The Curse of Meconium Stained Liquor

Dear unborn baby,

Please consider holding your poo in until after you are born. The big people on the outside get very stressed about your poo and will want to change the way you are birthed if they find any evidence that you have failed to keep it in. Your mother will be told that you are in danger, and will be strapped to a CTG monitor. This will: reduce her ability to help you through her pelvis by moving; prevent her from using water to relax; and increase your chance of being born by c-section. Your mother will also have her time limits for labour tightened up. This may lead to labour being induced or augmented which will put both of you at risk of further interventions. You will be expected to get through your mother’s vagina quickly and if you take too long you will be pulled out with medical instruments. As you are being born you will have plastic tubes pushed into your nose, mouth and throat to suction your airway. Once born, your cord will be cut immediately and you will be given to a paediatrician who may also put tubes into your nose and mouth. You will only be given back to your mother once you are crying effectively. You may not feel like breastfeeding after being suctioned – don’t worry, this is normal. In the first 24 hours after birth you will be disturbed regularly to have cold items put onto your skin to monitor your temperature, breathing and heart rate. In some hospitals you will be taken away from your mother to be observed in nursery. So, if at all possible do your mother and yourself a favour and try to hold on to your poo until after you are born.

Meconium facts

Meconium is a mixture of mostly water (70-80%) and a number of other interesting ingredients (amniotic fluid, intestinal epithelial cells, lanugo, etc.). Around 15-20% of babies are born with meconium stained liquor.

There are three reasons (theoretically) that a baby will open his/her bowels before birth (Unsworth & Vause 2010):

  1. Because their digestive system has reached maturity and the bowel has begun working. This is the most common reason and 30-40% of post-term babies will have passed meconium in-utero.
  2. Because their cord or head is being compressed (during labour) ie. a vagally mediated gastrointestinal peristalsis – the same reflex which causes variable heart rate decelerations. This is a normal physiological response and can happen without fetal distress.
  3. Fetal distress resulting in hypoxia. However the exact relationship between fetal distress and meconium stained liquor is uncertain. The theory is that intestinal ischaemia relaxes the anal sphincter and increases gastrointestinal peristalsis = passage of meconium. However, fetal distress can be present without meconium, and meconium can be present without fetal distress.

Meconium alone cannot be relied on as an indication of fetal distress: “… meconium passage, in the absence of other signs of fetal distress, is not a sign of hypoxia…”(Unsworth & Vause 2010). An abnormal heart rate is a better predictor of fetal distress; and an abnormal heart rate + meconium provides an even better indication that a baby may be in trouble. In addition, thick meconium rather than thin meconium is associated with complications. Despite this, babies who are known to have passed meconium (of any variety) without any other risk factors are treated as if they are in imminent danger. I am guessing this is because if a previously unstressed baby becomes hypoxic during labour it may result in the dreaded MAS.

Meconium Aspiration Syndrome (MAS)

MAS is the major concern when meconium is floating about in the amniotic fluid. It is an extremely rare complication – around 2-5% of the 15-20% of babies with meconium stained liquor will develop MAS (Unsworth & Vause 2010). Of the 2-5% of the 15-20%, 3-5% of babies will die. OK enough %s of %s – basically it is very rare but can be fatal.

MAS occurs when the baby inhales meconium stained liquor during labour, birth or immediately following birth. You can see a simple explanation of MAS in utero (where it usually happens) here. However this animation does not detail why aspiration might take place.

Babies make shallow breathing movements during pregnancy. Breathing movements slow down in response to prostaglandins before birth. During labour and birth it is very unlikely that a baby will inhale liquor (and any meconium in it). This will only happen if the baby becomes extremely hypoxic and begins to gasp in utero in an attempt to get oxygen. So, meconium alone is not a problem. Meconium + a hypoxic baby = the possibility of MAS (Davies & MacDonald 2008).

Bizarre Practice

So you would think that the sensible thing to do if a baby has passed meconium (for whatever reason) is to create conditions that are least likely to result in hypoxia and MAS. This is where I get confused because common practice is to do things that are known to cause hypoxia, for example:

  • Inducing labour if the waters have broken (with meconium present) and there are no contractions or if labour is ‘slow’ in an attempt to get the baby out of the uterus quickly.
  • Performing an ARM (breaking the waters) to see if there is meconium in the waters when there are concerns about the fetal heart rate.
  • Creating concern and stress in the mother which can reduce the blood flow to the placenta.
  • Directed pushing to speed up the birth.
  • Having extra people in the room (paediatricians), bright lights and medical resus equipment which may stress the mother and reduce oxytocin release.
  • Cutting the umbilical cord before the placenta has finished supporting the transition to breathing in order to hand the baby to the paediatrician.

Suctioning the baby’s airways?

I am unsure whether this is common practice or not. Evidence based clinical guidelines generally recommend NOT suctioning a baby’s airways unless they are unresponsive, floppy and require resuscitation. And then only to do so using a laryngoscope so that you can see what you are doing. Guidelines: NICE guideline, Resuscitation Council UK, more guidelines. Key research: Wiswell et al. 2000Vain et al. 2004. So, I would assume that practice would be informed by these guidelines.

However, on my frequent youtube birth-surfing trips I encounter suctioning of babies often (without meconium present). Both ‘on the perineum’ and following birth. I have seen this being done at hospital births, homebirths, and even unassisted births. You can see an extreme version of suctioning in this previous post. A more conservative method using the suction bulb pictured above seems to figure in a lot of the homebirths on youtube. So, I am guessing that this is a common routine practice in the US. Therefore, I feel obliged to reiterate why this is not only invasive and pointless but may also be detrimental. Suctioning at birth does not reduce the risk of MAS but can:

In addition I am guessing it is not a very pleasant experience/welcome for the baby. Anyway, the birth process takes care of the mucous and amniotic fluid in the baby’s airways. As you can see from the photo below the airways clear as the head is born and while waiting for the next contraction – the chest is compressed, squeezing the fluid out and gravity helps it to drain. Babies born by c-section miss out on this and are more likely to end up with problems associated with fluid in the airways and stomach.

From Navelgazing Midwife’s blog (hover on photo for link)

Suggestions

All babies deserve to have the least stressful arrival possible. It is even more important that a baby who has passed meconium does not become stressed and hypoxic during labour and birth because it could lead to MAS. The following suggestions apply to all births including when there is meconium stained liquor.

  • Avoid an ARM during labour so that any meconium present is not known about until the membranes rupture spontaneously (hopefully this will happen after much of the labour is complete). If there is meconium present it will remain well diluted and the amniotic fluid will protect the baby from compression during contractions.
  • Ensure that the mother knows meconium is a variation and not necessarily a complication… the practitioner needs to consider the holistic picture – a post dates baby with old meconium is very different to a 38 week baby with thick fresh meconium.
  • If this is a concerning scenario ie. not post dates and thick meconium… or fresh meconium occurring during labour then increased monitoring and/or medical intervention may be required.
  • Otherwise, create a relaxing birth environment.
  • Avoid any interventions that are associated with fetal distress – ARM, syntocinon/pitocin, directed pushing.
  • In hospital do not allow others into the room unless the mother wants them there. If there is a policy to have a paediatrician present they can wait outside the room to be called if needed.
  • To assist with airway clearing encourage a slow birth of the baby’s head in a position that allows drainage of the airways (ie. mother not lying on her back). Do not pull the baby out – allow the mother and baby to wait for the next contraction whilst the airways clear themselves.
  • Once baby is born leave the umbilical cord intact until it has stopped pulsing to allow a gentle transition to breathing.
  • Keep baby skin to skin with mother following birth.
  • Encourage the mother to let you know if she is concerned about her baby in any way over the next 24 hours (eg. feeling hot, noisy breathing, etc.)

Summary

Meconium in itself is not dangerous unless it is inhaled by the baby. For some babies meconium is a sign of hypoxia and they are at risk of meconium aspiration – these babies need additional monitoring and perhaps medical intervention. For most babies ie. those who are post dates, meconium is a sign of a mature bowel that has begun to function – in these cases the aim should be to avoid hypoxia during labour and therefore meconium aspiration.

 

About midwifethinking

independent midwife, lecturer and student of all things birthy
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122 Responses to The Curse of Meconium Stained Liquor

  1. Thanks for another informational post. I’m doing lots of research before I become pregnant and your blog posts are really helpful!

  2. A wonderful blog post as usual Rachel. I love the way you delve deeply into a topic and manage to make it easy to read at the same time.

  3. Thank you for ANOTHER amazing post. When I have share this information with others, health care providers as well as midwives, it goes unheard. So many midwives suction with their provocative “blue bulb”, regularly, as protocol. Thank you for the researched footnoted studies. I am a doula, midwife ass’t, childbirth educator, and a certified lactation counselor. I yell it from the rooftops……to stop suctioning. What a blessing you must be to your mamas! And brilliant to boot!

  4. Shirley says:

    When my 6th baby was born, there was meconium in the water, which broke as he crowned. We had an unassisted birth and although my head knew that discolored water was not a good sign, my heart knew that he was fine. He arrived looking beautifully pink and breathed straight away. I later did a bit of research and also discovered that hundreds of babies are born with meconium in the waters and most of the time this is not a cause for concern or intervention – its just another variation of ‘normal’!

    The birth story and pictures of my son immediately after birth are at Unassisted Child Birth Story.
    You can see the meconium-stained fluid on the white tiled floor at my feet in the one photo.

  5. Thanks for the comments. It’s nice to know people find the information useful.

  6. Thank you Thinking Midwife for setting out in a systematic way very similar thoughts to my own about meconium presence in liquor. As always as midwives we should be doing the least harm possible whilst being alert to potential problems. I have always felt that where meconium is known to be present I see my role as keeping the mother as calm and relaxed as the circumstances permit to make aspiration less likely.
    Do you ever tickle a babies nose to help her/him sneeze to clear the airways?

    • Hi Liz – no I’ve never tickled a baby’s nose but I’m sure it is a lot more pleasant than sticking a tube up : )

    • v says:

      Rachel, this is my intro post to your blog and I love it. Thank you.
      I like looking at the whole birth story holistically, mec present means shit. Sorry for the pun. Also, I would like to see a ban on the bulb syringes. I think they should be part of the the emergency res equipment, alongside the oxygen tank shuffled in the corner of the room, far away from everyone to do any harm but there not to jinx your karma. :)
      Seriously. When I gave birth to my second one the RM managed to stick that bloody syringe in his nose so fast I had no idea what hit me and when I protested it was too late and I was chided like a naughty school girl. :)
      I like the tip of asking other hospital staff to wait behind the door until called in.

      Crystal great to know you are researching. However, this will not help you to deal with RMs here. :) I had a fight with my own about this.

      about tickling a nose to assist with sneezing out … I am sorry but this just reminds me “what else can we do to the baby to assist his defective self”. In my personal experience … if a baby needs to sneeze … it surely will.

      • NanaKim says:

        Michel Odent has an interesting take on meconium. He says, “Zee significance of meconium is a patent anus!” It just means baby’s bum-hole works! The other factors that you mentioned are more significant than the appearance of meconium.

  7. Cassandra says:

    I just gave birth on 10/4 at 5:09 in the morning, after my water broke without contractions and large amounts of meconium chunks at 11pm on 9/30. My midwives did a fetal check every day to make sure there was no stress as contractions picked up and slowed down. Contractions finally hit steady midday 10/3 and at about 1am 10/4 finally entered active labor. Four hour active labor, half hour pushing for a first time, “high risk” momma, with several days broken water and meconium…I was blessed to be under the care of awesome midwives; I would have been sectioned for sure instead of having such an awesome birth!! As her head came out there was a thick chunk of meconium across her face too and the midwife just swiped it away in the water. She popped out two pushes later and went straight into my arms with banshee screams. Not a thing wrong with her!

  8. becky says:

    Okay I am sorry for posting this and I do not want to upset people. However I delivered a baby that passed away because she had inhaled meconium. After testing and autopsy the reason of her death was she had meconium in her system……

    • Please don’t be sorry for posting. Unfortunately meconium aspiration can cause death as I state in the post. This is why it is important to reduce the chance of the baby becoming hypoxic and inhaling during labour and birth if there is meconium in the fluid. For some babies this will not be possible to prevent. I am sorry that you lost your baby and it is important that you can share your story without apologising. x

      • Concerned says:

        But isn’t that why some babies pass meconium ie because they are hypoxic?????? Without fetal monitoring how do you know if that bub is hypoxic?

        • Did you read the post?
          “Meconium alone cannot be relied on as an indication of fetal distress: “… meconium passage, in the absence of other signs of fetal distress, is not a sign of hypoxia…”(Unsworth & Vause 2010). An abnormal heart rate is a better predictor of fetal distress; and an abnormal heart rate + meconium provides an even better indication that a baby may be in trouble. In addition, thick meconium rather than thin meconium is associated with complications.”
          You are assessing fetal heart rate during labour. Looking at the whole picture will inform what method is appropriate. eg. postdates, thin mec, no fh abnormalities with doppler = carry on with doppler… 39wks, fresh thick mec = indication for ctg.
          You could argue that you don’t know whether any baby is hypoxic without fetal monitoring… but obstetric guidelines specifically state not to monitor low risk women with a ctg as it increases c-section by 30% without reducing neonatal morbidity/mortality.

    • KAndrews says:

      Thank you for sharing that Becky. I am so sorry to hear about your daughter. I know several woman/babies who have had severe and life threatening experiences with merconium. I am shocked and alarm at this post and the comments in support. We should not be minimizing the risk in the minds of parents.

  9. Laura Jane says:

    Once again, a thought provoking post.

    I have hardly ever suctioned a baby on the peri as I prefer to let gravity do the job, or just give them another ‘perineal sweep’ wipe to ensure the mouth and nose are clear of excess goop before they take a big breath. They are usually fine.

    However I have seen a few babies badly affected by MAS – mostly with oligohydramnios + Mec 2/3, as well as babies badly affected by over-zealous suctioning and separation at the time of birth.

    Mec 1 is not even an issue in my book, that boat has sailed! If I can see through it and there are no flecks or chunks it seems a shame to tie women to a CTG!

    • I agree oligohydraminios + thick mec is not a good combination – even worse with a SGA baby. I have never suctioned a baby on the peri. We weren’t taught how in the UK because it was never done. The obs never did it either. I have suctioned a few babies after elective c-sections though – they really miss out on a good squeeze on the way through.
      It is usually hospital policy to put a CTG a woman if there is any type of mec. I find keeping the lighting dim results in light meconium not being noticed until after the birth is over ; )
      I hope you’re enjoying your new job.

      • v says:

        I agree with the lights. As I mentioned before I argued with my RM. The old policy was to see if mec was thin or thick before transferring to a hospital but new policy came into effect that any mec meant transfer. I was pretty choked and worried. I opted for no lights but a fireplace and streetlight streaming in, and in blue birthpool with black edge at the top. It turned out to be a good thing as there was a bit of mec, that went uncommented on and unnoticed until the lights went on. My dd was just perfect though. She had to be made to cry, however, just so we could all go “aaww, don’t cry, you are OK.”

        • Thanks for visiting my blog V
          I still find it hard to believe that bulb syringes are used in a routine way at birth. I have never even seen one in real life. I carry a mucous extractor in my kit but have never used it and it remains in the packet wrapped in the corner of the birth room, out of sight along with the ambi bag and oxytocics.

  10. This is definitely another reason for mothers to not allow their waters to be artificially ruptured. My 1st hbac (home birth after ceasarean) baby was in lower transverse arrest for two hours. I had made it clear before labour that I would not accept ARM under any circumstances. She was born in her caul, and when the amniotic sac was opened there was mec present (she was 5 days overdue). However, she was born screaming with Apgars of 9 and 10. As a ‘high risk’ vbac with a badly-positioned baby, had I allowed my waters to be broken and the mec was seen, I have no doubt I would have been rushed to hospital for an ‘emergency’ c-section.

    • I should add, though, that the midwife I had on the day was a very sensible one, and perhaps would not have recommended transfer (when the mec was seen after delivery she was the one who said not to worry, it was common in post-dates babies). My comment was a little more generalised, as in: under average circumstances, an NHS mw following protocol would most likely have recommended transfer if mec was seen pre-birth in a hbac labour/delivery.

      • Meconium is an indication for transfer from an NHS homebirth. So it was good that the meconium stayed hidden until it was too late. Also, you could have declined transfer if it was suggested. But who needs to be dealing with that while labouring : )

  11. Pingback: Being Informed About Childbirth, Breastfeeding, and Babies | Health, Home, & Happiness

  12. Cara says:

    I love seeing this written out, thank you! I hadn’t thought much about meconium in birth other than it was a concern and possible reason to transfer, and also that it could just mean a breech baby. I think the approach I’d take would be to just do more frequent baby heartrate monitoring, but thank you for bringing it up!

  13. Jade says:

    I have had 2 babies with mec staining in teh fluid. One was a hospital birth and they did all the things that you mentioned are a bad idea (I did research afterwards and found out that in my case what they did was certainly not best practice or logical) My homebirth baby we did nothing with other than what you mention about gravity and stress free environment etc. I am so angry with myself for letting them assault my poor baby boy but I knew no better. And it led to the horrid things you mention and in fact the breastfeeding never resolved, he would not could not stand anything near his mouth.

  14. mamapoekie says:

    Thank you so much, great post! Shatring this and Sunday Surfing it!

  15. Julie Robbins says:

    Hi,

    Great, informative post–I plan to use it to ask my birth center midwife about her policies about mec. Question: What if I plan to birth my baby in water? If there is meconium present, does it make a difference for better or worse in terms of safety? Thanks, Julie

    • Hi Julie
      There has been no research on water birth with mec because it is generally a contraindication for getting in or staying in water. Also there is usually a policy of CTG for any mec which then prevents the woman using water. I am sure home birth midwives and women who have home birthed have stories of waterbirth with mec though. You may find that a birth centre will transfer care if there is mec.

      • Rebecca says:

        Hi,
        Just found your blog for the first time! It’s fantastic.
        Julie, in my experience mec in a waterbirth is no different from dealing with mama poo in the water….if its solid scoop it out with a net. If it’s not particulate, the stained fluid just become further dilute as it mixes with the tub water. Babes don’t breath until their faces are out of the water anyway!
        That’s my homebirth practice though, if you’re at a birth center that follows is protocols closely, mec could definitely lead to being asked to leave the tub and/or transfer.
        Have a wonderful birth journey!

  16. sarah neilson says:

    what a wonderful blog, thankyou!

  17. Heather says:

    Both of my labors were actually realized when my water broke (I have major prodromal labor–4 weeks with my first, just a few days with my second, but one of those days was 7 hours of 2 minute contractions–on the day of an OB appointment and I declined to be checked and informed him that I was not in active labor and not to worry, lol). My first was an iatrogenic cesarean because my body needed to dilate past a 10, which is so rare as to be virtually unknown in the obstetric world and only a few midwives seem to know about it… or don’t care because they don’t bother measuring. So, after pushing ineffectively in several different positions for an hour and a half, I was too tired to continue and rather than let me rest (as I’d just gone into transition and couldn’t speak intelligently, felt panicked–the usual transition signs), they sent me off for the cesarean. Baby was cleaned and suctioned on my stomach for a minute or so before they cut the cord and showed her to me.

    With my second, she was a VBAC, I got to the hospital after waiting for transition, to find out that I was at a 2 (and still quite in transition–and would be… for 8 hours before I would get assistance and only finally because the baby and I had been in distress just too long–I quickly dilated and entered the pushing phase after pain relief was given… something I didn’t need in my first labor).

    My water broke as they were talking about sending me home–just as full of mec as her sister (who had been 42 weeks, my second was 39weeks, 5 days when I went into labor, 39, 6 when I gave birth). Neither hospital treated me differently upon discovering it, except that the second didn’t want to let me catch the baby due to the risk of aspiration, but my doctor overruled them, I caught her and pulled her onto my stomach, where she was suctioned (she had a very fast birth–20 minutes of pushing, but only a few minutes between head and body birth, she just rocketed out on a contraction–I wasn’t pushing–as soon as the nuchal chord was removed, barely giving me time to catch her). There were copious amounts of meconium in her mouth, nose and ears (I was still cleaning it out a few days later).

    I’ve wondered if a water birth would make it a safer transition for babies with meconium in the water. They just built a birth center in my city, so I have an option aside from the hospital, as long as they are licensed and insured for VBAC (so ridiculous that special insurance is needed!!) and I’m hoping to finally have the kind of birth I’ve always dreamed of.

    My first wanted me in the water, my second couldn’t stand it. When I got in the water, the pain became unbearable. Very strange.

    Anyway, just my musings. I do wonder why my babies like to poop in me and I really wish they’d cut it out, lol. With the first, being 42 weeks was likely the culprit, but with the second, they had no idea. Because my waters were filled before she ever went into distress, her dates were perfect (based on ovulation after a miscarriage), etc. Didn’t seem to fit any of the three known categories.

    Thank you for this interesting article. Being in the US, outside of some homebirths, I’ve never heard of a baby being born without being suctioned. I figured it had replaced hanging the baby upside down and hurting it to removed the fluids.

    • Thanks for sharing your experiences. Some would argue that a waterbirth is gentler for the baby and often the cord continues to pulse for longer allowing the baby to establish breathing gently and reducing the chance of gasping. As for suctioning… we used to hang babies upside down to remove fluids then moved onto abusing them with plastic tubes. Babies are perfectly capable of clearing their own airways and did so for thousands of years before we decided they needed help. I hope you get the birth you always dreamed of – make it happen : )

  18. Sara says:

    Thanks for another great post :) I think suctioning is almost always done here in the US, although I don’t remember if they suctioned my daughter- she was born super fast after we got to the hospital and I caught her myself, so maybe not! I was very fortunate in that we planned a hospital birth for financial reasons, but even my unborn child knew that’s not where I wanted to be- I labored calmly at home for about 3 hours (didn’t really know I was in labor) and realized she was close to being born when pushing started. We only live 5 mins from the hospital, so she was born 15 minutes after we arrived, peacefully (for me! Everyone else was a little panicked, lol). We delayed clamping the cord and moved almost immediately to a postpartum room. I was totally in a dream and couldn’t believe that it was over that fast. It was seriously about the most perfect labor possible and I couldn’t wait to do it again, even right that day. I knew I would have another baby!

    Contrast that with my coworker who had her baby a few months after me. I told her over and over how awesome labor could be and not to be afraid of it, that she really needed to trust her body. After her water broke labor was induced and she ended up with a c-section after only 8 hours. When we went to the hospital to see her her husband said “we’re not having any more babies!” I could see the trauma in his face; it really made me sad.

    I am really getting sad about the state of maternity and baby care here in the US, almost to the point of not wanting to say anything to people because who am I to tell them that their doctor is wrong? A friend of mine who is African had a baby last week and is already supplementing with a bottle because they told her that she didn’t have enough milk! She nursed her first son for over 2 years, and they are already sabotaging her efforts for this little boy. I tried to give her some advice, but why should I be the one doing it?! I work in an office doing data entry! ugh.

    anyway, sorry for that rant. So many people that I know are having babies and being let down by they system. It makes me very sad.

  19. Shann says:

    Thanks again for an informative post,
    Just a comment re protocols in Australia. My 2nd big baby passed mec on his way out (ie his head and shoulders where clean and no mec in the waters but as he came out he was squeezed and tonnes came out after him). They treated him as though he had inhaled the mec, suctioned, special care nursery, separated from me etc, etc. I kept telling him he couldn’t have inhaled it but to no avail. Also as he then passed no other mec in that 24 hours he was subjected to further tests regardless of my protests that a hell of a lot had already come out of him!

    • Your experience just illustrates how much practice has ‘lost the plot’. Instead of using common sense, people follow policies that are clearly stupid in many situations such as yours. Lots of babies pass mec as they are born – probably due to head compression and then their abdomen being compressed on the way through. And of course if he passed huge amounts of mec at birth he won’t pass as much after birth. It would be great if practitioners started looking at the bigger picture and listening to mothers.

  20. jespren says:

    (Just found this blog, I think its going on my weekly check/read list) I have an interesting story on mec: my 1st was born at home and was a beautiful labor that ended in a horrible last 5 min & a baby born without breath or pulse. My wonderful midwife got his pulse back (unfortunately they had to cut cord to work on him) but could not get his breathing going. It was only when they suctioned his lungs at the hospital did we find out he had a severe MecAsp that ended up requiring a run on ECMO and a 32day NICU stay (he’s a wonderfully healthy 2 yr old now). We were all surprised because there was 1) no mec in the waters, 2) no mec in the prebirth, 3) no mec on baby, and 4) no mec visible in the afterbirth. Now my 2nd child had visible diluted (thin) mec when my waters broke came out squalling and had no asperation issues. My point? Don’t really have one past that, as a mother of a MAS child that DIDN’T show mec I find it really hard to put that much stock in it as a protent.

    • Thanks for your sharing your experiences. There is so much we don’t know about birth and individual stories really highlight our lack of understanding. I’m pleased your son pulled through.

  21. roclafamilia says:

    Helpful blog, bookmarked the website with hopes to read more!

  22. Autumn says:

    Great post :)

    My home born babe also had meconium. I will assume that it was just because a. her anus was patent and b. her bowels were mature. She was born 20 hours before her EDD, in less than 30 minutes from the first contraction. It was a perfect, surprise, unassisted birth.

    I have to admit the mec. worried me a little when I saw it, but when I described it over the phone to my midwife she said to me “that sounds quite fresh, I wouldn’t worry about it” and then about 15 minutes later she came flying out :D

  23. Cherise says:

    I’m new to your blog and this post just struck me. Thanks for the information. Interesting read. My story: First child was a planned homebirth who had some fetal distress late in labor. Though heartbeat appeared to stabilize, my midwife was concerned and eventually decided we should transfer to hospital (note my water didn’t break until I was 7 cm, probably in the shower and unnoticed but no obvious meconium present as far as she could tell so at least she didn’t say that was an issue in the decision to transfer). I agreed. Once at hospital (already 10 cm by arrival), heartbeat stablized and all appeared fine. The OB on call asked if I wanted to continue vaginally as all looked well. I said yes. 3 hours later I was still pushing…my daughter finally came out, apparently full of meconium, and though the OB felt initially the situation didn’t warrant an extreme emergency, NICU came in immediately (so cord was also cut immediately), intubated my daughter and whisked her away. At the time, her doctor later told us, they did not think she’d survive the first 12 hours as they had never seen MAS so severe. The next 48 hours were concerning and ECMO was considered, then she did a magic turn around and by day 7 was extubated. She remained in hospital until 18 days old, but overall recovered really really quickly. The team (OB, neonatalogist, other experts) felt the aspiration probably occured very late in labor, possibly just as she emerged, because it was both so acute but also so quickly cleared given its severity. There’s no way to tell, and though my OB regretted the decision not to do a C-section and my midwife wondered if the decision to transfer to hospital was the right one, overall, we felt all decisions made were right at the time given the knowledge we all had. Fortunately, we have a wonderful outcome: a very healthy 4.5 yr old daughter who shows no signs of oxygen deprivation (another reason they felt aspiration occured late) or other significant delays (some gross motor delays the specialist felt was due to the heavy sedation for the first 7 days, all having now been resolved).

    Of course we wonder, what if things had been done different. And what steps we took might have caused this – did suction contribute? did the atmosphere at the hospital (high stress) contribute to the difficulty delivering?

    Baby # 2 was born at home with no incident, though labor also stalled at 7cm and my water never broke on its own.

    • Thanks for sharing your story. Sometimes we have to accept there may be no answer to why. The MAS may have during the heart rate abnormalities – who knows. You have a strong daughter who made it through a rare but dangerous scenario. By the way your 2nd labour didn’t ‘stall’ – pausing, slowing, stopping etc are all part of normal labour when left alone : )

  24. bebo mia says:

    Thank you so much for this post. I am a birth doula and I have noticed over the last year there has been a lot more interventions due to MEC then I ever have in my practice. This is the best blog/information I have found on this subject, thank you so much!

  25. lulu says:

    Hello. I was researching and came across this blog. I have a horror story. I waited until I was 32 to have my first child. On Sept. 11, 2010, I woke up in labor, I waited until about 4:00 in the day to go the hospital. None of my regular doctor’s were on call, but a nurse called my doc and she came in. I was dialted 4, and having horrible contractions so i got an epidural, I could always still feel my legs! My blood pressure crashed and the baby’s heart rate went to 60, they ganve me epinepherine * 2. Any way when I arrived at the hospital the nurse said did the doc mention she ruptered your membranes in the office Thursday, I said no. About 6:30 the doc started pitocin and broke my water, upon this she discovered the baby had had a bowel movement. I ask her if we should try to get him out and she said no. My baby was also having fetal bradycardia. At this point I am scared. At 9:30 she came in and told me to start pushing. Almost immediately his head came out and a soon as the contraction would end he would suck back in. I knew something was wrong, to,add to this he was face up. This went on for over an hour. His heart rate was going to nearly nothing. They turned the pic up and the epidural off. The doc starts to use the vacuum without telling me anything. Finally he came out with nuchal cord * 2. He was black. They suctioned him and brought him to me to breastfeed. He was screaming so loud and high pitched i knew something wasn’t right. That night they took him to bath him and do assessments, well they never brought him back the next da around 10 am the ped came in and I asked what’s wrong with my baby and she said he was doing some shaking and the nurse was afraid to tell me. She said she thought he would be just fine. Fast forward till right before we were going home. He stared having sezuires, they had to fly my child to a NICU, were it was discovered he had a subdural hematoma or brain bleed. We stayed in the hospial 4 days, my child was placed on phenobarb. After being home for 3 days he started jerking again so back to the hospital , repeat CT and EGG. Three days later we came home. I wouldn’t even drink caffiene when I was pregnant with my baby, so no one knows how it felt to have to give him that medicine. Luckily when we went back to the nureo scientist they let us ween him and he is now off the medicine, unfortantley they can’t rule out future problems. I woul like a profeesional opinion about all of this, no one can begin to understand how we have suffered and worried. My child is beatiful and happy. He laughs,plays, and is a joy. Hopefully he won’t have future complications!

    • I am really sorry that your experience of birth was so traumatic. I’m pleased your son came out the other side undamaged. I can’t really offer a professional because I wasn’t there so don’t have the full facts. It sounds like you had a lot of unnecessary intervention without consent (ie. the risks were not discussed with you). Intervention leads to intervention and the result is a disaster that has to be rescued. Do you have someone you can debrief with about this face-to-face? Any local midwives or doulas who can work through your experience with you?

  26. Pingback: Meconium in waters - what do you think? - Home & Natural Birthing Forum

  27. what a bloody magnificent blog. thanks for sharing.

    tremendous – just tremendous.

    xx

  28. Helen says:

    Thank you so much for this.

    During my pregnancy my waters were meconium-stained (grade 2. Means nothing to me but probably will to you). I laboured at home until 4cm, waters went spontaneously as I arrived in hospital. I was, as you mention above, immediately strapped to the CTG machine, on my back, on a bed. I wasn’t allowed to stand beside the bed and lean forwards (even though the wires were plenty long enough) as had been my method at home and as a result felt very panicked and out of control.

    There was no sign of fetal distress and yet I was sent for a c section. My husband had seen my waters (I couldn’t as I was lying on the bed!) and was frightened by the ‘dark green sludge’ appearance and so we did what most people would do – trusted the doctors. I ended up with what I have since learned was a premature (if not totally unnecessary) c section, I was unable to see my daughter for 3hrs following her birth and had to fight at every stage to be allowed to breastfeed. We had no skin to skin until 4 days PP when I was allowed home.

    Although my birth was abroad and hence not NHS, my second baby’s birth will be – this year. I am truly hoping that my chances for the natural birth I was heading for during my first pregnancy and reading this article has given me such hope that, even if I do end up with another meconium staining, it is not the terrifying danger that it was made out to me to be. This blog has given me so much hope that there are people out there who actually want me to get the birth I plan for, not hinder me at every step.

    Thank you so much for this blog.

  29. Midwife thinker says:

    Rachel you have answered so much more than anyone in the medical profession ever has been able to in my 3 years as a student midwife and now a few months as a graduate midwife.. on several occasions I asked why is MSL a SIGN of fetal distress.. no one ever answered it any other way than bubs is at risk or mec aspiration (not necessarily a sign.. more so a potential risk) .. Thanks for your wonderful insight and perfectly understandable explanation of all things MSL..!

  30. Fiona Harrison says:

    Where i work we only suction babies who are not breathing and floppy, and in need of some resus measures, a baby who is well and cries spontaneously is left with the mother regardless of there being Mec. The bulb suction does seem to be a US thing. I have worked at a few NSW hospitals and haven’t seen suctioning done at the perineum in many years (ie about 14 years).

    • In Queensland they were suctioning on the perineum for mec until a couple of years ago and still do in some private hospitals. But you know what they say about Queensland…

      • Jade Farmer says:

        My son was born in a QLD tertiary hospital, he was not suctioned on the perineum but as I mentioned earlier, he had his cord cut immediatly and was taken to a resucitation table, had tubes shoved down his throat etc. My waters were only slightly mec stained and I have since found out that it certainly wasn’t/isn’t best practice in my/his situation. It led to feeding issues, the breastfeeding never resolved and even bottle feeding was a struggle because he wanted nothing in/near his mouth. It also made it difficult to administer any medicines. Although I feel guilty about this experience, it did teach me a lot and it meant that when my daughter had the same issues, they were dealt with entirely different (admittedly she was born at home so was never in danger of that horrendous treatment).

  31. Vanessa says:

    I live in the USA. When I brought up the idea of not suctioning on the perineum, the hospital nurse nearly passed out in horror. Even my fairly forward thinking OB was shocked at the idea. Oh well. All hail the big blue bulb! Maybe we’ll catch up someday.

  32. mm says:

    Hi, I’m so glad to have found this blog post and for the great info. I wish I had read this when my waters broke with my son 4 months ago. He is my first baby and I went post-dates (according to the hospital, I disagreed) and consented to a stretch and sweep against my better judgement. My waters broke that evening with meconium in them; despite a normal monitor reading they wanted to induce straight away saying baby could be distressed; I said surely if he is distressed an induction will only make it worse? they sort of conceded and I was ‘allowed’ to wait overnight to see if I went into labour naturally, which I did but they then pressured me to augment to ‘get things moving'; the monitors still showed him doing fine but they still just wanted him out as quick as possible, and there seemed to be an unspoken expectation that i would think meconium was dirty and would *want* to induce to get him out and clean. The on-call Ob even used the word disgusting when describing thick mec. My heart (and the monitors) told me he was fine but I ended up with the drip, an epidural and vacuum extraction. When my little boy was born he was totally healthy! Scored 9 and 9 and no signs of even being overdue! There was a pedi in the room, she left as soon as he came out because he was so obviously fine. I hated the bright lights too. What I am still curious about is if the stretch and sweep could even have caused the meconium? I felt so unwell after having it done and would not do it again. Thanks for this great blog I will keep reading.

    • mm says:

      I should clarify that the Ob was talking about thick mec he had seen in other births, mine was apparently about medium.

  33. Fern says:

    My baby passed Meconium during birth and we had her unassisted! She’s 3 months old and healthy as can be. Never been out of her “birthing den” or poked or prodded. Thankyou for sharing this! Come on conscious Mama’s let’s take back our right to birth!

  34. happy mum says:

    Hi, I feel I have to find the time to write and say thank you for this post. I had my baby recently – plan unassisted, although I was under the care of midwifes, and was going to call them if things didn’t feel right. When my waters started leaking they were green(ish). You are told to call the midwifes immediately if you discover meconium waters and home birth is no longer allowed. Now, having read YOUR blog and this article, I knew it doesn’t have to be bad news, and what to do in order not to worsen the situation in case baby was in distress. I admit, I was upset initially but after a few minutes when the news sank in, I knew the baby was ok and went ahead with my unassisted birth. Shortly before the head crowned my waters broke properly and the water was quite brown. Still, he came out screaming and very well, I would say apgar 10. Thank you because had I not read this article I would have been so worried given the general misinformation about meconium that is out there. All the best, xx

  35. Orla callender says:

    A relative died due to midwives denying access to trained medical practitioners. It is a natural process for women and babies to die during birth. To change that people need to intervene. I have learnt that these people do not want to intervene as natural birth is best but they will offer to help to reduce the risk of death. God bless.

  36. Time4Latte says:

    Wonderful post! My second was born at 41 weeks 3 days and my water broke as I started pushing in the whirlpool tub. The hospital does not allow waterbirth so I had to get out of the tub. I changed positions several times. There was no indication of meconium stained fluid until he came out covered in greenish fluid. His apgars were great! When my doula mentioned something about him coughing up meconium, my doula and I started to get concerned, we both knew it was a common reason for an “emergency” c-section. It was my midwife who said he’s fine and that they didn’t recommend deep suction anymore for babies who have aspirated meconium. Her standard protocol was immediate skin to skin,delayed cord clamping. After I got home, I did some more reading. It really cemented that I made the right choice in provider.

  37. Kylie Mackay - Steen says:

    Wow… I’m 36/40 and so excited about my birth. I’m feeling empowered more so now about following my own path… Thank you

    PS- check out juju sundin ( Australian physio) and her birthing classes techniques they focus on movement, vocalization, breathing, and visualization. Basically they encourage birthing
    Mothers to make noise and listen to their bodies…. Please check it out. Her skills set may be useful to you also.

    Thanks again

    Kylie

  38. Maria Canterbolt says:

    EW this is disgusting!

    Maria Canterbolt

  39. Samantha Pike says:

    @Maria Canterbolt

    How old are you? You must be a tiny little child… “EW this is disgusting!” someday you may need this information.

  40. Molly says:

    Love your site!

  41. Pingback: The Curse of Meconium Stained Liquor | Midwife Thinking « natural birth resource

  42. April Rollins says:

    Does this only pertain to baby’s who are born with high apgar scores? My baby was born at home on her due date with a uneventful birth, when my water’s broke there were no signs of meconium, she also never had any signs of distress until she came out and was floppy, unresponsive and blue. She was covered in meconium. Just one hour before was when my water broke and I began pushing. I was directed to push even though I didn’t have any pushing sensations. My midwife believed that some woman need a little help to get baby down even though in my birth plan I stated I wanted to breath my baby down. I had been in 12 hours of intense back labor and hadn’t slept in 30 hours, so my condition to remember what I had written in my birth plan was not at the forefront of my brain unfortunately. I hold onto guilt that I caused my daughter to get stressed and have the meconium which may or may not have caused her to be born in her condition-she was a 3 on the apgar score but went up after receiving oxygen and I believe was suctioned. I don’t remember her cord being cut right away. How long is recommended to help baby’s be resuscitated? After 3 hours of observation my midwife noticed my baby was still flaring her nostrils and had a wheeze when taking breaths. We were advised by my pediatrician who was not in the office to go to the hospital where we stayed for 5 days even though my daughter cleared up in 12 hours after being put on pressurized air forced into her lungs to force the fluid they said she had. When I researched why this happened (no one could tell me, they just said some babies are born with fluid and need a little help) the MAS described her symptoms spot on. So I am pregnant again and would like to make sure I am educated and prepared in case this does happen again. I read your article on delayed cord clamping and baby resuscitation and wonder if this could apply to my daughter’s case? Thanks for any feedback or resources to help me better understand this situation since no one else seems to have any answers.
    April

    • Hi April… as always I cannot know what really happened unless I was there, and even then I often have no idea. However, I will try and answer some of your questions:
      – I don’t use Apgar scores as they have been found to be unhelpful. Basically a baby is compromised (hypoxic – floppy, blue/pale, etc) or not, and it sounds like your baby was very compromised. Meconium can become a problem if the baby is very hypoxic during labour/birth because severe hypoxia can initiate a gasp. Mild hypoxic suppresses breathing.
      – Directed pushing, particularly over a prolonged period causes hypoxia. When you are in labour you cannot effectively protect yourself or ‘fight’ for your wishes because your brain is right-brain functioning and you are under the influence of strong hormones. The directed pushing was not your fault.
      – A baby can be resuscitated for hours if there is hope. If a baby requires anything more than initial inflationary breathes they need to be transferred regardless of recovery. Effort during respiration (nasal flaring and noise) is not normal. If this does not resolve within the hour, even if everything else looks good I would transfer. If the baby required resus at birth I would transfer asap anyway.
      – I am not sure if your baby had MAS or just Transient Tachapnea of the Newborn (TTN) http://kidshealth.org/parent/medical/lungs/ttn.html. MAS is very serious and babies usually take longer than 12 hours to recover and can even require ECMO (oxygen exchange outside the body via a machine). TTN resolves quick once the fluid has moved. The cause of TTN is unknown. It commonly occurs after a c-section because the fluid is not squeezed from the lungs during birth. But, I have transferred a baby with TTN following a normal birth… he just had lots of fluid to move and needed a little help.
      – Delayed cord clamping assists with any resus and recover and should be standard practice.
      – It is extremely unlikely that the same thing will happen again.
      I hope that helps :)

  43. Christine says:

    I too want to say thank you for this article. I am currently in hospital with client, 2nd baby going for a VBAC 41.5 weeks, 1st dr.very concerned with meconium to the point of another section, 2nd dr. on duty was not. Read this article and found it so reassuring as I am sure baby maturity is the issue as baby is doing terrific otherwise. Hoping for a birth right soon. Blessings

  44. Holly says:

    First of all, thank you for the great information. It has definitely helped me a great deal with my current situation which brings me to my next reason for posting. I am currently pregnant with my second child and I am now 21/2 weeks past due. My first daughter, who is 31/2 now, was almost 4 weeks late and was born with meconium in her lungs and was in the NICU for a week. My husband reminded me this morning that they had said the meconium in her lungs was old and had caused infection, although my doula had said it happened in the birth canal. I had pushed for about two hours with her due to her position. Although we obviously had quite a scare, the rest of the birth experience was wonderful and I really want to have an experience like that again, minus the end ofcourse, without intervention. My doctor is anxious to intervene, while my doula is confident everything is ok. She’s been having me do some things to get the baby in a good position. I have been having lots of contractions for a couple of weeks now, which I usedidn’t have with my daughter. I have a dr. Appointment today and any advice or input would be greatly appreciated. Thank you!:)

    • As I always say :)… I can’t give you specific information about a birth I was not at – I can only keep my information general. I also do not give advice. So, I’ll try and address some of your questions. If a baby passed meconium at 41 weeks for example then that meconium floats about in the amniotic fluid until birth. This is referred to as ‘old meconium’. If a baby becomes stressed during labour and gasps then old meconium, along with the amniotic fluid can get into the lungs = infection after birth. Plenty of babies are born with old meconium and it only causes a problem if the baby becomes hypoxic enough to attempt breathing before birth. The chances are that this will not happen again. Enjoy your birth and baby and let us know what happens :)

  45. Jordi says:

    I don’t know you, love you already. Finding your blog has been the most liberating and inspiring experience for us. Going through our first pregnancy and having to face the militant ignorance and fear bred into the medical system by commercial interests, your teachings have brought us immeasurable relief and empowerment.

    Thank you.

  46. Pingback: Meconium: more resources and information | Birth Literacy

  47. Sarah says:

    Thank you for this amazing blog! My DS was born earlier this year – a 53 hour labor ended in a C :( I’ve been trying to piece together whether or not the surgery was “necessary” (at the same time without regretting a single moment of his beautiful birth). DS and I had several strikes against us: 1. He was OP 2. Bag of waters thought to have ruptured before contractions started – I lost a lot of amniotic fluid; however a bag was still felt 12ish hours in and 35 hours in the Midwife ruptured them (???) 3. Once I got to the hospital (27.5 hours after first contraction 30.5 hours after first sign of amniotic fluid) triage determined that the baby’s heart rate was going from 120 to 90 bpm with each contraction so I had to be admitted to have continuous fetal monitoring (booo) This pattern continued through labor. 3. I had an urge to push 40 hours in and did push for one hour only to lose the urge (was determined to be 8.5 – 9 cm dilated after urge was lost). At this point, I was encouraged to use pitocin to speed up opening – I opted for an epidural as well in order to rest. 4. During pushing DS passed lots of meconium (thick) – “thick meconium” and “failure to descend” were reasons given for the c-section. After 3 hours of pushing it was strongly suggested that I have a C-section because of the mec. Also, the midwife kept telling me she thought the baby was OA (but my monitrice disagreed albeit kept her mouth shut). I have to add that the epidural had worn off and I was able to feel pushing urges and move (mostly from back/side to hands and knees) as freely as I wished.

    Other things: Labor never was very regular or intense. However, I did notice that towards the end of the opening phase and during pushing I felt “cramping” constantly during contractions and between contractions.

    His birth ended in a C and he was whisked away to NICU and administered antibiotics for precaution due to the meconium (the lab determined there was no infection) and given oxygen for several hours and a chest x-ray (without my or my husbands consent) because his oxygen levels were below normal.

    There so much I don’t understand – did my bag of water break early on or not? Was the baby actually stressed – heart rate, mec, and then oxygen levels make me believe he was, but I don’t know? Were the antibiotics necessary? I do believe that this all happened just as it was supposed to, but in order to make decisions for the next birth, I just want to understand – should I have had the midwife rupture my membranes? should I have allowed pitocin be administered? Why did I feel continuous cramping? Is that normal? I don’t think next time I will do the epidural regardless of how tired I am. Siiiigh… I had to get that out. Any insight would be appreciated.

    • Hi Sarah
      I can’t answer your question as I was not there at the time. Have you had a chance to talk with the people that were there and ask your questions? There is no reason that any future birth will be the same. I suggest you gather information, try and find someone to talk through your experience with and build trust in yourself and your ability to birth in the future. Good luck x

  48. Jacqui says:

    Can I ask a question? My first daughter was born with meconium in the waters, after a few interventions in the labour, including oxytocin, ARM etc. She swallowed it, and was in NICU for a couple of days on anti-b’s and had her stomach suctioned, on the basis of an xray they determined she hadn’t aspirated it thankfully.
    On my second daughter, they ARM at the pushing stage as they weren’t going on their own, and they discovered meconium too (not sure what level), so she too was whisked away and suctioned, but was fine.
    I’m now pregnant on my third….and just wondering is it likely that this baby too will pass meconium? I’d like them to do delayed cord clamping, which obviously won’t happen in that case.

  49. Viv says:

    Thank you for this very interesting website.
    A. My first pregnancy – 39 weeks, and my daughter had passed meconium and I delivered vaginally (lower forceps). My second pregnancy was vaginal – 38 weeks (no complications), my third pregnancy – an exact 40 week term ( 9 years ago) was a c- section. When asked if his cord was around the neck, I was told no – the baby was just there and I had not dilated.
    B. I am currently pregnant for the fourth time ( and this pregnancy is twins) and I will be 39 weeks.
    C. From the start of my visits to Dr. during my fourth pregnancy, I have been told this pregnancy will be a c- section too because of my previous delivery being c- section and we would not want the uterus to rupture and the other reason is because its multiple pregnancy. I insisted I would try VBAC and later if required then a c-section.

    From week 37 I started spotting for about 2-3 days and stopped and later started spotting again (dark brown discharge) and still spotting. Its been going on for about 12 days now.
    The fetal heart rate was around 158 bpm with both the twins and with the following ultrasound a 146 bpm with twin A and 158 bpm with twin B. and in week 38 the heart beat was 130 bpm with twin A and around 140bpm with twin B. The Fetal position of twin A is Vertex presenting and twin B is Vertex anterior . Blood pressure has been normal through out the pregnancy until date. The twins are still moving, although not as much as before. Since last week they have slowed down however, I feel them stretch pretty strong.
    In the last 2-3 weeks, I have been having pains every now and then, but not a timed or patterned contraction pain wherein, when I lay down, the pain subsides.
    Last week, during my 38 week 2 days visit with my Dr. she insisted we schedule a c-section this week (that is 39 week) while I insisted we wait until 40 weeks in hope of natural labor pains to begin.
    She also mentioned usual duration is 36 – 37 weeks for twin pregnancies, but I am going on to my 40th week.
    My concerns are :
    1. Is it safe for multiple pregnancy to go on to 40 weeks ?
    2. Having spotting for about 12 days
    3. Concerns about babies passing meconium in the womb ?
    Any suggestions would be appreciated.

    • You really need to discuss your personal situation with your care provider. In answer to your general questions:
      1. It depends on your definition of ‘safe’ – a twin pregnancy is more risky than a singleton for a range of reasons regardless of a previous c-section
      2. It depends where the bleeding is coming from eg. cervix = not a problem, placenta = problem
      3. As your babies go past their due date they are more likely to pass meconium just like singletons. They are more likely to become hypoxic during labour (being twins) – therefore are at a greater risk of meconium aspirate.
      The chances are you will go into labour soon as twins usually birth before 40 weeks… having said that I know some women have gone beyond 40weeks with twins.
      Let us know what happens :)

  50. Pingback: Induction of Labour: balancing risks | Midwife Thinking

  51. annmarie says:

    hi, found your blog really intresting. Had my 1st daughter at 39wks without any complications. However after putting together a wonderful birth plan for my 2nd everything went pear shaped. I presented to the hospital having strong contractions 50secs every 3mins. Although was having mild cramp between just put it down to contractions coming on so quickly. As i was opting for a minimal assisted birth i had refused an exam so was told the sister was only happy for me to use the birthing pool after monitoring. I agreed as long as i could stand where i had been leaning since coming in. During each contraction though my daughters heart rate lowered from her normal 140-150 to 80-90 bpm. As i put so much research into this birth plan i knew that this wasnt good (therefore my stress level increased) I was then told i needed examined which now there was a medical reason for i agreed. After finding i was only 3cm with bulging waters i was advised to have ARM. I agreed (now in fear of something going wrong) She presented grade 3 meconium. This putting real fear in me whilst 2 midwives and sister seemed to argue of whether i should be transfered to the medical side of the ward! very unprofessional. I was transfered quickly and within 5mins in that room n baby having electrode on her head her heart rate dropped to under 20 n i was rushed to theatre to have her under GA. She needed resusitation after birth and never took her 1st breath for 3mins. She had ‘gross meconium aspiration.’She spent 2 days on a ventalator n another 6 in special care on oxygen and iv antibiotics. She had various procedures without our permission. Not that we would have denied her care but should have been asked. i wasnt allowed to see her for 7hours, just given a photo by my partner who had been down. I have mostly praises for all of the staff who looked after us although no those who were present in labour. I am still very confused as to why u would rupture membranes if there is suggestions of fetal distress? if a baby isnt coping with contractions surely making them worse isnt going to make it any better? :-/

    • I’m sorry your birth experience was not what you anticipated. It sounds like your daughter was in distress and the c-section saved her life (they do have their place). I also never understand the idea of doing an ARM on a baby that appears to be distressed in order to diagnose meconium ie. giving you more evidence of distress… but taking away potential protection. If you are getting a good CTG trace and it is showing deep decelerations that early on in the labour – I think that is enough evidence to get the baby out if there is no improvement with the usual position change etc.

  52. Robin says:

    My first born is 8 months old. I went 42 weeks and was scared into inducing at a hospital since I wasn’t able to birth at my birth center anymore. When my water broke, after many many hours of pitocin, there was meconium in it. Pretty much everything on that list of NOT to dos was done to me. It makes me so angry. Still dealing with it many months later. But I’m educating myself even more for the next one. Thanks for this info. It helps so much.

  53. Robin says:

    I should add that my whole pregnancy had been picture-perfect. Not a single issue. They had done an ultrasound between wk 41 and 42 and showed her at approaching 10 lbs – she was only 8 lb 1 oz. My mother went 42 weeks with both my brother and I, she was induced with my brother and c-sectioned with me, so she may have gone longer. And the last two weeks of my pregnancy were a hell. I was completely stressed as my birth center pushed up my “deadline” date to birth there and I was staring down the barrel of an induction. And the hospital was your typical high-energy, rushing around, stress inducing environment. Anyway,yeah. I still feel like a victim of the “system”. Like a poster child for crappy inductions and what it’s like to try and have a “normal” birth at a hospital. The only thing I walked away with was a vaginal birth. Although the position they had me in and the manner of pushing they had me do left me barely able to walk for weeks. I tore very badly. But that wasn’t for lack of them trying to CS me. I put my foot down on that and said no for 26 hours – another wonderful effect of inductions – long ass labors. :/

    • Robin – you an many others. It is so sad that your experience is commonplace. The constraints you are expected to birth within make it almost impossible… due dates, size of baby (which u/s cannot predict accurately). Thank you for sharing your experience. It is important that other women have access to these stories so they can know better. Unfortunately they don’t get the information from system.

      • Robin says:

        Thank you for replying. Just having someone like you sympathize makes such a difference. It seems the general attitude I’ve gotten from most people is to “get over it, wasn’t she worth it?” Which makes me feel guilty and infuriated at the same time. Of course she was worth it… She’s worth it a thousand times over… But my feelings and our emotional health are important too!

        • Being grateful for and loving your baby does not mean that you have to love and accept your birth experience. Your feelings about how you birth are very important. That attitude makes me mad… and sad.

  54. Ange says:

    I had an all-natural hospital birth. My water finally broke just before I started to push (after 32 hours of labour). There was some meconium present. Suddenly it felt like it was a huge emergency..a pediatrician was called in, and when my son came out they immediately cut the cord against my wishes to let it pulsate, and my precious new baby was taken over to a table to be suctioned….before they even got him there though he let out a yell, and the pediatrician said, oh nevermind, he is ok. Huh…maybe because he was totally undrugged and knew exactly how to cough up the fluids without all their “help”? Gee, thanks doc, for robbing me of that precious moment and also all the added benefits of letting the cord stop pulsating on its own. Of course I am grateful to have a happy, healthy one year old now, but you never forget your birthing experience and that is one thing that still really bugs me.

  55. Heather T says:

    This happened to my little one and the experience for us both was awful. That being said, I had an Osteopath on standby to adjust my little one after her birth. Since she was stuck in the ICU till 3am because of the Meconium, when they finally released her to us we kept her with us and her breathing was wraspy… Well we were finally released from the hospital at 8pm and went right to the Osteopaths. To this day I have no idea what he did, all I know was that within Minutes of him working on her, the wraspyness cleared up, her breathing became less labored. That adjustment was truly miraculous. It is worth looking into. That night when we got her home she slept for 8 solid hours.

  56. Sana says:

    I sent this article to my husband who believes that hospitals are the holy grail of safety. I’m hoping that this will open his mind to what really happens. We just got married a couple of months ago (together for six) and are hoping to start TTC within the end of this/beginning of next year….

  57. Thank you so much for this post, which I read for the first time in tears a few months ago after the birth of my first child. I am now reading it again, cooly and calmly as I plan out the birth of the next baby I’d like to have. Last time around I chose a home water birth but ended up with an emergency c-section. Everything was going great until the midwife got concerned about my lack of progress after a few hours at 6cm. Twice I declined to let her break my waters as it didn’t seem right to me and I desperately wanted minimal interventions. The pressure kept growing however, that she needed to ‘see the liquor’. I vividly remember desperately trying to find information on the internet on a dying laptop, under the exhastion of a long labour and between drug-free contractions, but alas to no avail. Alas, I eventually gave in and lo and behold, the meconium was there. If only I had seen this post before then. I was devastated just to be transferred to hospital. It’s a good job I didn’t know then just how much more was yet to come. Firstly continuous monitoring, which was a crushing blow to my hopes for freedom and natural movement.. Next augmentation by drip. Not that they need have bothered, they started on the minimum dose (as I wouldn’t agree to anything else) then gave up on me before adjusting it, wrote me off and finally I ended up with an emergency c-section. I felt like the fight drained out of me, along with my confidence each step of the way. I had never dreamed I would end up with a section. I was so confident, determined and I thought well-informed. I spent literally hundreds of hours researching before the birth. Well, now it’s one more and I reckon that last one might make all the difference next time.
    Heartfelt thanks,
    Christina Rose x

  58. aboveda says:

    Thank you for this article. I find it interesting and wish I would’ve found it earlier – although I don’t know that I would’ve done anything differently. My water broke at exactly 41 weeks (my OB’s deadline was 42). I had had no contractions – not even BH. I was almost 41 and this was an IVF pregnancy. Needless to say my water was green. We went into the hospital, and they allowed me to walk around (even though I was being monitored – they would take it off upon request). My baby was -3 and no effacing or dilation going. They attempted to dilate me with little pills on the cervix and only got to 2cm. 12 hours after water breaking they started me on pitocin (no epidural). They went as high as they felt comfortable with the pitocin to no avail. still 2cm, still -3, still nothing going on. They turned off the pitocin and I had no contractions. So at 24 hours of water breaking I was a csection. Although we wanted a natural birth and I grieved that loss, the health of our baby was the most important thing since we went through so much to get her. She was born healthy and fine and breast fed like a champ. I will keep this info in mind if we get pregnant again as we would attempt a VBAC.

  59. Lilly says:

    Thanks for a great post! The comments are very interesting too. I recently cared for a woman who wanted a waterbirth but had SROM with thin mec when there was head on view (41.5 weeks). I explained that it can be a sign if distress, or it can just mean baby has pooed already, but hospital policy requires continuous monitoring. She chose to decline getting out of the bath for continuous monitoring. Intermittent auscultation was still perfectly fine. After she gave birth to a healthy baby with a hearty cry, I was treated like a leper by other hospital staff and told I was being ‘reported’ for going against policy. It’s very upsetting to think that women’s autonomy would be passed over for ‘policy’ and that other midwives/ doctors would happily remove a woman from a position where she is happy, comfortable, and safe, by force if necessary.

    • That is awful. Regardless of policy a woman has the right to make and informed decision and you have a legal responsibility to respect her decision. It is so sad that midwives experience bullying from those who should be supporting them.

  60. ashanti says:

    Im planning my third pregnancy and im definitely going to find out the opposite of what can be done different with this one i had two c sections and i would not want to put my baby through what my first two baby went through im so glad i decided to read your info for mec and is definitely soothing information and the ladies story also help :)

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  63. Jake Buehler says:

    My wife and I planned a home birth and were so excited considering all the benefits and how natural it was. We despise hospitals.

    She was a few days past her ‘due date’ and our midwife noticed her blood pressure was a little high and showing protein traces in her urine. She gave us some herbal remedies and had her lying for most of the day on her left side and it seemed to reduce the symptoms.

    Unfortunately she started having slight chest pains so our midwife recommended we have the hospital take a look at her to be safe. At the hospital the doctor came back to us after the results and scared the beJesus out of both of us with zero bedside manner. Saying things like “your liver could explode unless we get that baby out.”

    We agreed to have her admitted for pre-ecclampsia and our mid wife stuck with us for the whole birth. The nurses were so rude to our midwife, even putting their hand in her face when she offered advice like “Talk to the hand.”

    Thinking about the whole experience my wife and I had to go through brings tears to my eyes. Hospitals are truly a horrifying place.

    Natural labor was beginning to take place but the nurses said my wife must be allowed to be treated with ‘their methods’ for pre-e or they would force us to leave against medical advice and ban us from returning.

    Between a rock and a hard place our midwife recommended we stay to be safe, and that she would help minimize their interventions.

    They immediately put my wife on magnesium to lower her blood pressure, which unfortunately stopped all natural contractions.

    Our midwife suggested we wait as long as possible to see if the natural contractions would return, but eventually the hospital forced us onto pitocin to create artifical contractions.

    They gradually increased her pitocin dosage until my wife was having 10 minute contractions that would peak so high, and when they would decline they would jump back up again allowing her almost no rest.

    My wife refused pain medication or epidurals to keep it as natural as possible and salvage what was left of our ‘natural’ plans. We even wrote out a birthing plan which the hospital completely scoffed at and ignored.

    The only thing on our birth plan that was honored was a natural vaginal tear.

    The nurse finally decided to check the machine and see that her contractions were 10 minutes long and finally took her off the pitocin and the contractions returned to a normal peak and fall.

    Our midwife, after birth, said that she saw our nurse crying to another nurse about a personal matter, and suggested she wasn’t doing her job properly watching my wife and allowing the contractions to get out of control.

    The nurse kept asking to check my wife’s dialation progress but our midwife suggested we continue to refuse because that would start the c-section clock. Our midwife put herself at risk by checking my wife whenever the nurses left the room, and when she found her to be 7cm she said it was OK for them to check.

    The nurses tried telling my wife when to push and when not to push but our midwife said to go with what felt natural. (Which not much of our birth was at that point anymore)

    The nurse eventually came in and broke the water sack which I have now read can increase meconium aspiration chances. (Something 3-10 out of 1,000 baby’s will experience in a natural birth)

    Sure enough our baby was born with a sever meconium asipration.

    They did not respect our wishes to delay clamping of the cord, or to place baby on mommy but immediately put her on their test tube science lab table with a bright light in her eyes. I had tears streaming down my face as my baby had vacuum tubes in her nose and 6 people poking her and prodding her.

    The doctor rolling his eyes at our requests and tired disrespectful responses to my questions. (I think his ego was affected when he suggested a 4th degree incision and we decided for the natural tear, which was a 3rd degree tear. Our midwife said “told ya so..”)

    Our baby has now been in the NICU for 15 days and has fully recovered from the meconium aspiration however she has been fed through a tube down her nose intermittently with mommy breastfeeding at every possible moment.

    After making a big enough stink about their feeding practices they agreed to let baby and mommy have a room so she could breastfeed around the clock and we are eagerly awaiting her release.

    What a horrifying experience. Words cannot express how sickened I am by the way things are run at hospitals.

    The NICU originally said that our baby couldn’t leave until she was eating ‘their’ recommended daily intake of fluids through the breast or the bottle. When I asked the head nurse how they could tell how much she was getting from mommy she didn’t have an answer.

    I asked if they had an accurate breast feeding scale so they could weigh the baby before / after feedings as this is the only way to calculate her intake and they said they don’t have a single one in the entire hospital. So I made the head nurse agree with me that they actually have no idea how much our baby is eating, yet her release from the NICU is entirely based on that…

    That is when they agreed to give my wife a room to feed her and remove the tube from her nose. The head nurse looks ready to sign off in the next 24/48 hours thank God.

    The nurses in the NICU also lecture us with their opinions of how formula is just as good as breast milk, and how a pacifier is actually a good thing, since they know we prefer not to have either for our baby.

    As of today, it has been about 24 hours since they gave my wife and baby a room together for exclusive round the clock breast feedings. Baby has been feeding great, 20 minutes at a time and latching fantastic (mommy produces more than enough milk from pumping consistently every 2-3 hours immediately after birth)

    However, last night baby fed at 12 midnight, but didn’t want to be woken at 3 am for a feeding. We’re trying to let baby decide feeding times to keep it natural and on baby’s schedule, instead of the NICU’s 3 hour force feedings.

    At 3am baby only took 10cc’s. Baby again was still sleepy at 6am but eventually did awaken and latch for 10 minutes on 1 breast.

    At 9am baby latched again for 15 minutes on 1 breast.

    Should we be concerned? Baby was feeding for 15-20 minutes (latched on mommy) consistently every 2-3 hours yesterday when the room was first given to them, but mommy is concerned this morning she was sleepy and didn’t want to be woken, not eating much over the 6 hours from 12am-6am

    My theory is baby is adjusting from not having food forced down the tube in her nose to drinking from mommy full time, and we should wait it out. But the NICU is scaring my wife again saying “She’s going to dehydrate!” “Her brain needs food every 3 hours for development!”

    Anyone with experience or advice on this would be greatly appreciated.

    My email is jacob.buehler@gmail.com but I will check back to this thread often…prayers are appreciated too. We just want our baby home =(

    • Hi Jacob
      What an ordeal for you and your wife. The birth was clearly not what you planned and was made worse by the attitude of the hospital staff and poor communication/collaboration between them and your midwife. However pre-eclampsia is not physiological. It is a dangerous pathological condition and intervention is justified. Once intervention is initiated it must be effectively administered, controlled and monitored. The birth is no longer physiological or ‘normal’. Medication, induction, breaking waters, epidural, monitoring, vaginal examinations are all part of the intervention package. Of course, consent must be given and some interventions do not improve safety ie. cutting an episiotomy. Basically what I am saying is that you can be reassured that if your wife had pre-eclampsia – intervention was justified… it was just badly explained and carried out.

      As for baby and breastfeeding. What you describe sounds like a normal feed pattern. Breast milk is far more nutrient dense than formula and alters from feed to feed – measuring volume is not helpful. Nor is time spent at breast – some babies take same volume in 10mins as others do in 30. Baby’s behaviour is a better indicator of intake. Passing urine (wet nappies); being alert when awake, moist mouth; settling after a feed; sounds of swallowing while feeding. Is your midwife supporting you? Do you have access to a lactation consultant? You probably need to get home and into your own space to relax and enjoy your baby.

      • jacobbuehler741 says:

        They won’t let us leave the NICU. I just talked to the nurse and she said baby needs to be eating a minimum of 50 cc’s every 3 hours to leave.

        I told her mommy is pumping more, but if baby feeds and is still hungry we don’t want to supplement with formula.

        She says that’s not fair to the baby

        I said I’m worried supplementing will impede mommy’s production, and overall isn’t necessary.

        I’m getting tired of arguing with them.

        They make it sound like baby is going to starve by eating only from breast.

        • Do they have a lactation consultant in the hospital? It sounds like they have little understanding of breastfeeding… and this baby is not a premature baby. If your baby is well and breastfeeding can you self-discharge?

    • annmarie says:

      Hi Jacob,
      Sorry to hear about your stressful delivery. It seems that hospital staff aren’t been very helpful to your family. As much as i understand your frustration surrounding your baby’s birth plan it sounds to me like the medics done best by your baby.
      In saying that i don’t understand their behaviour now. My daughter suffered gross meconium aspiration too and as soon as she was able to breastfeed they removed her feeding tube. The staff were very breastfeeding friendly though and were happy as long as she put on weight before leaving the hospital (and obv having frequent wet nappys etc).
      If your baby is thriving regardless of how long feed are and nappies show that your baby is hydrated then your right to challange their opinion. As much as it is frustrating though its important that you can look at the bigger picture. Your baby is doing well so far and willbe home soon!
      Good luck with your family!

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  65. I love this letter to the baby blog post! Followed by great information explaining and normalizing the birth process and what to expect to see with newborns being born vaginally. THANK YOU!

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  67. Jim says:

    Why is this happening to all our beautiful babies??? … my wife and I just went through this awful experience … our little girl spent 5 days in the NICU right out of the womb. Neither us even got to hold her for 4 days (they said they had to do a belly button line) and they kept us on edge with how sick she was, never letting us know when she might go home. In the end, they said all the throwing up was Acid Reflux … once we got her on mother’s milk, she made a miraculous recovery and we took her home in less than 48 hours. Thank god my wife’s mom came in and acted as our lactation specialist, because the only thing the “lactation specialists” from the hospital provided was stress and disappointment.

    Prior to this though, they pumped her full of antibiotics, formula and stress, and took tons of diagnostics on her (even a spinal tap) all for conditions that, in the end, didn’t exist.

    We wanted to go the route of a natural birth because we were inspired by “The Business of Being Born” … I truly believe that this, the tons of research we did throughout the pregnancy, our passionate love for ourselves and the support and prayers of our friends and family are the only things that prevented us from being broken completely by this experience.

    If anyone knows of any great malpractice lawyers, we are in the process of reviewing our options.

    And Jake, my heart truly goes out to you and your family … I am fighting tears (and losing the fight) as I write this. Please know that it’s nothing, nothing that you or your wife did. There is an a hidden agenda here, just like in our case. Don’t let them break you!!!

    Our prayers go out to all the family’s that are suffering these same experiences in silence.

    Jim

  68. Jen says:

    Hi! I haven’t seen this post until now. Oops. With our oldest, the midwife said there was no meconium in the water when it broke towards the end of labor. However, when we got home a few hours later (I was discharged from the birth center four hours after birth because it went smoothly and I wanted my own bed!), she spit up and it was almost black. The fluids were greenish after I had pushed her out.

    She was certainly fine, and we called to make sure there was nothing to worry about. I’ve always wondered, though, was that meconium that she spit uo? Would it have had to have been in the amniotic fluid for her to have swallowed it?

    I am just curious! :)

    • Hi Jen – impossible to say without seeing the ‘spit’ :) It could have been blood. Some babies swallow blood on their way out and spit it up later. A lot of babies pass mec as they are born ie. it is behind them and nowhere near their face. Even if she did swallow mec, it is OK. It only causes problems when it gets into the lungs ie. is breathed in rather than swallowed.

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  70. Zeemz says:

    Hi,
    I gave birth in July and had a pretty traumatic time of it. I went into spontaneous birth on a Sunday at midnight, I was 41weeks. I laboured through the night and we went to the hospital around lunchtime. I was three centimetres when I arrived at the hospital. When the midwife got to me she checked the baby,s heart rate and said she felt there was meconium in the waters so these were broken. There was a good amount of greenish/dark meconium. I continued to labour unassisted by pain medicine. They told me after a few hours that I hadn’t dilated much since arriving so they suggested inducing the labour. I was getting really exhausted so instead I opted for an epidural. This relaxed me a bit and within an hour I was eight centimetres. At this point there was a Change over of staff. The new mid wife got me to start pushing at around eight thirty. A doctor came in shorty and seemed really concerned and got me to really work hard at getting the baby out. Our son was born at a quarter past nine, weighting 4 kilos, a suction was used. He was flat, purple and unresponsive. The cord was cut and my placenta was out quickly.A paediatrician was called and was in the room to try and revive him. I remember counting eleven people working on him and me at the time. He was whisked away to the neonatal unit where they worked tirlessly to revive him. My partner was able to go see him at around eleven o clock and I eventually was let at about two in the morning. The paediatric consultant said the following six hours were vital to see if they could find a method of resuscitating him. By the morning they said none had worked so a team were flown in and he was put on ECMO. We all went to the UK for 5 days. He returned back to our hospital and he spent three months in the neonatal unit. He is doing well now and we,re hoping he,ll make a full recovery over time. My question is could I have done anything differently to prevent this happening again? Maybe if i’d been better informed i could have asked for things to be done differently?? I would love to have another child but I’d hate to put another through this pain. Thanks a million for the blog.

    • I am sorry – your son’s arrival must have been terrifying for you. I am so pleased he is recovering. Meconium aspiration is a dangerous condition. I am assuming that if you had an epidural you would have had a CTG machine monitoring your baby’s heart rate. It is unlikely that he would become hypoxic enough to inhale meconium without the heart trace picking it up. Directed pushing ie. telling women to hold their breath and push can make the baby hypoxic because it reduces the oxygen supply to the baby: http://midwifethinking.com/2010/07/30/pushing-leave-it-to-the-experts/ but this would have been evident on the heart trace. I’m thinking that the heart trace was abnormal when the doctor looked which is why he got you to push harder – this is the normal approach. However, if the baby is stressed due to directed pushing this just makes it worse. In this situation I would ask the mother to stop pushing to allow the baby to recover. Can you ask the team for a debrief? It might help to understand what happened from their perspective. And it is very unlikely to happen again. Meconium aspiration is rare. Thank you for sharing your experience.

  71. Pingback: How to Avoid MAS (Meconium Aspiration Syndrome) | theperfectbirth

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  73. kalibird says:

    Before I had three beautiful, easy and very fast homebirths, I had a little girl who died due to cord compression. There was a lot of meconium and my midwife did not encourage me to worry or take action. She let me go home to rest after my water broke in her office. She was obviously quite aware of the meconium being too dark and copious but she made a decision to not worry. I would have put up wit a whole lot of interventions to have had that gorgeous little girl live. It is 23 years later and I still cry on occasion about what a terrible and unnecessary loss this was. We were holding a very beautiful place for her in our family as our longed for first born child and I still feel bereft at times, remembering my midwife looking at the meconium running down my legs, holding it up to the light, calling other midwives (who encouraged her to transport me) and her reassuring that at 42 weeks, this was to be expected.

    • I so sorry that you lost your little girl. Thick meconium is a worrying sign regardless of gestation (excluding breech presentation). Thank you for adding your experience to the conversation.

  74. Pingback: The Curse of Meconium Stained Liquor MidwifeThinking Rachel Reed - Birth Balance

  75. yubba scrub says:

    Wowsers!!! If my water broke and there was meconium in it I would do everything in my power to get that baby out immediately! I think the advice to not intervene is scary and foolish. What is the big issue everyone has with C sections??? I had one bc my baby’s head did not descend (trust me I tried every position possible). I loved it! I will be having another one for my second child. No perineum tear/incontinence/sexual discomfort/dysfunction issues and I didn’t feel any pain whatsoever. Tell me again why this is a bad thing? And the csection fluid issue is nonsense. She had a little extra fluid but it went away after the first day and didn’t seem to bother her at all. Bf was smooth sailing. Any pregnant first time moms or those contemplating using a midwife don’t let people convince you a c/s is awful/horrible or somehow failing at giving birth. That just simply isn’t true. You know what is awful? A dead or brain injured baby.

    • Oh I see yubba. Just because you were happy with your experience means there is no issue does it? All the other mothers who hated their unnecessary c-sections don’t matter right? All the subsequent babies who died because of a uterine rupture next time around, caused because of the previous c-section are no big deal? Scientific evidence is very clear that c-sections carry greater risks than vaginal delivery -not just for the delivery at hand but for future ones as well – and therefore should only be used when absolutely necessary, i.e. the risks are outweighed.
      It’s great that you were happy with your birth experience, but hundreds of thousands of women are not. Let’s not try and dismiss all them just because their experience wasn’t the same as yours though.

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