Edie and Amy

Meconium: All You Need To Know

Once you get pregnant, you’d begin to learn new things. New things about your mind, your body, and your baby. A prime example of this is meconium.

Meconium is a thick, green, tar-like substance present in your baby’s intestines during pregnancy. Let’s just say meconium is the name for your baby’s feces while still in the womb. Normally, your baby does not pass meconium until after birth. However, in some instances, your little one can have bowel movements before birth and pass meconium into the amniotic fluid.

In this article, you’d learn about meconium during labor and the interventions performed. You’d also get to learn about the Meconium Aspiration Syndrome.

When do babies pass meconium?

Simply put, meconium is your baby’s first poo. Although babies begin to excrete urine into the amniotic fluid from as early as the 11th week, they don’t pass the first stool (meconium) ideally until after birth. Usually, this happens within 24 – 48 hours after birth, but it can also happen shortly after delivery.

Meconium in labor

If your doctor or midwife notices meconium during the labor and birth process, he/she will have to watch your baby closely for any other signs of fetal distress.

Thankfully, meconium staining of the amniotic fluid alone does not mean that your baby is in fetal distress. However, it is a sign for your health care team to be on the watch.

In certain cases, doctors or nurses may choose to conduct an amnioinfusion for better outcomes during labor.

An amnioinfusion is a procedure that involves placing a sterile fluid into the uterus via a catheter to dilute the meconium. This sterile fluid increases the volume of amniotic fluid present and ultimately increases a baby’s tolerance to labor.

Light-colored meconium does not pose much risk to your baby. It is also not likely to be a sign of fetal distress but rather, a sign of the maturation of your baby. Thicker meconium is more dangerous to your baby. This is due to the thickness and the greenish shade of meconium.

Interventions during labor

If there are signs that your baby is not tolerating labor well or that your baby is showing signs of fetal distress (sometimes during induced labor) that aggressive therapy has not corrected, your doctor or midwife will discuss with you other operative delivery procedures depending on how far away you are from a vaginal delivery.

These procedures include:

Passing meconium after birth

If your baby does not pass meconium before birth, he or she will still pass it within the first few days of life. Nevertheless, it is important to state that meconium can be quite messy and hard to clean off your baby’s buttocks.

A special tip for you if your baby did not pass meconium before birth is to coat your baby’s buttocks with oil after washing up during diaper changes. This will prevent the meconium from sticking and cleaning will also be easier.

meconium

Meconium Aspiration Syndrome

Meconium is more common in amniotic fluid if you are well past your due date.

When this happens, one of the concerns is the possibility of your baby aspirating the meconium during labor or birth.

This aspiration syndrome is managed by vigorous suctioning immediately your baby’s head is birthed, even before the rest of the body is born. This helps to reduce the amount of meconium available for your baby to aspirate.

Sometimes, your baby may swallow the meconium and this may not pose as much of a problem as if it is inhaled into his/her lungs. If your baby inhales the meconium, it may lead to a problem known as Meconium Aspiration Syndrome.

Due to the fact that meconium is thick and sticky, it can lead to problems for your baby during the process of initiation of respiration. This can also lead to meconium aspiration pneumonia. Both meconium aspiration syndrome and meconium aspiration pneumonia can lead to very serious problems, causing a child to stay in the neonatal intensive care unit (NICU) for a couple of days or weeks after birth for appropriate treatment.

The number of days or weeks a baby spends in the NICU depends on the severity of aspiration.

Risk factors that may cause aspiration of meconium before birth include:

  • Decreased supply of oxygen to the baby while in the womb.
  • Post term pregnancy leading to aging of the placenta.
  • Gestational diabetes in the mother.
  • High blood pressure in the mother.
  • Prolonged labor or other difficulty during delivery.

Symptoms of meconium aspiration syndrome

Symptoms of babies who have aspirated meconium include:

  • Reduced or no breathing: This is the lack of respiratory effort on the baby’s part.
  • Cyanosis (this is the bluish coloration of the skin due to reduced oxygen supply).
  • Difficulty in breathing: This is obvious when the baby is grunting or noisy when breathing. It is also seen when the baby is using extra muscles to breathe, or has a rapid and shallow breath.
  • Being limp or flaccid at birth.

Management of a baby with meconium aspiration syndrome

If traces of meconium are found in the amniotic fluid and the baby is active and crying, no treatment is needed. In cases where the baby is inactive or not crying right after delivery, the special care team in charge of your baby will initially warm and maintain a normal temperature in the baby.

Subsequently, the care team will dry and stimulate the baby, to help him/her start breathing without support.

If the baby is not breathing or has a low heart rate, the medical team will supply oxygen through artificial techniques using an air-filled bag.

Subsequently, the child would be transferred to the NICU for close observation.

Prognosis of a baby with meconium aspiration syndrome

The prognosis of babies with meconium-stained fluid is usually good as there are no long-term health effects.

Only about half of babies with meconium-stained fluid will have breathing problems and about 5% will have meconium aspiration syndrome. Rarely does meconium aspiration syndrome result in permanent lung damage.

Prevention of meconium aspiration syndrome

To prevent meconium aspiration syndrome, you need to stay healthy during pregnancy. You should also follow your doctor’s advice.

At the hospital, your medical team would be ready for meconium being present at birth and would have made adequate preparation to handle the situation.

Conclusion

Finally, it is helpful to note that meconium isn’t a common cause of problems during childbirth. In fact, all you need to do while expecting your little one is to eat healthily, exercise often, and attend your clinics regularly.

You and your baby are going to be just fine.

References

Addisu, D., Asres, A., Gedefaw, G. et al. Prevalence of meconium stained amniotic fluid and its associated factors among women who gave birth at term in Felege Hiwot comprehensive specialized referral hospital, North West Ethiopia: a facility based cross-sectional study. BMC Pregnancy Childbirth 18, 429 (2018). https://doi.org/10.1186/s12884-018-2056-y