The Perils of Meconium

Meconium is your baby’s first poo! It has the consistency of treacle, it is odourless and unlike later offerings it is sterile. It is very dark and almost impossible to wipe clean. Meconium consists of water, mucus, amniotic fluid, lanugo which is downy baby hair and also intestinal epithelial cells. For most babies it is just their first poo (one of many!) and means a very gooey first nappy but in some cases it can be a cause for concern. In five to twenty per cent of all births meconium passes into the amniotic fluid. It is easily detected because the usually clear amniotic fluid turns a green tinge colour. If your waters break before you have gone into labour and you do not have a midwife or doctor near you then check that the water is clear. If it is not you must inform your doctor or midwife immediately. Your baby can develop MAS – Meconium Aspiration Syndrome if he inhales the meconium stained fluid during labour or with his first breath. If your doctor suspects aspiration then he might use suction to remove as much fluid as possible from your baby’s lungs to ease breathing. Indicators of MAS could be rapid breathing, a slow heartbeat, low Apgar score or discolouration of the skin because if the meconium was passed a fair while before your baby’s birth then his skin could have a greenish staining. The consistency of meconium is thick and sticky so it can block the airways and if it does the efficiency of the gas exchange in the lungs is compromised. Also meconium-tainted fluid can inflame and irritate the airways which can lead to chemical pneumonia. Around a third of babies who have MAS need assistance with breathing and with more serious cases babies spend time in a NICU – neonatal intensive care unit. In most cases of MAS it is found that babies improve in a matter of days or weeks depending how serious their condition is. There is not normally any permanent damage to their lungs. Although research now indicates that babies with MAS can be at a higher risk of getting reactive airway disease which means that their lungs are very sensitive and can lead to asthmatic problems. MAS can happen because a baby becomes distressed during labour and this causes him to have intestinal contractions and for his anal sphincter to become relaxed. This allows the meconium to mix with the amniotic fluid, contaminating it. The risks that can lead to MAS could be; problematic labour and delivery, advanced gestational age, umbilical cord issues, poor intrauterine growth, expectant mothers who smoke, have diabetes, high blood pressure, cardiovascular disease or chronic respiratory disease. MAS occurs in approximately 5-10% of births where the meconium has contaminated the amniotic fluid. In a few cases the meconium can get congested in a part of the small intestine known as the ileum. This condition is known as meconium ileus and can be the first symptom of cystic fibrosis. By Eirian Hallinan