Transcript: Fetal Development: The Third Trimester
Fetal Development: The Third Trimester
Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.
KAREN RUBY BROWN: You just enjoyed your most comfortable, energetic trimester and now you’re in the final countdown to meet your baby. As your pre-natal appointment frequency increases and your baby is doing a lot of fine tuning developmentally, you’ll be feeling some changes as well. I’m Karen Ruby Brown, a certified nurse midwife, and today we’re discussing what to expect during your third trimester. This is Preggie Pals.
STEPHANIE GLOVER: Welcome to Preggie Pals, broadcasting from the birth education centre in San Diego. Preggie Pals is your online on-the-go support group for expecting parents, and those hoping to become pregnant. I’m your host, Stephanie Glover. Thanks to all of our loyal listeners who have joined the Preggie Pals club.
Our members get special episodes, bonus content after each new show plus special give aways and discounts. See our website for more information. Another way for you to stay connected is by downloading our free Preggie Pals app available on the android, iTunes and windows marketplace. Sunny our producer is now going to give us some information about our virtual panelist program.
SUNNY GAULT: Yes, hello everybody, so if you are not located here in San Diego where we record. You can still participate in our shows. We would love for you to like our Facebook page for Preggie Pals. Also follow us on Twitter. If you’re on Twitter please use the #preggiepalsvp. That VP stands for virtual panellist. And I will be twitting out some of the things we’re talking about here in the studio, gives you a great opportunity to join in the conversation. You can ask our expert questions live if you happen to be following along. And we just want to share this experience with you so be sure to check us out. And if you want more information about our virtual panellist program, you can visit our website at www.newmommymedia.com
STEPHANIE GLOVER: Great! Thank you Sunny. So, we’re going to go around the table here and introduce our panellist or rather have the panellist introduce themselves. So, I’m going to go ahead and start with Sunny?
SUNNY GAULT: Yeah. I’ll go ahead. I’m not pregnant but I will say that I have four children. My oldest is four. So I have a four year old, a two year old, both of those are boys. And then I have identical twin girls Ainsley and Addison, and those are my girls. And they are ten months old now
WILLOW BUCKLEY: Hi, my name is Willow Buckley and I’m thirty five? Yeah, turn thirty six next week sorry. I’m a labour doula and homeopathic practitioner. And I have two babies. I’m not pregnant at the moment. One is one and the other one is three years old. Older boy, younger girl.
MICHELLE ASHLEY: Hi, my name is Michelle Ashley. I am thirty four. I am an insurance agent. I am due on December thirty first with my second son. And my oldest is about a year and a half, they’ll be twenty months apart
STEPHANIE GLOVER: Great
SUNNY GAULT: So you can have a new year’s baby
MICHELLE ASHLEY: Yes
SUNNY GAULT: And make the news
STEPHANIE GLOVER: Well thank you. Thanks for joining us
SUNNY GAULT: Alright so before we get started with today’s show. We are going to review an app. And this is actually focused on breastfeeding but I know all of the mommas here in the studio have had babies before so we are familiar with breastfeeding. This is actually called Mommy Log, and it’s an app for the iPhone and iPad. And this is an app for either moms that exclusively pump or at least have pumping, you know somehow in their routine. It is a free app, which is one of the things I love about it because we have enough things to pay for as new moms. And this is a really simple way to basically keep track of how much you pumped and when you pumped. And if there are any notes that you want to include along with your pumping schedule or you know anything that you know happen that may be unusual or anything you wanted to take note of.
But it’s a very simple app to operate. You can export all the information, if it’s something that you want to keep track of personally, or if you want to send it to your lactation consultant. And one of the things we just found on here that I really like is the idea of a timer. And at first I was like “oh, you know, I don’t like to look at a clock when I’m breastfeeding. I just kind of like to, you know, go with it” but for pumping, especially for those of you who are on a limited pump schedule like you’re at work and you need to be, you know, you just have a fifteen minute break or something like that. It does have a section that you can record and it actually gives you a countdown of how much time you have left. So anyways, I wanted to kind of throw this out there to our panellist and to Stephanie to see what you guys thought of this app if you had a chance to test it. And if not, just speaking from experience in pumping prior, is this something you think you would use? Stephanie, what do you think?
STEPHANIE GLOVER: Yeah, actually, yeah, we were talking about how to use the timer and I, I do agree with you know I think that it is a good option if you are on a limited time and fitting it in to a break. I was not a working mom so I do not have to pump often but I did take a class recently where I was pumping. And I did have to run in to another room for I only had ten minutes at that time. So I could have definitely used this app to help with that
SUNNY GAULT: Yeah. Totally!
STEPHANIE GLOVER: How about you guys?
MICHELLE ASHLEY: Well, I think if I was pumping exclusively I would probably use it more frequently. But the app itself is really simple and straightforward which I like. But again, with pumping I never got a lot out pumping with my first. So it actually was harder to track it because then I would be like
SUNNY GAULT: You’d be sad
MICHELLE ASHLEY: I’d be sad. I just like all that time and hardly anything. So, I think if I were in a situation, where I had to pump exclusively then I would definitely want to use something like it
WILLOW BUCKLEY: Yeah, I agree, I think if you’re exclusively pumping, you’re definitely going to have more of a use for it than those of us who are lucky enough to be at home more and not have to be on that rigid schedule of pumping. But I like the notes section because I noticed when I do have to prep for a trip or something where I’m going to have to kind of like rack up a ton of milk. I like to know, when I fed them last when I pump so I know “Oh my gosh I got eight ounces just now” but that’s also cause I was gone for ten hours. Or how did I get that much. You’d like to prep like “oh, I know I could probably get two ounces, maybe four” and that sounds like a very useful tool for those that aren’t pumping as often
SUNNY GAULT: Yeah. Absolutely
STEPHANIE GLOVER: And as a midwife, Karen do you have any, would you recommend this to another mom or?
KAREN RUBY BROWN: I had my kids during the days of pen and paper
SUNNY GAULT: What’s that?
KAREN RUBY BROWN: And I actually still have notes that I wrote. And they’re kind of keepsakes now so, the first thing that occurred to me is that
SUNNY GAULT: You wouldn’t have that anymore
KAREN RUBY BROWN: You wouldn’t that keepsake. But that’s not what it is about. I guess that’s okay. You know, for moms who are working, I think it could be really useful. And if babies are in the NICU
SUNNY GAULT: Oh yeah
KAREN RUBY BROWN: You should be able to [inaudible] so for new moms who are just getting all these going who don’t have their babies attached to them, it could be really helpful. I absolutely see the value. I like the fact that it doesn’t have a lot of bells and whistles because I think
SUNNY GAULT: It’s more simple.
KAREN RUBY BROWN: Less is more.
SUNNY GAULT: Yup, exactly
KAREN RUBY BROWN: Except when it comes to milk
SUNNY GAULT: That’s right
KAREN RUBY BROWN: Usually more is more
SUNNY GAULT: And there is a reason to cry over spilled milk in that case too
KAREN RUBY BROWN: Liquid gold, liquid gold
SUNNY GAULT: So again it’s called Mommy Log, it is a free app for Iphone and Ipad. And it sounds like were all giving it a thumbs up, yep?
STEPHANIE GLOVER: Thumbs up
SUNNY GAULT: Alright, thumbs up
STEPHANIE GLOVER: So today on Preggie Pals we’re continuing our series on foetal development moving on to the third trimester. Joining us today is our expert panellist is Karen Ruby Brown, a certified nurse midwife with extensive experience in a variety of birth settings including hospital, birth centre and home. She received her midwifery training and Masters of Science in Nursing from Yale University in 2002, has been with UCST midwifery service since 2003 and most recently opened a solo practice called Erin Midwifery, offering home and birth centre deliveries. Thank you so much for joining us Karen
KAREN RUBY BROWN: Thank you. Good to be here
STEPHANIE GLOVER: Great. So, when we’re talking about the third trimester, what week of pregnancy correlates to the third trimester?
KAREN RUBY BROWN: So the third trimester is the last third of pregnancy and it’s about twenty eight weeks till the time you deliver which could be. You, I know you asked that question yes?
STEPHANIE GLOVER: Yeah
KAREN RUBY BROWN: I like you ask that question
STEPHANIE GLOVER: Of course, well yes. So, I read that recently ACOG which is the American College of Obstetrics and Gynecology recently changed the definition of term from thirty seven weeks to thirty nine weeks. So, you know how, well actually I just answered that but, how, what would you find the range that’s most common for full term in your practice like what’s the most common delivery week I guess I would say
KAREN RUBY BROWN: Most people are going to have their babies a week or two before or a week or two after their due dates. The due date is really just kind of our best estimation based on all the information we have last period and it really, ultrasounds, that sort of thing. But
STEPHANIE GLOVER: And why do they change it? Do you know? From thirty seven to thirty nine weeks?
KAREN RUBY BROWN: A lot of you may have heard about the latest efforts to prevent early inductions to thirty nine weeks. So, we’re wanting to wait to thirty nine weeks now because we know that babies just do better. The longer they simmer inside, the better they do on the outside. So, thirty nine weeks is what we consider the earliest appropriate time for what we call elective induction, so inductions for no clinical reason. Honestly, you’re probably better waiting until forty or forty one weeks. Thirty nine is the early, kind of that early border
STEPHANIE GLOVER: Okay. Okay
KAREN RUBY BROWN: That said, babies who are born at thirty seven weeks are considered technically full term but they’re early term
STEPHANIE GLOVER: Early term. Okay, yeah because I think I read somewhere too that it’ll help with kind of the miss dated due date too if you kind of wait longer for induction, then you have less of a chance of premature delivery correct?
KAREN RUBY BROWN: Absolutely
STEPHANIE GLOVER: Okay. And so, when we’re talking about the baby’s development, when do babies lung mature?
KAREN RUBY BROWN: So long development actually takes place from early, early pregnancy and continues to the couple years of life. So it’s this whole continuum and it can be broken down into bits and pieces and to specific faces. Basically what happens is starting at about the twenty six week of pregnancy, the lungs start to manufacture a chemical called surfactant. And surfactant allows for the exchange of gases and that’s what the lungs do right they exchange gases. And that process of producing surfactant continues, continues, continues . . .
Like I said through year one, year two, year three but the critical, the critical kind of transition happens at around thirty four weeks. And so, sometime after thirty four weeks most babies have enough surfactant that babies are going to do alright if they’re born a little early. Even getting to thirty six or thirty seven, thirty six, thirty five weeks, kind of those early, the late pre-termed babies we call them now, can have a little bit of difficulty transitioning. So, thirty four weeks is kind of this magic line in the sand that is kind of, I suppose it’s arguably arbitrary, but we have to choose these lines in the sands somewhere right? And we find that most babies after thirty four weeks can breathe okay on their own. Some can’t, most can and before thirty four weeks, they have a higher risk of not being able to breathe on their own. So,
STEPHANIE GLOVER: And requiring being like what? on oxygen
KAREN RUBY BROWN: Re, yeah, yeah, various interventions to help them oxygenate. This goes in to all the reasons why if someone has preterm labour, they might get some corticosteroids injections to help the baby’s lung mature. So this goes in to a whole branch of kind of perinatal science. But, that’s what’s happening in the third trimester. And it’s critical of course, because that’s the main transition that happens when the baby is born, they got to breathe
STEPHANIE GLOVER: I feel like it goes hand in hand sometimes when we’re talking about term is whether or not the baby’s lungs we’re mature enough for the outside
KAREN RUBY BROWN: Exactly
STEPHANIE GLOVER: And I wanted to ask our panellists, what week gestation were you’re kiddo’s born?
MICHELLE ASHLEY: My son was thirty eight weeks.
STEPHANIE GLOVER: Okay
MICHELLE ASHLEY: So, he was just under ten days or just under two weeks. And so I was very lucky. My maternal side is where like faster cookers so I was prepared to go to forty three weeks because I know that’s just what happens. I didn’t have to, he was ready. And then my daughter was five days before her due date and I was annoyed because I had to wait longer than my son.
But with clients and everything else I noticed that there’s such a. I’m so over pregnancy and it becomes such a personal thing. Instead of looking back it really what’s the baby doing? So I think this panel right here and this information you’re offering could really help those who are so like itching, this senior IDIS they call it pregnancy tides right? They, they’re just done right? They’re so impatient but there has such a personal thing. And to take them back out of the self and go back to really what is developing still and what, there’s a reason why a baby’s not ready generally so
STEPHANIE GLOVER: Yeah I think my first was thirty five weeks, four days? Or I’m sorry thirty nine weeks, four days. And then my second was thirty eight, six so kind of on
MICHELLE ASHLEY: Opposite
STEPHANIE GLOVER: Yeah, a little bit earlier but. . . but yeah, it’s always interesting to see the broad range. So, Karen, how did the baby, how does the baby’s appearance change in the third trimester, you know for thinking about, you know, do they have hair, are they still scrawny, you know what are they looking like?
KAREN RUBY BROWN: There’s a ton of changes that happen, they’re finessing their appearance in a lot of ways. They have hair called lanugo which is that soft, downy, fuzzy hair that you can see especially on darker skin babies like on their ears and their shoulders, they’re so cute. And that tends to appear, uh, when does that appear? It goes thru different phases also. Lanugo has a history to it but in the third trimester, early third trimester, after twenty eight weeks, you’re going to see it developing. And it’ll get thicker. And then it’ll start kind of falling off towards the end of pregnancy. So the older a baby is in gestational age at birth the less hairy and fuzzy they’re going to be
STEPHANIE GLOVER: Okay
KAREN RUBY BROWN: Go hand in hand with the lanugo is the vernix which is that cheesy, that white cheesy substance. I describe it like the top of full fat yoghurt
MICHELLE ASHLEY: That’s a great description
STEPHANIE GLOVER: And what is the purpose of vernix?
KAREN RUBY BROWN: The vernix is really fascinating. It has a lot of different purposes. It’s an emollient so it kind of protects the baby’s skin as the baby’s kind of sleeping in a water bath for all that time. So it’s a very emollient skin barrier. It’s a bio film basically. It has microbial properties as well. It’s a very complicated complex cool substance that for a long time used to be just wiped off at birth although back in the day before gloves, nurses used to rub it in their hands as hand lotion because it’s the best, I mean we should bottle this stuff really
STEPHANIE GLOVER: It’s funny that you say that because when I had my second, she was, you know, cheesy and my husband was holding her and my doula was like rub it in, don’t you think about, and so my husband was like “yes” you know taking directions. He was just rubbing it right in she’s like that’s good stuff, you can’t get that anywhere
KAREN RUBY BROWN: No, you can’t
WILLOW BUCKLEY: There’s no beauty supply store for that
KAREN RUBY BROWN: They actually tried to make synthetic versions and they’ll have it just like making formula for breast milk. It’s going to have some of the properties but it’s not going to have all of the properties.
MICHELLE ASHLEY: The magic.
KAREN RUBY BROWN: It’s not going to have the magic. That’s exactly right. It also helps the skin transition to [inaudible]. So if the baby is not bathed for the first week, it’s going to help that baby transition. We think it also affects the microbiome. So there’s a lot of good stuff to vernix.
STEPHANIE GLOVER: Our baby’s movements as jerky as they were in the second trimester in the third trimester
KAREN RUBY BROWN: In the third trimester, the baby’s kind of run out of space. They get a little straight jacketed. So rather than feeling karate kicks and punches, you are going to feel more wiggles and jiggles
STEPHANIE GLOVER: Okay. And weight wise, where does the baby start out in the third trimester and how much do they typically weigh at the end?
KAREN RUBY BROWN: At the beginning of the third trimester, they’re about three pounds, two and a half, three pounds by the end. They can be anywhere from six to nine pounds or more. They pack on about half a pound a fat a week
STEPHANIE GLOVER: Oh wow
KAREN RUBY BROWN: Yep
STEPHANIE GLOVER: Great. And when does the baby respond to outside sounds or lights?
KAREN RUBY BROWN: Oh gosh. Early
STEPHANIE GLOVER: Oh okay
KAREN RUBY BROWN: Yes
STEPHANIE GLOVER: So before the third trimester?
KAREN RUBY BROWN: Before, well, yeah. If there’s a door slam, you can feel the baby startle. So that, those reflexes are in play in the uterus
STEPHANIE GLOVER: Okay. When we come back, we’ll discuss more fetal changes in the third trimester, we’ll be right back
STEPHANIE GLOVER: So, welcome back. Today we’re discussing fetal development in the third trimester. Certified nurse midwife Karen Ruby Brown is our expert. Okay so when does baby typically assume his favourite position in the utero?
KAREN RUBY BROWN: You know some babies assume a position really early on. They’re little creatures of habit. They find their little corner and they just tuck themselves in and they’ll be head down from you know, twenty weeks or whatever. Other babies are a little slower to follow the instructions of the universe
MICHELLE ASHLEY: To come in a jar
KAREN RUBY BROWN: To come in, exactly. Clinically we start paying attention fairly early at thirty weeks is when we really start kind of documenting. Get babies head down, the babies not head down, the baby’s sideways, the baby’s this way, that way. Because remember in the third trimester, baby’s going to be packing on fat right?
So, you want to allow them to get in to a good optimal position for birth before they’re too chunky to be able to move. You know, it gets to be, they have as harder time moving as we do when we’re fully pregnant. We’re rolling over in bed is the big event. It’s like, here we go, rolling over now.
So babies also just get very comfortable in two certain positions. So, for example, by thirty weeks most babies are going to be head down by thirty four weeks. We start maybe having discussions with the baby about getting head down. And most of those babies still are going to be head down by thirty seven weeks.
STEPHANIE GLOVER: Okay
KAREN RUBY BROWN: And if that’s not the case, then we have other discussions on what we can do. There is a really great website called www.spinningbabies.com I’m sure you all know about this. It’s packed full of information, there’s a lot of stuff in there. But if you can get into the spinning babies zone and spend some time with it. You could learn
STEPHANIE GLOVER: It’s got a manoeuvre through, but it’s filled with so much valuable information. Wonderful
KAREN RUBY BROWN: Yeah. So, by thirty four weeks most babies are going to be head down. Some are going to be stubborn
MICHELLE ASHLEY: Do you ever see in your practice the difference? Because I noticed with second time moms, because their uterus is now not like they say a pear. It’s more like a, an apple or something. Like it’s you know and it’s done it before. That they are likely to have more of a chance of flipping later in gestation than they would the first time which has that tighter uterus
KAREN RUBY BROWN: You mean flipping two breach? Or two, just any kind of
MICHELLE ASHLEY: Or back and forth like, you know, breached to non in the second baby or subsequent instead of the first?
KAREN RUBY BROWN: Yeah and it’s not just the uterus that’s changed shape. The whole body changes shape right? Once you’ve squeezed a human being in your body. All of the micro architecture, the ligaments, the muscles, the pelvis, everything
MICHELLE ASHLEY: Okay. Good point
KAREN RUBY BROWN: But, so they can flip more easily, but it also makes me less concerned as a midwife if I see a second time mom or third time mom who has a posterior baby late in pregnancy it just doesn’t concern me as much because more likely the body’s just going to help that baby pivot around
MICHELLE ASHLEY: Right! It’s done it before instead of the first time which is more lodged
KAREN RUBY BROWN: Yeah. But we do see moms who have had a bunch of babies who really don’t have the muscle tone anymore. And those babies can get into all sorts of funky positions.
MICHELLE ASHLEY: Right!
STEPHANIE GLOVER: And how would you determine the baby’s position? Is that, is it something that you would need an ultrasound for or you can tell it with your hands?
KAREN RUBY BROWN: A skilled clinician can tell with their hands. But we are sometimes faked out. So, ultrasound is can be helpful if your hands aren’t giving you the feedback that you need. But it also has to do with how much amniotic fluid is in there. If you’re like a tight water balloon it’s going to be hard to feel fetal parts and in cases like that ultrasound can be helpful. Now I will say that all midwives have sometimes gotten faked out by frank fringe babies feeling like they’re head down
STEPHANIE GLOVER: Because of the bottom
KAREN RUBY BROWN: So, you don’t necessarily need an ultrasound to help figure out that position. If you’re okay with this, a vaginal exam at that point you can feel the head
STEPHANIE GLOVER: Oh okay. And, for the panellist, did anyone have any positional challenges with your babies late in pregnancy or in labour?
WILLOW BUCKLEY: I guess. I might, I was a spoiled challenge because I did all my exercises, you know the spinning babies protocol and I had a nice optimal feel position that you know, on the left, the other way and it was super nice. And I went to a late night movie, the night before I went in labour, you never know when you’re going to go. Didn’t do uhm, wasn’t doing exercises and he ended up OP, so I had a little bit of back labour which I’m actually thankful for, I got to experience it.
So I know what it’s like because he turned pretty fast with some other things but that was the most which is big, like I said. It was a gift that that was I had to do
STEPHANIE GLOVER: Michelle, how about you?
MICHELLE ASHLEY: He was always head down
STEPHANIE GLOVER: He was compliant
MICHELLE ASHLEY: Very active but, no, he would, I think he knew where he needed to be to get going
STEPHANIE GLOVER: Nice. He read the books, he read the books.
WILLOW BUCKLEY: Let’s hope she does to.
STEPHANIE GLOVER: And it was interesting I agree with the OP position because both of mine were OP presentation we didn’t realize it was my first until I was already pushing for some time. And my second was OP over and over I was trying for a VBAC the second time around but she, she told my body what to do when I was labouring then I was hands and knees and I was just following queues so she did turn thankfully at the last minute. But which is funny they’re all different
MICHELLE ASHLEY: I’m just assuming the OP is what? Sunny side up?
STEPHANIE GLOVER: Yep
KAREN RUBY BROWN: That’s really fun
MICHELLE ASHLEY: You definitely was not
WILLOW BUCKLEY: Yeah the expression on your face as you said fun
KAREN RUBY BROWN: Well having had an OP baby myself having then attended women through OP labours, they’re not fun
WILLOW BUCKLEY: No, there’s nothing beautiful about back labour in terms of when it’s happening to you
STEPHANIE GLOVER: And when pregnancy comes to an end we hear a lot about baby engaging or dropping, what does that mean?
KAREN RUBY BROWN: So babies come down in to the pelvis before they have to come down to come out right? So the uterus kind of holds them, kind of high, the uterus holds them a little high in the belly. But at the end of pregnancy the pelvis relaxes a little bit. And the baby kind of twist and turns and splungs a little lower into the pelvis right?
So the head gets engaged into that boney bowl of the pelvis. And what that means is that then there’s more space up top so you may take a deeper breathe, you can enjoy a full meal, maybe you get some more heart burn because all of the soft tissue was loosening up and [inaudible] allow the gases to come through so some women experience more heart burn at that point. And if you thought you were peeing a lot, yeah a head on your bladder will speak loudly
MICHELLE ASHLEY: I’m always curious because there’s such a interesting camp on low amniotic fluid in women and what that means and what those numbers really are and testing in the doctor’s office. First the hospital, and then adding position and the health of baby in the induction words start to come. Do you see or do you have a number or do you see there’s ways to build it up or . . .
KAREN RUBY BROWN: The number has changed a little bit especially the top value. We used to think of too much fluid is being around twenty seven meters. And that’s a measurement on ultrasound. They’re not cubic centimetres or milli, it’s just a measurement. It’s how we’re able to do a vertical measurement on ultrasound. So that number is now twenty five.
So, again these things are, there is subjectivity to all of these right? Low fluid is considered to be less than five centimetres of fluid. Sometimes if moms hydrate really well, the baby will pee out more fluid because that’s all amniotic fluid is, it’s just baby pee.
Sometimes if there’s a low number it’s because it’s all in the kidneys and the baby needs to, they’ve swallowed that’s in the kidneys and need to pee. They pee, there’s more fluid.
MICHELLE ASHLEY: So it can vary within the week.
KAREN RUBY BROWN: Absolutely! It can vary from day to day. It can vary from hour to hour really.
MICHELLE ASHLEY: So could moms request another test?
KAREN RUBY BROWN: Yeah, of course it all depends on contacts but in certain contacts it would not be unreasonable to ask to drink a ton of fluid and then to re-test. But that’s something that it’s only once right? You need to talk about it with your health care provider. But it’s not always the best idea.
MICHELLE ASHLEY: No, definitely. I know it’s all individual. There’s so many different things around it I’m always curious
KAREN RUBY BROWN: Yep
STEPHANIE GLOVER: Well, thank you for joining us today Karen. For more information about Karen Ruby Brown as well as information about any of our panellist, you can visit the episode page on our website. This conversation continues for members of our Preggie Pals club. After the show, Karen will discuss fetal changes in post maturity, which is when the pregnancy continues beyond the average gestation. To join our club, visit www.newmommymedia.com
ANNIE LAIRD: Hi Preggie Pals we have a question for one of our experts. Joana in Seattle writes: I’m interested in seeing a midwife for my next pregnancy. But I’m so confused about the alphabet soup behind all their names. CNM, CPM, LM, CM. what does that all mean?
SUSAN MELVICO: Hi this is Susan Melvico I’m a certified nurse midwife and I’ve been practicing for thirty years in home, birth centre and hospital. And I wanted to answer your question about the alphabet soup behind the midwife’s name. Yes they are very confusing. But CNM stands for certified nurse midwife, CPM stands for certified professional midwife and LM stands for Licensed Midwife. And the difference in the connotation is the type of training for the midwife that’s had.
Certified nurse midwives are also registered nurses who go on for graduate training usually through university and then their master’s degree and are termed certified nurse midwife. Certified professional midwives are usually apprenticeships. There’s another homebirth midwife. And they usually apprentice for two to three years with a midwife where you one on one with them how to handle homebirth. And licensed midwives are licensed by the state that they work in and usually have either gone to a training school or to an apprenticeship as well.
Certified professional midwives are nationally certified and licensed midwives are usually licensed by the state. And certified nurse midwife are also nationally certified. And each state has its own regulations governing how a midwife can practice. So it’s important to know what your own state regulations are
STEPHANIE GLOVER: That wraps up our show for today. We appreciate you listening to Preggie Pals.
Don’t forget to check out our sister shows
• Parent Savers for parents with new born, infants and toddlers
• Twin Talks for parents of multiples
• Our show The Boob Group for moms who breastfeed their babies
This Preggie Pals; “Your Pregnancy Your Way”
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