The presence of meconium either when your waters break or at some point during the birth process is something that often causes alarm as it tends to be seen as a red flag that your baby is not coping well with labour. Meconium on its own is just one possible factor and when other factors are not present it may be less of a concern.
Meconium is present when a baby has opened it’s bowels. In a well-gestated baby, past 40 weeks, the likelihood of its presence increases. This is because a baby’s bowel will naturally mature and discharge it’s contents at some point and that may unfortunately be before or during labour.
Depending on local policy, if you are birthing with NHS midwives and meconium is present they will almost certainly suggest transferring to hospital as a precaution. They may suggest this even when all other signs are that mother and baby are well and that its presence is not a clear indication of distress. The meconium may be ‘old’ or well diluted indicating that the baby discharged their bowels some time ago. The main concern with meconium is that the baby may inhale it during the birth process and this can cause rare but serious complications and is generally associated with thick meconium. While the presence of meconium is not uncommon and seen in 15-20% of babies, Meconium Aspiration Syndrome (MAS) is an extremely rare complication. Around 2-5% of the 15-20% of babies who will have meconium stained liquor will develop MAS (Unsworth & Vause 2010). Of the 2-5% of babies with meconium present, 3-5% will die. In short it is very rare but can be fatal.
It’s important to remember that as with everything it is your decision if you feel transfer is the best option. Some families choose to continue with their plans to birth at home even when there is meconium present depending on the type of mecomium, how the baby is coping and the stage of labour.
If you have had a previous longer pregnancy where your baby passed meconium and feel that this alone would not be sufficient reason to transfer in your current pregnancy, as per local policy, you can ask to see a Supervisor of Midwives to inform them of your position. This can be helpful in avoiding you and birth partners having to explain your informed choice when you are in active labour. If you choose not to, ensure your birth partner/s are well informed of your wishes and confident in advocating for you.
The main thing to remember is that meconium alone is not a firm indicator of distress. The type of meconium – old, fresh, thick, grade 1/2/3 etc – can be helpful in your decision making so do ask your midwives and birth partners to help you consider the whole picture. Also take into account that a ‘well cooked’ baby is more likely to have naturally discharged their bowel.
Further information on meconium can be found in the links below.
Midwife Thinking – The Curse of Meconium Stained Liquor
Midwife Archives – Meconium