meconium in waters - is it always dangerous?

Hi,

This is a bit long to explain, and will take me a while to get to my actual question but I will try:

When I had Liam, I had contractions that started spontaneously at around midday on Sunday. We trotted off to hospital at about 8.30pm, as the contractions were coming every 3-4 minutes, lasting around 30-40 secs and frankly, I was needing the comfort of being in hospital care. The contractions went on all night, with no change in the rhythm. At around 8am on Monday, I still hadn't dilated to even 3cms. When my OB broke my waters there was meconium in them, so the decision was to start me on a drip to induce. But, before doing this, they put in an epidural, at which point Liam's heartrate dropped with each contraction, so plans changed & it became an emergency c-section. Prior to my waters being broken, I'd had no medical intervention, bar a shot of pethidine (mmm, pethidine...), so the meconium was all Liam's doing, not anything caused by outside influences. Also, I was pretty much spot on for 40 weeks, and my EDD didn't change from the first date given, so neither early nor late as far as dates go.

But - and here is the question - is meconium always going to be a problem? or is it possible that had I not gone to hospital & just stuck it out at home for the night and a little bit longer that I would eventually have started to dilate & had a natural birth that was safe for Liam too, even with meconium in my waters?

I guess I kind of feel disappointed that after 18 hours of contractions my body really had done stuff all, and there's part of me that thinks maybe I wasn't brave enough because I went to hospital so early. And although we're a while away from thinking about number 2, I'd like to have a VBAC, so I guess I'm just trying to work out what else I could have done to make it work so to speak, so that I can do this next time.

Thanks :)

Meconium in your amniotic fluid is only a problem in a very small percentage of cases. It depends on it's consistency and colour as to how immediate of a problem it is. If it's just lightly stained your fluid then it just means the baby was stressed at some point in the past. In the absence of any other indicators it's not significant. Dark, thick fresh mec is more of a reason for concern.
The best way to avoid the problem of meconium stained liquor? Don't let them break your waters!! They can't stress about what they don't know about!

I had it in my waters with my first baby who had to be quickly vac extracted because of it (it was fairly dark). I always thought it was symptomatic of distress so i'd say it was dangerous.... however I found this article from the Purebirth site:

Meconium Isn't the Problem; Induction Is - by Gail Hart of midwiferyeducation


Meconium (mec) is not a problem- unless mec is a symptom of severe distress. And then the problem is the distress- not the mec. With good fetal heart tone and a normal labor, even thick mec is rarely a problem.

Meconium is more common in labors which are induced, by any and all means of induction, and it's debatable whether mec is even more common in post-dates labors since induction is often a confounding factor. I recently came across a study (as follows) that looks at the liklihood of whether heavy mec is actually a risk for meconium aspiration. It's older, but large- it looks at almost a thousand babies with "thick or moderate meconium". All sorts of things were found to contribute to the rate of mec; but only a couple babies out of a hundred actually developed meconium aspiration syndrome- MAS- even though the entire group had mec (39 out of 937).
Induction was a strong link to both meconium waters and to meconium aspiration syndrome- but (and this surprised everyone) POSTDATES was not found to be a factor in the babies who developed MAS: MAS was distributed equally among all gestation groups. MAS was correlated with thick mec primarily when there were other risk factors present- need for resucitation, poor heart tones, or ceserean delivery.
Induction of labor was the strongest association with MAS. We know that we see more mec in induced babies, and we know we see more MAS in induced babies. A logical guess may be that we see more mec in post-dates babies simply because post-dates babies are far more likely to be induced than are 40 week babies.
This study confirms what most of us have seen: that meconium is "rarely a problem"- even when it is thick.

No Benefit Seen With Suctioning During Birth of Meconium-Stained Neonates SAN FRANCISCO (Reuters Health) Feb 11, 2003

Suctioning during delivery of infants who present with meconium staining apparently does not prevent meconium aspiration syndrome. These findings, presented at the meeting of the Society for Maternal-Fetal Medicine, contradict current practice guidelines.

Lead study author Dr. Edgardo Szyld, of the Hospital Diego Paroissien in Buenos Aires, Argentina, believes that "we should consider revising the current recommendations" of suctioning these infants during delivery.

A total of 2514 infants with meconium-stained amniotic fluid were randomized to oro- and nasopharynx suctioning or to no suctioning just before delivery of the shoulders. Of those infants suctioned, 3.5% developed meconium aspiration syndrome (MAS), as did 3.6% of those not suctioned. Five newborns died in the suctioned group, and three in the group not suctioned.

No differences between the two groups were observed in the frequency of thick meconium, C-sections or need for resuscitation.

A single study back in the 1970s was the foundation for the recommendation of suctioning when meconium staining is evident, Dr. Szyld said. Recommendations to suction, set forth by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (ACOG) makes the practice "widespread--and it's done around the world."

However, he said, the current study shows that suctioning before the shoulders are delivered does not prevent meconium aspiration or its complications.

"The data presented by Dr. Szyld's team provides convincing evidence that suctioning probably does not" alter outcomes, Dr. Laura E. Riley, chair of ACOG's Committee on Obstetric Practice, told Reuters Health.

"Because suctioning has been beaten into clinicians for so many years, I'm not sure the current findings are really going to change clinical practice," Dr. Riley said. "Still, I think the findings may provide some reassurance to clinicians that when meconium aspiration syndrome occurs it probably didn't have anything to do with how adequately the infant was suctioned."

While Dr. Riley believes that the researchers succeeded in showing that suctioning is probably unnecessary, she said they didn't address "whether suctioning may actually have harmful effects, such as causing facial trauma."

My DS was born 2 weeks late by emergency CS and my waters were very heavily mec stained - it looked like brown runny poo (sorry for TMI!!). He was fine but did have to go to the special care nursery overnight the first night as he was gagging and choking on all the muck in his lungs. With a vaginal delivery this usually gets "squeezed" out so is not a big prob. My DD was born 1 week late by VBAC (yay for me!) and while my water was again mec stained she was fine.

Hi Janno
Meconium in the waters is an indication that baby is under stress or has been placed under stress at some point in your pregnancy. It is not usually a danger to your baby unless it is thick and sticky as this can block the airway or accumulate in the lungs causing breathing problems. There are a couple of reasons that your babies heat rate dropped. The epidural could have caused this depending upon the drugs used. The other thing is breaking your waters. If baby is not fully engaged when your waters are broken it is possible for the cord to be pushed low into your uterus, and in some cases out of your cervix. The baby’s head/shoulder can then press on the cord. At each contraction the head/shoulder can press on the cord hard enough to cut off the blood supply to baby and thus dropping the heart rate.

My third baby was a perfect pregnancy, and a quick 2 hour labour. My waters broke about 1.5 hours in, and were very dark with meconium. They flipped my on my side and pulled my son out fast. He was not breathing and was completly black and blue. It took a while to get him back. He needed 3 types of rescusitation to come back, eventually being tubed. He had swallowed so much. He was also suctioned constantly for 12 hours to get it out of his lungs.

So with no drugs, interference and a good labour, the meconium could of ended my little boys life. My nurse actually said had my ob not been so quick or experienced, he may not have made it. Due to this experience I would never hesitate to get another baby out asap if needed.

I am so sorry you ended in a c-section, but waiting hours for you to labour yourself may of been devastating in the end.

You should be proud that you got your little bubba here safe and sound honey!! In hindsight, your son may have fine, but he also may not have been, if your labour was very long.

You WERE brave, and gave your son the best chance you could. So well done!!:hug: