Much ado about meconium
My patient came in for an induction because her baby was a week late and showed no sign of budging from her fully furnished nicely decked out digs inside her Mama. After a little paperwork and the obligatory IV, her doctor came in and checked her cervix. She was already a couple centimeters dilated so the doc suggested we rupture membranes to get labor going. When she got out the amniohook (which looks like an extra-long crochet hook) and "snagged her bag" (technically called artificial rupture of membranes,) we got a little surprise. The usual affect is a warm, gush of clear fluid followed by the patient saying, "Eww, it feels like I'm wetting my pants." Oh yes, it's a glamorous experience but never more so than when, instead of clear fluid, there's meconium.
Meconium is baby poop. Like I said, glamorous. Sometimes, babies poop while they're still inside their mom. Gross, yeah, but also normal a lot of the time. It's a pretty common event when babies are past their due date or under certain stressful circumstances. If the meconium doesn't accompany other ominous signs that baby's not tolerating labor then meconium itself is no big deal. It's actually quite clean; consisting of 85-95% water and doesn't cause infection of the uterus. The problem arises when baby takes that first breath. We don't want baby to inhale that poop into his lungs where it could block the airway or cause MAS - meconium aspiration syndrome - stuff like respiratory distress and pneumonia. These are pretty uncommon, even when meconium is present, but a problem to be watched for nonetheless.
Since meconium happens in approximately 13% of labors past 34 weeks, it isn't usually much of an emergency. Nurses and doctors will say, "Huh, there's some mec, whadayaknow. Then we'll describe it with terms like, thin, light, chunky or, the worst—pea soup. We might manage it in labor by doing an amnioinfusion. That's when we place a tube (similar to IV tubing) called an intrauterine pressure catheter, inside the uterus and up alongside the baby. We connect that tube to an IV containing warmed, sterile IV fluid and run it into the uterus. It essentially thins the meconium out and bathes the baby making it less likely that thick meconium will get into the airway.
Meconium management at delivery varies somewhat. Used to be, once the baby's head was delivered, we'd tell mom to quit pushing and we'd suction out baby's mouth, nose and as far down into the airway as we could. We'd deliver the baby's body and hope it wouldn't cry before we could suction the airway again, this time deeper. Most the time, baby would cry anyway and suctioning was no longer the thing to do. Nowadays, all we do is suction baby's nose and mouth with a bulb syringe and if baby's born nice and vigorous, we don't worry about it. No more suctioning. Babies that are born not breathing, floppy or with cardiac problems get suctioned and resuscitated until they perk up. We can talk about resuscitations in another blog. Studies showed that all that deep suctioning didn't really make any difference and you can be sure, it annoyed the babies. Most of the time, breathing a little baby poop is no problem. Only a very few babies develop problems from it. Those that do make a trip to the NICU and are watched and treated carefully.
Most babies hold their poop until after delivery when they can really impress their parents with all that black tarry gook, It takes a few days to clear out of their little systems and then it changes to the looser, yellowy-green gook we're all more familiar with. But if a baby poops inside, don't worry about it too much. If a baby's gotta go, a baby's gotta go. Poop happens.
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