Q1) What is meconium?
A) Meconium is our first poo. It starts being produced inside the intestines while we are still within the womb and remains there until the bowel becomes mature enough for the baby to do its first poo. It is made up of amniotic fluid, intestinal epithelial cells, lanugo, mucus and bile.
Q2) Why do some doctors think that meconium as a bad thing?
A) Some doctors consider the present of meconium in the amniotic fluid to be a bad thing as it produces the risk of meconium aspiration. More details on meconium aspiration can be found in the answer to Question 4.
Q3) What does meconium look like?
A) Meconium usually looks green-black or olive green in colour and has a tar-like consistency, meaning that it is very sticky. It is mostly odourless. When meconium has been passed in utero it can make the amniotic fluid appear to be any of various shades of green, brown or yellow.
Q4) What is meconium aspiration, how common is it and what can be done to prevent it?
A) Meconium aspiration is the one real risk of there being meconium present in the amniotic fluid. It occurs when the baby inhales meconium during pregnancy, labour or birth and results in the meconium being lodged in the lungs. While meconium is present in the amniotic fluid of 5-20% of all births only approximately 5% of those babies will aspirate meconium, making it not very common compared to other risks of childbirth, and yet it is still more common than uterine rupture or hemorraghe, however the rates of infant death as a result of meconium aspiration is higher than the rate of infant deaths where no meconium is present.
Currently there is nothing “official” that can be done to prevent meconium aspiration; however some birth professionals have suggested that induction of labour, speeding up labour with drugs, hyper stimulation of the uterus and baby before it is born (or before the head is out in the case of breech babies) and severe dehydration in the mother can contribute to it happening. Other causes like a brief cord accident and placental abruption cannot currently be prevented. Suction of the baby directly after a vaginal birth may help with removing the meconium within the amniotic fluid in the mouth and throat that has been pushed out from the lungs however as meconium aspiration from the meconium that remains in the lungs still occurs even with this technique and its success is limited. A caesarean delivery where meconium is present may also produce higher rates of meconium aspiration as the baby’s body has not been squeezed through the birth canal and the fluid can remain in the lungs even after suction is done.
Meconium aspiration can cause respiratory distress which can then turn into pneumonia in babies and can be fatal although I do not currently have the Australian statistics for fetal mortality from meconium aspiration.
Q5) What should I do if meconium is present in the amniotic fluid?
A) First of all, don’t panic. While 5-20% of all births have meconium in the amniotic fluid only 5% of those will result in meconium aspiration, which makes it a rather small number of approximately 0.25% or less of all deliveries which is really quite low.
Secondly, relax. As long as baby is happy and is not in actual distress (a scalp clip monitor or ultrasound are currently the best ways to assess how baby is coping and if distress is present) then you have nothing to worry about.
Lastly, the risk of meconium aspiration is very low, and well trained care providers can pick it up very fast and treat it quickly.
Q6) My doctor told me that meconium was present in the amniotic fluid on the ultrasound and said that I needed to have a caesarean section, is this really my only option?
A) For all of you pregnancy/birth-savvy readers who know as much as I do or more than I do about meconium, yes this is a real question that was asked a few months ago in a pregnancy support group (I have however changed the wording of the question). For those who don’t understand what I mean and are wanting to learn more – meconium cannot currently be identified via ultrasound. It is currently impossible to be able to see meconium on an ultrasound, even on those fancy 4D ones.
So to answer this question – No, caesarean is not your only option! You can birth however you want, whichever way you want. At this point I would be doubting the capability of any doctor who mentioned that to me, and anyone who is told this should question their care provider fully on how they came to this conclusion.
Q7) What causes meconium to be produced?
A) Meconium presence can be caused by hypoxia (lack of oxygen to the brain) which can cause the bowels to contract and release meconium, fetal distress is along the same lines as hypoxia in how it produces meconium but is usually not quite as bad and can eventually result in hypoxia as well if it is not picked up quickly, and it can also be a cause of baby being post estimated due dates. Meconium can also be produced during labour when the baby’s head is compressed while moving down the birth canal combined with the lack of oxygen during a contraction when the blood is squeezed out of the uterus by the contraction of the uterine muscles (a very normal thing and this can be reduced by breathing normally throughout contractions and while pushing instead of holding your breath). This can stress the baby out a bit – being squeezed and having your oxygen supply limited could stress anyone out really – which results in the involuntary contraction and release of the bowel and passing of meconium, this is not the same as true fetal distress however.
Q8) Is there anything that I can do to prevent meconium from being produced?
A) No not really. It is usually out of our control, however some birth professionals have suggested that avoiding an unnecessary induction (just being post dates, baby estimated as being “big”/“large” or having controlled gestational diabetes does not automatically mean that you need to be induced if baby is still happy in there), and avoiding augmentation (speeding up) of labour can reduce the occurrence of some of the things (fetal distress and unexpected cord compression) that can cause meconium to be passed early. For the most part in a normal pregnancy meconium is only produced once the babies bowels are mature, so if you go into spontaneous labour and baby is otherwise happy and there are no signs of fetal distress and there is meconium present then you can be assured that your baby is ready to be born and his/her bowels are mature.
Q9) Why must I be constantly monitored if meconium is present in the amniotic fluid?
A) The idea behind constant monitoring is to pick up fetal distress early enough for emergency life saving measures to be implemented. As the presence of meconium can sometimes indicate that the baby is in distress hospital policies, and many obstetricians themselves, prefer to err on the side of caution and monitor the baby continuously so that the distress can be picked up quickly if it occurs and the monitoring is usually done using a CTG machine. However recent research on constant monitoring has found that constant fetal monitoring does not improve outcomes by very much and the CTG machines can show false readings if baby moves too much or if the mother moves. The monitoring also limits movement of the mother which can result in other issues as well. Intermittent monitoring using a hand-held Doppler, constant monitoring using a scalp clip or regular monitoring by ultrasound can give better results and prove without a doubt whether the baby is in distress or not.
Q10) So I really shouldn’t stress about meconium then?
A) This depends on the reason for the presence of the meconium. If it is because baby is already in distress then it is time to worry, and you will be meeting your baby very soon either via caesarean or if you are already pushing then usually via assisted delivery using either forceps or ventouse (vacuum) extraction. If it’s there just because you are post estimated due date and baby is otherwise happy then you don’t have to worry. Meconium can also be present but be “old” meconium from a few weeks to a month or more earlier which can be caused by severe dehydration in the mother, baby pinching his/her cord, medication that the mother was given or another reason entirely. However it is always best to try not to stress at all and even if baby is in distress try to remember that your care provider will do everything in his/her power to make sure that baby arrives safely and is healthy and happy.
To conclude this blog post, as a general rule Meconium is nothing to be really worried about with no other issues present. It can be a sign of fetal distress which can be accurately ruled out via ultrasound, Doppler and fetal scalp monitor. Meconium aspiration as a result of meconium being present while it is a bad thing it is not very common at all and should not be a concern if there are no other risk factors and baby does not get over stimulated enough to take a breath before the mucous has been cleared from his/her lungs. Meconium can be produced by hypoxia or fetal distress (which as stated can be confirmed or ruled out quite easily), and can also be a very normal part of development for a baby in utero.
As always, feel free to share!
Student Birth Doula
FOOTPRINTS & RAINBOWS