you can see how someone may come to the conclusion that, well, it's just going to easier if I do a c-section. Again, not saying that it's right, but you just have to understand the background of where we're practicing. The American society in particular doesn't do very well with understanding that sometimes bad things happen, and it's not necessarily even anyone's fault. Things could have been done completely right, but people want to assign blame to something, to someone when things don't go as anticipated, and that can just be a challenge. It can definitely be a challenge to navigate that as we take care of our patients.

(00:59:41): All right, so there you have it. Do me a favor, subscribe to the podcast where every, you're listening to me right now, so you'll never miss an episode. You can also leave a review in Apple podcast. I appreciate that too. And come follow me on the Gram. I'm on Instagram at @DrNicoleRankins. That's a great way to continue the conversation. My dms are open if you ever want to shoot me a message. I absolutely love to hear from you. So that's it for this episode. Do come on back next week and remember that you deserve a beautiful pregnancy and birth.