Meconium

[Kylix]

How much of an issue is meconium in a home birth? Is it something that you need to transfer to the hospital for, if the midwife discovers meconium in the broken waters??

Kylix

[indigolilybear]

In my experience, no. They didn't transfer me and I had a moderate amount. I think it's more if the baby still sounds okay etc. Depends on the situation though I assume. And their comfort level and agreements w/back-up dr's. I'd guess. YOu'd have to ask your MW. Mine were fairly conservative, though, to give you an idea. From my understanding, it's fairly common. HTH

[khrisday]

Yes Kylix,
If there is a considerable amount of meconium they will transfer you to the hospital. My dd was born at home with meconium, but my water didn't break until I was pushing so there wasn't time. She was literally crowning by the time they checked me. The midwives had wanted to break my water earlier, but I refused. My midwives were very calm and professional, but it was a scarrey thing. I had to deliver the placenta as soon as I could, take a shower and hop in the car to take the baby to the hospital. The midwives had called the ped and told him to meet us there. Shortly after she was admitted and they could see that she was not responding to the treatment that they could provide, and a Universtiy hospital was called to send a transfer team to come and get her. I knew it was serious, but I didn't realize that babies DIE from meconium. She spent the first week on a heart/lung bypass machine called ECMO, and three weeks total in the hospital. This procedure is not even done in most hospitals, and it is only done on patients who meet certain criteria. Part of which is an estimated survival rate (without this treatment) of 20% or less. The reason they want to get a baby who is presenting with meconium staining is in case is has been aspirated. They can get treatment to the baby much sooner, but of course there are the drawbacks.

[Kylix]

Hmm...two different answers...

Khrisday--WOW is all I can say about your story! I didn't realize it was so serious. I'm glad your dd was able to get treatment.

I've always thought meconium was fairly common especially for babies overdue (which I'm thinking mine will be since I (and my sisters) were).

Kylix

[pamamidwife]

The thing about meconium aspiration syndrome is that it occurs in utero - not necessarily with that first breath, as is commonly believed. That's why suctioning right at birth can cause more harm than good.

Moderate meconium is something that is part of a bigger picture. How is baby doing? Meconium with great fetal heart tones is something that is not an indication to transfer care. Meconium - even light meconium with non-reassuring heart tones is something that I would consider transferring for (this is a sign of a baby that is not doing so well and could get worse quickly) if the birth wasn't imminent. It's not a black/white answer, but it rarely ever is with homebirth!

Thick meconium is something that could be more serious - and I'd feel more comfortable transporting from home.

I'm really opposed to vigorous suctioning of babies at birth - unless they're needing to be resuscitated and there is a concern about efforts forcing the meconium into their lungs, or blocking an airway. Using an endotracheal tube (deep suctioning) at birth on a baby has been shown over and over to further COMPLICATE the meconium situation, rather than improve it in any way.

Here is some great information from a midwives email list:

From that site:

True meconium aspiration is often a prenatal/prelabour event. There are several documented cases where babies were born with MAS after elective sections. Both the meconium and the aspiration are usually related to hypoxic events in utero. The baby, if subjected to severe enough an hypoxic insult in utero, will gasp (sort of a last-ditch reflexive effort to get oxygen) and will then get the meconium down below the vocal cords.

This is why there is some question as to how useful it is to suction babies on the perineum with mec (although everyone I work with still does it) with respect to preventing MAS. And why many babies, despite lots of mec at birth, will be vigorous with no problems.

The worst MAS case I encountered was in my labour-support, premidwifery days. The baby crashed in latent labour (about 3-4 cm, contrx q 10 and mild), with a sustained bradycardia (for at least five minutes) at 50. (Fortunately, I had already heard one significant decel at home, which was why we were in the hospital so early.) When the membranes were ruptured by the (idiot) resident who thought she should put on a scalp clip, the fluid was basically thick, old mec. The OB ran in, tore a large strip off the resident, did the fastest informed consent for a section I've ever seen, and they had the baby out in 10 minutes. He'd aspirated, was in the NICU for about a week and a half, ended up okay.

I, on the other hand, sprouted many more grey hairs and quickly understood the responsibility I was taking on doing this work!

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Hope these help!

[TiredX2]

This is just my personal experience, but...

I also had water break very late in labor, but the water was pretty "clean" looking. After DS was born, though, he wasn't breathing. We were able to get him going with no problems. He was *covered* in Meconium (and I was too). Accd to the midwives he not only passed it very recently but quite some time before, as well (his nails were stained with it, which she said showed an earlier passing). Anyway, apgars of 2 and then 9 and we stayed at home. I felt it was handled great and was soooo happy to be at home. He also had the cord around neck, shoulder and arm, but I pushed him out with just a small tear.

I *loved* my home birth!

Kay

[Czen:)]

My midwife had me transfer to the hospital because of meconium. My water had broken in a leaky way at 9 pm. At 6 am no labour started and meconuim suddenly appeared in my leaky water. I called her at that time, she met with me, assessed the amount, took into consideration how many hours since the water started leaking and said this called for a hospital birth. The great thing is that she has hospital priveleges and still delivered my baby. A ped was in the background for the actual pushing but my midwife dismissed him as soon as she saw the baby. Her words "nothing wrong with this baby" were great to hear as she handed my little one to me.

Turned out her umbilical cord was the shortest my midwife had ever seen and she has been doing this forever. Seems when baby started to descend it stretched the cord and caused distress.

So I guess it can go either way, serious or no side effects at all.

[MossbackMeadow]

With my third birth, my water broke just as I was pushing and was very dirty. We were a little worried and midwife set up suction equip but baby was lusty, strong, and crying when he was born. We didn't suction him after all and everything was fine. We stayed home.
It had been a very long labor, ( 3 days) and he had a vanished twin ( came out pulling a big sac full of nothing but water) , so he must have had stress of some sort.

I don't think it's neccesarily a bad sign.

[Breathe]

My labor began with my water breaking and it was very lightly stained with mec. Midwife had me go into the birth center for a fetal non-stress test, which tuned out fine, and she then reassured me that in 70% of full-term babies w/mec staining, it is totally normal. I was surprised that I hadn't heard that statistic before then -- all I had heard was that meconium is bad, bad, bad! She did have me watching for fresh staining or for "pea soup", but neither happened and 48hrs after my water broke, ds was born (at a birth center) with Apgars of 9 and 10.

[miriam]

Alittle T

I never had meconium staining with any of my dear children who were all born at home. My last baby came out pooping all over though, but no staining in the amniotic fluid prebirth.

There had been a baby born in the hospital three minutes from me who died because the pediatrician and nursery staff never noticed that he never made a "poopy" diaper.

He was released from the hospital with his teenage mother, and died a few days later.

When he was brought to the hospital, and the reason for his death became obvious, the hospital staff accused her of switching babies on them and bringing in a baby that had died at a home birth.

Imagine having your newborn die because of a hospital mistake, and then being accused of doing a switch-a-roo by the hospital staff!

The young mother sued the hospital and settled out of court, but not after lots of publicity. The pediatric nurse was fired, but I think the supervising pediatrician/neonatalogist who released the baby should have been fired also.

Unbelieveable! Needless to say, when my dear son was born healthy and pooping too, I was very happy!

[TrinitysMama]

When Lily was born, there was a lot of meconium. My water broke at 8cm. Awhile after that I felt something fall out of me while I was sitting on the toilet and found that it was a lot of thick meconium. By then I was 9cm and delivered about an hour after that.

Lily's heart tones were great the whole time, but she was pretty floppy when she came out. I started talking to her and she started pinking up. The midwives ended up suctioning a ton of meconium out of her stomach and she spit up some more later that evening.

They never mentioned to me that I needed to transport, but I'm sure that they would have if they thought either of us were in danger. Everything turned out fine. It was a very messy birth and there was poop everywhere!

[JesseMomme]

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[candiland]

My midwife has never transferred because of meconium. No, wait, now that I think about it... a woman was three weeks overdue, she had a slight fever, and when her water broke at, like, 4 cm., there was thick meconium, so she transferred. But she's never transferred anyone during pushing or after the birth. She brings the DeLee suction device to each birth and clears the baby out herself... although she has only had to do this a couple of times. Meconium is much more common in the hospital because of the stress the mother endures.

[Alexander]

Also http://www.gentlebirth.org/archives/mecabs.html

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[miriam]

I attended an elementary midwifery course in which I learned that meconium has a molecular structure in which it behaves as sharp crystals. Therefore, when it lodges in the lungs of the baby, it causes bleeding and breathing problems, tearing at the integrity of the lung tissues which are only beginning to be used in the newborn's life.

[frogertgrl]

Good recent study showing that suctioning (before shoulder delivery) doesn't alter meconium aspiration risk or improve mortality rates.

http://www2.eobgynnews.com/scripts/o...=aqo030380701c

[thebabycatcher]

I agree with everything Pam said.
Pam, what midwife list did that come from? It looks familiar.
Also, the NRP protocol is thatt you suction all mec. babies on the perineum. You used to have to visualize the chords on all babies, but now you don't have to on "vigorous" babies.
Of course, I don't suction all my mec babies, in fact I VERY rarely suction. If the mec is that bad we transport.
Also, I don't know who mentioned this, but the mother taking castor oil doesn't make the baby pass mec. Castor oil doesn't pass into the baby. It doesn't get into the mother's bloodstream

By the way, I'm new here. My name's Megan. I'm a homebirth midwife in Madison, WI.

[frogertgrl]

Hi Megan, the email list (archives really now) is in the link she posted above the quote.

One of the things I was most certain of with my homebirth (and my next one later this year) is no suctioning. I cannot watch any suctioning in births - it makes me want to scream. Plus, I couldn't risk my baby struggling to nurse after having anything put in his tender mouth. I don't care how gentle someone claims they are with that bulb.

[candiland]

the mother taking castor oil doesn't make the baby pass mec. Castor oil doesn't pass into the baby. It doesn't get into the mother's bloodstream

Right, but just like Pitocin or anything that augments contractions, I would assume that longer, stronger, more frequent contractions would raise the possibility of the baby getting stressed out and passing meconium. Right?

[JesseMomme]

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