Babies not infrequently pass meconium in the womb. Sometimes we can
never find a reason, but sometimes it's a response to the stress of
labor, a pinch in the umbilical cord or some other problem that
causes a drop in oxygen levels. It used to be thought that this only
became a problem if the baby breathed it into her lungs with her
first breaths after birth.
For several decades a great deal of energy was focused on methods to
prevent meconium aspiration syndrome by developing better suction
methods after the birth of the baby's head. It was a great
disappointment when the incidence of MAS did not drop! Further
research showed that meconium aspiration *occurs in the womb* and not
with those first breaths (unless inappropriate resuscitation blows
meconium into the lungs). A baby born with MAS has already suffered
damage before he is born--our suction efforts have little effect.
Babies do normal breaths while in the womb. Under deep distress they
take deeper breaths--a sort of "last gasp"---and take fluid (or
meconium) deeply into their lungs. Our efforts to prevent MAS should
focus on the prevention of fetal distress in labor and on correct
suctioning/resuscitation techniques for the depressed newborn. Little
can be done to prevent MAS. It is a result of a serious problem in
labor--it occurs before anyone can prevent it.
The baby whose MAS started this discussion was born by emergency
ceserean. The deep fetal distress that prompted the cesarean also
caused the meconium aspiration. Being six days past the due date is
an entirely irrelevant factor. The baby passed meconium and breathed
it in *because* of fetal distress--he aspirated meconium before he
was born, not after. It was no one's fault--it could not be
prevented. Great medical treatment is providing the necessary support
while his lungs heal. He should recover without problems.
-Gail Hart, midwife, Oregon
Reprinted from Midwifery Today E-News (Vol 2 Issue 29 July 19, 2000)
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