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Natural Birth
iris427
member
Meconium during delivery?
iris427
member
One of the reasons we did my c/s was because my daughter started passing meconium during the pushing phase. Prior to that, the amniotic fluid had been clear. My OB also felt that she wasn't moving down and was stuck in the pelvis--combined with the presence of meconium and that my water had been broken for 12 hours at that point, she recommended a c/s. Fetal heart rate was normal and if it hadn't been for the mec, I probably wouldn't have agreed to the c/s, at least not yet.
I'm thinking now that my OB was too quick to recommend a c/s based on the mec. My current doctor thinks she was and doesn't think the mec was necessarily a sign of anything. Iris was born with 8/9 Apgars so I don't think she was distressed. I'm pretty sure the mec she passed was pretty light. I was 41 weeks and apparently more mature babies are more likely to pass mec but not necessarily be in distress.
I've also read that coached pushing may lead to lower oxygen levels reaching the fetus and more meconium passage. I remember feeling like I was suffocating while trying to hold my breath and push for a count of 10, so I wonder if she was not getting enough oxygen. Again, she never had any sign of distress on the heart rate monitor. There was nothing urgent going on because I asked my OB if I could have another half hour to think about it and try more pushing and she said yes. So this was not an emergent c/s.
Anyone know much about meconium and determining whether the baby is in distress or at risk for aspiration? Any experiences with meconium during delivery?
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Re: Meconium during delivery?
For my delivery I was @ 10cm and my dr. then broke my water since it never broke on its own and meconium was present. My dr. then told me it was there and that we needed to try and get the baby out somewhat quickly. She never gave me the impression that I had to rush because it was a dire emergency to get him out. So it tooke me 2 hrs. to push him out and he never showed any distress during the pushing peiord. The only scary part was toward the end when he was almost out she had them call in the Respitory Team to check him out as soon as he was delivered to make sure he hadn't aspirated any. Thankfully he was completely fine with no issues what so ever.
My water didn't break with DD until she was crowning, and there was meconium in it. She never showed any signs of distress and her apgars were 8/9 as well.
My MW suctioned her and there was no mec in her mouth/throat, they didn't even need to call the pedi. I really don't know much about it, but from my experience it wasn't an emergency, it was just another thing that happens some of the time. Nobody seemed worried about it at all.
That said I had a very short labour. I went to the hospital at 11am-ish and about 7-8cm ( I had no idea I was that far along), and DD was born at 1:12pm.
I had meconium in my fluid when my water broke on its own during early labor. Because of that, they did require that I wear an external monitor continually (which sucked in that it was super itchy!) but that didn't impede my ability to move about or anything.
There was a NICU team on stand by when I delivered but kiddo had 9s on his apgars so he clearly wasn't impacted. And there was never anything on the monitors that gave my midwife cause for concern during labor or pushing.
ETA: If it matters, about 7 hours passed between my water breaking and kiddo's birth. I pushed for about 45 minutes.
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My water broke at 6 a.m. and had meconium in it. I labored all day at the hospital and I did not reach 10 cm until midnight (18 hours after water breaking) which is when I started pushing. I had intermittent monitoring during labor but she never showed any sign of distress. I pushed for 3 hours (she was posterior) and my daughter was born approximately 21 hours after my water broke.
An NICU team was present at birth and I could not have her immediatley on my chest. She checked out fine and is now a healthy 2 year old. A c-section was never mentioned to me but after about 2 and 1/2 hours into pushing, my OB asked whether I had the strength to keep going and I told her yes. I assume if I said no, she would have offered a c-section.
DS had meconium in the water. Once they realized that I had to stay on the monitors more frequently, but it didn't change my delivery other than the doctor suctioned him BEFORE he was fully delivered and had taken his first breath. His head was out but the rest still in.
I didn't get to pull him out and onto my chest like I had with DD either, they took him for more suctioning but brought him right back over to me, it was literally like 5 minutes later and he was back on me but they did check him first.
I can't speak technically on the issue, but I do know that when I asked my MW what they would do if they found meconium in my waters, she said that it depended on how much there was and the thickness of it...if it was light and everything else was good (Lily and I), then we could continue with the homebirth.
Despite Lily being so late and my waters being broken for so long, I thankfully did not have to deal with this issue...however a couple of fellow homebirthers I know IRL (and who used the same MW) did have some meconium in their waters and still delivered their babies at home with no problems. know that this is only antidotal evidence, but the fact that our MW was comfortable moving forward with the homebirth in these situation tells me there much be some evidence based research out there somewhere that supports her recommendations because she always seemed to have a study or article on hand any other time that I asked her for more information.
I will be interested to see what others have to say in this post.
Thanks everyone for sharing your stories, and thanks especially for the info from the NICU nurse.
The more I learn, the more I think my c/s was either unnecessary or iatrogenic. I thought my OB was really natural friendly when I picked her but I feel like I got caught in the net of defensive medicine. Sigh. Giving my doctor the benefit of the doubt, I guess she was worried that because of the timing of the meconium, it was an early sign of things going wrong and it would be better to perform a c/s that might not be necessary than wait and risk something going wrong? But at least I wish she could have communicated that more to me.
It is so hard to know at the moment though....I remember seeing so many stories on here about people having meconium and going for automatic c/s, etc so that when DS had it I immediately asked my doc that and he was like "heck no, we'll just wait and see".
How long did you push again? I can't remember but it was a couple of hours wasn't it?
I had my DS at 40w6d and when they broke my water there were "crumbles" of mec in the AF. They had NICU staff on hand b/c of this, even though my midwife thought it was overkill. As you know, I had a c/s with DS, but he wasn't in any distress, so that's not really answering your question.
However, with DD (my 40w1d VBAC in a different hospital where they are more "natural") there was a small amount of mec again and they didn't do anything special and she was just fine.
Haven't had any post partum appointments yet to discuss this, but found it interesting how it was handled so differently by different practitioners.
My water broke while I was in the tub, so I'm not sure if there was any sign of meconium or not. It wasn't mentioned to me when my cervix was checked after my water broke.
I labored and pushed DD out (pushed for about 50 minutes) and there were no signs that she was in distress. However, there was meconium when she was finally born. I don't know what her Apgars were, but they weren't good and she wasn't breathing. I had her on my chest for literally a moment, then they had to get her breathing and call the NICU team. DH told me much later that she was totally gray and not making a sound.
She started breathing on her own so I got to hold her for a minute, but she was struggling and had to be given supplemental oxygen. Her x-ray was not quite normal, so we ended up in the NICU for a week so she could get IV antibiotics for suspected pneumonia.
She was breathing on her own with no supplemental oxygen within two days and has been 100% normal ever since, but it was a very scary couple of days and a long week in the NICU. If I had known, I don't know which I would have chosen - a c-section with no breathing complications/NICU or a med-free vaginal birth with two scary days and a week in the NICU (but no lingering issues).
I will say that DH still gets teared up when he talks about seeing DD struggling to breathe right after birth. I don't know about immediately rushing to a c-section, but meconium is not joke either.
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Yes, it's hard to analyze things and think about your options when you're in labor.
I pushed for something like 2 hours. My memory is a little fuzzy. I think I pushed some for an hour and a half with just the nurse but I'm not sure. I had a very strong epidural and was so numb, I don't know how well I was really pushing. The nurse told me I was making good progress, baby was moving down and at +1. She never said anything about meconium. This was in a squatting position.
Then my OB came in, had me get on my back and push for her. I swear she only had me push a few times before she said I needed a c/s because the baby wasn't moving down at all when I pushed, was only at 0 station and was passing meconium. I asked for another half hour to try pushing some more but at that point I was exhausted and crying and I felt defeated. I couldn't really focus on pushing and trying to get my baby out. So then we went in for the c/s something like 2 hours after I had started pushing. When the OB did the surgery, she found Iris in the OP position.
So who knows? I still wonder if I could have gotten her out vaginally with a more supportive doctor but I'll never know. I guess I'll just have to see what happens with this baby and I'm trying to learn from my past experience to give myself the best shot at a vaginal birth this time around.
Hey Iris, I don't know if you read this blog, but she had a post about meconium during labor: https://midwifethinking.com/2010/10/09/the-curse-of-meconium-stained-liquor/
DS1 never had meconium while I was pushing, but I think he had a bit when I finally had my c-section (and considering I had pushed for 4+ hours after a decent amount of labor, small wonder, right?). My water broke at home with DS2, and we didn't notice if it had meconium, but the midwife did see some when I was pushing, so they were on alert about DS2 possibly aspirating. When he came out, his cord was clamped right away and he was checked out by the pediatricians before I could really hold him, but it wasn't much and he was fine in the end.
In regards to whether your c-section was truly necessary, ugh, I know how you feel. Even though I had a VBAC, and that went a long, long way with me being able to let go of how DS1 was born, I still wonder if getting stuck in the hospital in early labor was what made the difference between having a c-section or not. Who knows. But like my doula and midwife said with this past pregnancy: it's a different pregnancy and a different labor. You'll do great!!
DS2 - Oct 2010 (my VBAC baby!)
LO did have meconium and was born in distress, but I think that was probably more an effect of the epidural I got to try to have the strength to continue birthing him (I made the epi call at 55h into a 63h labor). I think the epi reduced his heart rate and then the intense pushing the dr required made it worse. (The dr told me I had 30 min to push him out "or else".) His first Apgar was a 2. His second was a 9.
More Green For Less Green
My midwife broke my waters when I was 10cm dilated and after I'd been pushing for around 30minutes.
There was "fresh" meconium present.
Baby had 9 on apgars and was placed straight on my chest, where she stayed for the next hour.
However in our situation baby was already well descended into my pelvis, and there was never any suggestion that she could be stuck.
Elizabeth 5yrs old Jane 3yrs old
From what I understand, there are different levels of meconium...
DD was born at 41+6 and had no mec.
About 1.5 years after DD was born, one of my friends gave birth at 41+something and there was mec in the water -- I don't know the full details to know if she aspirated it or not. She developed PPHN (which, as I understand it, can be caused by meconium aspiration, but can also be caused by other things -- it has a fatality rate of about 20% so it's pretty serious) and had an extended NICU stay and a lot of medical issues overall.
So, when I was considering homebirth, with that experience on my mind, I specifically asked my midwife about meconium. And she said that when it happens, she judges things based on how thick the meconium is, how long mom has been in labor, how the baby is responding, etc. It can certainly be cause for hospital transfer if it's serious enough.
I was glad I asked, as during DS's birth (at 39+5), my water broke right as I was starting to push and it was stained yellow. I asked my midwife, "Meconium?" And she said, "It's very light. Nothing to worry about." As far as I could tell, it didn't change anything about the rest of my labor (notably, I was still able to waterbirth) -- but then, it was only maybe 30 mins from water breaking to DS being born. He did have some breathing issues after birth. It wasn't serious enough to even mention hospital transfer or anything, but I definitely got the sense that my midwife was a little concerned until he started breathing well and pinked up nicely. Then again, DD had similar issues after delivery, with no mec, so who knows if DS's issues were related to the mec or not.
A few months later, one of my other friends gave birth, at a VERY natural birth friendly hospital with a VERY natural birth friendly midwife. (It was the midwife/hospital that I was using prior to switching to homebirth.) She had mec in her water when it broke, shortly before pushing started -- I have no idea how thick. Her baby's heart rate was also dropping. So they called in the NICU team. But they still let her push in the tub until he was just about to crown. He did have to stay in the NICU for a few days afterwards, so I would definitely say that experience was on the more serious end of mec problems -- but again, this was a place that is VERY supportive of natural birth, so I'm not surprised that my friend managed to have a vaginal delivery in spite of it. BTW, her son's Apgars were 8/9, so good Apgars don't necessarily mean a baby that is perfectly healthy.
At any rate... there you have three experiences with meconium, with the outcomes ranging from fairly normal to extended NICU stay. But no c-sections...
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