Meconium Happened….Now What?

There have been a few births recently where a mama’s water has broken & baby has done their first poo inside. Do you know what it means for your birth plan & how it can actually change your options?

Many are surprised to hear that meconium stained ‘waters’ is not only common in woman approaching or over full term, but it is also not a reason to fear and  throw all your birthing plans out the window. In fact, some local statistics state that 40% of women will have meconium in their waters by the time they approach 42 weeks. For mother’s in their 40th an onwards we are looking at a 15% likelihood. Does this mean that all of these women and babies are in harms way? To know, let’s break it down….

What is Meconium Stained Amniotic Fluid (MSAF)?

“Mec” is babies first poo. It is comprised of all the stuff in your babies belly that has been with him or her since conception. Ideally, when baby is born they will have their first brown, tar like, sticky poo into their nappy. Although sometimes it can before this, and appear in your amniotic fluid that baby still sits in.⠀You can have what ‘light’ staining which will be watery but have a light green or overly yellow tinge to it. Significant meconium stained liquor is defined as dark green or black amniotic fluid that is thick or contains lumps.

What’s the problem with ‘Mec?’ in the hospital’s eyes?

Simply put, we are worried that baby is distressed & that baby will inhale the sticky fluid and then have a hard time breathing when they’re born. This is called MAS (Meconium Aspiration Syndrome). Now, of course, this seems serious and yes it certainly should be considered on a case by case basis. What is important to recognise is now birthing mother’s are asked to submit to a cascade of intervention which could exaserbate the problem or create a host of new ones. For many who have been in this situation before, you may have been told that “your baby is in distress,” simply based on the fact that ‘mec’ is present when there are actually three loosely evidence based theories for this:

1. Your baby’s intensitinal system has reached it’s full maturity, which would obviously correspond to the breaking of your waters close to term.

2. Your baby’s cord or head is being compressed in labour (which isn’t always a bad thing) as many babies are born with a trail of poo as they are pushed out the birth canal.

3. The theory is that a lack of oxygen relaxes the anal sphincter and releases meconium. However, it is important to remember that fetal distress can be present without meconium, and meconium can be present without fetal distress.

What are the actual risks to my baby?

Meconium Aspiration Syndrome (MAS) occurs when the baby inhales the tar like substance during labour or at birth. It is an extremely rare complication. According to one local guideline, 5% of all those mothers I mentioned (that’s 15-40%) will have their baby inhale the meconium – BUT only 0.002 will actually die as a result. This risk will go up and down depending on individual circumstances eg. prematurity, additional labour complications (more on this next…)

So what is next & why do I care?

If you remember above I said that because the hospital have now noticed mec in your waters, they are going to want to do something about it. Essentially, “get that baby out of there quick smart.” Usually this means, induction of labour or augmentation of labour if you have started your surges but still in the early stages. You will also find they suggest continuos monitoring (even though the guidelines suggest this isn’t necessary if you have ‘reassuring heart tones.’) The problem with this, apart from it’s most likely not in your birth plan is explained really well below…

Here is a little exerpt from Rachel Reed who is runs a podcast, blog & is well known midwife.

“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 he must be extremely asphyxiated and have gone through a number of stages. 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)….So, meconium alone is not a problem. Meconium + an asphyxiated baby = the possibility of MAS”

So now we are actually increasing the likelihood of distress in your baby which could then lead to a lack of oxygen, increasing the chances of your baby inhaling or the possible need for caesarean section (which increases the risk of MAS again).

What are my options?

Well, I like to remind my mother’s that they should always discuss their thoughts with their midwife or OB, but I like to ask them to ponder on this question.

“If you’re water did not break at this time, and your labour was to start naturally, then how would we handle the situation of MAS?”

You see, many women will have meconium in their waters, but their waters don’t break until close to their baby being born. Sometimes no one even notices because she is labouring in the bath, or the shower. Does this mean that those women are not recieving adequate care? Are their babies in more danger than those who KNOW for sure the baby has done an early poo? The answer is no, because there is usually other signals that a baby is not ok and the staff have acted on them already.

So now, you wonder, well what should I do? That’s up to you mama, but now you have the real facts. Your options are to decline induction & labour as you planned or be induced at a time that suits YOU! I like to suggest setting a time frame. Usually at least one evening (that’s when birth hormones are heightened) and at least 24 hours (do your own research why).

For more information on Rachel Reed and her blog regarding Meconoum staining see below!
https://midwifethinking.com/2015/01/14/the-curse-of-meconium-stained-liquor/

 

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