meconium?

[txgal]

The first birth I attended as a doula, the baby aspirated meconium and sadly passed away a few days later. I am still working through the emotional part of that, but would also like some insight into the biology/medical side of it all.
Basic birth story: Mom labored at home starting on a Tuesday afternoon, we headed to the hospital @ 2 AM wednesday morning and were sent home, mom was only 2-3 cent. Went home rested, contractions slowed down for a few hours then picked back up @ 1 PM wednesday. Mom's water broke @ 5:30, fluid was clear. We headed back to the hospital, she was 5 cm on arrival and was complete by 9:00 PM, pushed for @ 3 hrs, no signs of meconium at the hospital, no sign of distress on the EFM, completely natural birth. Head is born followed by thick meconium at 11:30.
My main question, I always assumed that meconium that thick would have to build up over time and that it would be evident once the membranes ruptured. Everyone including the doctor seemed shocked to see that much meconium, that apparently accumulated in just a couple hours. Just curious to know how often this happens, what might have been done differently if they had known. Any insight?

[MsBlack]

I too would like to hear from other professional about this. All I can say is that I saw this once, but the baby was stillborn (w/lungs full of mec at birth) and no cause was ever determined. And it seems to me that perhaps the mec was not a 'cause' in the story you tell, but more of an effect of something else--as it seemed to be in the story I mentioned.

I am curious tho--was the baby born vigorous, or at least--heart still beating, trying to breathe? Or did med staff have to attempt full on resuscitation immediately upon delivery?

Sorry you're having to deal with this....I know it is so hard.

[txgal]

The baby was intubated at birth, she came out limp and blue, but with a heart rate of @ 50 bpm., I never saw her breath on her own. That was another thing that didnt' make sense, I can't figure out when the baby would have aspirated the meconium since she never took a breath. There was a shoulder dystocia (only stuck for 1 min. though), so I am not sure you can even call that a true dystocia. My own birth the body took a full min. after the head just because she was a compound presentation. The baby's heart rate was perfect until the shoulders got stuck, doc had to reach in and rotate the baby while the nurse applied pubic pressure, then it dropped from the 140's to the 50's for the min. that the shoulders were stuck and never recovered.

Lydia

[kate3]

Well, what you describe is not the usual presentation for mec aspiration, but it can happen. If the baby got a mouthful prior to delivery, even if she never took her own breath outside the womb, she could still have aspirated before birth (remember, babies do practice breathing). She could have passed very thick mec that didn't have a chance to be "diluted" in amniotic fluid. Three hours of pushing could have been just enough stress to release the meconium plug, and if that made it into her lungs, that would explain her presentation at birth.
I'm a NP now and work outpatient, but when I did inpatient OB/GYN, mec aspiration was one of the two things that was really terrifying to witness (the other being group B sepsis). I practice in a large city and we are very lucky to have numerous ECMO beds throughout the area, so we have very few fatalities from mec. But it is still a horrible complication. The clock starts ticking the moment you realize that is what is wrong, and the sooner the babe can be put on ECMO the better the chance of survival.

[3cuties]

Is this something that is not easy to predict or monitor and when it does happen, it is a situation that is best dealt with in the hospital?

[kate3]

Is this something that is not easy to predict or monitor and when it does happen, it is a situation that is best dealt with in the hospital?

There really is no way to predict it. It is seen more in post dates pregnancies, but can also happen randomly. Most often you see mec in the amniotic fluid, but if the membranes are intact there is no way to know if the baby has passed meconium. In a hospital setting where continuous monitoring is the norm, you might pick up abnormal heart rate patterns (lates, no variability).

My patients all deliver in the hospital, so the MWs that do homebirth would have more information on whether this is managed at home or not. My guess is that it is probably an indication for transfer (especially for moderate to thick mec), but I could be wrong.

[maxmama]

The current thinking with MAS (which drove the NRP changes this time around) is that mec aspiration doesn't occur at birth but in utero, in response to asphyxia. It makes sense if you think about it -- all those meccy babies who come out screaming and do fine probably had physiologic meconium passage, not an anoxic event, and the babies who have an anoxic event and incidentally also have MAS -- well, it's very hard to tell what damage was caused by the mec and what was caused by the anoxic event that precipitated the mec.