Meconium in the amniotic fluid

Here are two “studies” on Meconium.  The worst thing you can do with a baby who has meconium in the waters is to cut the umbilical cord (Mother Nature’s oxygen backup).  The other worst thing is starting any type of “resuscitation” measure too quickly.  In a hospital, these 2 mistakes are likely to be made.  Gloria Lemay, Vancouver BC


Meconium aspiration syndrome: reflections on a murky subject.
Katz VL, Bowes WA Jr
Am J Obstet Gynecol 1992 Jan;166(1 Pt 1):171-83
Meconium-stained amniotic fluid occurs in approximately 12% of live births.
In approximately one third of these infants meconium is present below the
vocal cords. However, meconium aspiration syndrome develops in only 2 of
every 1000 live-born infants. Ninety-five percent of infants with inhaled
meconium clear the lungs spontaneously. Recent investigations have suggested
that a reexamination of our assumptions about the etiology of meconium
aspiration syndrome is in order. Several authors have provided evidence that
support the hypothesis that it is not the inhaled meconium which produces
the primary pathologic condition of meconium aspiration syndrome but rather
it is fetal asphyxia that is the etiologic agent. Asphyxia in utero produces
pulmonary vasospasm and hyperreactivity of the pulmonary vessels. With
severe asphyxia the fetal lungs undergo pulmonary vascular damage with
pulmonary hypertension. The damaged lungs are then unable to clear the
meconium. In the most severe cases there is right-to-left shunting and
persistent fetal circulation with subsequent fetal death. The incidence of
meconium aspiration may thus be essentially unaffected by current obstetric
and pediatric interventions at birth. For the asphyxiated or distressed
infant we recommend suctioning at birth and tracheal intubation. In the
healthy fetus observation may be sufficient.
 

Comment from Gloria:  What causes fetal asphyxia in utero?  Primary culprits are induction and anaesthetic drugs. 

Management of Infants With Meconium-Stained Amniotic Fluid    

Treatments to prevent meconium aspiration syndrome have included amnioinfusion during labor, intrapartum suctioning, and endotracheal intubation and suctioning of infants with meconium-stained fluid. The most recent evidence suggests that these practices are not helpful and do not prevent meconium aspiration syndrome. Table 4 <http://www.medscape.com/viewarticle/558124_Tables#T4>  offers the current evidence about these practices.[54-56] A 2006 review[57] shows no benefit to infants from these practices. 

Two classic nonrandomized studies done in the 1970s[58,59] suggested that suctioning the airway before the birth would decrease the incidence of morbidity and mortality associated with meconium aspiration syndrome.

Subsequent studies comparing DeLee suctioning with bulb suctioning found no differences in the incidence and severity of meconium aspiration syndrome, respiratory rates, or Apgar scores between the infants who had suctioning either before delivery of the head or after birth.[60-62] In 2004, the Meconium Study Network[55] conducted a large multicenter RCT comparing outcomes of vigorous infants with meconium staining, with or without suctioning on the perineum ( Table <http://www.medscape.com/viewarticle/558124_Tables#T4>  4 ). No difference was found between the two groups for any outcomes, even when analyzing the subgroup with thick meconium. This suggests that intrapartum suctioning does not prevent meconium aspiration syndrome. Similarly, no benefit for the prevention of meconium aspiration syndrome has been found following amnioinfusion[54] or from endotracheal intubation and suctioning of vigorous term infants.[56] These practices should not be used to prevent meconium aspiration syndrome.[57]

Comment from Gloria:  What they don’t mention is that babies have “drowned” in their mother’s body after having “amnioinfusion”–injection of saline solution into the uterus.  Healthy babies have also had nose and throat damage from suctioning.  If the medical profession would leave the baby’s umbilical cord pulsing, that would be the least invasive and most baby friendly way to assist a baby with meconium.

  

Gastric Suctioning 

  

It has been suggested that gastric suctioning of the newborn might prevent regurgitation and aspiration of meconium or other stomach contents. A MEDLINE search on gastric suctioning of the newborn revealed only one study relevant to this review. 

Widstrom[63] studied the effect of gastric suction on newborn circulation and subsequent feeding behavior. Healthy, term newborns were randomly assigned to have gastric suction (n = 11) or no gastric suction (n = 10). At birth, the newborns were dried and placed on the mother’s chest. No suctioning of the airway was done, and all infants began to breathe spontaneously. The umbilical cord was clamped and cut between 60 and 90 seconds after birth. Pulse and blood pressure were recorded every minute from 5 to 10 minutes of age. Between the first two blood pressure recordings, infants in the suction group had a #8 suction catheter inserted through the mouth into the stomach, and the contents were aspirated. The procedure lasted approximately 20 seconds. The infants were maintained in a prone position on their mother’s chests and were observed for 3 hours. While the two groups did not differ in average heart rate, one infant in the suction group had an episode of bradycardia, and infants in the suction group experienced an increased blood pressure when the catheter was withdrawn. Defensive motions were observed in nine of the suctioned infants.

Suckling was delayed until 62 minutes in the suction group versus 55 minutes in the no suction group. There was also a greater lag in hand-to-mouth movements in the suction group (P = .005). This small study found harm and no benefit from gastric suctioning, indicating that it should not be used in the routine care of the neonate.

Comment from Gloria:  Who on earth came up with the cruel idea that passing a tube into a baby’s mouth, throat and all the way down to the stomach would help with meconium aspiration (into the lungs).  Probably the same people who worry that an operative patient will vomit and inhale the acids in their stomach (a rare event).  A newborn baby is not an operative patient and this type of thinking doesn’t apply.  When the catheter passes over the vagal nerve in the throat, the body goes into a gag reflex and many emergency responses ensue.  I’ve had a gastric tube passed down my throat and into my stomach and, believe me, it is a most unpleasant experience—the body just keeps on gagging and trying to get rid of the foreign object in the throat.  Not a very nice introduction to the planet for a baby.

3 thoughts on “Meconium in the amniotic fluid

  1. “Thanks for this info, Gloria. Perfect timing as I am editing the film that educates fathers not to allow the non-medical technologies. The hospital birth baby in my film had gastric suctioning. The father helped hold him down because he THOUGHT it was necessary to do this to his child.

    At age two the litle boy was not making sounds. Not a baa–baa, not a daa-daa, and sadly, not even “mama”. He just screamed to communicate, and he had an eating disorder. The young man at the beginning of my trailer, who speaks of the “missing piece of the puzzle,” was the baby’s speech therapist. He said they couldn’t figure out why baby had these issues. That clip of him is after he watched the birth footage. You are so right. It is a horrible introduction to this world, when all they want and need is to be in mama’s arms, when their body will do the work of learning to breath by moving stuff out. Their tissues have never experienced anything and you are right .. it’s horrible for any age, imagine new baby’s experience.

    Think of how many babies recieve this treatment “in case” and so the staff can show they “did everything possible”. And how many children now see speech and occupational therapists for eating and sensory disorders, but no one “knows” what these things are rising.

    There is research in ’05 that looked at EVERY thing they do for meconium and NONE of it altered the incidence of meconium aspiration. (Clinics in Perinatology, 33 (2006) 29-42). I’ve noticed that “meconium” is now a way to do this for any baby they want. There wasn’t staining for the hospital born baby but he got the full treatment anyway — to teach a resident how to do it. Poorly, as Karen Strange will point out.

    My trailer is on YouTube, please check it out:

  2. The people who came up with this procedure are probably the same ones who circumcise babies and think that that is ‘good’ too.

  3. Hi Gloria,
    I understand that centuries ago babies were not gastrically suctioned, but there was also an increase in morbidity than today. What I would like to know is by gastrically suctioning the baby at birth does this affect the stability of the infant’s sugar level? If the sugar levels are stabilized with the ambiotic fluid in the abdomen not removing them, but changing to only removing the meconium fluids from the abdomen to prevent aspiration later. As a respiratory therapist my concern is the abdominal pressure related to the diaphragm and the ability for the infant to take larger breaths to push out excess ambiotic fluids from the lungs.
    There was also a time when the Physician who washed his hands between deliveries was so ridiculed by the American medical society he had to practice in Cuba. Once it was noticed that his morbidity rate had dropped so low that the American medical society could not reject his theory any longer, the American medical society invited him back to show them what he was doing to prevent so many deaths. He refused them the information for years. Finally his wife convinced him it was in the better interests of children lives to return and show the American medical society what he was doing. He did, and once his practices where implemented it took a number of years for the American medical society to get him to forgive them and return to the United States.
    Metal forceps where also used at birth for a number of years until the softer suction was applied. Neither of which are the device of choice to use in a delivery. We all wish we could have perfect births without any complications but that is not reality. We as a medical community hopefully have learned from our mistakes. Or better equipment has been devised.
    To a mother and father the morbidity of their child is too great of a loss. The loss of 2 out of a thousand children with meconium aspiration at birth, when the medical community has procedures to use in these situations, is too great.

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