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My guest for Episode #254 of the My Favorite Mistake podcast is Gina Mundy, author of the book A Parent's Guide to a Safer Childbirth: Expecting the Best: Using the Power of Knowledge to Help You Deliver a Healthy Baby.

Gina is an attorney who specializes in childbirth cases. Throughout her career, Gina has traveled nationwide, engaging with healthcare professionals such as doctors, nurses, and midwives to explore all aspects of labor and delivery. Meeting with experts from various states, she has explored and analyzed the myriad of issues that can arise during labor and delivery, impacting both mother and baby. v

Gina lives in Clarkston, Michigan, with her family (husband, kids, and dogs)… and she enjoys visiting wineries. Me too (the wineries part)!

Join us as we embark on Gina Mundy's transformative journey from a legal expert in childbirth cases to a successful author. We explore how challenging circumstances, often derived from personal experiences, inspire noble feats like authorship, turning potential mistakes into powerful preventive guidance. Gina's book serves as an incredible testament to her efforts to help expecting parents bypass potential risks and navigate childbirth with ease.

Dive into a discussion touching upon critical topics such as recognizing the signs of distress or complications early, understanding the impact of medications like Pitocin in childbirth, and the implications of labor after water breaks. Our guests underline the importance of being forewarned and forearmed, thereby uplifting childbirth experiences with informed decisions.

And we'll hear about Gina's favorite mistake from her legal career, and decisions she made as a working mother — how much does she regret those decisions today?

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Questions and Topics:

• Now 10 years later… was that a mistake??
• What were the adjustments?
• What led to writing the book — and first learning about problems and mistakes that occur during childbirth??
• What's the difference between naturally occurring bad outcomes vs. mistakes? Is that always clear?
• What are the most common problems that occur during childbirth?
• Does time of day matter? 5 pm Friday??? July?
• And how can people help prevent mistakes?
• Who gets sued, the resident or the attending??
• How often does info from the legal case help drive improvement and prevention?

Scroll down to find:

• Video version of the episode
• How to subscribe
• Quotes
• Full transcript

Find Gina on social media:

• LinkedIn
• Instagram

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Quotes:

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Automated Transcript (May Contain Mistakes)

Mark Graban:
Hi. Welcome back to my favorite mistake. I'm Mark Graban. Our guest today is Gina Mundy. She's the author of the book A Parent's Guide to a Safer Childbirth, Expecting the Best: Using the Power of Knowledge to Help You Deliver a Healthy Baby.

Mark Graban:
So Gina is an attorney who specializes in childbirth cases. Throughout her career, Gina has traveled nationwide engaging with healthcare professionals, including doctors, nurses and midwives, to explore all aspects of labor and delivery. So we'll be able to talk about that today, including some of the issues that can arise, unfortunately, during labor and delivery that would impact both the mother and baby. So I'll link to Gina's full website and full bio in the show notes. She lives in my home state.

Mark Graban:
She's in Michigan with her family, which includes her husband, her kids and dogs. And her bio says she enjoys visiting wineries. So that's something else we have in common. Welcome to the podcast, Gina. How are you?

Gina Mundy:
Thank you, Mark, for having me. I am doing great and I am excited for our conversation today.

Mark Graban:
Yeah. And before we get into that, I have to ask not to get too sidetracked on wine. Do you have a favorite region or winery or wine to visit and or open up at home?

Gina Mundy:
Oh, yeah. Niagara on the Lake—do you know where Niagara Falls is? Niagara on the Lake is right there. It's like a secret winery, filled with the most amazing wines.

Gina Mundy:
So that, by far, is my favorite. And then I actually really enjoy Michigan wines. I have been hitting the Michigan wineries a lot over the last few years. It seems like they've really nailed it, nailed down how to make some good wine. So there's Marquette Winery in Ludington, and that is probably by far one of my favorite wineries.

Mark Graban:
Well, cool off to go. Check that. I'll expand my horizons and support my home state a little bit someday and check that out. So, okay, so this is not my favorite winery podcast. That might be fun to do someday.

Mark Graban:
Maybe that would be popular. But we are going to talk about mistakes, as we always do. So, Gina, I would love to hear your story. What would you say is your favorite mistake?

Gina Mundy:
So, this is a hard one, and I just want to put it out there. I've been reading your book and learning all about the mistakes. And I know this question is subjective, but I remember when I first thought of my answer. It was literally ten years ago. I had gone to.

Gina Mundy:
So I'm a partner at my law firm, and I'd been a partner at the time, and I had just had my third baby and child and not a baby anymore. And basically, I had gone to my firm, and I'm like, listen, I'm capped out. I'm tired. I'm exhausted. It was Christmas.

Gina Mundy:
I have my little man. I got my two girls, and I'm also married to a pretty busy business owner. And so I felt like my kids were like little orphans running around. So I had gone to my firm, and I'm like, I can't do this. I quit.

Gina Mundy:
And they were like, okay, you're stressed out over the holidays. You need to go on vacation, and when you come back, we'll talk about it. And that was over Christmas. And we basically, I just kind of. I didn't really work.

Gina Mundy:
I kind of kept an eye on my cases. We didn't really talk about it. It was kind of odd, I'll be honest. And then I think we were into April, and I had emailed or called. I don't remember my kind of boss at the time.

Gina Mundy:
And I'm like, listen, you guys got to stop paying me. I think I'm really going to quit. And I had health insurance benefits. It was great. I'm like, this is crazy.

Gina Mundy:
I mean, I keep an eye on my cases, making sure nothing bad, there's other people working on them, whatever. And I. So they were like, well, if you could come in and just argue one more thing. And it was against a pretty prominent attorney in our. In our community, actually, since, you know, it.

Gina Mundy:
It was Geoff Fieger, and could you come in? It was a baby case I had worked up. And he's like, can you argue, you know, this against him? And then we'll go to lunch, and then we'll figure out, you know, if there's something that we can accommodate you or whatever. And so that day, I went and argued against him, and we ended up, um, you know, we were pretty happy with the results.

Gina Mundy:
So then we went to lunch. So it was interesting because that kind of got me on my high again. You know, I'd had my long break and. And whatever. But basically, then we decided that I would actually stay, you know, at the firm and that I would not quit.

Gina Mundy:
And we made some adjustments or whatever. So that was. That was ten years ago. And now that my, you know, so I just continued to work instead of going to be a stay at home mom, which is kind of what I wanted to do. So now, ten years later, you know, my kids are older, they're 20, 16, 10.

Gina Mundy:
And I feel like, did I miss something? Did I. Did I, you know, I kept working. So, you know, that was. That's always been.

Gina Mundy:
I don't know. I always. I've always struggled with that. I never did try to quit again. I did try to pay more, you know, focus on the family as much as I could or whatever.

Gina Mundy:
But, no, I stayed and, you know, I continued to work over the next, you know, ten years.

Mark Graban:
So, I mean, it sounds like as you're thinking through this and, you know, thank you for sharing that and your reflections, because part of. I think part of the subjectivity is trying to decide, was it a mistake? It sounds like you're. You're still. I appreciate the process of still trying to think through that.

Mark Graban:
Was it a mistake to. I mean, what were some of the adjustments that were made in terms of, was it a matter of having fewer cases, having better balance to be home more, that that made it seem okay, at least during that time?

Gina Mundy:
Yeah. So I basically. So it's interesting, my office is right next to where you grew up, but that is about an hour from my house. So one of the adjustments was, I don't need to come in anymore.

Mark Graban:
Yeah.

Gina Mundy:
So it was, you know, things like, but that's huge. That's 2 hours of my day. Okay, well, now I have two more hours, plus, I don't have to get ready. So there's an extra few minutes, too. Yeah.

Gina Mundy:
Or whatnot. But I could probably, you know, finish the full thought on the good part of that decision, or. I don't know if you wanted to ask me about it.

Mark Graban:
No, go ahead. Go ahead.

Gina Mundy:
So to come full circle with my mistake, my favorite mistake, because I did stay in my industry and whatnot. So I am an attorney specializing in the childbirth cases. So then, 19 years deep into my profession, I wrote a book, and I wrote a book to expecting parents on how to basically avoid these mistakes and complications that I've seen now for 21 years and have a healthy baby. And I can tell you right now, if I would have left the industry ten years ago, I would not have written this book to parents. There is absolutely no way that, you know, I wouldn't have had the knowledge base.

Gina Mundy:
I wouldn't have kept my foot in the door. I wouldn't have kept continued working up these cases. And just so your audience understands when I say there's a childbirth case or a case involving childbirth, these are cases involving the birth of a baby. When there's a mistake or a complication and basically something goes wrong and baby is not born healthy, babies may pass away during childbirth. In some sad cases, moms passed away.

Gina Mundy:
So basically, as the attorney. I come in and I figure out what happened, what went wrong, why and what should have been done. So baby was born healthy or mom around to raise her baby. So again, like you had said, these questions have taken me all over the United States, meeting with delivery teams, hashing out every aspect of labor and delivery. I still continued to travel even after I, even after I, you know, even with my different schedule, but I continued to travel and still learn and whatever.

Gina Mundy:
But again, staying in the industry then helped me to have the knowledge base and the foundation to write this book to help other families. So when I made that decision, basically, I've always gotten involved in the aftermath of something going wrong now with writing this book, I'm trying to get involved before childbirth. So hopefully prevent these mistakes.

Mark Graban:
Yeah. Yeah. So there's a lot to explore there. I should have let you finish your closing statement. You hadn't made your closing statement.

Gina Mundy:
Like, I come full circle at the mistake aspect.

Mark Graban:
Yeah. Not that we're not wrapping up the case here, meaning the episode, but, yeah, so, I mean, I hear, like, even if you're still wondering, like, was it a mistake to not quit, it led to something positive. You know, you're proud of the book, and we'll talk more about what you've learned and what mothers and hospitals need to be doing. But, like, without not trying to pry too much into, you know, family life, but since you brought it up, your kids are now ten and what ages? Like, there's still that nagging doubt of, like, what might have been different had you stayed home with them or just that lingering, what if?

Gina Mundy:
Well, now that they're older, you know, I'm. The 20-year-old's going to be out soon. The 16 year old, if she announces one more time that she's leaving when she's 18, I'm just going to. And she's like, oh, my goodness. I know you're leaving when you're 18, but, you know, all of a sudden, I just feel like I'm getting really close to, wait a minute, I'm.

Gina Mundy:
Now I have all the time in the world to work. I can work all day, every day, obviously. And then my ten-year-old —you know, he's becoming way more independent. He's very into sports. If you can't throw a football, he does not want to hang out with you.

Gina Mundy:
So on Sunday, I literally had to sit and throw a football back and forth. Otherwise, I don't think he talked to me. So if you want time with the kid, you have to throw a football. You know, so it's. I'm like, wait a minute.

Gina Mundy:
Did I. Did I miss something? Because I. Now that I realize, you know, I'm 48, so, you know, I do have some more. I have many more working years, so I'm just hoping I didn't miss out on too much of that, you know, mommy homemaker stuff or Susie homemaker stuff.

Mark Graban:
Yeah, well, and, you know, still, I mean, I guess maybe it's a situation where only more time will be more telling, you know?

Gina Mundy:
Right.

Mark Graban:
You know, opportunity to take advantage of the time you do have when they do enjoy being around you.

Gina Mundy:
Yeah.

Mark Graban:
Yeah.

Gina Mundy:
I'm like, well, we'll see how I do as a grandma. We'll see. We'll see if I can get my act together as a grandma.

Mark Graban:
Yeah. So again, our guest today, Gina Mundy. Gina, tell us more about your path into, you know, this focus, this study, this passion around trying to help prevent childbirth mistakes.

Gina Mundy:
So writing a book was never on my radar until we had, like, a near-tragic family event. So I. My sister's oldest daughter was pregnant, and she basically had a birth experience that was very, very scary. The day that she went into labor, I was 1100 miles away that day. And I remember it was 05:00, March 17, and I was in my kitchen, and my phone rang, and my kids ran over because they were waiting to hear the good news that cousin Sam, you know, had the first baby of our next generation.

Gina Mundy:
And I answered the phone, and it was speakerphone. And instead of hearing, you know, she had a girl, it was my sister hysterically screaming. The baby crashed. The baby crashed. And obviously, I just ran out the door so my kids could not hear their aunt Kelly screaming.

Gina Mundy:
And I went outside, and I sat on my porch listening to her cry hysterically. And of course, my lawyer brain was going through her labor. Like, what happened? What happened? And, you know, it's interesting because her labor had gone very similar to how a legal baby case goes, because there are common facts, there are common issues that occur in these cases, and her.

Gina Mundy:
It was. It was right there. I mean, I was. It was scary watching it unfold, and. But then as I listened to my sister cry, I went from, you know, my attorney analysis to a human analysis, and I just.

Gina Mundy:
I'm like, this is how the families feel. And it was awful. And it was like there was, you know, at that point, no decision now is gonna change the past. And you can just sit and you can hope and you can pray. And that's what I did.

Gina Mundy:
And we did get news that the baby was gonna be okay. But, you know, that. That moment really, it just stuck with me. And it was. It was hard that day.

Gina Mundy:
It just. That weekend was hard. It was a Friday at five that we'd gotten the phone call, and it was just a hard weekend. And then I realized, what if I'm not around for the birth of my grandkids? Or, you know, what if I'm 1100 miles away, and then I'm like, wait a minute.

Gina Mundy:
I need to start writing down what I know, because there are common facts, there are common issues, like I just said, and I can tell you, as an attorney specializing in childbirth cases, how I would prepare my family for childbirth is completely different than how a normal family, you know, who doesn't know what I know, would prepare. So I started writing everything down, and as I wrote it down, it was like a floodgate of information. And I quickly figured out that this is information that could not only help, you know, my kids have healthy kids, but it could help families across the world have health, you know, healthy babies.

Mark Graban:
Yeah. Yeah. Well, thank you. Thank you for doing that. And hopefully, there were no ill effects for that baby as they were growing up.

Gina Mundy:
Yeah, baby. Our baby is fine. So in these cases, there's a lot of. There's close calls, and we landed on the right side of a close call. In my cases, it's the other side.

Gina Mundy:
It's the wrong side of a close call that a lot of times end up in the baby cases, because, unfortunately, families can be one decision or minutes from a healthy baby.

Mark Graban:
Right. Yeah. And, I mean, the bad outcomes range from death to lifelong disability as a result of some of these mistakes. And I guess that's where the legal battles and the settlements become potentially huge. The cost of care, a lifetime of, let's say, special care for a child who's been harmed during a childbirth mistake.

Gina Mundy:
Oh, yeah. It's astronomical. It's a lot of money to care for a baby that has suffered a significant brain injury during birth.

Mark Graban:
So when there's a bad outcome, and this is probably what gets litigated, trying to distinguish between a naturally occurring bad outcome versus something that was clearly caused by a mistake. Like, is that. That's where the legal battle comes into play.

Gina Mundy:
Exactly. It's, you know, whether there was anything that could have been prevented. Sometimes, you know, unfortunately, a baby will come in with a pre existing brain injury before mom even comes in, walks in the door. Those babies also have a hard time transitioning from intrauterine life inside mom to, we call it extrauterine life. So yeah.

Gina Mundy:
Distinguishing, is this a baby that had pre-existing injury and just then wasn't, couldn't handle labor, or was it something that happened during labor? Yeah, it's a huge issue in the cases.

Mark Graban:
Yeah. So what are some of the most common problems, especially problems caused by a mistake within the delivery room?

Gina Mundy:
So that's. Yes, chapter eleven of my book, which makes it different than any other pregnancy book, goes over the top ten. I'll give you the top three. Number one, the most common fact in a legal baby case is the drug called Pitocin. Pitocin is the drug that is used to induce mom's labor.

Gina Mundy:
You hear of. Okay, I'm going in for an induction of labor. That's going to happen with pitocin. So when there is a mistake or there's a complication, typically Pitocin is involved. So number two.

Mark Graban:
And what goes wrong? Is it the wrong dose of that medication or what's the mistake involved with that medication?

Gina Mundy:
So it's kind of. It's all over the board. Sometimes Pitocin, it doesn't have to be the direct cause of the problem. Sometimes it is. But I'll tell you, it's in.

Gina Mundy:
Take it as it is. It's in almost every case. When it does become a problem, in many cases, it's because it is a dosage issue. So pitocin is a very individualized drug, meaning how one person responds to it is completely different than how someone else responds to it. So, you know, if you have a doc, and I'll tell you, I don't know how much you know about pitocin.

Gina Mundy:
Across the board, I know nothing. Okay. So across the board, there is agreement that pitocin can be administered safely, and it can be a good option for some moms. Absolutely. It comes into, you know, individual circumstances where maybe they're increasing it too fast, too much, and that makes mom contract too much.

Gina Mundy:
Because I'll tell you, you know, I'm known for saying this, but contractions suck. Contractions suck you're a guy. But contractions do suck, I'm sure you've heard. And mom's lucky. Mom can get an epidural.

Gina Mundy:
Contractions, though, I think what parents don't realize also suck for baby. And it's because when baby is in the uterus, when there's a contraction, the uterus squash squeezes down on the baby. When that happens, the oxygen to baby stops. Now, nobody freak out. I know everyone freaks out when I say that.

Gina Mundy:
No one freak out. Babies are literally made to handle contractions. However, pitocin, those are artificial contractions. You want to try to mimic what your natural contractions would be, and that can be very difficult. So making sure you take the slow and steady, let it hit your sweet spot method is definitely going to help you have a safe pitocin induction, because what happens is a lot of times in these cases, there's too many contractions.

Gina Mundy:
And then it's just, they describe a contraction like going underwater. So just imagine. So during the contraction, baby's like, underwater. You're underwater. As the contraction releases, you come up for air.

Gina Mundy:
So if you keep contracting underwater, contracting underwater, the baby can only handle so much. I e. That, you know, when my sister called, the baby crashed. The baby crashed. I'm like, ah, crap, too many contractions.

Gina Mundy:
You know, so, so that, that's probably the main thing. So, you know, and just so your audience understands in my book, while I may identify, hey, listen, pitocin is the number one most common fact in a baby case. It's a drug that, you know, I have seen, seen, and analyzed since February 2003, when I had my first case. So then I have a chapter on this is what parents need to know to have a safe pitocin induction. But number two, this one shouldn't surprise you.

Gina Mundy:
A busy labor and delivery unit. So many times I sit and I meet with people, and they're like, I remember that day. It was extremely busy. So that's basically, you know, everybody's running hard, they're running thin. So that definitely is a common fact in the baby cases.

Mark Graban:
That kind of environment is just going to lead to more human error. That's just a fact. It's part of our human nature. When we're under stress, when there's too much going on, we get distracted, we forget. I mean, that's a mistake factory, that kind of environment.

Gina Mundy:
Oh, 100%. And so in that scenario. So that's why I wrote the book to parents. Okay, listen, you roll up to the hospital, and you got a busy labor and delivery unit. This is what you need to do.

Gina Mundy:
This is what you need to understand and whatnot. And listen, mom's in labor. She needs to focus. So, you know, I give them other ways to handle it. Like, okay, dad, time for you to step up.

Gina Mundy:
You know, instinctively, you know, men want to protect their wife, they want to protect their baby. I tell them how to do that, you know, in the book. Or, you know, grandmas are actually loving my book, too, because a lot of moms show up because they've had their, you know, for grandkids, I will. And that's going to be me. Grandma's going to be there waiting.

Gina Mundy:
But again, identify the problem. But families, this is how you can make sure if you do roll up, this is what you need to know to make sure that you. Nothing like that happens to your baby.

Mark Graban:
Yeah. Number now give us a third.

Gina Mundy:
Yes. Number three. Most mistakes and complications occur after mom's water breaks. So once, so that basically what happens. Baby's hanging out in the uterus with the placenta, with the umbilical cord.

Gina Mundy:
So placenta is all the nutrients for baby umbilical cords, like the lifeline. And then every. Everything is surrounded by this fluid. So when the water or that fluid, the amniotic fluid comes out of mom and it leaves that environment, that environment changes, and it can leave. You know, baby can be more susceptible to an injury or something, or something happening inside.

Gina Mundy:
So once the water breaks, it's very important to do, you know, certain things. But also with that one, I hear a lot of doctors recommend, hey, let's break your bag of water. Okay. So my point with getting that out there to families is like, that's a really big decision. This is not.

Gina Mundy:
This is. No, if baby is sitting pretty, you know, and everything's fine, don't be careful about breaking your bag of water. Um, so, you know, if the doctor says, hey, I want to break your bag of water, you know, I think I wrote in the book, literally word for word, you know, mom, dad should look at the doctor and say, is there a medical reason why you want to break my water, or do you want to be home for dinner? Listen, as a childbirth attorney, I've heard both. So they do.

Gina Mundy:
They will break water if they have something to do, unfortunately. Now, listen, a physician may be listening to this and be like, I would never do that. Great, great. You're a great doctor. I'm glad.

Gina Mundy:
Please. It's like every profession, you have people who do different things. So this is not across the board to all doctors by any means. I know some amazing ob gyns who would not do that.

Mark Graban:
Yeah, I've heard there was one hospital system I was working with that was really trying to push back when mothers were potentially making a mistake in choosing a day for an elective c section. And, you know, they have a lot of data that. That shows, you know, if that elective c section is done too early, maybe at the doctor's choosing, or a lot of times it was the mother's choosing. They would have situations where mom wanted the baby born on a day that was cute or meaningful to them. I want to have a Halloween baby.

Mark Graban:
I want to have my baby born on my mom's birthday. I want to have my baby born on the. Whatever the reasons are. Like, the hospital was in that situation where people in healthcare would say, the customer is not always right. If mom says, I want you to induce me, and it's too early.

Gina Mundy:
For.

Mark Graban:
A good outcome, this hospital was getting better at communicating and basically saying, no. Now, the mother might be upset from a patient satisfaction standpoint, but I mean, come on. The safety of the baby has got to be the most important thing.

Gina Mundy:
Oh, 100%. And if the hospital or doctor, if it's too early, then they're making a good decision. So, you know what? If she doesn't like it, she can go somewhere else.

Mark Graban:
And I think that happened in some cases.

Gina Mundy:
So, sorry, but no, definitely, you know, you have this innocent, helpless baby, and if you have a mom flaking out that she wants to have a Halloween baby, at the risk of having a healthy baby, absolutely. That. No, put your foot down. 100%.

Mark Graban:
Yeah. I think there's systemic factors, like how busy, how well staffed is the unit. I wonder, like, does time of day or day of week matter? Like, when, in the story you told earlier, when you said it was Friday at 05:00, like, in my head, maybe I'm, you know, overreacting, but a little bit of a warning bell goes off. Like that.

Mark Graban:
Was that a time of day where, I don't know, you know, maybe some staff had gone home or. You know, I'm not trying to blame the individuals, but I'm thinking, like, an overnight delivery, an early Sunday morning delivery, are there certain times of day where, I don't know, because of fatigue or other reasons there might be more mistakes? Have you seen that at all?

Gina Mundy:
No, you're right. No, there. That's actually a great question. I address it in the book. Actually, that's one of the most common factors in a baby case is shift change.

Gina Mundy:
That you. There's number four. Oh, you got. Yeah, you got it. Number four.

Gina Mundy:
Ding, ding, ding. Yes, shift change. Yes, you have. So labor and deliveries, you probably know this 12 hours. So you have people who have now done a twelve hour shift, especially during the night, and then you have a fresh day shift coming on.

Gina Mundy:
So, yeah, there's definitely. I have a lot of shift changes, 100%. And then in terms of timing or months. So in Michigan, the labor and delivery units are really busy. May, June and July.

Gina Mundy:
Those are like the busy times. And then the other busy times are in the morning. So those are definitely the busier times, May, June and July and another. Now, I did not include this in the book, but hospitals that are teaching institutions that have residents, doctors and training, basically these are, you know, kids. I can say kids these days because I'm, you know, aging.

Gina Mundy:
The kids that basically they just go to school, their nose is in the books. They get into a residency program, and now they get to practice on mommies.

Mark Graban:
You know, they're still doctor kids.

Gina Mundy:
I know they're doctor kids, but they.

Mark Graban:
Don'T have that practical experience. And, yes, not just in labor and delivery. Medical mistakes in general are much higher in that month of July.

Gina Mundy:
That's there. I didn't include that. I didn't include that in the book.

Mark Graban:
I'm not trying to get all of the top.

Gina Mundy:
That is definitely, definitely a time where I've had more cases in July and August than any other month. Actually. I did, like, I did ended up doing a chart. I tallied everything with a lot of the cases, and by far are July and August at the most tallies and nothing. Again, there are some amazing residents, but that's what people, you know, there are some really good residents.

Gina Mundy:
There are some other residents, but I'm sorry, it is what it is, but, you know, they have these residents really running the show on labor and delivery and, you know, but again, they haven't had that hands on experience. So sometimes things, you know, get missed.

Mark Graban:
Yeah, well, and I mean, I would say that's part of that systemic problem. And, I mean, you know, you've got the resident, let's say they're, they're making decisions. They're supposed to be supervised by an attending who is like the professor doctor. If something goes wrong, I mean, do they both get sued or does that fall mostly on the attending?

Gina Mundy:
They both get sued.

Mark Graban:
They both get sued. So welcome. Welcome to healthcare.

Gina Mundy:
Mm hmm. Absolutely. Because the residents are always jumping up and down saying, I was under, you know, I was under the doctor, and I'm like, sorry, you're going to get criticized. Just like the doctor is going to get criticized. It happens in all the cases.

Mark Graban:
So, yeah. So what advice would you have for a mother or loved ones who are helping a mother make a decision in terms of preventing mistakes? How much of it is a matter of choosing to have labor and delivery in one facility versus another? Like, I love data, but, you know, is there data that shows which hospitals tend to have better outcomes?

Gina Mundy:
I don't know. Not that I'm aware of. I mean, I really focus on just individual cases because a lot of I do, do podcasts. People ask me, like, the data and maternal morbidity, all that stuff, and I'm like, I don't know.

Mark Graban:
Well, but even from your experience, do you see kind of, you know, clusters of, like. Yeah, there's more cases involving these certain facilities or that's sort of out of the scope of what you.

Gina Mundy:
Yeah, I don't really look. I mean, everything is just a case comes in, we look at it. So it's, it's hard to say if there's one facility over another getting sued more.

Mark Graban:
And I'm going to just wonder out loud, I'm curious what thoughts you have around what's discovered through the legal process, through a case about the mistakes, the causes, different contributing factors. A hospital and the physician are going to defend that case, but how often does that information then get fed back to help drive improvement, to help prevent the next mistake and prevent the next case, legal case?

Gina Mundy:
I think it depends on the hospital. In the hospital system, some hospitals have really good methods on if there's a problem, you know, then they want to have suggestions on how to fix that problem. They identify the problem. I think just the hospital systems are very different in that respect. I think some work really hard to learn from their mistakes while others don't have the systems in place to allow them to do that.

Mark Graban:
Yeah. One other question I wanted to ask you, Gina, and this is, I think, part of systemic issue thinking of workplace culture and hierarchy. How often are there disagreements or challenges, let's say, when it comes to nurses and the physicians, of the nurses wanting to speak up. You know, if the nurse, you know, if the nurse spoke up and was listened to, that might have prevented some sort of problem, like in your visits of different hospitals. I think when we talked before you, you've had a lot of conversations with nurses who have a lot of ideas about how things should be different.

Gina Mundy:
100%. That is more of, you know, since I have published my book, for instance, Pitocin. Nurses love my Pitocin chapter. They are like, thank you for writing this down, because we're constantly getting, you know, the doctors are constantly on us, up, up, up, and the nurse. So the doctors typically are not at the bedside.

Gina Mundy:
Doctors are called in to catch the baby. It's the nurses that are running the pitocin induction. But if the induction is taking too long, then the doctors will be like, up, up, and, you know, they're rushing it. They're rushing it, which is a problem, a huge problem, by the way. And so when they're doing stuff like that, it depends on the nurses.

Gina Mundy:
The more senior nurses are, you know, they'll give pushback a little bit. The newer nurses. Listen, labor and delivery is rough, and I've heard from so many nurses over 21 years. I mean, it takes a good five years to figure out how to be a really good labor and delivery nurse. So then the doctor is telling you to up up everything, and you're learning, you know, maybe you up it even though you don't want to.

Gina Mundy:
But, no, the nurses absolutely love my book because they have not had this in writing before. That pitocin is the number one most common fact and issue in a baby case, meaning when a baby's not born healthy, Pitocin is typically involved in the case. And then, you know, I've also analyzed this drug again since February 2003. I've seen that induction's gone wrong. You know, Utah.

Gina Mundy:
I mean, I've done so much research on this drug. So then I wrote this chapter, which the nurses love. So I've had nurses. I have one traveling nurse right now, and she takes my book to all of the hospitals for the. And she puts it at the nursing station on labor and delivery for the nurses to go through, saying, listen, if you don't want to up it, just point to Gina Mundy's book.

Gina Mundy:
You know? So, yeah, no, the nurses, they've had nothing to stand on until my book was published, and they're out there. I mean, I'm in podcasts with a labor and delivery nurse, Kelly Hoff, called the birth journey. I mean, she just loves the pitocin chapter. She was like.

Gina Mundy:
She's like all my nursing friends, you know, she's like, here you go. This is the ammunition you finally have against these doctors who want to keep upping it. So. Yeah, no, it's, um, you know, the labor and delivery nurses, they are, like, my favorite people. You know, even in my cases, they show more human emotion than any, you know, other fact witness for the defense.

Gina Mundy:
They're. They're just. They're amazing humans. They're trying to help these moms, and sometimes I think they feel like their hands are tied. But, you know, there is information in my book that's definitely helping them to be able to speak up and have a basis for it.

Gina Mundy:
Finally.

Mark Graban:
Yeah, in a situation like that, as you've talked about the doctor saying up, up, that leads to harm to the baby, is the nurse also getting sued, or is that the doctor's decision?

Gina Mundy:
Oh, no, they up it. They're getting sued. And that's what they don't like, they'd answer, the nurses do not like that answer. But I've been talking with the nurses, and I'm like, listen, you up that pitocin? Because they're like, well, do we just chart that we disagree with it?

Gina Mundy:
I'm like, yeah, you're incriminating yourself, but go ahead. No, the thing is, is you have to advocate. You have to go to your charge nurse. You have to go to a different doctor, tell them you are not comfortable with upping the pitocin. And this is why you're just gonna have to.

Gina Mundy:
You're gonna have to advocate. It's called going up the chain of command. Now, some hospital systems and nurses do that more frequently. Maybe smaller rural hospitals don't do that as much or whatnot. But, no, I'm like, you're on the hook.

Gina Mundy:
If you up it. If you think upping it may harm the baby and you don't do anything, you are 100% on the hook.

Mark Graban:
And then there's a choice of, you might get yelled at. That's better than getting sued, and it's better for the baby.

Gina Mundy:
Yeah. Ultimately, the goal is the delivery team's primary responsibility is to deliver a healthy baby. That is what they are responsible for in these childbirth cases. It is the care of the delivery team that is at issue and analyzed more than any other aspect of the case.

Mark Graban:
Yeah. So one other question about the nurse pushing back. Let's say if spouse or partner of the mother has read this chapter, they're aware of this risk. They're in the delivery room. You're not really in a position to try to micromanage the doctor or to say, hey, you might be upping it too much.

Mark Graban:
That probably doesn't happen.

Gina Mundy:
Should. So I've. So I've been on, you know, it's interesting. I've been on a lot of, like, podcasts, and it's a lot of moms, actually, who have started podcasts because they had such a horrific pitocin induction, and it literally traumatized them, you know, as humans. And so I had one mom, she had to have a second pitocin induction because her husband was getting deployed.

Gina Mundy:
And that second, her first one was so traumatic. Baby was okay, but it was very traumatizing. So the second pitocin induction, she was like, she talked about it to her doctor during the pregnancy, not at the hospital. She said, listen, I want it slow. I want it steady.

Gina Mundy:
Before it is increased. I want to know. I want it only increased by one, not to. Basically, I was so proud of her during that podcast that I was actually blown away because what she's recommending is exactly what my chapter says. And so.

Gina Mundy:
No, this is. Listen, mom is the decision maker in labor and delivery. The delivery team, the doctor, the nurse, the midwife, the resident, and anybody else there are technically medical advisors. Mom makes the decision. So if mom or dad, probably mom.

Gina Mundy:
Cause it's her body. Mom's like, you know, if you're gonna have an elective pitocin induction, again, this is discussion during the pregnancy, how much are you going to increase it? So if you want an increase by one and not two, a doctor should accommodate that. And if a doctor doesn't… get a new doctor, and not only that, you know, you wanna know how often is it gonna be increased? And then make sure they tell you.

Gina Mundy:
So we talked about my niece's labor. She was on pitocin, and I had to go give them the pitocin rundown real quick. The delivery team never increased her pitocin without telling her. They actually asked her if they could increase the pitocin, and then they explained why. And together, they made a good decision.

Mark Graban:
Yeah. Yes. That kind of partnership. And I feel like I made a mistake in how I framed that previous question. I'm not a parent.

Mark Graban:
I've never been in a labor and delivery room, so I'm exposing my ignorance about all this. When I asked about the husband or spouse or partner, I wasn't trying to take away the mother's agency over her body and birth. But I think I asked it that way, thinking like, well, if the mother's in pain or I, you know, I think I made a mistake.

Gina Mundy:
I'm sorry, actually, Mark, for not asking that. No, you didn't make a mistake at all. Actually, there's a whole chapter in my book on that. So, basically, because mom is in labor and mom has to physically and mentally focus on delivering the baby, dad actually needs to step up to the plate and, again, protect his wife, protect the baby. And again, that's what my book tells them how to do.

Gina Mundy:
But in doing that, he needs to be an advocate. His wife needs to be able to look at him, give him the look, the nod, whatever. And husband needs to act and move and know how. Again, my book will help him know how to do that. So, no, the husbands actually are one of the keys, literally, to having a healthy baby by sitting there and protecting his wife, protecting his baby.

Gina Mundy:
So, no, that is 100%. I think, up until my book was written, I think dads didn't really know what to do during labor. And delivery. So this really lays out. This is what you need to know.

Gina Mundy:
This is how you can help your wife. So, no, dad's a huge, huge role in having a healthy baby, 100%. And I can tell you from what I've seen in my cases, if dads would have known some of the information that is in my book, it's possible that they would have had a different outcome.

Mark Graban:
Yeah, well, hopefully, it's all a team in that labor and delivery room, parents, nurses, doctors, everybody involved. You know, hopefully, I think a better team environment is going to lead to better outcomes.

Gina Mundy:
So that is definitely what is stressed in my book. It's everybody working together. You know, when I say, for instance, the delivery team, they get busy, they're running hard, they're running thin. Okay, then you. This is what you need to do to work with your delivery team to make sure that they understand what's going on.

Gina Mundy:
Because, listen, if you know the delivery team is missing something or your baby's in trouble or you're in trouble, it's important to be able to work with them because the delivery team, it's almost like a treat when they're busy. Like, it's like a triage. So if mom or baby over here is in trouble, but, you know, this mom may have stalled out in labor, but the baby's fine, they're going to go to mom and baby that's in trouble. I mean, they're unequivocally going to do that. They're going to beeline for them and fix them it, you know, so.

Gina Mundy:
But as long as they know, and that's where the family comes in is, again, it's more working with your delivery team again to make sure you're on the same page. Yeah, this is, you know, a lot of when I log on to podcasts or people look me up, everyone's like, well, which side do you represent? Or, you know, they'll ask me, and I'm like, listen, when I'm out here talking about my book, how to have a safe, you know, delivery or whatever, you know, I don't even. This is not an adversarial proceeding. This is about everybody coming together, everybody working together.

Gina Mundy:
So the baby is born healthy, so mom is around to raise her baby. And that's what the most important thing is. Obviously, the lawyer part of me, that's an adversarial proceeding, and that's, you know, that's a bit different.

Mark Graban:
Yeah. Well, Gina, thank you for sharing your stories and knowledge here. I hope it helps people, pointing them to your book I know is going to help them a lot. So our guest today again, Gina Mundy. Her website is ginamundy.com.

Mark Graban:
We'll put links in the show notes. Her book is a parent's guide to a safer childbirth, expecting the best, using the power of knowledge to help you deliver a healthy baby. So, Gina, thank you for your knowledge and for your caring and advocacy, you know, around all of this. Thank you so much.

Gina Mundy:
And Mark, you are so welcome. And I just want to throw this out there that I have been reading your book and thank you for putting that out there because I think I make more mistakes than even just in my, in my life as a mom or whatever. And, but just, you know, having your perspective on them, cherishing them, learning from them. You know, if somebody in my house makes mistakes, understanding and being kind. But yeah, your book is definitely an amazing book.

Gina Mundy:
I've learned so much from it. And let me tell you, I've recommended it to so many people.

Mark Graban:
Well, thank you. I appreciate that. And, you know, maybe down the road we could do another episode with you and your attorney hat on, talking about fear of mistakes in the courtroom and going up against Jeffrey Fager. There's so much more we could talk about. So maybe someday.

Gina Mundy:
I love it. Great idea.

---

Mark Graban:
Thanks a lot, Gina.

Episode Summary and More

A Guide to Safer Childbirth: Understanding the Risks and How to Minimize Them

Understanding Common Childbirth Complications

Childbirth is a beautiful, transformative experience, but it does not come without potential risks and complications that can affect both mother and baby. This process, often idealized in media and social conversations, is a complex medical event where numerous variables come into play, and where, unfortunately, mistakes can and do happen. These challenges, when they arise, can lead to long-term health impacts or even tragedy.

Healthcare professionals such as doctors, nurses, and midwives play a crucial role in monitoring, managing, and supporting labor and delivery. When supported by a knowledgeable and experienced delivery team, the likelihood of complications can decrease substantially. However, when mistakes occur, they can lead to severe consequences such as birth injuries or fatalities, affecting the baby or the mother. Understanding these potential mistakes and how to avoid them is integral to ensuring a safe delivery. Recognizing the signs of distress or complications early and knowing the questions to ask your healthcare team are vital components of a proactive approach to childbirth.

Balancing Legal Expertise with Family Life

Mixing professional life and personal aspirations is never an easy task, especially in high-pressure jobs such as legal advocacy in childbirth cases. For many professionals, including attorney Gina Mundy, the struggle to maintain a work-life balance is quite real. On the one hand, there is a cemented career, nourished over years of practice and professional growth. On the other hand, there is the undying appeal of dedicating time to family, raising children, and seizing the irreplaceable moments of motherhood.

Even successful professionals can find themselves at a crossroads, contemplating a shift from their careers to spend more time at home. But such a decision is not without its doubts and possible regrets. When reflecting on choices made for their career over the years, individuals, especially parents, may wonder what impact their absence has on their family life. As children grow older and become more self-reliant, the desire to stay home might blend with acknowledgment of the professional success and contributions made to society during those same years. Still, it is common for working parents to grapple with the nagging question — did I miss something?

The Journey to Authorship

Amidst the personal and professional challenges, striving to make a positive difference outside the courtroom leads to extraordinary endeavors like authorship. Mundy, for instance, channeled her extensive knowledge and experience into writing a book aimed at helping expecting parents navigate the complexities of childbirth. Her venture into authorship was fueled partly by a personal family experience, which brought to light the harrowing emotional rollercoaster that families go through when birth complications arise.

Writing a book, especially about such a critical topic as childbirth and its potential risks, stands as a testament to the years of accumulated knowledge and the desire to extend help beyond legal proceedings. Through literature, expertise traditionally reserved for the aftermath of unfortunate events in delivery rooms can powerfully transform into preventative guidance for parents. It's a noble attempt to shift the focus from reactive measures to proactive preparation, in hopes of avoiding childbirth complications and ensuring healthy deliveries.

In the end, whether juggling work and family, engaging with medical professionals nationwide, or authoring books to educate parents, it’s the endeavor to enhance safety and health in childbirth that unifies these experiences, cementing a legacy in the crucial balance of life, law, and the pursuit of well-being.

Enhancing Awareness to Prevent Pitocin-Related Complications

Understanding medication in the context of childbirth is crucial, particularly when it comes to Pitocin. Pitocin is an artificial form of oxytocin used to induce or augment labor but its use requires careful, tailored management due to varying individual responses. Dosage mistakes can result in excessive contractions, which can compromise oxygen delivery to the baby. A lack of oxygen, even transitory during contractions, can lead to significant lasting injury to the child.

Education is the first step in avoiding such incidents, and expectant parents must be empowered with information to engage actively in the delivery process. They must understand that contractions, while a natural part of childbirth, can become too frequent and intense due to Pitocin, leading to potential distress for the baby.

Proactive Approaches for Families in a Busy Labor and Delivery Unit

• Recognizing Signs of Overwhelm: Families must discern when a labor ward is busy beyond its capacity, as this can signal an increased risk of oversight and errors.
• Being Vigilant During Shift Changes: With healthcare shifts lasting up to 12 hours, the period of staff rotation requires extra vigilance from the family to ensure continuity and consistency of care.
• Understanding Shift Cycles: Awareness of the peak months for childbirth and their correlation with staff availability and hospital busyness can inform families when planning ahead.

Navigating Labor after Water Breaks: A Critical Window

Water breaking signifies a change in the baby's environment, demanding immediate and attentive care to minimize risk. While a natural stage in labor, membrane rupture can render the baby more vulnerable to complications. Families should be counseled to question interventions such as artificial membrane rupture and understand the implications for the baby's safety. It's not just a matter of personal or logistical convenience but a significant medical decision that should be made with the baby's well-being as the top priority.

Advocating Safer Inductions and Respecting Biological Timelines

The decision to induce labor is not one to be taken lightly. Unfortunately, inductions are sometimes performed for non-medical reasons, including convenience or personal significance of specific dates. These choices can precipitate premature births and accompanying complications. More hospitals are becoming diligent about declining elective inductions that could endanger the child, prioritizing safety and advocating for naturally occurring labor whenever possible.

The pushback against non-essential early inductions and c-sections is a testament to the ongoing commitment to safeguard infants' health. While patient satisfaction is one aspect of healthcare, it must not override clinical appropriateness and the health of the baby and mother.

Combatting Seasonal and Institutional Risks

• Navigating Resident Training: At teaching hospitals, the presence of newly minted residents amplifies the need for transparency and communication with patients about the level of experience of the individuals directly involved in their care.
• Understanding the “July Effect”: The transitional period as new medical residents begin their positions in July has been associated with an increase in medical errors – an institutional pattern that families should be aware of during this time.

By translating intricate medical knowledge and procedural pitfalls into actionable insight for families, professionals like Gina Mundy aim to bridge the gap between clinical practices and patient safety. These efforts represent a shift toward a culture of preventative measures in childbirth, where being forewarned is forearmed.

Broadening the Support Network for Safer Childbirth Experiences

Building a Collaborative Delivery Team

Childbirth is an intricate dance requiring each participant to recognize their role and the importance of their contributions. One key aspect of ensuring a safe and healthy birth experience is to foster a sense of collaboration among the delivery team, which includes not just the healthcare professionals but also the parents-to-be.

• Encouraging Open Communication: Mothers and their partners should feel empowered to voice their concerns, preferences, and needs. They can ask for clarification on medical terms and procedures and should be provided explanations in layman’s terms to ensure understanding.
• Understanding Team Dynamics: Being aware of who is on the delivery team and their respective roles can help parents navigate interactions effectively. Knowing when to speak with a nurse, a midwife, or directly with the attending physician can provide clarity during the delivery process.
• Developing Birth Plans: A well-documented birth plan can serve as a reference point for both the family and healthcare team. Due to the unpredictable nature of childbirth, birth plans should be flexible. They can also guide discussions and highlight the mother’s preferences regarding interventions like Pitocin.

Empowering Parents Through Education and Advocacy

Educational resources like Gina Mundy's book play a critical role in equipping parents with the knowledge they need to be effective advocates for themselves. Fathers and partners, in particular, can leverage this information to support the mother’s wishes, especially when she may be unable to advocate strongly for herself during labor.

• Knowing When and How to Advocate: Understanding the potential implications of medical decisions enables partners to confidently express concerns and collaborate with the healthcare team to make informed choices.
• Staying Informed About Medical Interventions: By recognizing the potential risks of interventions like Pitocin inductions, parents can make more cautionary requests for its use and ensure that any increase is both necessary and incremental.

Legal Considerations and Nurse Advocacy

The legal implications surrounding childbirth are not just for educational purposes but serve as reminders of accountability in healthcare delivery. Nurses, for example, who may manage Pitocin during labor, bear responsibility for ensuring its correct administration. Awareness of legal outcomes helps empower nurses to advocate more confidently for safe patient care.

• Navigating the Chain of Command: When in disagreement with medical directives that could harm the patient, nurses should know how to escalate concerns, seeking support from senior nurses or alternative physicians when necessary.
• Documentation as a Double-Edged Sword: While charting disagreements is essential for legal records, it is more important to actively seek alternative actions to prevent adverse outcomes. It is this proactive advocacy that can make a difference in patient safety.

The Role of Systemic Change within Healthcare Institutions

Finally, it’s vital to address systemic issues of safety and error in healthcare. When mistakes are made, the path to improvement involves transparent acknowledgment and discussions about the root causes. Healthcare institutions must be forthcoming in these discussions and use the information derived from legal cases to prevent future errors.

• Implementing Feedback Loops: Hospitals with effective methods for identifying problems and enacting improvements demonstrate a commitment to learning from past mistakes and adapting for better outcomes.
• Fostering a Culture of Safety: Workplace culture and hierarchy can influence the degree to which staff feel empowered to speak up. Encouraging a culture where nurses’ insights are respected and considered can lead to positive changes and fewer complications.

Through a combination of individual empowerment, systemic improvements, and an understanding of the legal landscape, parents-to-be and healthcare professionals together can create safer birth experiences. It’s about cultivating a team-oriented, informed approach to childbirth, ensuring everyone involved is aligned in the pursuit of the best possible outcome.

Integrating Compassion and Understanding into Childbirth

Childbirth is not just a medical event but also a deeply personal and often emotional experience for the expectant parents. It is essential that healthcare providers integrate compassion into their professional conduct to support the emotional well-being of mothers and their partners.

Embracing a Non-Adversarial Approach

• Uniting for a Common Goal: Healthcare professionals, parents, and legal advocates should not view one another as adversaries but rather as integral parts of a team, all striving for the safe delivery of the baby and the health of the mother.
• Valuing Each Perspective: Every member of the childbirth experience brings a unique viewpoint, whether it's the medical knowledge of the healthcare team, the preferences and instincts of the parents, or the legal understanding of patient rights and safety. Appreciating each perspective helps create a more holistic care environment.
• Practicing Empathy: Providing emotional support and understanding can make a significant difference in the childbirth experience. When healthcare providers practice empathy, they not only foster a better environment for decision-making but also support the psychological needs of the mother.

Fostering a Learning Culture in Healthcare

• Learning from Mistakes: Acknowledging and learning from errors is crucial in any high-stakes environment, especially in healthcare. Training programs should emphasize the value of examining mistakes, not for assigning blame, but for preventing future occurrences.
• Cultivating Kindness and Patience: Recognizing that mistakes happen in all areas of life, including parenthood, can foster a culture of kindness and patience. This understanding can help alleviate the fear that often surrounds the process of childbirth, both for parents and healthcare staff.

Future Collaborations and Conversations

Looking ahead, there is an open avenue for further discussions that consider multiple perspectives on safe childbirth practices. Whether it’s through podcast interviews, literature, or seminars, these conversations must continue to broaden understanding and foster improvements in the field of maternal healthcare.

Potential Topics for Continuing Dialogue

• Legal Perspectives in Healthcare: Engaging with legal experts in conversations about childbirth can illuminate the importance of patient advocacy and the protection of rights and safety during childbirth.
• Learning from Experience: Healthcare providers and legal advocates can come together to discuss past cases and medical experiences, sharing insights that could lead to systemic and procedural improvements.

Bridging Gaps Between Fields

• Collaborative Projects and Resources: Cross-disciplinary projects, like jointly authored books or shared speaking events, can help bridge the gap between healthcare practices and legal understanding, creating more comprehensive resources for expectant parents.
• Professional Synergy: When experts from different fields—such as medicine, law, and patient advocacy—collaborate, it creates a synergy that can lead to more robust practices and better outcomes for patients.

By encouraging such multifaceted dialogue and collaboration, the approach to childbirth can continue to evolve, prioritizing safety, understanding, and the well-being of both mother and child.