Keep calm.... Meconium happens!
Keep Calm…. Meconium Happens!
Meconium… Our fancy medical way of saying “baby poo”. This is the greenish/black substance we sometimes see when the waters break or that god awful, tar like first nappy. It can lead to a huge cascade of intervention in labour if it is in the waters so this post just sheds a little bit of light on this and what to do if it happens. The sh*t literally hits the fan. So what actually is meconium and why does it appear in the waters around baby?
Meconium is a combination of water, amniotic fluid, intestinal epithelial cells, lanugo (the soft fuzzy hair). Around 20% of babies are born with meconium stained liquor. There are several ideas of why this meconium occurs before delivery (in utero):
- One theory is that a baby's digestive system has reached maturity and the intestine has started working and moves the meconium out. This is the most common reason and explains why this most commonly occurs in term or post term babies.
- Another suggestion is that the umbilical cord or head is being compressed (during contractions) and this can cause vagal mediated gastrointestinal peristalsis (basically a nervous response causing gut movement) – the same reflex which causes variable heart rate decelerations (heart rate dips). This is a normal physiological response and can happen without fetal distress. It certainly explains why babies are delivered with a big black poo following them!
- Another theory is that there is fetal distress. This is a common misconception and there is plenty of evidence to contradict this. The main evidence being most babies born with fetal distress do not actually have meconium present. There are many reasons for fetal distress and the presence of meconium may well be coincidental.
There are 2 different types of meconium:
1. Insignificant: Thin, green, watery (looks like pond water).
2. Significant: Thick, green, with green/black lumps in it.
Side by side:
(This is as close as I could replicate at home.....)
So... your waters break. There is what you think may be meconium according to either description. What do you do? Call the labour ward. We do need to see you. See the waters, the colour etc. Put a maternity pad on. Yep, we like you to wear a pad all the way to the hospital and we like to look at it. Its a glamorous job isn't it! From here we determine what to do about the meconium.
Now my recommendations are based on the most up to date guidance from NICE and Royal College of Obstetrics and Gynaecology (UK).
UAE disclaimer: Your care plan will depend on your individual doctors practice. But knowing the best evidence out there allows you to make shared decisions about your care!
If the meconium is insignificant (so as above, thin, watery, light green) and there are no other risk factors present, then evidence suggests that continuous CTG monitoring is NOT necessary. This is according to RCOG and NICE recommendations and as such is commonly practiced in the NHS. In private care, where defensive practice is more prevalent, have this conversation with your OBGYN.
I have looked after many women here in Dubai, with experienced doctors who know the difference in the meconium types and see a bigger picture and women have subsequently had low intervention, normal deliveries without constant monitoring.
However... significant meconium is an entirely different situation. This is the thick green/back particulate meconium. This does require constant monitoring of your baby. If you are in a birth centre then you will transferred to the labour ward. You should expect the CTG (monitoring) to be on until your baby is born. This does not mean you cannot get off the bed or move positions. As long as we can see the baby's heart rate then you can do whatever you want. As a precaution we will often have a second midwife, or doctor, or neonatal nurse present at delivery. This is usually in case of Meconium Aspiration. These words are thrown out often and some people don't know what they mean.
Meconium aspiration occurs in 1-3% of births. It is when your baby inhales the thick, particles of meconium. It can happen in utero, which is why we constantly monitor if it is present. Or it can happen at delivery when baby gasps. Which is why you will have extra staff in the room in case. We prepare for this, even though the odds suggest it is unlikely.
All I can say, is don't panic about it. Easy coming from me, I know. But we are good at what we do. We know what to do if this happens. The point of this article is to explain to you that if you have thin, insignificant meconium and your doctor is pushing you in to a care plan you aren't sure about, that you know there are options and there is evidence to make sure you can make informed choices. Scare mongering is ever so common and incorrect intervention due to defensive practice can actually lead to negative outcomes.
Forewarned is forearmed. Know your sh*t.... literally. Remain in control of your birth. Decisions should be fully explained by your doctor and nothing should be done without your consent. I feel I should add here.... I am not telling you not to listen to your OBGYN, they are the experts in high risk births, I am simply saying use this information to ensure your care is the best for your situation!