What happens if the baby poos?

[ann_of_loxley]

So my friend just had her baby today - her first home birth!...She sent it went well and she is really proud of herself that she got her home birth...But there were a few things she was not happy about. She said the MW was a bit pushy - telling her what to do when she really just wanted to be left alone...But she said the baby has passed meconium in the waters which you could see when her waters broke in labour, so perhaps the MW was trying to rush her a bit because of that?....

So lets talk about when the baby poos - what that could mean, how we can avoid it?, what we can do if it happens to avoid any bad stuff (especially pushy MW! lol)

[Kessed]

What I remember from last time is that mec can be really bad...

It depends on how thick. A small amount of mec shouldn't be a problem. It will be thin - and can easily be wiped from the baby's face as he is being born.

Thick mec can be very dangerous. If the baby inhales too much - then it can fill the lungs. It can be very hard to suction out. Remember how sticky it is. If the baby's lungs are filled - that can mean trouble getting enough oxygen leading to brain damage.

If the baby inhales a small amount - that can lead to later infection.

My sister had an 'emergency' homebirth with her second. Luckily she called her MW when her water broke because there was thick mec. Her midwife came to their house to check on things and to advice on when to transfer (this was out of my sister's comfort zone). But only 70 minutes after her water broke and 10 minutes after her first contraction - my sister had to push. Luckily my sister was able to control her pushing to give the midwife enough time to suction things well. The midwife then stayed with them for many hours to keep an eye on the baby.

[barefootpoetry]

A small amount of meconium isn't a big deal. A lot, on the other hand, can be dangerous, like the PP said. My son had a little meconium pass prior to birth and he was fine.

I've heard that inducing with castor oil can cause baby to pass meconium, so I definitely wouldn't do that.

[ann_of_loxley]

I've heard that inducing with castor oil can cause baby to pass meconium, so I definitely wouldn't do that.

Yeah...im one of the few on here that say 'what are you crazy?! - Dont do it!' when it comes to the 'im going to take castor oil now' posts. It still amazes me that people are all 'yeah its fine - do it!'.

[DreamsInDigital]

There isn't really much one can do to prevent meconium prior to birth. It happens sometimes, even in babies that are not distressed or postdates and there rarely seems to be an identifiable cause.

That said, even thick meconium presenting at rupture of the waters is not in and of itself a problem, only if the baby gasps prior to its head being delivered and inhales a lot of meconium. And even then, not all babies develop meconium aspiration syndrome. I think deep suctioning babies routinely just on the presence of meconium alone is not evidence-based practice. I tend to favor a watchful eye instead, being alert for signs that baby did in fact inhale meconium and addressing it accordingly.

[Defenestrator]

There's a lot of misinformation on this thread.

Castor oil does not cause meconium to be passed.

The quantity of meconium does not affect how dangerous it is.

Suctioning a vigorous baby does not keep her from aspirating meconium.

Thick meconium is not more likely to be aspirated than thin meconium, though the presence of thick meconium indicates either recent passage or low amniotic fluid, both of which can be signs of problems on their own.

[Kessed]

Originally Posted by Defenestrator

Suctioning a vigorous baby does not keep her from aspirating meconium.

Suctioning a woman's vaginal opening to remove extra mec filled fluid WILL reduce the risk of it being inhaled!!!!!!!!!!!!!!!

That's what was done in my sister's case. She resisted every second push to give the midwife time to remove the mec fluid from her and from the baby's head. Both suction equipment and multiple towels were used.

Thick meconium is not more likely to be aspirated than thin meconium,

If there is fluid on the baby's face which contains mec - the thickness of the mec DOES influence the chance that the baby will inhale some. That's basic probability. If there is VERY LITTLE mec - then there is VERY LITTLE chance that any will be inhaled.

If there is thick mex - then more is likely to be inhaled.

What are you talking about????????????

[barefootpoetry]

Originally Posted by Defenestrator

Castor oil does not cause meconium to be passed.

Maybe not every time, but it makes sense that it happens...it flushes out the mom's bowels, and if it passes on to the baby it flushes out baby's bowels as well.

[Kessed]

Originally Posted by barefootpoetry

Maybe not every time, but it makes sense that it happens...it flushes out the mom's bowels, and if it passes on to the baby it flushes out baby's bowels as well.

I heard that the action of strong stomach cramps (rather than uterine cramps) is what can do it. I think that castor oil is purely intestinal - so there is no way for it to pass onto the baby.

[CEG]

Originally Posted by barefootpoetry

Maybe not every time, but it makes sense that it happens...it flushes out the mom's bowels, and if it passes on to the baby it flushes out baby's bowels as well.

Castor oil works mechanically, not chemically, so it is not passed on to baby. It simply lubricates the intestines. Mec is more likely in post-dates babies who are also more likely to have someone try to use castor oil to get them out.

[barefootpoetry]

Originally Posted by Kessed

I heard that the action of strong stomach cramps (rather than uterine cramps) is what can do it. I think that castor oil is purely intestinal - so there is no way for it to pass onto the baby.

Originally Posted by CEG

Castor oil works mechanically, not chemically, so it is not passed on to baby. It simply lubricates the intestines. Mec is more likely in post-dates babies who are also more likely to have someone try to use castor oil to get them out.

Ahh, that makse sense. I was wondering as I typed it, but that's what I've always been told, so....I guess it's more of a coincidental thing. Thanks!

[leerypolyp]

Originally Posted by CEG

Castor oil works mechanically, not chemically, so it is not passed on to baby. It simply lubricates the intestines. Mec is more likely in post-dates babies who are also more likely to have someone try to use castor oil to get them out.

Yes, this! Absolutely!

[Reha]

Originally Posted by Kessed

Suctioning a woman's vaginal opening to remove extra mec filled fluid WILL reduce the risk of it being inhaled!!!!!!!!!!!!!!!

That's what was done in my sister's case. She resisted every second push to give the midwife time to remove the mec fluid from her and from the baby's head. Both suction equipment and multiple towels were used.



If there is fluid on the baby's face which contains mec - the thickness of the mec DOES influence the chance that the baby will inhale some. That's basic probability. If there is VERY LITTLE mec - then there is VERY LITTLE chance that any will be inhaled.

If there is thick mex - then more is likely to be inhaled.

What are you talking about????????????

Well, actually, it has been shown in multiple studies now that suctioning of the baby does NOT prevent MAS (meconium aspiration syndrome) . Here's an article:
http://www.medicalnewstoday.com/articles/12051.php

This doesn't mean that it (suctioning with meconium) isn't still a common practice. But, there are lots of routine OB practices that aren't evidence-based that continue to persist. :

Here's a quote from the article above:
"Once again, since Archie Cochrane labeled obstetrics as the field with the largest number of unproven therapies in use, a widespread procedure has failed to pass the test of rigorous experimental evaluation"

In fact, what they are realizing now is that MAS is something that usually takes place in utero, when a baby experiences hypoxia: baby gasps in utero, aspiring the meconium, as that is a reflex when humans are deprived of oxygen.

As a midwife, I don't do anything different during a birth simply because of the presence of meconium (regardless of it's viscosity), as long as baby's sounds normal and shows no signs of distress.

[MsBlack]

I have never heard of doing things like wiping mec out of the vagina and off the baby's head prior to birth, in all my years of studying midwifery. That is someone's theory that I can't see holding any water. Mec is thick--and not that easy to suck in, just by being on the baby's face. I have seen several mec births, only 1 of the babies actually aspirated any and all we did was help remove it from his nose and mouth with towels as it emerged when he breathed/cried. He continued to work up mec-y fluids from his lungs for a couple of days periodically, but was just fine.

Even the current Neonatal Resuscitation Program does NOT recommend suctioning for any vigorous baby--even in the presence of mec (because this does NOT prevent mec aspiration syndrome); suctioning is recommended only for babies who have already aspirated in utero and whose airway is essentially too blocked for breathing to occur.

Many get nervous in the presence of mec at birth, and more pushy w/moms because of that nervousness, but really, it rarely poses any problems.

[theretohere]

Both of my birth have had mec, no problems either time. neither were suctioned, either.

[DreamsInDigital]

Lennon, sorry to pick on you but since I respect your opinion so much I have to ask, what would/do you do when you suspect a baby has aspirated meconium and they are NOT vigorous? Is that an immediate hospital transport or what? My textbook gives a really ambivalent answer...

[ChristSavesAll]

What Reha said makes sense "In fact, what they are realizing now is that MAS is something that usually takes place in utero, when a baby experiences hypoxia: baby gasps in utero, aspiring the meconium, as that is a reflex when humans are deprived of oxygen."

I was wondering why on earth people didn't just water birth then to help keep the baby from taking a breath when the air hit them, this way the baby could be cleaned off under the water and it would eliminate the issue. However, if it is accurate that baby does it in utero because of a lack of oxygen I can totally get that.

[pamamidwife]

Originally Posted by DreamsInDigital

Lennon, sorry to pick on you but since I respect your opinion so much I have to ask, what would/do you do when you suspect a baby has aspirated meconium and they are NOT vigorous? Is that an immediate hospital transport or what? My textbook gives a really ambivalent answer...

To answer this (I know I'm not Lennon), the reason why the baby is not vigorous is very likely to be an issue of hypoxia (lack of oxygen), NOT meconium aspiration.

Mec aspiration happens nearly all the time in utero when a baby is seriously deprived of oxygen. It's last-ditch-effort is to attempt a breath. This is when the meconium is inhaled and because the lungs have not expanded, the particulates settle in and cause issues (pneumonia, etc.).

If a baby is not vigorous and does not respond to resuscitative measures at birth then of course a transport would be the next step. However, assuming that even thick meconium without poor heart tones means problems for baby is jumping the gun a bit. I still would NOT suction a baby with thick meconium - I believe you're only risking further issues by deep suctioning. Anything else is likely to get swallowed into the stomach, not inhaled with the first breath. Babies breathe through their noses, not often through their mouths.

(Which is, essentially, what Lennon said.)

[Reha]

:

It's also important to remember that not all mec aspiration (which is defined as any mec below the vocal cords) leads to MAS. In fact, only 5-10% of babies that have been determined to have aspirated mec go on to develop MAS. So, of course, if baby remained unresponsive (not breathing), or started showing serious signs of fetal distress, I don't think transport would be needed.

And I forgot to mention in my previous post that the only that the only times I would consider suctioning any baby would be for a baby who had a physical block in it's airway and needed resuscitation....something that doesn't occur very much at all ( babies that need resuscitation OR babies with a blocked airway needing resuscitation). I have yet to see a baby who needed to be suctioned.

Meconium isn't usually a big deal at all.

[Defenestrator]

Originally Posted by Kessed

Suctioning a woman's vaginal opening to remove extra mec filled fluid WILL reduce the risk of it being inhaled!!!!!!!!!!!!!!!

That's what was done in my sister's case. She resisted every second push to give the midwife time to remove the mec fluid from her and from the baby's head. Both suction equipment and multiple towels were used.



If there is fluid on the baby's face which contains mec - the thickness of the mec DOES influence the chance that the baby will inhale some. That's basic probability. If there is VERY LITTLE mec - then there is VERY LITTLE chance that any will be inhaled.

If there is thick mex - then more is likely to be inhaled.

What are you talking about????????????

There is a lot of evidence that nearly all meconium aspiration happens in utero. So, all of this suctioning and wiping probably didn't have much of an impact. Sure, I don't want a baby to aspirate anything after the birth and if I see fluids running all up a baby's nose I might try to keep it from being flooded by fluid, mec-stained or not. I don't quite understand what you mean by quantity of meconium. Since it ends up in the fluid, you could have a large quantity of lightly mec-stained fluid. Is that a lot of mec or a little mec? I would worry more about a flood of light-colored fluid than I would thick terminal mec that happens to get on a baby's face.

The new neonatal resuscitation guidelines say treat thin and thick mec the same in regards to suctioning, which is, don't do it, unless the baby is not vigorous.

I've seen several waterbirths where I could see mec streaming out of the noses of the babies as they were born. They were all fine.