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Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Meconium References

A few things make me question our meconium beliefs -- First, the incidence of meconium aspiration syndrome has NOT decreased in the last 15 years since deLeeing on the perineum became standard practice -- or even in the last 10 years or so when visualizing cords and intubation has become accepted (and expected).. If it works better than simply wiping and/or bulb syringeing the baby then we should have seen a BIG decrease! But we haven't..... Mec aspiration and mec aspiration pneumonia is just as common (or as rare) as it has historically been.

And I'm told research centered in Yale is showing that what we assumed were meconium aspiration babies (that baby had clear lungs and simply inhaled at birth) are really babies with long standing problems -- they had damaged lungs INSIDE the womb; probably from some mild but chronic stress.

A quote was recently attributed to one of the docs who worked out the first published meconium protocols "DeLeeing on the perineum was a great idea -- too bad it didn't work".

Even the Guide to Effective Care says that suctioning (with syringe) "may" prevent mec aspiration but it's effectiveness is unproven. They say that tracheal suctioning should be carried out "only for infants who are depressed at birth (heart rate less than 80 - 100..) and have meconium in the pharynx." But some practitioners are still holding down vigorous struggling babies and trying to scope them!!

Two of the studies from when we did a lit search in '88 states that even tho postterm babies have a higher incidence of mec, they do not have a higher incidence of asphyxiation than term babies. Same search did not support vigorous deLeeing after the birth of healthy babies: "Immediate tracheal suction is not a harmless intervention, and should be considered superfluous in a vigorous term neonate with meconium stained amniotic fluid." The study did report deLeeing on the peri is helpful, but should cease once a strong baby is born. Usher, et al., American Journal of OB/GYN, Feb. 88; and Linder, et al., Journal of Pediatrics, April 88.

That's when we quit overreacting to mec alone. We still have bulb and deLee out, but sure don't use em like we used to!

MIDIRS has two recent abstracts on mec staining and aspiration. Pretty much the same conclusions:

MIDIRS 5:1, page 62 was a prospective study of single pregnancies at 37-42 wks identified as low risk prenatally. "FHR abnormality was more closely associated w/ adverse outcome than mec staining, thin mec alone was not associated w/ any adverse outcome except respiratory distress." Mahomed, et al., Pediatric and Perinatal Epidemiology, vol 8, #3, July 94.

MIDIRS 5:3, page 318 examines recent work on MSAF and its relationship to MAS. Some highlights: MAS is much commoner in America than in the UK. (!) Increased frequency of mec passage in postterm babies was not associated w/ an increased problem with MAS, despite a higher rate of mec found below the cords at higher gestations. "MAS certainly occurs before birth but the normal shallow breathing of the fetus is not sufficient to aspirate thick meconium." "Animal work suggests that fetal acidaemia is necessary to cause MAS in utero". (Gee, just as we've been saying) "it is the persistent pulmonary hypertension complicating MAS that causes the major problems." Meconium may not be the cause of MAS. (?) "it is unlikely that hypoxia secondary to meconium in the alveoli caused the changes in the alveolar arteries. Some other agent was probably responsible." Interesting review. Houlihan, et al., Journal of Reproductive Medicine, vol 39, #11, Nov. 1994