Meconium is the medical term for a baby’s first bowel movement, which is typically a dark green or black, tar-like substance. When meconium is present in the amniotic fluid during labour, it often results in a cascade of interventions that can negatively impact the birthing process. This can include strapping a CTG machine onto your abdomen, which reduces your ability to move and increases the likelihood of a c-section or instrumental birth. Additionally, time limits for labour may be tightened, resulting in induction or augmentation, which can increase the chances of foetal distress and c-section for first-time mothers. During birth, the baby may be subjected to airway suctioning, which can cause a vagal response and difficulties with breastfeeding. After delivery, the baby’s umbilical cord may be cut prematurely, and the baby may be given to a paediatrician who may also suction their airways. The baby may also be regularly disturbed in the first 24 hours after birth to have their temperature, breathing, and heart rate assessed. In some hospitals, the baby may be taken away and observed in a neonatal unit.
However, it’s important to note that meconium-stained amniotic fluid is not always a cause for concern. Meconium is a mixture of mostly water (70-80%) and various other ingredients, including amniotic fluid, intestinal epithelial cells, and lanugo. Around 15-20% of babies are born with meconium-stained liquor, and there are several reasons why this may occur. One reason is that the digestive system has reached maturity, and the intestine has begun working to move the meconium out. This is most common, and it occurs in 15-20% of term babies and 30-40% of post-term babies. Your baby may also be in a breech position and as your baby moves down into the pelvis, the compression of the abdomen causes meconium to be excreted. Another reason is that the umbilical cord or head is being compressed during labour, which can stimulate a vagally mediated gastrointestinal peristalsis, and finally foetal distress resulting in hypoxia. This may relax the anal sphincter thus resulting in meconium being expelled from the intestinal tract into the amniotic fluid.
While meconium-stained amniotic fluid can be an indication of foetal distress, it cannot be relied upon as the sole indicator. An abnormal heart rate is a better predictor of foetal distress, and an abnormal heart rate combined with meconium-stained amniotic fluid may provide an even better indication that the baby may be compromised. However, most babies with meconium-stained amniotic fluid are born in good condition, and most babies who are born in poor condition do not have meconium-stained amniotic fluid.
Meconium Aspiration Syndrome (MAS) is a rare complication that can occur when a baby inhales meconium-stained amniotic fluid during labour, birth, or immediately following birth. Around 2-5% of babies with meconium-stained amniotic fluid will develop MAS, and of those, 3-5% of babies will die. However, the risk of MAS is very low, and it can be further mitigated by individual circumstances such as prematurity, congenital abnormalities, and additional labour complications.
Please see study below for more information:
https://www.sciencedirect.com/science/article/abs/pii/S1751721410001120
Meconium is only a problem if inhaled by the baby, and if there are signs in labour that the baby is in distress and may be compromised in some way due to hypoxia then this may increase the risk of meconium aspiration syndrome.
There are ways in which to minimise the risk of this such as:
Avoiding artificial rupture of membranes (ARM) during labour to prevent the detection of any meconium until the membranes rupture spontaneously, ideally after most of the labour is complete. In case meconium is present, it will likely be well-diluted, and the amniotic fluid will provide protection to the baby from compression during contractions.
It is important to know that the presence of meconium is a variation and not necessarily a complication. The practitioner should consider the entire situation, as the presentation of an overdue baby with old meconium differs significantly from a 38-week baby with thick and fresh meconium. If there is a concern, such as thick or fresh meconium during labour, increased monitoring or medical intervention may be necessary.
Creating a relaxing birth environment is crucial. Any interventions associated with foetal distress, such as ARM, Syntocinon/Pitocin, or directed pushing, should be avoided. In the hospital, no one should enter the room unless you desire their presence. If a paediatrician is required, they should wait outside the room until called upon.
To assist in clearing the baby’s airways, it is recommended to encourage a slow birth of the baby’s head in a position that allows airway drainage, with you not lying on your back. The baby should not be pulled out and you should wait for the next contraction while the airways clear themselves.
After the baby is born, the umbilical cord should be left intact until it stops pulsating to allow for a gentle transition to breathing. The baby should be kept skin to skin following birth. Report any concerns you may have about your baby in the next 24 hours, such as feeling hot or noisy breathing.
In conclusion, while meconium-stained amniotic fluid can be a cause for concern, but it is not always an indication of foetal distress, and most babies with meconium-stained amniotic fluid are born in good condition. Therefore, it is important to carefully evaluate the situation and individual circumstances before making any hasty decisions or interventions during labour and delivery.
For more information about the support and advocacy services I can offer, visit my home page:
https://loucinabirthkeeping.co.uk
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