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Pregnant in Prison – A Recipe for High-Risk Pregnancy

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As a mom who was unaware of the issues surrounding these moms-to-be, I was troubled when I read that women are “the fastest growing segment of the prison population.”1 Over a 30 year period, the number of imprisoned women went from 11,212 to nearly 113,000 women.1, 2

Within this population are huge state-to-state and regional disparities. In 2004, more than 10 times more women were imprisoned in Oklahoma than in Massachusetts or Rhode Island.1 Though the reasons for such differences are beyond the scope of this article, those states with high female imprisonment rates need to prepare for the very real issue of pregnant women within their system. More women= more moms-to-be in jail.

So, why the rise in women calling prison their home? According to The Rebecca Project for Human Rights, “Women have borne a disproportionate burden of the war on drugs, resulting in a monumental increase of women who are facing incarceration for the first time, overwhelmingly for non-violent offenses.”3 When compared to men, the crimes of incarcerated women are typically non-violent offenses, and often the result of alcohol, drug, and property offenses.4

The Reality: Pregnancy and Incarceration

Six to ten percent of women entering jail are pregnant.5 The nature of this population means the majority fall within the classification of “high-risk.” Medical problems that negatively affect pregnancy outcomes are common. These include: diabetes, epilepsy, HIV, hypertension, cardiac and renal diseases. Also, many of these women have not received adequate medical care prior to their imprisonment. They are more likely to smoke, be heavy drinkers and use illicit drugs.6 These factors have a significant impact on their requirements for increased (often specialized) prenatal care, as well as their need for education, counseling and substance abuse treatment programs throughout pregnancy and beyond.

Prematurity: A Difficult and Complex Problem in Obstetrics

A racial disparity exists, not only within the prison population where 67% are non-white6, but also in preterm birth (PTB) where Black women have the highest rates (17.5%), followed by Hispanics (12.1%), then Whites (11.1%).7 Research has shown that Black women are three to four times more likely to have their babies very early (between 20 and 24 weeks), in part because of their predisposition to infections.8 Many of the problems discussed mirror the risk factors for PTB (a birth occurring at less than 37 weeks gestation). PTB is a major global issue, where sadly the US ranks worse than most other developed countries. The conditions described in this article all contribute to prematurity.

The risk factors for early birth, the leading cause of infant morbidity and mortality, are those with8:

•A history of pregnancy loss or PTB ( #1 risk factor)

•Womb abnormalities or carrying multiple babies

•A family history of PTB

•Diabetes*

•Periodontal disease*

•Bacterial vaginosis (BV)*, and other genital infections like trichomoniasis, chlamydia, syphilis and gonorrhea.

•High stress*

•A history of cervical surgeries (including multiple D&C/abortions)*

As well as:

•Black women (who have a higher risk if they are underweight or overweight)*

•Obese women with a BMI of 35 or more or those with a low BMI

•Teens

•Heavy smokers*

•Those taking certain antidepressants

•Unemployed women*

•Heavy drinkers, cocaine or heroin users*

* These factors are highly likely in incarcerated pregnant women.

Of Special Concern for Prison Healthcare Personnel8 (Edited excerpts from the book High-Risk Pregnancy- Why Me?)

Based on risk factors of women within the prison system, certain conditions and issues are likely to be encountered in this environment. The following are probable pregnancy issues medical personnel may be faced with when working with this special needs population.

Preterm Premature Rupture of Membranes (PPROM)

Who’s at Risk? Women who:

* Have had a previous PTB

* Are at an economic disadvantage

* Have a low BMI

* Have had a cerclage or biopsy procedures to their cervix

* Are experiencing early contractions

* Have a urinary tract infection or STD

* Are experiencing vaginal bleeding

* Are smokers

Women with suspected early ruptures should immediately be provided specialized care and confirmation using NitrazineTM paper and/or observation of “ferning.” An appropriate management plan under the direction of a perinatologist should be devised depending on the type of rupture (remote from term, near term, etc.). (Women with term ruptures should also be evaluated/monitored immediately.) Other management options will likely include hospitalization throughout the duration of the pregnancy, antibiotics, antenatal corticosteroids and routine monitoring for infection/contractions. Important: care should be taken to limit (preferably avoid) internal examinations to reduce the risk of infection/inflammation. (This is the largest problem faced by providers when managing PPROM, along with preterm contractions.)

Preeclampsia

This condition only affects women and their unborn babies during pregnancy, typically after 20 weeks, or during the six-week period after birth. Preeclampsia is present in about 5-8% of pregnancies. Since imprisoned women are more likely to suffer from hypertension, it is extremely important to monitor these women for this condition. (The #1 risk factor is having had this before, followed by women with a high BMI, a history of chronic hypertension, diabetes, or a kidney disorder, as well as those over 40 or under 18.) Regular prenatal visits are mandatory to track and manage the possible onset. If detected, specialized care must be sought to develop an appropriate monitoring program for the health and safety of mom and baby. (Note: Acetylsalicylic acid (aspirin) has been shown to provide a significant reduction in the incidence of severe preeclampsia, hypertension and IUGR. Magnesium sulfate is another common drug used.)

Warning signs all providers working with pregnant women should be aware of:

* Hypertension of 140/90 or greater, observed twice within a six-hour period. A rise in the diastolic of 15 degrees or more or a rise in the systolic of 30 degrees or more is cause for concern, especially with other symptoms.

* Edema, especially in the hands and face.

* Protein in the urine. A 1+ or higher could mean the start of preeclampsia, even if blood pressure is below the threshold. A 2+ is a major red flag.

* Sudden weight gain of more than two pounds in a week or six pounds in a month (though, this isn’t the most reliable detection method).

* Migraine-like headaches that don’t go away, even when treated.

* Nausea and/or vomiting in the second or third trimester (not to be confused with a stomach bug or food poisoning).

* Changes in vision, such as temporary loss of vision, a sensation of flashing lights, heightened sensitivity to light, blurred vision, or spots before the eyes. This is a very serious symptom and should be checked out immediately.

* Stomach pain beneath the ribs on the right side of the body and/or right shoulder pain. This can be mistaken for heartburn, indigestion or kicking.

* Sudden and specific lower back pain, different from the normal aching in the lower back. This is a possible sign of HELLP or other liver problems, especially if patient is displaying other symptoms of preeclampsia.

* Hyperreflexia.

Placental Abruption

This occurs when the placenta separates from the uterus due to internal bleeding, sometime between the twentieth week and when the baby is born. A hematoma further separates the placenta from the uterine wall, causing compression and compromise of the blood supply to the baby. Though quite rare, only occurring in 1% of pregnancies, it is included here since women with hypertension (the most common cause, occurring in 44% of all cases), diabetics, heavy smokers and/or drinkers, or a history of cocaine use are at a higher risk.

Tests to determine this condition include: abdominal ultrasound, complete blood counts, pelvic exams, fibrinogen levels, partial thromboplastin time and prothrombin time. Placental abruption should be suspected when a pregnant mother has sudden localized abdominal pain with or without bleeding. The top of the uterus (fundus) may have to be monitored, as a rising fundus can indicate bleeding. Early recognition and proper management are key.

Symptoms of Placental Abruption

* 80% have vaginal bleeding.

* 70% have abdominal or back pain and uterine tenderness.

* 60% of the babies show fetal distress.

* 35% have abnormal uterine contractions.

* 25% experience premature labor.

Intrauterine Growth Restriction (IUGR)

Newborns are considered to have had restricted growth when their birth weight and/or length is below the 10th percentile for their gestational age and they have an abdominal circumference below the 2.5th percentile.

This is a complex issue with multiple etiologies. There are, however, several well-known risk factors including: alcohol abuse, drug addiction, poor nutrition and smoking. Ultrasounds for diagnosis and delivery of the baby at the right time, not too early and not too late, are necessary for the effective treatment in pregnancies affected. (Fundal height monitoring can also help to detect growth restricted babies, but ultrasounds are more accurate/ideal.) If IUGR is identified, monitoring should then include vessel analysis and biophysical testing every week or two, depending on the situation.

Short Cervical Length, Preterm Labor, Incompetent Cervix (IC), Infection

These are complex topics within the Obstetrical arena with thousands of studies and just as many opinions. They are either directly or indirectly related to each other, so due to space constraints, I bundled them together. Below is a brief summary of the recent research, treatments and strategies.

Risk Factors for Short Cervix (and IC) and the Chance of a Premature Baby

* Previous cervical surgery, including laser cone biopsy, cold-knife conization, or Loop Electrosurgical Excision Procedure (LEEP)

* Damage from a previous traumatic birth

* A malformed cervix or uterus

* Previous trauma on the cervix from D&C, multiple abortions

* Deficiencies in cervical collagen and elastin

* Genetic susceptibility/environmental factors (infection, inflammation, uterine activity)

A preventative cerclage, a piece of “string” which is looped in and around the cervix to reinforce it, should be considered for all women with a history of spontaneous second trimester losses, those who’ve had large portions of their cervix removed, etc. Prison medical providers should seek the guidance of a specialist in these cases.

Cervical Length – A Preemie Predictor

There’s general consensus, which is backed by the research, that the shorter the cervix, the greater the risk of an early delivery. (A short cervix is commonly defined as ≤2.5 cm prior to 24 weeks gestation.)

Transvaginal sonography (TVU) – has increased the ability to predict and even treat women at risk of a premature baby by measuring cervical length.

Suggested TVU Screening Scenario:

* One check at around 18-22 weeks in low-risk women

* For high-risk women – e.g., those with a prior preterm birth – two checks, one at 14-18 weeks and another at 18-22 weeks

* For extremely high-risk women – i.e., those with a history of a second-trimester loss or very early spontaneous preterm birth – TVUs are recommended every two weeks from 14 until 24 weeks.

Understanding the Numbers:

* A length of less than 2.5 cm is best for predicting an early birth. The earlier a short length is seen, the higher the risk.

* A cerclage should be considered in high-risk women with a cervix shorter than 2.5 cm (prior to 24 weeks). The reduction in preterm birth following a cerclage has been shown to be about 30%.

* Cervical length of greater than 3.0 cm at 24 weeks = low risk of an early delivery.

Provider Options to Managing Early Birth

•In situations of preterm labor, providers need to consider whether there is an underlying problem, such as infection, triggering it. There are many side effects, with the use of tocolytics, to both mom and baby, so experience in this area is required. Research has shown promise in the ability of these medications to extend pregnancy to allow for transfer and steroid administration, as well as stopping a bout of preterm labor (specifically, Nifedipine due it’s overall safety profile and Indomethacin).

•17 Alpha-Hydroxyprogesterone Caproate (aka 17P or progesterone) is a hormone which is shown to reduce PTB by 33% in women with a history of a prior early birth. Every woman with a history of a spontaneous early birth should be prescribed this medication during pregnancy. (Low-risk women with cervical shortening of ≤2.5 cm vaginal progesterone has demonstrated a substantial decrease in delivery before 33 weeks, as well as reduced neonatal morbidity and mortality.9)

•Fetal Fibronectin (FFN) swabbing is a test used to help “predict” the likelihood that the patient will deliver within 7-10 days. A negative equates to a >90% confidence that the woman will not deliver during this period. There is a huge range of variability with positive results, meaning only about 9-46% confidence. When swabbing of the cervix confirms the presence of fetal fibronectin (FFN) after 22 weeks, a link to PTB has been shown to exist. (Combined FFN swabbing and cervical length determination is the ideal approach when determining management plans for symptomatic women.)

•Steroids should be considered for women being treated for preterm labor between 24 and 34 weeks (dexamethasone or betamethasone).They are given as a series of shots in the muscle, two shots 24 hours apart, or 4 shots 12 hours apart. The use of steroids has drastically reduced preemie death rates, respiratory distress syndrome and intraventricular hemorrhage.

Make Adequate Prenatal Care, Nutrition and Education a Priority

Though an extremely complex issue, it’s important to provide these moms-to-be proper care and nutrition throughout imprisonment to meet their additional needs during the antepartum period and to help ensure healthy outcomes for mom and baby. This would ensure they “are not further compromised by poor care during imprisonment.”6 Pregnant women with specific problems, such as diabetes or hypertension, need to have access to specialist care.

It should be noted that studies have shown that there may actually be a beneficial effect for babies when mom is imprisoned, by providing food (leading to higher birth weights), shelter, protection from abusive partners, access to prenatal care, and moderation/elimination of alcohol and drug use.6, 10, 11 Though, there still appears to be much needed improvements within many state systems in order to meet the needs of this specialized population. The Rebecca Project reported that 38 states received a failing grade in prenatal care, which include inadequate policies, prenatal care, nutrition, screening and treatment for women with high-risk pregnancies.3

Providing education, with a combination of written through the library and on-site classes are ideal and should be a priority. Women should be provided the opportunity to educate themselves about pregnancy, what they can expect, body changes, potential risk factors, signs, symptoms or issues they should be aware of (such as the signs and symptoms of PTB, PPROM or preeclampsia), the importance of proper nutrition, etc.

Steps for Medical Personnel to Help Ensure Healthier Pregnancies

•Every incoming female should be tested for pregnancy as soon as possible to identify those who will need antenatal care. An ultrasound should be performed on all pregnant inmates to determine gestation. (Note: First trimester ultrasounds are more accurate for pregnancy dating than later ultrasound testing.)

•All pregnant women should take prenatal vitamins with folic acid as soon as they arrive in the facility or are identified. Along with preventing neural-tube defects, it has also been shown to reduce PTB. (Education about the benefits to the baby’s development may help with compliance within this population. Explaining to mom that her baby could be severely disabled or die as a result of not taking vitamins may help her to better understand the needs of her developing baby, hence, improve her willingness to participate.)

•Programs within the system should include smoking cessation, as well as comprehensive alcohol and drug programs. These behaviors are linked to not only PTB, but low birth weight, IUGR, PPROM, placenta previa and placental abruption.

•A FULL and DETAILED medical history should be obtained for every pregnant woman by a trained obstetrical provider (including detailed discussions around risk factors). This evaluation should be used to determine the specific needs of each woman and the likelihood of pregnancy issues and early birth. (Sadly, actual access to prenatal care has been shown to be sparse and inconsistent within the prison system, which was designed to meet the needs of males.3)

•Women should be screened and treated for sexually transmitted infections and HIV.

•Programs which meet the specific nutritional needs of pregnant women must be implemented (and followed). (Proper nutrition reduces the risk of PTB, certain birth defects and low birth weight babies.)

•As stated previously, education materials and one-on-one discussions to help women better understand their situation/needs and pregnancy/birth in general should be mandatory.

The Doula Perspective – Birth and the Confined Mom

As a doula (a woman who assists women and families during the birth process, physically and emotionally), I couldn’t let this article go without a mention of labor and delivery for imprisoned moms.

•Thirty-six states received a failing grade for their shackling practices of pregnant women.3 Shackling should ONLY be reserved for the most violent of offenders (so a very small fragment of the female prison population) or those with a previous escape attempt. This practice is not only a health and safety issue, it is inhumane and falls under cruel and unusual punishment. (I couldn’t imagine giving birth while tied up.)

•States should evaluate the use of prison nursery programs which help foster the bond between mom and baby. (Thirty-eight states failed for not offering this to new imprisoned moms.3)

•Pregnant inmates should have a plan for their birth in a hospital or birth center. Under no circumstances should a woman give birth in her jail cell.

•Every mom-to-be should receive education regarding the labor and birth process, help developing a birth plan (her choices for pain relief, etc.) and should be allowed to have someone there for support during her birth (ideally family, significant other, or a doula for non-violent, low-risk offenders). Prison doula programs should be considered to help support and educate incarcerated pregnant women.

•The basic needs of pregnant women should be met, even during imprisonment (adequate beds, pillows and clothing to manage body changes and back pain).

Even Small Changes Matter

The complexity of issues regarding pregnancy and prison must be overwhelming to those who work within and manage the prison system. Even baby steps can lead to great change. Each in turn, will make a positive difference and impact within the population you serve. Providing mothers and babies with a healthy start trickles down to shape a better future for children born to imprisoned women.

References

1. Frost NA, Greene J, Pranis K. HARD HIT: The Growth in the Imprisonment of Women, 1977-2004. Institute on Women & Criminal Justice (The Punitiveness Report) May 2006

2. Guerino P, Harrison PM, Sabol WJ. U.S. Dept. of Justice, Bureau of Justice Statistics, Prisoners in 2010; Dec. 2011, NCJ 236096

3. Saar MS, Bisnott B, Mathon-Mathieu F, et al. The Rebecca Project for Human Rights, National Women’s Law Center, Mothers Behind Bars: A state-by-state report card and analysis of federal policies on conditions of confinement for pregnant and parenting women and the effect on their children. Oct 2010

4. Hotelling BA. Perinatal Needs of Pregnant, Incarcerated Women. J Perinatal Education 2008;17(2):37-44.

5. Clarke JG, Phipps M, Tong I, et al. Timing of conception for pregnant women returning to jail. J Correct Health Care 2010;16(2):133-138.

6. Knight M, Plugge E. Risk factors for adverse perinatal outcomes in imprisoned pregnant women: a systematic review. BMC Public Health 2005;5(111).

7. Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary Data for 2008. National Vital Statistics Reports 2010;58(16).

8. Whitehead, Kelly. High-Risk Pregnancy- Why Me? Understanding and Managing a Potential Preterm Pregnancy. A Medical and Emotional Guide. McAfee, New Jersey. Evolve Publishing, 2012.

9. Romero R, Nicolaides K, Conde-Agudelo A. Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: a systematic review and metaanalysis of individual patient data. Am J Obstet Gynecol 2012;206(2):e1-124.

10. Tanner R. Pregnancy outcomes at the Indiana Women’s Prison. J Correct Health Care 2010;16(3):216-219.

11. Knight M, Plugge E. The outcomes of pregnancy among imprisoned women: a systematic review. BJOG 2005;112(11):1467-1474.

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Mobile Document Shredding Services – 10 Good Reasons to Hire a Professional Paper Shredder

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Thanks to new laws passed by the government, creating a document shredding plan has become a part of doing business. This is to keep non-public information handled by businesses and organizations secure and to prevent identity theft. However, some companies still shred paper themselves. In this article we’ll look at 10 good reasons why it is a good idea to hire a mobile document shredding company to handle this work for you.

  1. Ease of Use – Mobile shredding companies provide clients with secure locking containers. When sensitive materials need to be disposed of, they can simply be dropped in the locked console, rather than having to shred them individually. Forget removing staples, paper-clips or bindings…With high volume capabilities, you can toss huge folders of paper work into shredding trucks and they are shredded beyond recognition in seconds!
  2. Cost Efficiency – Shredding trucks shred paper faster and have much more capacity than any regular in-house shredding machine can provide. If you were to assign an employee to do this task, it would cost your company more than hiring a shredding company. It is even more cost effective than having a minimum wage employee do the shredding, let alone someone who gets paid good wages. Why waste the time of talented employees by making them stand over a shredding machine? Also, shredding machines are not cheap, and can require repairs if used a lot.
  3. The FTC Safeguards Rule of the GLB Act mandates that private data be monitored for destruction.

    Most mobile shredding services have observation screens where you can watch the papers being shredded. You are also provided with a certificate of destruction. Other services, such as recyclers can easily lose your papers on the way to the recycling plant. They pay little attention to the security of your data. Why increase your legal exposure and risk huge fines for improperly disposing of private data?

  4. It’s An Ethical Business Practice.

    Do you really want papers your customers’ or clients’ non-public information blowing in the wind? Think of how bad you would feel if your customer data was stolen because you were too lazy to take simple precautions…Not to mention the huge PR damage your business could take.

  5. With A Shredding Service, You Get Major Help From Pros

    Let’s face it…Compliance with all of the various shredding laws is not always simple. There are many laws and it can be hard to decipher all of the various sources of information. When you hire a shredding company, you get years of experience behind you.

  6. The Environment.

    It’s good to know shredded paper is baled and ends up in paper products like those coarse paper towels you wipe your hands with in public bathrooms. Many shredding companies sell the the bits of paper to paper mills and it is recycled into new paper products.

  7. Better Than ‘Off-Site’ Destruction

    On-site shredding is way more secure. You can actually see the paper being shredded first hand before it leaves your property. By having it done on-site, you eliminate all of the possible risks of exposing your data in it’s complete form after it leaves your premises.

  8. Self Interest & Competitive Advantage

    Many business secrets have been lost to improper handling of important information. Keep your competitive advantage by keeping your data private! Corporate dumpster divers have cost companies millions. With a secure mobile shredding service, you can eliminate (or minimize) risk of competitors and make more money.

  9. Organization

    By organizing your papers and creating a shredding schedule, your home or business can become more efficient. Shredding papers saves tons of storage space and frees up room for more important office equipment.

  10. Peace of mind – Without the proper safeguards, information ends up in the dumpster where it is readily, and legally, available to anybody.

To learn more about how to choose a shredding service and to find a company near you, visit The Document Shredding Directory today.

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How To Find A Good Social Security Disability Lawyer

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Man is a social animal. He cannot do away with his society completely and live an isolated life. He may need the help of his society at some point of time or the other. Keeping this in mind you need to pay for the social security all your life, so that if you are disabled or unable to earn your living at a later stage in life, you will be able to enjoy the benefits of social security disability insurance. However, claiming social security disability insurance is not an easy job and requires professional help.

Here are some of the ways to find a good social security disability lawyer:

Ask your friends and family. You can also talk to your relatives and neighbors. They are always a good source of information. Being your well wishers, they will never try to mislead you. Hence you can get the best kind of feedback from them. If you are lucky, you will find out that one of them may have come across such an expert, and can provide you with all the necessary details about him.

Another method which you can easily adopt is to look for your service provider on the net. The Internet is one of the best ways to find out what you need. Browse through the official websites of law firms that provide the services you require. You should carefully read all the information that is given about them on their websites. This will give you a clear idea about the law firm, and help you decide whether you should hire their services or not. Check to see if the service providers have testimonials written by satisfied customers. This is a good way of finding out what the customers, who have already opted for their services, feel about them. Moreover, it is advisable that you choose such a law firm which has efficient lawyers, offering their services to clients for a long time. Experience is an important factor that matters a lot while taking such important decisions. Lawyers who are well experienced in taking care of social security disability cases for a long time, will be in a better position to be able to help you get the best benefits possible.

Another effective way to find out the best professional of your choice is by talking to other lawyers. You may be knowing another lawyer who offers some other kind of services. However, being in the same profession he will easily be able to give you a referral of a reputed lawyer who can help the client make a claim for social security disability insurance. You can then easily fix an appointment with him and check whether he will be able to serve your purpose well.

If you are in need of a lawyer who can help you get the benefits of insurance policies related to social security disability, Martinsburg WV is the best place to start your search.

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Collaborative Divorce or Cooperative Divorce?

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Introduction

“Collaborative divorce” is the new buzz word in family law practice. Its proponents enthuse about better and less costly settlements, greater client satisfaction, fewer accounts receivable, and less stress in the practice of law, than they can achieve through a conventional approach to family law disputes. How realistic are these claims? What are the down sides of “collaborative divorce”? Does the concept of “collaborative divorce” present ethical pitfalls and possible malpractice minefields for the unwary practitioner?

Lawyers who participate in the “collaborative divorce” movement use methods borrowed from more established alternative dispute resolution procedures to resolve family law disputes without litigation. However, unlike more accepted dispute resolution procedures, in “collaborative divorce” the lawyers and their clients agree that they will not engage in formal discovery, will voluntarily disclose information, and will settle the case without court intervention of any kind . They assume a duty to inform the attorney for the other party of errors they note in opposing counsel’s legal analysis or understanding of the facts. If they are unable to settle the case, both lawyers must withdraw from representing their respective clients and the estranged spouses must start over with new counsel.

Good Lawyers Routinely Practice Cooperatively

Even the most enthusiastic supporters of “collaborative divorce” concede that the concept of settling cases rather than litigating them is hardly novel. Capable family law practitioners have always directed their effort and creativity toward reaching agreement rather than duking it out in court. It isn’t news to anyone that litigation is expensive – sometimes prohibitively so – and that the most satisfactory settlements derive from skilled negotiation between capable counsel rather than a court-imposed resolution of disputed issues. How does the idea of “collaborative divorce” differ from what experienced practitioners do as a matter of course?

Courtesy. The commitment of lawyers and parties to treat each other courteously is not a new one. Capable attorneys consistently endeavor to work cooperatively with opposing counsel to identify and value assets, set and meet scheduling deadlines, and otherwise facilitate resolution of the case. They respect legitimate positions taken by the other party and encourage their clients to be realistic and respectful as well. They are willing and able to compromise, and they are creative in crafting acceptable resolutions of disputed issues. “Collaborative divorce” supporters intimate that their process is unique because lawyers commit that they will not “threaten, insult, intimidate, or demonize” other participants in the divorce process. Good lawyers don’t do that now. The American Academy of Matrimonial Lawyers, which historically has provided a model for good practice nationally, has promulgated “Bounds of Advocacy” that set a high standard for professional courtesy and cooperation.

Emotional cost. “Collaborative divorce” proponents say their process is designed for parties who don’t want to go to war and who don’t want “to hate each other for the rest of their lives.” This description fits the vast majority of family law clients, including most of those whose cases end up in court. Clients almost always care about the emotional cost of adversary proceedings, and about the impact of the divorce action on their children and other family members. To suggest that people who really care will give up the protections provided by court oversight is to do a vast disservice to most of our clients.

Financial cost. “Collaborative divorce” supporters want to reduce the costs of the process by streamlining the discovery process. This also is not a new idea. Good lawyers have always sought to keep formal discovery to a minimum, to share costs of appraisals, to stipulate to values, and to cooperate in other ways to keep costs down. Many experienced practitioners routinely utilize mutually agreed upon short-form interrogatories, four-way meetings, joint telephone or in person conferences with experts, and other such collegial arrangements.

As the above analysis indicates, the goals espoused by “collaborative divorce” lawyers do not differ in degree or in kind from the goal of the vast majority of the family law bar. Most lawyers try a cooperative approach first. Most lawyers agree – and most of their clients concur – that resolution of issues by settlement is preferable to litigation. And in most cases, lawyers and their clients resolve disputed issues by agreement and do not resort to the courts.

The Limits of Collaboration

Despite the most concerted efforts of capable counsel, we all know that not all cases settle, and those that do settle sometimes don’t settle easily. All of us have encountered the frustration of the last-minute, courthouse steps agreement, after completion of all the work and stress of trial preparation. Why is it that some cases don’t settle until the very last minute, and some cases don’t settle at all?

Unsettled Legal Issues. Legitimate reasons to resort to litigation are not always evident at the beginning of a case. Much appellate work involves issues the existence of which – or at least the seriousness of which – did not surface until significant discovery and negotiation had occurred. Where the law is unsettled or where counsel genuinely disagree about the appropriate interpretation and application of the law to the facts of their case, it is not only reasonable but necessary to ask the judge to intervene. Cooperative counsel can reduce the complexity and expense of litigation by limiting contested issues, stipulating facts where possible, agreeing in advance to the admission of exhibits, declining to engage in delaying tactics, and other behavior that is both practical and considerate. Lawyers can commit themselves to conduct the proceedings without animosity and can counsel their clients to be courteous to the other side. But the court has the last word on interpreting and applying the law.

Reality Testing. All clients say they want a “fair” result and many of them genuinely mean it. But they may have a very self-absorbed definition of “fair.” Many years ago Leonard Loeb, whose wisdom and example have greatly influenced the development of a civilized standard of practice for family law attorneys, pointed out an important truth: “Sometimes the hardest negotiation you have to engage in is the one with your own client.” A client who simply cannot see the broader picture despite counsel’s best efforts may require the reality therapy of a temporary order hearing, or a pretrial with the judge, or a deadline for responding to formal discovery, in order to be capable of backing down from an unreasonable stance so settlement negotiations can proceed.

Scheduling Orders. We have all represented a left-behind spouse who does everything possible to avoid or at least delay the divorce, or a party who is preoccupied with business affairs or other family problems and just can’t get around to dealing with the work and decision-making implicit in the divorce process. If one party would prefer that the marriage continue, or if completing the action is not a priority, the court may need to facilitate progress in the case by issuing a scheduling order and setting deadlines. Counsel can cooperate by being reasonable and courteous in setting initial deadlines and in agreeing to extensions where necessary. The process need not be – and usually is not – antagonistic.

Financial Disclosure. A client may, deliberately or inadvertently, fail to disclose assets without the rigorous attention to financial detail that formal discovery entails. Surely we have all had the experience of finding forgotten assets when a client produces the records necessary to back up his or her interrogatory answers. In other circumstances, the client and/or counsel may need the assurance of due diligence in discovery in order to be comfortable with a proposed settlement, especially where the estate is complex or the assets are substantial.

Stability. Then there is the personal factor: divorce presents a significant life crisis for most of our clients, and we see them at their most vulnerable and most needy. The commencement of a divorce action is often accompanied by anxiety, guilt, an danger, and may throw a family into chaos. If one party’s antagonism toward the other is so overreaching that he or she is unable to proceed rationally and courteously, interim court orders may be the only way to achieve a level of stability that permits collaborative discussion of the long-term issues presented by the case.

In each of the above situations, the legal system provides structure and finality, and often sets the stage for the ultimate negotiated resolution of the matter. Court processes, rather than being an impediment to settlement, often facilitate it.

The Effectiveness of a “Collaborative Divorce” Approach

Do “collaborative divorce” techniques provide an effective response to the above limitations? Unfortunately, they do not.

Reality Testing. A client whose sense of “fair” is out of kilter with that of the other party and the lawyers will defeat the collaborative process, and both sides will have to incur the expense and delay of starting over with new counsel. Reality testing through a temporary order hearing or a pretrial with the judge is not an option in “collaborative divorce.” The lawyer representing a difficult client must either advocate for the client’s unreasonable position or take a public position adverse to the client’s view. An attorney cannot ethically make either of these choices, The first is at least arguably frivolous; the second violates the requirement that we advocate diligently for our clients. Proponents of “collaborative divorce” have not provided a solution to this ethical dilemma.

Delay, Expense, and New Counsel. A client who wants to stall progress in a “collaborative divorce” can do so indefinitely, until the court threatens to dismiss the action and the party wishing to proceed must then retain new counsel to request a pretrial. Again, both sides incur the expense and delay of bringing a new attorney up to speed. The attorneys who know the facts and have established rapport with their clients cannot continue to be involved. How can this result benefit anyone?

Diligence. Lack of due diligence in discovery may subject the attorney to a malpractice claim [see Helmbrecht v. St. Paul Ins. Co., 122 Wis.2d 94, 362 N.W. 2d 118 (1985)], may violate the ethical requirement of diligent representation, and may make the client uneasy about signing on the dotted line. In complex cases and cases in which there is a disparity in the spouses’ respective familiarity with or involvement in financial affairs, the security of formal discovery is not available to help resolve “collaborative divorces.”

Timely and Efficient Court Intervention. If there is sufficient antagonism that experienced counsel are unable to negotiate an agreement, or if one party refuses to comply with an agreement, court intervention is necessary. Under the “collaborative divorce” approach, both lawyers must withdraw just at the time that an attorney who knows the case is most effective.

Malpractice Issues

In collaborative divorce, the parties and their respective lawyers sign a single contract, at least arguably creating obligations of each lawyer to the other attorney as well as to both clients. The collaborative law contract puts each lawyer in privity with both parties and with opposing counsel, creating a basis for contract claims to which an attorney is not exposed in standard practice. Moreover, the collaborative divorce contract assumes, though it does not specifically state, that each client completely waives his/her attorney’s obligations to maintain client confidentiality and not to inform the other party or lawyer of his/her legal, factual, or strategic errors. Yet, the contractual commitments required for “collaborative divorce” eliminate these obligations and substitute in their place obligations to disclose and to inform that are at least theoretically actionable either as contract claims or negligence (malpractice) claims.

Assume that Attorneys A and B and their clients have agreed to proceed with a “collaborative divorce.” Attorney A makes a mistake that disadvantages client A and benefits client B. If Attorney B fails (deliberately or negligently) to correct the error, can client A sue Attorney B for malpractice? If Attorney B corrects the error, to his/her own client’s detriment, can Client B sue Attorney B for malpractice? Does the existence of a “collaborative divorce” contract provide a defense to malpractice? Does it increase malpractice exposure by permitting each party to sue both lawyers?

If, unknown to Attorney A, Client A fails to provide full financial disclosure and thus disadvantages Client B, can Client B sue Attorney A for malpractice? Can Client B sue Attorney B for failing to take steps to discover the omission? Can Client A sue either or both of the attorneys for malpractice if the nondisclosure was inadvertent and would have been discovered through standard formal discovery, and if the effect of the error is that the judgment is vacated and litigated with new counsel with Client A held liable for Client B’s additional costs?

If Attorney A fails to spot an issue that would likely be resolved in Client A’s favor, does Attorney B have a duty to raise the issue? If Attorney B fails to do so, can Client A sue Attorney B for malpractice? If Attorney B raises the issue, can Client B sue Attorney B for malpractice?

Have you notified your insurance carrier? How will you pay for breach of contract litigation and possible judgments against you that your malpractice insurance does not cover?

“Collaborative Divorce” May Increase the Cost of Divorce

“Collaborative divorce” is marketed as a cost-saver for clients, but is it really? We all know that settlement is less costly than litigation. The issue is not whether “collaborative divorce” is less expensive than litigation, but whether it permits participants to spend less than they would if they employed more conventional settlement approaches. Most lawyers try informal discovery first and proceed to interrogatories or requests for document production or depositions only where informal attempts have failed or where the information provided is suspect. Most lawyers schedule contested trials only after repeated attempts to arrive at negotiated settlements. Most lawyers genuinely believe that better and more creative settlements can be achieved through negotiation and creative planning rather than through a court-imposed resolution. Virtually no good lawyer chooses litigation as the first and best option.

In a conventional divorce, the lawyer who has worked up the case, who knows the client and the facts, and who understands the interpersonal dynamics of the case, can use this knowledge base to proceed if necessary to a litigated conclusion. In “collaborative divorce,” if negotiations fail the clients have to begin again with new counsel and pay a new lawyer to learn the complexities of the case. If the clients have a relatively simple financial situation, they probably can’t afford to pay twice. If they have a complex situation, the time and expense necessary to duplicate or recreate the financial analysis and valuations will likely be outrageously high. In some cases, clients may save some money, though there is no evidence that “collaborative divorce” is less costly or less time-consuming than any cooperative settlement approach. In other cases, however, overall costs will skyrocket, and the time it takes to complete the process will be significantly extended because of the duplication of effort entailed by substitution of counsel. And while “collaborative divorce” proponents suggest that its practitioners will have fewer uncollected accounts, one may reasonably question whether clients who are forced to change lawyers will fully pay both sets of counsel.

Is “Collaborative Divorce” a Better Process?

Advocates of “collaborative divorce” say that clients are motivated to learn problem-solving strategies because there are no “court threats.” In some cases that may be true. Experienced attorneys know, however, that with many clients it is precisely the ability to schedule court dates and set deadlines that provides the impetus for settlement. Cases often settle only when delay is no longer possible and the time for gamesmanship is over. We’ve all had the experience – probably on both sides – of dealing with a client or opposing party who stubbornly sticks to a position until trial is imminent. Clients who employ more efficient problem-solving strategies do so in most cases because they understand that they will get the best results that way, and a contested trial date need not be scheduled in order to negotiate a settlement. There are no “court threats” because they are able to resolve their differences without the looming specter of a contested divorce. Moreover, where the bargaining positions of the respective clients are unequal – one is more financially experienced, or more legally knowledgeable, or simply more intimidating – the reality of “what the judge will likely do if we go to court” may be crucial to a fair settlement.

“Collaborative divorce” supporters also claim that clients are “more satisfied” with the results achieved with the collaborative approach. It’s not news that clients are more amenable to and more willing to comply with the terms of an agreed settlement than one that is court imposed. But what is the evidence that clients are “more satisfied” with a collaborative settlement than with a settlement reached through conventional cooperation and negotiation?

“Collaborative divorce” proponents contend that the process offers a way to practice law that is “more positive, more challenging, more rewarding, and more fun” than conventional practice. This is simply not the case for those of us who have historically settled most of our cases creatively, without having to give up the option to litigate if negotiations break down, or to dodge ethical issues, or to assume additional malpractice exposure..

Cooperative Divorce

The attorneys who are spearheading the “collaborative divorce” movement have adopted this idea with the best of intentions. They are looking in good faith for a more humane and less stressful way to deal with the sturm und drang of marital dissolution. They are legitimately frustrated with the waste of time and duplication of effort that goes into simultaneous settlement negotiations and trial preparation. They want to make a hard time easier for their clients and for themselves.

We can work toward these goals without running afoul of ethical rules, increasing malpractice exposure, and refusing to use the available resources of the court system appropriately to facilitate negotiated settlements wherever possible. Let’s call it “cooperative divorce.”

The “cooperative divorce” practitioner would:

Respect all parties and counsel and treat all participants courteously.

Respond promptly and in a straight-forward way to requests – both formal and informal – for information. (No paper bags full of unsorted documents, receipts, and junk mail in response to a request for production of documents; if you need an extension of time, explain why and ask for it rather than leave the opposing attorney to guess when he or she will hear from you, etc.)

Cooperate with rescheduling requests, requests for extensions, and the like as a matter of common courtesy. Everybody needs a break sometime.

Tailor information requests to the information needed for each specific case, rather than sending blanket, form discovery documents or routinely scheduling depositions without a specific purpose.

Educate his or her client about the other party’s rights and perspective, rather than simply supporting the client’s position regardless of its merits or the realities of the case.

Encourage the client to take a broad view and consider relationship issues. Help the client focus on the issues that can be resolved within the legal system and discourage justification of the client’s bad behavior on the basis of the estranged spouse’s total lack of redeeming qualities.

Prepare seriously for settlement negotiations; do the homework that is necessary to conclude the case. Run after-tax cash flow schedules and marital balance sheets; put together comprehensive parenting plans, update financial statements – as if the case were going to trial instead of a negotiation session. Too often we contribute to delays by being unprepared to negotiate effectively.

Keep his or her word. If a cooperative lawyer commits to provide information or a document draft by a certain date, he or she does so or makes a courtesy call to explain an unavoidable delay. If a cooperative lawyer makes a proposal in negotiation, he or she does not renege on the proposal on the table and retreat to a more favorable position for his or her client.

Use the legal system as a resource to help settle the case if appropriate.

Understand the rich menu of alternative dispute resolution resources and recommend their use as appropriate.

Maintain a civil and courteous approach. If litigation is necessary, stipulate where possible, cooperate with the admission of exhibits, accommodate the other side’s expert witnesses, and advocate for his or her client without becoming antagonistic.

Most good lawyers do most of these things most of the time. But we all slip up on occasion. Committing to “cooperative divorce” avoids the problems of “collaborative divorce” and improves the practice of family law.

Thanks to Gary Young, Allan Koritzinsky, Linda Balisle, and Margo Melli for their input and support of the “cooperative divorce” concept.

This articles provides general information only and is not intended as a substitute for legal advice. Nor does this article imply any attorney client relationship. This article is for informative purposes only and may not apply in your state, please consult an attorney in your area.

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Internet Business Secrets – The Power Of An Automated Money-Making System

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I was reading an email by a pretty high-profile marketer recently and he brought across what I thought was an excellent point. The truth is, I’ve been an advocate of having an automated business system online, as that is the best way to fully make use of the Internet to generate a stable income.

Having a sales system (or marketing funnel or whatever it is you call it) ensures that your business is powerful and reliable. Moreover, this system goes out to work for you.

A sales system, for those of you are not sure what it is, is the funnel your customers go through when they experience your business. This includes your website, your order form, your download page or order confirmation page, your bonus products, your email follow-up system, your customer support, and everything else your customer experiences.

On the Internet, unlike in offline sales, it’s not you yourself that’s generating the sales, it’s your machines! It’s your autoresponder, it’s your merchant account, it’s your web page.

Once you set it up and put your input into (say creating a web page), the ‘thing’ goes out to work for you and generates sales for you.

When you combine these factors, it comprises a system. And that system is powerful leverage.

Marketing and traffic is important, but so is your marketing system! So before you even start marketing and advertising your business, ensure that you have a marketing system in place, that will ensure your business gets off on a very strong footing that almost guarantees your future profits.

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How to Make Money Online by Proven Methods of Successful Internet Marketers

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Technology is changing daily at a very fast pace. Business is using this changing technology to improve their sales. Online Businesses and internet entrepreneurs can incorporate different techniques to use the internet to make money online; These techniques are not limited to but include; (1) Affiliate Marketing; (2) Surveys; (3) Software/Game Testing; (4) LinkShare Applications; (5) High-Powered Sales Promotions; (6) Multi-Level Marketing (MLM); (7) Gambling.

I have researched for years which online businesses have become and continue to be successful. Some businesses can be successful with very little thought but get lucky and are at the right place at the right time. They are what I call “fly by night” ventures in which someone has an idea and is able to get people to buy in to them and the founder makes a lot of money. They don’t last. Many of these are associated with the late night TV show promotionals in which you will see an authority figure such as a Doctor or PhD who says their product will help you become smarter, physically more attractive or lose weight to be glamorous. They all have web sites that continue the hard sell and you as a buyer must be astute not to be taken advantage of. These can be high-powered sales promotions or multi-level marketing (MLM) programs that sound great on the surface but underneath are pretty shacky. You might say these methods are not very ethical but many start-ups are not regulated and the result can be “let the buyer beware”.

Some are established, well founded organizations that have structure, purpose and missions with logical business plans. Those include Affiliate Marketing, Software/Game Testing and many LinkShare Applications. These are the ones that have well thought out business plans and will be around for the long term. I recommend you investigate these techniques if you have a desire to sell or test products.

Other online businesses are as simple as having you, as a consumer take surveys for money, click-on-links to make money or you can also find gambling opportunities for you to hopefully win money. Remember that gambling is money that is risked for possible monetary gain (“Great souls have wills; feeble ones only have wishes.”) and these internet business techniques, although well established and in many cases lucrative, utilize hooks to suck you in and make you believe you can beat the odds to make money online.

I have been successful at Affiliate Marketing and recommend this approach. All techniques can be investigated and you can make money doing them. But there are no free lunches in this world and you will need to work very hard and persistently to find the right technique for you.

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Things To Know When Selecting An Online Casino

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Online casinos are nothing but the online version of the conventional casinos. The popularity of online casinos is increasing tremendously in recent times. Online casinos enable the gamblers to play their favorite casinos games from the confines of their home. If your a casino enthusiast and want to play online then these tips would help you find the right US casino sites online.

1. While choosing an online casino the foremost thing to do is to check whether the casino has a good registration process. The registration process should be such that it should do a complete identity check and it must keep all your personal details secured. Some online casinos require you to give your own user name and the casino provides (administrator defined) password. It is advisable to not join such casino because the administrator defined password can be easily cracked and they can be easily manipulated.

2. While choosing a casino you must also consider the money security factor. You must choose a casino that offers you fund security. You must choose an online casino that uses reliable and authentic tools for money transfer.

3. To avoid any problems you should carefully read the contract details before joining. You can easily distinguish authentic casinos from others by their contract itself. These legitimate casinos have a detailed specification of their contracts. You should not join a site that refrains from giving its terms and conditions as chances are high that they can be fake.

4. Once all your security concerns are sorted out you can choose a casino that offers the best gaming experience and offer a high quality user interface.

5. You must choose a casino web site that provides a good payout scheme. You can also check an online casino directory for sites that provide good online casino bonuses.

6. Last, make sure the casino site accepts players from the country you live in. Not all casinos accept US Casino players for example so make sure the site accepts players from your country.

Once you have selected an online casino you will want to earn money and be successful at it. The key lies in learning the casino basics. The following tips would help you to be great gambler:

1. Before you start gambling on online you must pre-determine the amount with which you would play. Effective money management is the most basic tip to be a competitive gambler. If you set a limit for yourself you will lose less money and only what you can afford.

2. To start winning you should be very patient and be aware of other players moves. You can take advantage if you see other players are on a roll and you can increase your bet and increase your chances of winning.

3. If you are a beginner you must always start with games that require only limited experience. Though these games usually do not pay big winnings, they will help you to become a good player and allow you the opportunity to gain experience. You should not play complex games until you are ready and experienced enough. Once you have gained confidence of winning in these games you can go on to bet on games which requires higher skills and knowledge.

4. A very important tip to be successful while gambling on online is to know exactly when to stop playing. If you are reckless and continue to bet even when you are losing continuously then you can lose a lot of money. You must immediately stop betting when you are on a losing streak.

You must be aware of these facts and you must utilize the above mentioned while you gamble on online casinos.

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