Meconium & Meconium Aspiration Syndrome

The existence of meconium during labour can be a significant sign of fetal distress during labour and delivery. Meconium Aspiration Syndrome (MAS) can be a significant complication during labour and delivery and can lead to long term, or permanent injury.

Some basic medicine

Before we get into the discussion of meconium and meconium aspiration syndrome it may be useful to have a short discussion of some basic medical principles.

The first basic principle is that every human cell requires oxygen and nutrients, such as glucose, to survive. Of course, some cells require more oxygen and nutrients than others. The cells of the fetal and newborn brain have a high demand for oxygen and glucose. If either the oxygen or the glucose levels fall below a critical level the cell dies. A brain injury can thus be thought of as the death of a significant number of brain cells.

How does your baby get oxygen in utero?

It might also be useful to discuss how cells of the fetal brain are supplied with the necessary oxygen and nutrients. Before your baby is born, your baby (the medical term is fetus) does not breathe in the traditional sense.  Your baby’s lungs do not supply oxygen to the fetal blood.

Rather, the process can be thought to start with your (the mother’s) lungs. Your lungs supply oxygen to your blood. This blood moves from your lungs to your heart, and then is pumped throughout your body, including to your placenta.

The placenta exchanges oxygen and nutrients from the maternal blood to the fetal blood and carbon dioxide and waste products from the fetal blood to the maternal blood. The oxygenated fetal blood flows through the umbilical cord to your baby.

The significance of this is that your baby does not rely on his or her lungs to oxygenate the blood and accordingly the presence of meconium in the amniotic fluid does not have a direct negative effect on your baby. That changes at birth when your baby’s lungs are required to function efficiently to ensure proper oxygenation of your baby’s blood.

What is meconium?

Meconium is a medical term for the first bowel movement of a fetus or baby. It is a green tar like substance. In up to 25% of deliveries the fetus will pass meconium before birth.

Meconium mixes with the amniotic fluid and may go into the throat and lungs of the fetus. This is significant for two reasons:

  • Sign of fetal distress: First, it is generally recognized that a fetus that is not appropriately compensating for the stress of labour might, as a consequence, pass meconium. Thus, the fact your baby has passed meconium prior to delivery is a warning sign that your baby may have been subjected to possible fetal distress.
  • Meconium Aspiration Syndrome:  The other significant factor is that meconium in the throat and lungs of the newborn could prevent the newborn from breathing properly and may also prevent the effective functioning of the lungs to be able to oxygenate the baby’s blood. This is referred to as Meconium Aspiration Syndrome (MAS) and while potentially serious, the symptoms are usually transient in an otherwise healthy baby.

However, babies with asphyxia tend to be more vulnerable. If it is known that your baby passed meconium during labour it is essential to have a physician present at the delivery who can suction your baby’s throat both above and below the vocal cords, if necessary. It is essential to suction as much of the meconium as possible immediately after birth to minimize the risk of meconium aspiration syndrome.

What are the legal issues?

From a legal point of view, several questions arise:

a) Was there evidence that the fetus was not tolerating labour which, in turn, should have resulted in the delivery of the baby prior to the baby passing meconium?

b) Did the healthcare providers recognize that the passing of meconium by a fetus is a sign of fetal distress and did they react appropriately?

c) Did the healthcare providers ensure that there was a physician present at the delivery who was tasked with the suctioning of the baby’s throat above and below the vocal cords?

d) Was the suctioning of the meconium properly performed?

If you suspect your baby may have suffered an injury during labour or delivery, your birth injury lawyer will investigate all these issues to determine if there is evidence to establish whether meconium played a role in your baby’s injury.

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