When meconium is noticed in amniotic fluid during labour it often initiates a cascade of intervention. A CTG machine will often be strapped onto the woman reducing her ability to move and increasing her chance of having a c-section or instrumental birth. Time limits for labour may be tightened up further resulting in induction or augmentation, which increases the chance of fetal distress and for first time mothers, c-section. As the baby is being born they may be subjected to airway suctioning which can cause a vagal response (heart rate deceleration) and difficulties with breastfeeding. Once born, the baby is likely to have their umbilical cord cut prematurely and be given to a paediatrician who may also suction the baby’s airways. In the first 24 hours after birth the baby will be disturbed regularly to have their temperature, breathing and heart rate assessed. In some hospitals the baby will be taken away from their mother to be observed in a nursery.
This is a lot of fuss for a bit of poop which in the vast majority of cases is not a problem. Indeed, many of the interventions implemented because of the meconium are more likely cause complications than the meconium itself.
This post is mostly based on two journal articles. One in an obstetric journal (Unsworth & Vause 2010) and the other in a midwifery journal (Powell 2013). Both articles agree that there is very little known about meconium and whether it is a problem at all.
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 five reasons (theoretically) that a baby may open their bowels before birth:
- The digestive system has reached maturity and the intestine has begun working ie. moving the meconium out (peristalsis). This is the most common reason – 15-20% of term babies and 30-40% of post-term babies will have passed meconium before birth.
- The umbilical cord or head is being compressed (during labour) ie. a vagally mediated gastrointestinal peristalsis. This is a normal physiological response and can happen without fetal distress. It may be why a lot of babies pass meconium as their head is compressed during the last minutes of birth and then arrive with a trail of poop behind them.
- If the baby is in a breech position, compression of the abdomen as their bottom moves through the vagina usually squeezes out meconium.
- Intrahepatic cholestasis of pregnancy often causes the baby to pass thin meconium during pregnancy. This may be due to increased movement of fluids through the baby’s bowel caused by bile acids.
- Fetal distress resulting in hypoxia. However, the exact relationship between fetal distress and meconium stained liquor is uncertain. The theory is that intestinal ischaemia (lack of oxygen) relaxes the anal sphincter and increases gastrointestinal peristalsis. However, fetal distress can be present without meconium, and meconium can be present without fetal distress.
Bear in mind these are theories and there is no evidence to support them. Indeed, in ‘animal models’ the theory that hypoxia results in meconium has found to be incorrect. There are also other theories about meconium in pregnancy – that the baby continually passes it – but I think this post is confusing enough without wading into them (see the key articles for further information).
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 may provide an even better indication that a baby may be in trouble. In addition, thick meconium rather than thin meconium is associated with complications. In summary, it is important to remember that:
- Most babies who are born in a poor condition do not have meconium stained liquor
- Most babies with meconium stained liquor are born in good condition
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 MAS is very rare but can be fatal. For those who like numbers if you have meconium in your amniotic fluid your baby has a 0.06% (1:1667) chance of dying from ‘MAS’. This risk will go up and down depending on individual circumstances eg. prematurity, congenital abnormalities, additional labour complications, etc.
MAS occurs when the baby inhales meconium stained liquor during labour, birth or immediately following birth. Babies make shallow breathing movements during pregnancy. Breathing movements slow down in response to prostaglandins before birth. In order for a baby to gasp in-utero they must be extremely asphyxiated. This is unlikely to happen without anyone noticing the baby is in trouble ie. an abnormal fetal heart rate during auscultation and an abnormal labour (or induced contractions). A baby is able to maintain aerobic metabolism until oxygen levels at the ‘placental blood exchange site’ drop 50% below normal levels. The baby then undergoes a number of physiological compensatory responses and if the oxygen level does not improve, or worsens he will descend through hypoxaemia, hypoxia, anaerobic metabolism, metabolic acidosis, asphyxia, and then become ‘unconscious’ at which point his limbic system will initiate a gasp in an attempt to get oxygen.
Meconium in the lungs can cause problems with respiration and increase the risk of infection. For 3-5% of these babies it can result in death… but remember there are often other issues occurring along with the MAS eg. prematurity.
So, meconium alone is not a problem. Meconium + an asphyxiated baby = the possibility of MAS
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 asphyxia and MAS. However, 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. So, I would assume that practice would be informed by this research and 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. 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 (Kumar, Kumar & Basu 2019) and may cause the baby to gasp ie. inhale deeply which is exactly what you are wanting to avoid with meconium stained liquor. For any baby, meconium or no meconium, it is likely to be a very unpleasant.
The physiological process of birth takes care of the mucous and amniotic fluid (and meconium) in the baby’s airways. As the baby’s 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.
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 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 – mother and baby can 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.)
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 digestive system that has begun to function – in these cases the aim should be to avoid hypoxia during labour and therefore meconium aspiration.
You can listen to an interview/discussion I had with Pregnancy Birth and Beyond Radio about meconium.
If you want to know more about physiological childbirth – join my online course!
Thanks for another informational post. I’m doing lots of research before I become pregnant and your blog posts are really helpful!
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.
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!
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.
Thanks for the comments. It’s nice to know people find the information useful.
I have been struggling to understand why my 4th died and your article answers so much. His heart rate was normal (in the 140’s) all pregnancy and I was taking hawthorn berry for blood pressure, but managed to keep my bp in the normal range all pregnancy after an early spike in the first month.
Anyway, basically what happened was the night I went into labor my bp(blood pressure) spiked to 162/100 and the midwife checked the baby’s heart rate and it was around 80. She recommended transport and me not knowing what to do followed her instructions. When we got to the hospital the heart rate had gone back up to 112. Not great, but better. The nurses didn’t disturb the doctor who was home sleeping.
As our little guy descended his heart rate did the same. The nurse insisted on an internal heart rate monitor and as she stuck it inside me she broke my water, declaring that there was thick meconium (yellow). They put me on oxygen to try and get more to the baby. As he crowned his heart stopped. I am thinking since his heart rate had gone down to 50 that he gasped in an attempt to get oxygen as they told me he wasn’t getting oxygen? Of course he came out pink, but was unresponsive so what do they do? Cut the cord immediately and race him over to some table to start trying to revive him. Our midwife was there and later told me that she would have massaged him while he was still connected to the cord. I would have rather had her try that, but the nurses and doctor (he finally showed up) grabbed him and cut the cord so fast no one could think about it. Plus they don’t bother to tell us what they are doing. Anyway, they were unable to revive him.
I had been questioning whether it was my blood pressure that caused this and blaming myself, but from the sound of it and other research this was likely a case of hypoxia? Perhaps the transport only stressed me and the breaking the waters before he crowned only made things worse. I guess we’ll never know, but I had my first 3 at home and have a feeling if I had stayed home my little guy might still be alive. Either way, your post was informative and I thank you!
Firstly – I am sorry for your loss. From the information you provide I don’t think that staying at home would have made a difference to the outcome in your situation. There seemed to be some underlying pathology occurring – your bp was an indicator/symptom not a cause (were you tested for pre-eclampsia?). Your baby was showing signs of struggling before transfer to hospital and did not really recover fully afterwards. There may have been inadequate oxygen transfer at the placental bed. I think by the time he was born it wouldn’t have made a difference if he had been resuscitated differently. I am very surprised that the nurses did not call the doctor in when you were admitted. There were signs of hypoxia during your labour.
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 : )
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.
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.
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!
Thanks so much for sharing this birth story. A fantastic demonstration of what trust and patience can lead to. Enjoy your new baby x
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
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.
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.
My best friend’s daughter also died from inhaling meconium after being allowed to labor too long by her midwife. Traditional medicine is not always wrong.
Traditional medicine is questioning the link between meconium and poor outcomes – please read the article by an obstetrician linked in the post. Complications in labour cause death, sometimes meconium is present, most of time it is not. There is no medical evidence to link the two, only theory. Traditional medicine changes and evolves as knowledge and understanding changes. Traditional medicine used to involve the use of leaches and a belief that sperm contained the entire fetus!
Love the blog…but I have big problems with people giving their own experiences without more details:
Firstly, in Becky’s case, I’d like to know more about her situation: Was her labor induced, was she put on medications, was the baby born early, did she have artificial rupture of membranes, etc. Also, “meconium in the system” to me doesn’t seem like an adequate reason for the baby dying. If the baby was distressed due to interventions, then the hospital has a good reason to state that the cause of death is “meconium in the system.” (Including if the baby was treated for meconium aspiration and the treatment went south.) If there were interventions, does Becky recall being properly informed as to the risks and was “distress” mentioned, and, if so, did she receive an explanation as to the implications of fetal distress (like meconium aspiration if meconium is present)?
Without these answers (and probably many, many more), how can anyone come to a conclusion about what happened in Becky’s case? Rather, it’s more likely to prey on the emotions of pregnant women who are reading this blog and aren’t equipped to filter out other people’s tragic stories.
Commentors like KAndrews and Barbara Holly have NO EXCUSE for their comments. At least Becky can tell us first hand what happened to her (even though the comment is old, and she might chose not to…at least she is the person it actually happened to), but KAndrews and Barbara Holly likely have very little details about what happened to their friends’ babies.
For instance, KAndrews didn’t even specify that his/her friends babies had aspirated meconium, just that they had “life threatening experiences with meconium.” This can mean a WIDE range of things…it could mean that the babies were born with meconium in their amniotic fluid and were treated as if they had aspirated it – deep suctioning and possibly being put on oxygen. Those interventions alone could have been the complications, not the meconium. Or, it could simply have been that the parents were informed by the medical staff that meconium was present and the parents were scared stiff by the medical staff’s reaction and explanation of the possible outcomes of meconium aspiration, so the parents went away telling their birth stories with a lot of emphasis on the fact that their baby was born with meconium present and that it was life threatening (when it actually wasn’t).
We also don’t know what years these things took place or the policies that various hospitals used to address meconium in amniotic fluid or how to determine if the baby had aspirated it. Current practices may be better than 10, 20, 30 years ago that were realized to cause more harm than good..thus why “complications with meconium” could easily occur. We simply don’t know the details in the accounts being presented by KAndrews and Barbara Holly.
In Barbara Holly’s third hand account, we know that a baby died from aspirating meconium, but we are only told that it was the midwife’s fault for allowing the woman to labor too long. Well, what we don’t know is if laboring too long had anything to do with it…were there interventions performed? Were there medications or recreational drugs involved? Did the mother CHOOSE to labor that long and then later blame the midwife for “allowing” her to labor that long? Were there signs of fetal distress beforehand? If there were no signs, was it because the woman chose NOT to have fetal monitoring? Was the baby born with meconium aspiration and then treated for it? Was it the treatment that could have caused the poor outcome versus a do nothing approach?
You see, we don’t have answers to these questions, and it always drives me bonkers knowing that people will read through these comments and be influenced by them without realizing that these comments are completely baseless.
I like to hear from people who have first hand experience, even if it is contrary to what the blog author is saying, but only when we’re given enough and thorough detail…perhaps detail is hard for someone who has a first hand experience of losing a child, and perhaps giving that detail can feel like an admission of guilt or realization that one’s medical provider was responsible for their loss. But if there is any merit in offering a personal experience to counter someone else’s educated presentation of information, then it HAS TO BE SUBSTANTIATED.
FYI, I am a pregnant mom, and I read through this blog ALL the time and many others like it, and I find that people make emotional, baseless appeals all the time based on their “personal experience” (though, often it’s second hand or third hand experience). I can’t imagine being a first time mom searching for truth and having to juggle all the bologne…
When my girlfriend’s daughter died, her cause of death was listed as meconium aspiration. She was in Missouri which at the time did not allow midwifery. The state threatened to bring my girlfriend up on wrongful death charges because she did not follow conventional medical practice, and the untrained midwife had allowed her to labor a day following her water breaking. I had two successful home births with RN midwives, and I think my experience encouraged my girlfriend to also try a more holistic approach. It was a tragic ending.
Ladies I,(as a grandmother) am in this situation today (Thursday February 18th 2016). My precious Grandson was born on Sunday-Valentine’s Day-Feb. 14th. He is now in a NICU dealing with this dreaded MAS. He was a full term baby with a good weight. The problems set in when they did the C–section. I am no doctor but I do have a suspicion that when the mother was given the epidural –her body–was stunned/knocked off track so to speak; because her labor stopped–her dilating stopped and then 7 hours later they do the C-section and all those interventions were used. I had 4 children without those Epidural’s and I thank God every single day that he helped me through it. I have witnessed this C–section/epidural scenario twice now within the last 4 years; and thank God my Granddaughter did not have this MAS. They were delivered at different Hospitals and apparently different procedures. I am still in the ANGRY state of mind and very very worried. I would love to know if research has been done —connecting these 2 issues–Epidural & C-sections. Both of these women were 1st time Mothers in their early 20’s.
It must be very difficult to watch those you love going through this. Yes – for first-time mothers an epidural increases the chance of c-section for a number of reasons – especially if syntocinon is used to speed up the labour when it slows down in response to the epidural. Women need to be told this before consenting to an epidural. I hope your Grandson recovers quickly.
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.
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.
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 : )
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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!
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.
Thank you so much, great post! Shatring this and Sunday Surfing it!
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
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.
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!
I agree with you re. waterbirth and meconium – thanks for sharing. Unfortunately it rarely happens except outside hospital/birth centres.
what a wonderful blog, thankyou!
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 : )
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.
Rants are welcome. We learn so much from reading/listening to other people’s experiences. I would do a smiley but I have no idea how you are all making them!
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.
(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.
never ever ignore mec i had baby born with mec ,she was blue no breathing at all first 8 minutes of her life ,5 days on ventilation 3 days cooling treatment to minimize the brain damage 14 days in special care in redcliff hospital oxford uk,so please be careful it can be very complicated and dangerous for your baby .my baby is doing well now but i been told first 2 years there are risks of lung infection and and others developments issues.
Helpful blog, bookmarked the website with hopes to read more!
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 😀
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 : )
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!
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?
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what a bloody magnificent blog. thanks for sharing.
tremendous – just tremendous.
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.
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..!
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…
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).
Hi, no I don’t know what they say about Queensland??? Having had 4 babies in the 1980s in large tertiary hospitals in Brisbane and working as a ICN nurse and now a midwife I have never had or seen a baby suctioned on the perineum. I am not sure where you are getting your information from but it is misleading. Good on you for discrediting safe practice that is research driven, ie precautions with meconium liquor, in the ultimate goal of the vaginal birth despite the wellbeing and safety of the baby.
I have worked as a midwife in Queensland for 10 years and continue to teach midwives from all over Australia. Perhaps Brisbane is unique but other hospitals in Queensland have only recently stopped suctioning on the perineum. I am pleased you personally have never encountered this practice.
You state: “I am not sure where you are getting your information from but it is misleading.”. I have been very clear about my citations regarding meconium: “This post is mostly based on two journal articles. One by obstetricians in an obstetric journal (Unsworth & Vause 2010) and the other by a midwife in a midwifery journal (Powell 2013). Both agree that there is very little known about meconium and whether it is a problem at all.”
If you are able to offer alternative good quality research to support your claims of ‘good practice’ I’d be happy to consider them.
It is also important that as midwives we are able to discuss practice and differences of opinion in a collegial and professional manner. Only by showing each other respect, being open to alternative perspectives and reflecting on our practice can we best serve women.
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.
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.
I should clarify that the Ob was talking about thick mec he had seen in other births, mine was apparently about medium.
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!
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
Congratulations! Thanks for sharing your story 🙂
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.
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.
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.
EW this is disgusting!
How old are you? You must be a tiny little child… “EW this is disgusting!” someday you may need this information.
Love your site!
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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.
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 🙂
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
How exciting! Come back and let us know about your birth and new baby 🙂
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 🙂
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.
Enjoy your first birth journey and new family member 🙂
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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.
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
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.
I am sorry that your care providers did this to you and your baby. This baby may or may not pass meconium too. You need to know what the hospital policy is and define your boundaries… or find another care provider. There is no need to immediately clamp the cord, especially if the baby requires any resus: http://midwifethinking.com/2010/08/26/the-placenta-essential-resuscitation-equipment/
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 🙂
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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.
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.
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.
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.
It bugs me too
I’ve been told get over it
Your lucky your baby is alive
But nothing changes unless lessons are learnt
We’d still be getting enimas and being shaved with our legs in stirrups if we didn’t say
Enough I want better
My sister the angel said keep talking about it till you no longer need to
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.
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.
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….
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.
Christina Rose x
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.
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.
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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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 firstname.lastname@example.org but I will check back to this thread often…prayers are appreciated too. We just want our baby home =(
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.
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?
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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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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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.
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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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.
Yes midwifethinking is correct in that your birth was RARE. EVERYTHING else she is telling you is incorrect. You should have more children if you want them. Find a maternal-fetal medicine doctor for your next pregnancy and deliver in a neonatal center if you can. Or a nurse- midwife with a background in high risk obstetrics. Don’t go beyond 41 weeks and consider induction earlier to prevent this. I want you to know that pushing your baby out quickly by holding your breath and bearing down saved his life. Fetal monitoring saved your baby’s life. (It has lots of downsides and can increase Cesarean sections in the wrong hospitals and with the wrong doctors, but it does prevent deaths and can determine when a baby has reached it’s limit). You are probably not going to find the answers on the internet to explain the events of your birth to you, there is too much ignorance and misinformation. You did the right thing by being in the hospital with meconium at 41 weeks. You did not do anything wrong to cause this. You were brave and fearless. I would have a very candid and open conversation with your next provider about everything that happened, find someone who listens closely to you, and fully explains to you the reasons behind why this happened so you can go into your next pregnancy with confidence and health. Good luck.
Could you provide some links/references/evidence to support your statement that my information is incorrect. I am always happy to edit and amend posts if I have provided incorrect information. I tend to assume that research articles published in peer reviewed journals or Cochrane Reviews are correct. I totally understand that personal experience is strong and alters how we interact with and respond to information.
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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.
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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.
You should brush up on your neonatal resuscitation guidelines before you post manipulative, fear-based articles on the internet. What about the women who do actually require hospitalization for their births? Do you think that the hospital practices or the fear you are perpetuating is causing dysfunctional labour?
I teach neonatal resuscitation to midwives and review the guidelines often. I’m not sure what you are referring to as the post is entirely based on two literature review articles (see links) and research evidence. My aim is not to perpetuate fear but to provide information and discuss the evidence. If women are birthing in hospital they need adequate information on which to base their decisions about care… if you find the fact that many policies/practices are not evidence based and may be harmful frightening – you are not alone!
Love your work Rachel 🙂
love your work too 🙂
Reblogged this on Intuition Yoga and commented:
This week, on Wednesday we talked a little about the risks associated with meconium (baby poo) being found in the amniotic fluid (waters). I have to admit that my knowledge was a little rusty, so, this morning I’ve been revisiting the notes I made at my last study weekend. We were very lucky to have a wonderful professor of midwifery from Robert Gordon University in Aberdeen come and speak to us. What she said, particularly about not all meconium necessitating increased intervention, chimes with a lot of this article.
I’ve just re-blogged this. Hope that is ok?
of course… thanks for re-blogging 🙂
Hi Rachel. Thank you for another wonderful post and your effort for providing evidence-based information in a clear and easy to read way.
I would like to ask for your permission to translat this article to Spanish and share it in my midwifery blog, of course creating a link to your original blog.
I’ve been following your for a while and I would like my colleagues in Spain would enjoy your post as I do, but I am afraid English level in Spain it’s not always as good as we would like. Thank you.
yes of course 🙂
Thank you Rachel. I am sure Spanish midwives will appreciate this 😉 I leave you the link to the Spanish translation!
Plz mention about the effect of meconeum on the skin of the newborn and the due care to be taken.
I’m not sure what you mean. Meconium can be washed of with plain warm water. It is best not to use any soaps or detergents on newborn skin for at least 4+ weeks until the skin has fully developed and the healthy skin bacteria has effectively colonised.
My cousin gave birth to a male baby which died immediately after birth due to inhale of meconium. We were told it is a rare case. We are very disappointed. Can’t doctor avoid this. Is it not their fault.
I am sorry for the loss of your cousin’s baby boy. Meconium aspiration is rare. Sometimes it can be avoided and sometimes not. It really depends on the circumstances of the pregnancy and birth.
Hi my baby girl was born 2014 last year, but died after swallowing meconium, and I gave normal birth, I’m pregnant again and scared that the same thing can happen. My gynae suggested that I must have a caesarean this time, should I be concerned or not.
I am assuming your baby died due to meconium aspiration ie. inhaling meconium into her lungs? This is very unlikely to happen again (see the stats in the post). I would be concerned if your gynae is telling you that you ‘must’ do anything. It is your body. You need information and support in order to make a decision that is right for you – not to be told what to do. I am hoping that the risks of caesarean for you and baby were discussed and a debrief of the previous birth and contributing factors to the meconium aspiration. It is totally understandable to be scared about this next birth – you are grieving for your baby.
I wish I had known this before my daughter was born. “A cascade of intervention” was exactly what happened to me. I went in planning on having an unmedicated, vaginal birth and ended up being pumped up with pitocin and eventually given a C-section when my body and my baby couldn’t take the trauma any longer.
I am sorry that this was your experience of birth. Unfortunately you are not alone.
Hi! Thanks for this interesting article. I have a questions about likelihoods and statistics presented in your article.
I first heard about meconium when I was 21 and couldn’t have been further from planning a pregnancy, so I just vaguely remembered 15 years later how this was assumed to be super dangerous and problematic in conversations about how my cousin birthing her son went 15 years ago. I’ll soon have a baby myself, at almost 40 weeks and no sign of anything happening yet, and with the percentages you were giving, this might become a problematization at the hospital where I will have to give birth. My impression is that despite their own self assessment they do a lot “after the book”, they stick to a lot of routines.
So, just to understand the numbers better you are giving in your article. Are the percentages of babies having trouble and getting infections of meconium inhalation referring to 100% of babies born with or without meconium in the waters/ during birth? Or are those the percentage of the number of babies that have meconium present, with all other babies that do not ever get suspected of being close to their meconium already excluded?
That would give me a better understanding how far the hospital practices are in place to help babies, because 2-3 percent of all births is still a lot, while 2-3 percent of 15 percent is a lot less.
2-3% of babies who have meconium in their amniotic fluid will develop MAS – not of all babies born.
I have just heard Silke Powell (see the reference to her article) present at a conference about meconium. There is actually no clear link between meconium in the amniotic fluid and poor outcomes for babies. Many diagnosed ‘MAS’ symptoms are probably caused by other unrelated problems with the baby e.g. hypoxia in labour etc. It is a very complex topic. We have connected one thing – MAS symptoms, with another – meconium, when in fact they may be unrelated.
Good luck 🙂
I too, have had a baby pass from MAS, but Mec stained amniotic fluid should be a yellow flag, not a red one. As stated, MOST mec is ok, & MOST distress does not have mec.1st, HCP needs to determine if mec is related to current ongoing distress or just a one-time fluke. Not too hard to tell the difference! Choose your HCP wisely!
I rarely see mec stained waters, though often baby poops as it is being born.
HI Rachel, thanks for this wonderful article. I had a scan at my 41+1 appointment today. The doctor told me thst because the waters were misty it could mean that there was meconium in the waters. A trace revealed it wasn’t to do with fetal distress. I haven’t been able to find anything online about meconium being evident in scans…? Is this an accurate assumption and do you think it is a cause for concern?
Thanks to your article, which I has read a few times before, I wasn’t panicked when she mentioned the meconium otherwise I think i would have panicked! I’m hoping for a vbac and am going against hospital policy in regards to waiting until 42+1 before agreeing to another section – sometimes I wonder if they are just trying to scaremonger me into an earlier section :/
I would expect meconium to be present in the waters at 41+1… there is still debate re. whether you can identify meconium via ultrasound – eg. floating vernix would look similar. You care providers are probably just on ‘high alert’ and wanting to monitor you because they are unused to women making informed decisions to decline recommendations and don’t have a lot of experience of post-dates pregnancy (most women get induced) 🙂
Thanks so much Rachel! I’m vbac as well so I guess they are extra causious with me! I’m booked for a section at 42+1 so really hoping something will happen over the next few days but after today’s appointment have begun to feel a little deflated…
I read a fellow Irish mother has meconium in her waters when they realised at 10cm and ended up with an epistomy and vacum. Is this normal practise? I notice you quoted a 0.06% risk of MAS … What would you suggest in my situation? If my waters release during or before labour and there is meconium in the waters what would be your policy?
Thanks so much for your help Rachel! Xox
You have a very high chance of going into labour before your scheduled c-section. I’d suggest having some nice relaxing time for yourself – get a massage 🙂
No it is not normal to respond like that to meconium unless there is also fetal distress. The usual hospital response is to put a CTG monitor on to keep a closer ‘eye’ on the fetal heart rate… they will want to do that anyhow with you being VBAC and post-dates.
I don’t have policies for my practise – one of the benefits of working outside of the hospital system. If there is meconium during labour I inform the woman about the risks and she decides what to do… although we have usually talked about it antenatally because it is so common in labour. So, we already have a plan. Most women stay home if the fetal heart rate is good. Because the membranes usually break right at the end of labour there is not much time to anything usually. 🙂
Ok so what if there were no monitoring of babies heart rate , there had been an induction , a 22 hour labour … It had been noted the night before induction that there were no waters, the babies had the cord 3 times tight round its neck , there was then a dry birth but with thick gooey poo , ot took a team of docs to get baby to come round , it was rushed to high dependency baby unit , for anti biotic intervenes drip and was being tube fed as couldn’t suck , temperature kept dropping , eventually after a few days being moved to special care baby unit , would ur opinion be that there were no further issues , 13 years ago this happened with my 2nd child , now I am having assessments carried out as for years iv said something wasn’t quite right but what a fight iv had on my hands …. She has lots of difficulties , and I am 100% certain her traumatic birth is the reason why , still till this day o am unsure if she actually swallowed the poo , but why else would they give her antibiotics by a drip? Something’s not being said I know it!!!
There must be effective and continous fetal monitoring during an induced labour. The biggest risk factor for fetal distress is a syntocion/pitocin infusion. The strong contractions caused by this medication can result in an inadequate ‘resting phase’ between contractions = lack of oxygen to baby (hypoxia). See the information on MAS in the post. When a baby is born in a poor condition antibiotics are often given ‘just in case’ the cause is an infection. My opinion is that there are major issues in your experience and for your baby at birth. If there was no monitoring of your baby’s heart rate then your baby could have been very distressed without anyone knowing or acting. There may also have been some underlying issues as your baby already had reduced amniotic fluid which can by a symptom of a problem http://midwifethinking.com/2013/08/14/amniotic-fluid-volume-too-much-too-little-or-who-knows/.
Are you an MD? I ask because your misinformation and poor advice, is dangerous. Meconium isn’t USUALLY a problem, but there are enough babies born for whom it is a serious and life-threatening sign to definitely merit intervention. Will your baby probably be fine without it? Yes. Will you get a second chance if they’re not? No. Don’t let your child become a statistic.
Thank you so much for your information
I have a three month old baby
And I have nightmares about the birth of my beautiful son
He is my seventh child
I was about five center meters dialated
When meconium was found to be present so my water was broken to hurry things along
From that moment on the nightmare began
I began pushing uncontrollably and couldn’t stop.the pain was out if this world.i was saying please let me die
And with the pain of each contraction I would pass out and come to with the next contraction,begging to die
My sister had bruises trying to stop my thrashing body from falling off the bed.
I pushed nonstop for three hours in this state before the midwife came and injected me with morphine which I said no to.after three hours of torture I got an epidural which I begged for
Then the OB said I needed a C section because I had been pushing so long
I refused as having had the epidural I was calm and felt it not needed
he said i will be back in two hours if your still not fully dilated I will operate
He tried to stick a heart rate monitor into my babies skull
I pointed my finger in his face and said don’t you dare touch the babies skull
He was quite upset and said get your finger out of my face I said your stressed over a finger in your face
How do you think the baby feels having a pin inserted into its skull
He said we’ll if you and the baby want to die it’s up to you
Even though I already had a heart rate monitor on my belly
All the while the babies heart rate through all this Kaos was perfect.
The midwife put the syntocinin up high and two hours later he was born perfectly happy and healthy with no problems
All this because of a little poo
I had six children prior to this and had no urinary or bowel problems after birth nor back problems either
I now wet myself poo myself and had to get a chiropractor to put my pelvis back in place so I could sit on my bottom without excruciating pain
All the pushing pushed my pelvis out of place
I have postnatal depression and I believe that there are many woman who have had unnecessary interventions in birth because of a little poo
It horrifies me to think others will continue to go through this
More research needs to be done into meconium in birth
And I wish more midwifes we’re aware of this website
My waters broke early in my labor and I had meconium stained amniotic fluid. Even though I had read this post and wanted to stay home if the heart rate was okay, I was scared into going to hospital by the midwives who told me we were putting our child at risk when the heart rate was still okay. At the hospital a sonde was applied to my babies scalp because the CTG didn’t pick up the heart rate and it showed late deceleration. From then on, I wasn’t asked anything anymore. Things just happened and I am so angry at myself I couldn’t stand up for myself anymore and intervene when things just started going without anyone asking me anymore. I ended up laying on my back in preparation for an assisted delivery, directed pushing, immediate cord clamping, baby taken away, no information about his well-being… Despite the fact that I was dilating very quickly, trusted my body and was laboring instinctively so far, they took over and managed me, rather than empowering me to do the work I was already doing. I felt so detached during birth, I feel I was completely excluded. I was treated like a birth machine, rather than a mother. Because no one told me how my son was after birth and I had picked up some numbers, I thought my son had very low oxygen levels and probably had permanent brain damage.
It turned out all was well with him initially. His Apgar score, his cord pH, his arterial blood gas analysis… He showed respiratory distress after 15 minutes, but only needed some oxygen. Leaves me wondering if he had been with me, in my arms where he was supposed to be, with delayed cord clamping whether he had ever developed respiratory distress.
I remember this birth every day and that I cannot remember how my son came into this world without grief and anger makes me very sad.
I never again want to give birth with a midwife who doesn’t know me. It’s something so beautiful and sacred, and I was completely undermined. I am certain that my boy would have been born as quickly and with a better outcome if the midwives had worked with me, rather than “about” me.
Thank you for sharing your experience. I am so sorry that you were treated that way – it is inexcusable.
Yep. My babies waters were mec stained and we rushed to hospital but it was too late. The mec was fresh and she died probably 30mins before birth. If we’d been in hospital and had all that terrible intervention, or God forbid a c-section maybe she’d be alive.
I am sorry for your loss.
Hi I started having contractions and bloody show at 38 wk 5days, I went to hospital and they told me to go home as I was not dilated at all. This was my second pregnancy. I went home and was having contractions on and off every hour. I thought my time had not come and went on doing my daily chores. In the night the contractions became stronger and we rushed to hospital, the contractions were 4 minutes apart. They put the fetal heart monitor on my tummy, my contractions became very strong and suddenly the babys heart beat went down to 90. They started rushing me to labour room. At the same time my water broke on its own and I saw greenish liquid. The duty doctor saw that and told me baby has passed meconium and that too long time back. They rushed me to the labour room. Once there baby heart rate again became normal. They prepared for episiotomy. They asked me to push n baby came out with 4 or 5 attempts. He cried as soon as he came out. I was still worried. But he was perfect normal and healthy.
I’m a mother and Doula and just experienced the very unhelpful, unproductive and potentially dangerous spiral of intervention you describe as causing labour complications, much rather than the meconium itself. For the very least, once again, the more and more inhuman, policy-fied and zero-common-sense/trust-nature approach of modern hospitals here in Sydney has just taken away the possibility of a blissful birth for a mother, a tranquil, healthy entry into the world for a bubba and peaceful beginning of a new family. Thanks so much for confirming what I saw and felt in the insights and research you share. I will be browsing more through your blog once I’ve recovered from a long night myself.
It can be frustrating, demoralising and heart breaking trying to support women in some institutions. Take care of yourself as well as the women x
I gave birth at the RBWH in Brisbane, Queensland. It was singled-handedly the worst and most demoralising experience of life. After being ‘kicked out’ of the birth centre for having a baby in the 95th percentile of largeness (actually he was born under 9pounds) things went downhill from there. Exhausted after 48hrs of spurious labor, my midwife (still from the birth centre) suggested an ARM and being a naive first time mum, I agreed to it. Not long after this, the intervention-obsessed obs from the birth suite pushed pitocin on me, and my midwife didn’t back me up on my reservations to have it. Needless to say, my posterior baby was pushed further into my pelvis with abnormal contractions and went into distress. It could have all been prevented with putting me in good positions and avoiding pitocin. I truly believe this. The “unnecaesarean” was the most terrifying, traumatising and debilitating thing ever, the after effects nearly ruined my marriage. After birth I measured a slight fever, and the RBWH took the extreme measure of splitting me up from my baby for 36hrs and putting us both on (unnecessary IV abs for this time (when they could have just monitored us instead). It was extremely traumatic and the worst, there was next to no breastfeeding support at that hospital and absolutely no psychological support for traumatic births. It is such a backward maternal system at that hospital.
Yubba scrubba your comments are so disgusting and dreadful, how dare u try to paint caesareans as being so casual and flippant.
I am so sorry that your birth experience was traumatic. I hope you can find the strength to write to the hospital and let them know the impact of their ‘care’. I also urge you to contact BirthTalk: http://birthtalk.org – the women in this organisation can help you to work through your traumatic experience. Thank you for sharing on this site.
Well but not clearly mention grading of meconium
Is 1:1667 actually 0.06%?
My baby was born and died after 12 hours. She was on an oxygen machine which failed after public electricity failed. She was put on the oxygen machine because she didn’t cry after birth. My wife told me later that when her water was broken the fluid was greenish. I’m now wondering is she died of MAS.
I am so sorry that your baby died. Is it possible to meet with someone from the hospital to ask them about what happened?
Hiya, when you say – ‘a post dates baby with old meconium is very different to a 38 week baby with thick fresh meconium’ – can you explain this a little further? I don’t quite understand the significance of finding ‘old’ mec vs ‘fresh’ mec and the difference in management you would then take.
It would be expected that a post dates baby would pass meconium as the bowl matures and begins to function ie. I would consider this ‘normal’ and not a sign of complication – just physiology. When the water breaks at the end of labour you will see this ‘old’ mec.
However a 38 week baby in labour with previously clear fluid… then ‘fresh’ mec would make me question ‘why mec now’… is it a sign of distress or breech presentation? It would be unlikely to be due to maturation of the bowl at this gestation and in the middle of labour. Different clinical picture because different physiology/pathology is underlying.
Thanks for your reply. So for a woman at term, what would be the implications of finding fresh vs old meconium then?
It would greatly depend on the holistic clinical picture in determining if this may reflect fetal distress or not.
Dear Rachel, thank you very much for your fantastic blog that has tought me so many things. Here I would like to add a newer study from last year:
Ogbonna L. Evaluation of Clinical Diagnosis of Fetal Distress and Perinatal Outcome in a Low Resource Nigerian Setting. J Clin Diagnostic Res. 2016;10(4):8-11. doi:10.7860/JCDR/2016/17274.7687.
Thank you for sharing this article 🙂
Have you ever had baby born and 48 hrs later still no meconium… passing gas, small ant gold stool. 6-8 wet diapers a day. No apparent distress, no abd detention or pain on palpation. Color WNL. Plz respond ASAP… Thank you!!!!!!!
This is unusual but not necessarily abnormal. Passage of meconium in the first days can be influenced by a number of factors including whether mec was passed during birth and what the baby is being fed eg. formula can cause constipation.
If you are worried you should have your baby checked by a health care professional who can assess the whole situation.
I know of two babys who have been breast feed and had only one stool every four weeks or so, from the start (one was mine 😉 ). They both developed perfectly. I myself was never concerned and thought it great to have just one SUUUPER HUUUGE poop every 4 weeks or so (which dmittedly always was a HUUUUGE mess!!!!) . I am sorry but I can’t remember when he had his first poop.
Just in case this helps :-).
Hi. My waters broke 10am and were green. This was the first time my waters had broken naturally, and knew something was not right. On arrival at hospital ADU I showed evidence of what was coming from me. Even the midwife seemed shocked. However labour did not progress, my baby’s heartrate dropped and he was oblique. I was given a drip to induce labour in the evening, but this did not work and at 11.29pm my son was born by emergency c section. He was on time and an average weight 7lb 9oz however did not develop or grow like his siblings. He now has growth issues possibly due to poor appetite, and is being assessed for certain conditions. He never had a big appetite even as a baby so his weight gain was slow as well as growth. He has Global development delay and often wonder if failing to deliver my son sooner has contributed to the way he is today? I hope someone can answer this please. Thank you.
I am sorry you are experiencing this with your son. It really is impossible to answer the ‘what if’ questions. Most brain injuries that become apparent at or after birth occur before labour starts. It is already existing problems of the baby that result in the baby being unable to tolerate the labour process and/or to transition to extra-uterine life. In some cases – yes – severe hypoxia during labour can cause brain damage and development problems.
However, It looks like both you and your care providers responded quickly and you had a c-section. If your baby was well at birth (i.e. needed minimal resus) then the chances are the problem was already there before birth and is now showing itself.
Dear Rachel, thanks a lot for your great post(s really). I learn so much from them. I would like to ask an additional question about meconium before birth – namely this: in utero, if baby should have its first stool, does this stool contain bad bacteria? My logical thinking tells me no, not ordinarily. Everything that baby has been digesting has passed through mum already. So having had the first stool, with or without uterine rupture, does not change the bacterial balance within the baby’s or mum’s environment – so even if there is meconium after PROM (or PPROM) – it is not a reason to expect the chances of infection to go up that usually after PROM. The studies how to handle PROM and PPROM still apply?
Is there any facts out there I should be aware of that would change this? Thanks!
There is an increased chance of infection after the membranes break (more than if no meconium). There is no ‘proven’ reason why. Theories = the meconium provides a medium for external bacteria to grow. Or in the case of a pre-term baby meconium + ROM may be symptoms of infection. There is some (limited) research suggesting that antibiotics will reduce the chance of chorioamnionitis (the sac) – but not rates of neonatal infection.
Thank you for your reply!
Could you provide a link to the reference for Powell 2013 please as the link in text does not work?
If not could you provide the title so I can try to find the article?
Hi Deb. I have updated the link so you can see the publication details. Unfortunately the article is not open access.
Thanks, I can access it ☺️ x
I have just found your blog which I love and read your posts on managed placental stage, Meconuim and directed pushing. I experienced each of those scenarios in my first child’s labour (2016) and have always wondered about it as I am now 24 weeks pregnant with my second child and want to do things differently if possible.
Please bear with me as I tell my birth story. I had a healthy boy by the way!
My waters broke at home at 7pm at night on my due date and I noticed the colour was green tinged. (It wasn’t a big gush, just a continual trickling). I rang the birth unit of my hospital and they told me to calmly drive in to hospital. Upon arrival they put a monitoring belt on for 30 mins and checked my pad for the colour of my waters. The baby’s heart rate and movement was all fine. However they said the baby had had a bowel movement in the womb and was at risk of having difficulty breathing if he took some in. They said babys can pass meconium when they are distressed and so they need to get the baby out fast. They said I had to be induced seeing as my contractions had not started yet. I asked if I HAD to be induced (as I knew of the increased likelihood of further intervention needed in induced labours) and if anything else less invasive could be done and they said no. Being a first timer, I didn’t know any different…
They also warned me a doctor would need to be present straight after birth as they may need to take the baby from me to suction if he had troubles breathing at birth.
They hooked me up to a drip at about 9pm but during this period I had noticed that my natural labour had begun. I told the midwife this as a last ditch attempt to avoid induction but she said that my natural labour would take too long and the baby needed to come out faster than that. I had a monitoring belt on and was attached to the drip but was allowed to sit on a gym ball close to the bed rather than being on the bed which I was grateful for.
I couldn’t manage that for long though so I moved to kneeling on the bed (which was in a seated position and resting my arms over the top of the upright part) where I could access the gas for pain relief. In total from first being hooked up to the drip to birth was 6.5 hours. At some point during labour they opted to remove the monitoring belt as they had not picked up anything abnormal with the baby and they said my contractions were working efficiently and my labour was progressing well. In the midst of it all I went from being 1cm dilated to 9cms dilated in 1.5 hours.
I then noticed myself changing to doing more of a rocking up and down movement (rather than swaying my hips in a circular motion previously) and really intense contractions. The midwife told me it was time to start pushing. I tried kneeling on the bed but they moved me to lying on my back (which I knew wasn’t optimal birthing position) and holding my legs for me but they said I would get more force that way; which I did notice.
I was directed by the midwife to push hard during contractions. As time went on she directed me to hold my breath while pushing and then only take a little breath, before holding my breath again and pushing till the end of the contraction. I kept pushing and pushing so hard with all my might that out of the whole birth that was what scared my husband the most. He thought I was going to damage myself from the force I was putting my whole body under. After 2 hours of pushing the midwife said I had 30mins until they would call doctor to help (which I knew meant forceps or vacuum and I really didn’t want that). So I kept pushing. Then she said 15 mins until the doctor would be here and so I tried and tried but I knew that my pushing was less and less effective as I was so tired.
The doctor was called in. She was very kind and personable. She explained what she was doing the whole time. I was given a needle anaesthetic for the episiotomy and then my bub was delivered by vacuum with help from pushing from me. The Dr told me to put my hands down and she put my hands under the babys arms so I could pull him out myself, straight onto my chest. My cord was clamped and cut straight away and an injection given to deliver the placenta.
My baby didn’t cry but was looking up at me and I back at him, and in that moment I wasn’t worried at all. I knew he was ok. However the doctor was alarmed there was no cry and took him from me and headed over to the “intervention table,” but as soon as bub left my arms, he cried, so they gave him back.
I then began to deliver my placenta. Pushing as directed whilst the doctor pulled my cord and pushed on my stomach. It was more painful than birth I think! The cord then snapped and it took a little extra time to get it out. My medical notes said the placenta was queried complete. (I bled for at least 8 weeks after that and it always worried me that there was something left behind. But an ultrasound confirmed all was well.) They stitched up any tears and my episiotomy whilst I breastfed.
Baby was fine in the end, they kept us in for an extra day or 2 as he was a little jaundiced, but we went home and on to breastfeed with minimal issues.
I didn’t know if there was any other option, but always wondered why I was induced, when baby was not showing any other signs of distress throughout the entire process? Was the fact that after 40mins of my waters breaking, I hadn’t begun labour, a thing truly to be concerned about? I also wondered if the injection to bring on the placenta affected my cord snapping? Is it better to have the injection after an induced labour rather than natural third stage?
I don’t resent any of the midwives or doctors as they were doing what they understood to be best, and I felt safe in their hands. But I want to be more informed about my ability to decline intervention and whether the potential risks of a complication outweigh the risks of intervening
This time round I really want to have a natural labour if possible, particularly delayed cord clamping and a natural third stage…
Thank you for sharing your birth story. Your’s is a common experience… care providers appearing to intervene against physiology (and evidence) and creating problems that need to be fixed. Of course I was not there and there may have been a good reason for inducing etc… but you should have been informed of that reason to gain consent.
If medication has been used to induce labour contractions it is safer to use medication to induce the contractions for the placenta too. The cord snapping was likely due to the cord being pulled before the placenta had separated from your uterus.
Can you get a doula or an advocate for your next birth? It is difficult to assert your wishes while you are in labour. And care providers tend towards their normal routine interventions.
How can you tell the difference between old and fresh meconium when waters break?
When my waters were broken after more than 28 hours labour (another story, I had a choice of going home and letting it progress further naturally without the gas and air, or letting them break my waters to bring on labour) there was a light yellowy-green colour to the amniotic fluid with a slight smell. The midwife wasn’t sure and had to go do a test to see if it did contain meconium. When she confirmed it did, she arranged for an ambulance to send me from the community midwife unit where I was to the labour ward in the next city. it was made out to be absolutely necessary due to it being very risky, but when I got there I was left for about an hour with nothing happening, stressing out that something was wrong with my baby.
In the end labour didn’t progress past 7cm dilated (baby was in OP position and the drip did nothing) and I had to have a section. On reading your posts, I now regret letting the midwife break my waters and suspect my daughter (born on her due date after 49 hours labour in total) just had a mature digestive system as I was heavily monitored and at no point had she become distressed.
Generally if you are having difficultly identifying meconium it is old i.e. has been there a while and is well diluted with amniotic fluid. Fresh meconium is usually very obvious ie. thick, dark brownish and lumpy.
Thank you so much for sharing this vital information.
Thank you for writing this. This has been the information I’ve been searching for for 2.5years. I had a hospital birth for my first born, he was 12 days ‘over due’ and I laboured well in the bath until my waters released and there was meconium in it. Then it was such a panic and all my birth wishes went out the window, basically all the things you said not to do, made get out of the bath, wheeled into a room with bright lights, forced to put on a ctg despite saying no, put on the clock, was told ‘you should be feeling a pushing sensation by now’, ‘had’ to have a VE by the consultant to tell me I was 10cm (so painful), told I had to stay on my back with feet in stirrups and coached pushing despite saying no, was being pressured into having an episiotomy and vaccum, was told I had to have episiotomy for vacuum, was rushed into making a decision “I can’t do this without your consent” (basically saying hurry up and just say yes), so many people in the room, so many hands on baby wiping him when he came out I had to shout at them to get away, paediatrician went to cut the cord without my consent and MW had to fight to get her to wait until it turned white, took baby from me to give him oxygen but didn’t tell me what was happening. Thank goodness he is OK and breastfeeding went well for me but they stole what could have been a beautiful first birth for me and clearly put him in more danger despite making me feel like I was the one putting him in danger by refusing their interventions. They made my sons first few moments of life very stressful and I think I’m still processing the trauma. I had my second boy 3 months ago at home in a birth pool in my bedroom with just my midwife and my partner with no VE or any interventions and it was the best experience of my life. Thank you for sharing all that you do, you contribute to so many women’s positive births. Xx
Thank you for your blog and podcast, I thoroughly enjoy both. I have a question I hope you’ll be able to answer please.
I planned a home birth with NHS midwives. They thought I wasn’t progressing quickly enough because I had (stupidly) agreed to a VE after ~6 hours of strong, regular, progressively intense-feeling contractions and was only 3-4cm dilated. Then contractions calmed down over the next 4 hours, they asked to do another VE, and I was 6-7cm but I guess because of the previous one they thought I should be further along.
One of them wanted to do an ARM, the one doing the VE didn’t want to do the ARM so instead she did a very aggressive VE with a “bit of a sweep” to move things along. I don’t think she intended to do this, but she broke the waters in the process of doing the VE. In her words I “sort of SROMed”. There was thick meconium, so we had a transfer and a whole bunch of unpleasantness (pushed into lithotomy, directed pushing, told to hold my breath, hands-on perineum, tearing, shoulder dystocia, and hemorrhage).
Luckily, my baby’s heartbeat was normal throughout (although slightly decelerated with the final few pushes which the midwife said was pretty normal). The dystocia resolved quickly (McRoberts). APGAR was 9, 10, 10.
I know thick meconium is associated with distress, but I can’t help feeling that it was caused by the midwife doing that VE and jabbing my baby in the head, because what else would have caused it? There were no other signs of distress.
Is that possible? Is it plausible? Is it likely?
Thanks again, especially for the podcast, it really is a lovely listen xx
I can’t comment on individual situations without having been there. When there is less amniotic fluid (eg. after an ARM) then any meconium that is passed will appear thicker because it is not diluted.
There are all kinds of reasons a baby will pass meconium in labour that are not to do with distress. In the absence of an abnormal heart rate – meconium is not a sign of distress.