Mec staining in out-of-hospital birth?

[MaterPrimaePuellae]

I keep forgetting to ask my birth-center/homebirth midwives about this, so I thought I'd post here and get some idea of what others have done before discussing it with them next week--

DD was born in-hospital. She was post-dates by some amount of time (2+ weeks by LMP, 1+ week by US dating). She was small (7 lbs 1 oz) but had no vernix, and there was meconium staining when the CNM broke the amniotic sac at 8 cm. It was enough that, when she swept around the cervix with her fingers after breaking the sac, I could see green goop on her fingers. That was before any pitocin was used, so I can't really blame the meconium on anything except a long labor (it has been 24 hours at that point).

Of course, they brought in the resp. team, and I assume they suctioned DD pretty thoroughly... however, she had zero problems and was crying heartily even before the suctioning, and they didn't take much time with her at all.

Since her birth, I've read different things about meconium; some people seem to think that the suctioning is good, while others think that, in the event of a serious problem, the suctioning just pushes the mec deeper into the throat/lungs (?).

So: is mec staining a reason for transfer? Are there precautions I can take to avoid it this time around?

[theretohere]

Originally Posted by MaterPrimaePuellae

I keep forgetting to ask my birth-center/homebirth midwives about this, so I thought I'd post here and get some idea of what others have done before discussing it with them next week--

DD was born in-hospital. She was post-dates by some amount of time (2+ weeks by LMP, 1+ week by US dating). She was small (7 lbs 1 oz) but had no vernix, and there was meconium staining when the CNM broke the amniotic sac at 8 cm. It was enough that, when she swept around the cervix with her fingers after breaking the sac, I could see green goop on her fingers. That was before any pitocin was used, so I can't really blame the meconium on anything except a long labor (it has been 24 hours at that point).

Of course, they brought in the resp. team, and I assume they suctioned DD pretty thoroughly... however, she had zero problems and was crying heartily even before the suctioning, and they didn't take much time with her at all.

Since her birth, I've read different things about meconium; some people seem to think that the suctioning is good, while others think that, in the event of a serious problem, the suctioning just pushes the mec deeper into the throat/lungs (?).

So: is mec staining a reason for transfer? Are there precautions I can take to avoid it this time around?

I've had two babies with mec staining- one at the hospital, one at home. Both were lightly suctioned with a bulb syringe, but neither needed anything else. I wouldn't transfer for light staining and a baby that pinks well.

[erin_brycesmom]

I've also had two babies born with meconium staining, one at the hospital and one at home. At the hospital, cord cut, we were seperated were ds had deep suctioning. At home, there was no separation, no cord cutting and no suctioning, not even the bulb. We were able to nurse right away. It was soooooo much better at home. Home was a waterbirth and there is some speculation that this is safer for babies with MSAF (according to Barbara Harper) Both babies were born past their due dates and no pitocin with either. With both, I didn't allow AROM and my water broke while pushing. I prefer this as there isn't time to stress or worry at that point. Suctioning isn't evidence based unless the airways need to be cleared for resuscitation. Suctioning can be harmful so I wouldn't do it without evidence. It definitely does not prevent MAS.

[mamakori]

There was mec staining with my birth center birth. My bag of water didn't break until pushing (which lasted all of 5 minutes), so transfer was out of the question. It was not a big deal at all. If my water had broken with mec staining earlier in labor, I guess it could have been a reason to transfer had there been other signs of distress. But with that birth it was a non-issue. They used a bulb syringe to clear fluid from his nose and mouth with no aggressive suctioning and he had no aspiration issues.

[SwanMom]

I had a homebirth & my son was one of the rare cases where he had to be in a NICU on a ventilator for more than a week due to aspiration pneumonia. The doctors there were amazing & we are blessed to have a very healthy 3-year-old who hasn't had to go to the doctor since he was 3 weeks old.

I don't know why he aspirated. Maybe my blood pressure dropped? Maybe it was the long labor? We don't know. It happens. They say it's more common in stressful births, so for me that would have been the hospital. When he was born, they called for transport right away when it was plain that he wasn't able to breathe well. The great thing about being home (other than not having a c-section due to the long labor) was that I was able to hold him & look into his eyes all the way to the hospital. Once there, he was transported to the nearest NICU (30 miles away) & since I was feeling fine & wasn't a hospital patient, I could go with my husband to the NICU right away. If I had given birth in our hospital without a NICU, I would have "been their prisoner" & had to wait to be discharged before I could have gone to the NICU.

Anyhow, I'm having another home birth.

[MsBlack]

The American Academy of Pediatrics is the org. that created and runs the Neonatal Resuscitation Program, which is the 'CPR' for neonates--all medical personnel and licensed mws have to certify/recertify in this training every year (well, if they work with pregnancy/birth/newborns). By the AAP's newest guidelines, suctioning should NOT be done, even in the presence of meconium (or heavy mucus), for any vigorous baby who is making respiratory effort (cough, sneeze, cry, breathe). Instead, suctioning should be avoided so as to avoid shoving meconium further into the respiratory passages and also to avoid causing abrasion and irritation to those tiny new passages--which can only make baby's condition worse.

AAP says that suctioning is only appropriate when the baby's airway is completely blocked and you need to clear an airway to get breathing started at all. In case of a fully blocked airway, the risk of abrasion to baby's mucus membranes is less important than getting air into baby!

Few docs or mws follow these newest NRP guidelines, as far as I can tell, if they started working before these guidelines came out in 2006. I've watched some hospital births in the last year or so where even babies with NO mec were suctioned, just routinely, by force of habit.

I personally think a baby with mec in the water is safer at home, as long as all signs are good during labor, and as long as your care provider knows better than to suction if baby is vigorous and has an airway. At birth, as SwanMom points out, respiratory distress signs can be observed, and transfer for med care can occur to help the rare neonate who does need some medical help. But IMO, which I think SwanMom agrees with --if babies signs during labor ARE good, better for birth to occur at home for gentler treatment of baby in those early minutes, more bonding and skin to skin time--all of which helps babies immeasurably in recovering from such stress.

I do want to emphasize that only rarely does mec in the water mean that baby will have any issues at all. Most often, it causes no problems whatever.

[gardenmommy]

I had one baby with light mec. staining born at home. She pinked up very quickly, good apgar scores, nursed right away, etc. She was born on her due date, not a long or stressful labor, so no idea why there was staining. I guess that's less important at this point than the fact that she is now a happy, healthy 5 yr. old. I agree with PP that being at home was very calm. My MW didn't get stressed about it (well, maybe she did, but she didn't let me or DH know). I think if we had been in the hospital, there would have probably been more fanfare with the staining. Who knows. I'm just happy that it all worked out.

[happyblessedmama]

My 3rd child was born with "heavy" mec staining (thick meconium - not a little - but a lot). I had a low risk pgcy, was 8cm at the birth center when they broke my water. They did transfer me. They were using doppler to monitor heartrate intermittently and it had seemed fine.

At the hospital, baby was born (total time in labor from first ctx to delivery was 2.5 hours), and was in distress. First apgar was 2, 2nd was 8. Long story short, she had a 2 week NICU stay with 1 week on a ventilator.

All my NSTs had been fine, BPPs fine, during labor everything "seemed" fine but wasn't.

I haven't attempted an out-of-hospital birth since. I found an awesome doc and a very low-intervention hospital (they do not offer epidurals) and I'm happy with it. I'm not sure what would've happened had my baby not been born at the hospital with the neonatologist in attendance, as she needed immediate full resuscitation.

So I'd say at least in some circumstances, YES, it warrants transferring. It was one of the things my birth center transferred for. My baby definitely needed it.

[amberskyfire]

Here's my take on it:

I had a UC at home and had mec staining. My daughter was born perfectly fine with top apgar scores. She had quite a bit of fluid in her lungs, but it all came out by the next day and she was perfectly fine and healthy. My bulb syringe did not work. The midwives who came to check us out afterward said to just keep her on her side instead of her back so that all of the fluid would drain from her lungs.

Meconium is usually okay, but sometimes it can be an indication in labor that the baby is stressed for some reason. This can be determined by checking heartrate, however. Usually, there's nothing wrong. Baby just passed a poop

The problem after birth, as you know, is that meconium in the lungs can cause pneumonia. What is important to know, however, is that it is extremely unlikely for your baby to get pneumonia at home. On the other hand, it is extremely LIKELY for your baby to get pneumonia from the hospital. Hospitals are full of sick people, after all, and pneumonia is extremely prevalent in hospitals.

That being said, if your baby has had meconium in the lungs, it is probably in your best interest to stay away from the hospital unless necessary.

Using a suction does cause the baby to suck more meconium into the lungs, so I hear many mothers and midwives are now speaking out against doing it. Our suction did not work, so I tried sucking the fluid out with my mouth, but it didn't work. I wouldn't do it again. I also would not take a baby with meconium staining to the hospital after the birth. I would avoid any situation which could increase my baby's chances of getting pneumonia such as rooming in with baby for two weeks and allowing minimal visitors.

[josie423]

Both of mine had light meconium staining (born at home, water didn't break until I was pushing). Neither were suctioned and both were absolutely fine. Both of them spit up mucous and meconium a few hours after birth. I was freaked out, but my midwife said its normal and nothing to be concerned about.

[happyblessedmama]

What is important to know, however, is that it is extremely unlikely for your baby to get pneumonia at home. On the other hand, it is extremely LIKELY for your baby to get pneumonia from the hospital.

Um, no. Meconium in the lungs functions as an irritant and effectively can give the baby CHEMICAL pneumonia. There isn't a bacterial component. If the baby is affected to the point of having mec actually in the lungs, you DO need medical attention. Meconium is sterile - and I can tell you the damage had occurred before my baby was born. She did NOT have bacterial pneumonia - that's not the way meconium aspiration syndrome works.

[amberskyfire]

Originally Posted by happyblessedmama

Um, no. Meconium in the lungs functions as an irritant and effectively can give the baby CHEMICAL pneumonia. There isn't a bacterial component. If the baby is affected to the point of having mec actually in the lungs, you DO need medical attention. Meconium is sterile - and I can tell you the damage had occurred before my baby was born. She did NOT have bacterial pneumonia - that's not the way meconium aspiration syndrome works.

You are correct. It can cause chemical pneumonia, but it is very rare. I do not doubt that in your case there was an emergency or that your baby had chemical pneumonia, but meconium aspiration can also cause bacterial pneumonia which is a much more common form.

[happyblessedmama]

Really... because it is my understanding that mec is sterile and wouldn't be the medium for transmission of bacterial infection.

Yes, one can contract a secondary infection (indeed, I worried about that when my baby had a direct pathway with a vent tube going down into her lungs) but mec as the source for a bacterial infection? Please cite your source.

I'm aware that MAS is "rare" but it's not something to be taken lightly. Obviously, my kid was not vigorous at birth. If a baby is OK, and you are comfortable, that's one thing - but if not, don't stay home just for fear of "what might happen"... things go south quickly with respiratory distress.

[Viola]

Both of my labors started with my water breaking containing meconium. One was born in the hospital, and I had a number of interventions including an epidural, pitocin and amnio infusion. The other was born at home. In the hospital they had the neonatal specialist there and took her away to suction her as soon as she was out, but with the homebirth I got to hold her, although I think there was also some suctioning done.

[amberskyfire]

Originally Posted by happyblessedmama

Really... because it is my understanding that mec is sterile and wouldn't be the medium for transmission of bacterial infection.

Yes, one can contract a secondary infection (indeed, I worried about that when my baby had a direct pathway with a vent tube going down into her lungs) but mec as the source for a bacterial infection? Please cite your source.

I'm aware that MAS is "rare" but it's not something to be taken lightly. Obviously, my kid was not vigorous at birth. If a baby is OK, and you are comfortable, that's one thing - but if not, don't stay home just for fear of "what might happen"... things go south quickly with respiratory distress.

You misunderstand. I said that the mec. was NOT the source of the bacterial infection. Mec. is not sterile, but very nearly so. It does, however, act as an enhancer for the growth of pneumococcal bacteria. It acts as a feeding ground, if you will, much like the jelly in a petri dish. Pneumonia can grow on many things that accumulate in the lungs, most often mucous. The pneumococcal bacteria does not come from the mec. It comes from outside the body. This is why pneumonia occurs frequently in newborns in the hospital, but not commonly in homebirthed babies. There is less chance of the baby coming into contact with the pneumococcal bacteria at home.

You are not wrong. You are correct. I think you just misread what I wrote. You are right that it's okay to stay home if all is OK. It's important, obviously, to head to the hospital if anything develops. It's a personal choice, but there is a higher risk of pneumonia if you take the baby to the hospital. Personally, I go by odds. Sure, XYZ can happen, but there is ALWAYS a chance of something going wrong at any point in life. I try to stay on the safe side and do what is less likely to cause a problem so long as I can see that everything is going okay.

[happyblessedmama]

This is why pneumonia occurs frequently in newborns in the hospital, but not commonly in homebirthed babies.

Interesting discussion. Maybe it's chicken and the egg in some ways... of course the sick babies end up at the hospital. Kind of like some hospitals that handle exceptionally high risk women have higher c/s rates.

So what I'm reading is that it makes it easier to pick up pneumococcal bacteria and it provides a good breeding ground for that bacteria.

I guess you could also argue that if a baby with mec is KEPT at the hospital after going to get checked out, there's probably a reason for it (poor oxygenation) and then interventions just up the likelihood of transferring bacteria into damaged lungs.

Sad stuff.

[amberskyfire]

Originally Posted by happyblessedmama

Interesting discussion. Maybe it's chicken and the egg in some ways... of course the sick babies end up at the hospital. Kind of like some hospitals that handle exceptionally high risk women have higher c/s rates.

So what I'm reading is that it makes it easier to pick up pneumococcal bacteria and it provides a good breeding ground for that bacteria.

I guess you could also argue that if a baby with mec is KEPT at the hospital after going to get checked out, there's probably a reason for it (poor oxygenation) and then interventions just up the likelihood of transferring bacteria into damaged lungs.

Sad stuff.

It is Especially since it's not really the hospital's fault. They do all they can not to transfer germs, but when you're in a building full of sick people...

But on the bright side, we HAVE hospitals to help when there are problems like that, so we lose a lot FEWER babies to pneumonia than we used to. Plus, if a baby is already being kept there for problems, you have the advantage of that. It overrides the danger of contracting an infection because you already need the medical help anyway.

But yeah, it's like going to the hospital for surgery when you are sick and ending up getting an internal infection Darned if you do, darned if you don't.