How to Avoid MAS (Meconium Aspiration Syndrome)

About Meconium Aspiration-
Meconium aspiration is overhyped as conditions to create MAS (meconium aspiration syndrome) have to be right (or, wrong, as it were) for it to be an issue, and even then the attentive parent will observe problems with their neonate and be able to seek timely medical treatment if necessary.

“To date debates continue to rage regarding the optimum
obstetrical approach, resuscitation measures at birth and
subsequent management of the critically ill neonate with
meconium aspiration syndrome (MAS).” – (http://medind.nic.in/maa/t10/i2/maat10i2p152.PDF)

Risk Factors with Meconium Aspiration-
Babies that are being born in a disturbed environment or are experiencing a traumatic birth, particularly via Cesarean, are at greater risk for meconium aspiration. Almost exclusively, full term and post-dates babies are at risk of releasing meconium (not necessarily aspirating, but releasing). This can be stimulated or brought about just from normal stimulation of contractions. Seeing meconium in the fluid should not cause instant alarm and the more easy and natural the birth, and the more time the meconium has had to mix and circulate with the fluids present in baby‘s environment, the less of a threat meconium poses. Aspiration becomes less likely.

In one study of babies born with thick meconium-stained fluid, 39 developed MAS and 898 did not.
http://www.sciencedirect.com/science/article/pii/002978449500124A

Another study from Australia and New Zealand says, “A higher risk of MASINT was noted at advanced gestation, with 34% of cases born beyond 40 weeks, compared with 16% of infants without MAS. Fetal distress requiring obstetric intervention was noted in 51% of cases, and 42% were delivered by cesarean section.”

“The incidence of MASINT in the developed world is low and seems to be decreasing. Risk of MASINT is significantly greater in the presence of fetal distress and low Apgar score..”, and “Death related to MAS occurred in 24 infants (2.5% of the MASINT cohort; 0.96 per 100000 live births).”
http://pediatrics.aappublications.org/content/117/5/1712

That same publication remarks on an increase in MAS amongst home births and indigenous (minorities) within the population, but this quite possibly has a lot more to do with how individuals are treated than medical and biological predispositions.

How Do Babies Aspirate Meconium?-
If the baby passes meconium in utero, it typically mixes with the fluids in the womb. The baby has been practicing swallowing these fluids and the fluids are being replenished. If meconium is fresh and thick and the baby is soon delivered, and the meconium is by or in the airways at that time, this would pose a threat of aspiration. Aspiration may then lead to MAS, and could require medical treatment at that time. A baby having a vaginal birth where the fluids have a better opportunity to be squeezed out of the lungs and airways at birth would have less risk for aspiration and MAS. The baby does not take its first real “breath” until after birth. The baby isn’t breathing in the womb. It “practices” breathing in the womb without actually inhaling. Any aspiration would occur upon delivery. Method of delivery and birth then becomes particularly important in the presence of meconium.

This link (http://kidshealth.org/parent/medical/lungs/meconium.html#) has some alarmist medical perspectives on meconium, but take note of the following quotes:

This image seems to show meconium already settled into the lungs before the baby has taken a full breath, still in utero.

“Normally, fluid is moved in and out of only the trachea (the upper portion of the airway) when there’s breathing activity in the fetus. “

“Although 6% to 25% of babies delivered have meconium-stained amniotic fluid, not all infants who pass meconium during labor and delivery develop MAS.”

“Most babies with MAS improve within a few days or weeks”

“In some cases doctors may recommend amnioinfusion, the dilution of the amniotic fluid with saline, to wash meconium out of the amniotic sac before the baby has a chance to inhale it at birth.”

This last quote also indicates how meconium which has had the opportunity to be diluted in or cleansed from the amniotic fluids poses far less a threat to the baby. Birth should not be rushed, and meconium present is not an indication that birth should be hastened. A natural physiological birth is still called for if there are no reasons to suggest the baby is in immediate distress. Remember that meconium itself does not equal distress.

Please take heed, this, though:
“However later studies reported that this procedure [amnioinfusion] was
not accompanied by any statistically significant reduction
in adverse foetal outcomes. Moreover this procedure
had fallen into disrepute for its increased association
with foetal heart rate abnormalities, operative/instrument
deliveries and infection. “  (http://medind.nic.in/maa/t10/i2/maat10i2p152.PDF)

“Although MAS is a frightening complication for parents to face during the birth of their child, the majority of cases are not severe. Most infants are monitored for fetal distress during labor, and doctors pay careful attention to any signs that would indicate meconium aspiration.”

And so do parents. Signs of difficulty related to MAS are obvious and will not escape an educated and attentive home birthing parent. These include:

• Bluish skin color (cyanosis) in the infant
• Difficulty breathing (the infant needs to work hard to breathe)
• No breathing
• Rapid breathing
• Limpness in infant at birth

(http://www.nlm.nih.gov/medlineplus/ency/article/001596.htm)

That last link indicates that a low APGAR may indicate needing help breathing. This is not always the case. I was transferred for meconium in fluid from my homebirth. My baby was given a lower APGAR score for color. His color was naturally pale and he had no actual complications or health conditions.

“In most cases, the outlook is excellent and there are no long-term health effects.
In more severe cases, breathing problems may occur. They usually go away in 2 – 4 days.”

“Meconium aspiration rarely leads to permanent lung damage.”

The link goes on to state:

“If the baby is active and crying, no treatment is needed.”

This was true for my baby and he was almost immediately returned to me upon inspection.

I do not advise automatic hospital transfers at the sight of meconium-stained fluids. Hospital transfer increases risk of trauma from travel, and fear/distress to mother and consequently baby. Fear causes tension in the uterus and deprives organs and fetus of blood and oxygen which increases fetal distress (and meconium release). Emergency efforts are often exaggerated and can be found to exacerbate any issues surrounding meconium (and more). Keeping birth calm and peaceful in a comfortable setting and observing the newborn at birth will be the baby’s best chance of avoiding MAS.

Treatment of Neonates w/Meconium Aspiration-

“the current evidence
suggests that intrapartum suctioning of the oro/
nasopharynx may not reduce the risk of aspiration.”

“Subsequent tracheal
toileting which was earlier advocated has been
challenged on the precincts that it is only the depressed
neonate who runs the risk of MAS.”

“It is likely that MAS
will develop in a small minority of apparently healthy
meconium stained infants, but there is no way of
identifying these neonates at risk during childbirth”

“Meconium is almost always sterile. Yet
several workers routinely administer antibiotics to the
babies with MAS… the consensus opinion does not favour the
routine use of antibiotics in babies with MAS ”

“It is necessary to maintain an optimal thermal environment and minimal handling because these infants are agitated easily and become hypoxemic and acidotic quickly.”

“Several modalities of monitoring and treatment are available, but these are yet to be substantiated with quality scientific investigation.”

(http://medind.nic.in/maa/t10/i2/maat10i2p152.pdf)

Another Good Link:
Midwife Thinking: The Curse of Meconium-Stained Liquor
One highlight: “During labour and birth it is very unlikely that a baby will inhale liquor (and any meconium in it). This will only happen if the baby becomes extremely hypoxic and begins to gasp in utero in an attempt to get oxygen. So, meconium alone is not a problem. Meconium + a hypoxic baby = the possibility of MAS (Davies & MacDonald 2008).”

I am a lay person. I am a self-educated freebirther (unassisted birther). I have left the medical birth system because I have learned how to make birth safer myself, at home. Therefore, none of this constitutes medical advice– these are my observations and opinions as I continue to grow in knowledge.

How Prevalent is Childbirth Trauma?

Trauma in childbirth doesn’t necessarily have to be felt psychologically. It can be something the body experiences physically. When it’s classified as “normal”, it is not accepted as “trauma”, but it still is. This is how someone could feel totally satisfied mentally about their birth, but still undergo a level of trauma.

Obviously, the reverse is true too. You could feel trauma on a psychological or other level, even though it may not be apparent physically to some.

Now, because the brain and body work closely together (wink), where there is one type of trauma, there is often the other. If your body feels traumatized on a level you are not conscious of, you may still feel unexplainable psychological effects. When you confuse the body, the brain may follow. And vice versa.

The mammalian needs in labor/birth to have a true safe, physiological experience (as described by people such as Michel Odent) requires an undisturbed birth that honors darkness, silence, warmth, and (relative) solitude (or non-observation/interference).  Human beings are mammals, but we tend to give other animals more respect in birth than we give to ourselves and each other.

Plenty of women who have become mothers have unresolved issues or feel a level of imbalance and cannot trace the source. Trauma in childbirth is one reasonable leap regarding most. Most human beings have a plethora of “issues”, but childbirth and the ramifications of being traumatized during or as a result of is a colossal one– unmatched and practically universal amongst modern mothers. Not only can manifestations from trauma be traced to this one life-altering experience, but we also use motherhood as a way of identifying and defining ourselves. All of these provide for the perfect opportunity and cocktail for depression, emotional breakdown, mommy wars (reasons why women can’t just understand each other and be friends, constant comparison and cattiness), etc. If we felt no level of violence or trauma, and if we felt psychologically sound (in terms of being at peace with our choices, less defensiveness), we wouldn’t feel so threatened by others and so much of a need to fight against people who choose (non-abusive) different birth or parenting paths. Secure, well people do not fly off the handle in order to compete or attack with no provocation. Those who suffer from this would do well to receive assistance and support for healthy management of whatever issues or imbalances lie beneath the surface.

And this is just surmised through the observation of people who can articulate their thoughts. This says nothing for what the babies of traumatic birth feel and carry with them. Their first moments have lasting physical and psychological impacts, it would be logical to assume. Of course sometimes it manifests in an obvious physical way, but even more often it does not.

Looking around at the landscape in the parenting in birth worlds, I can answer my own question– it’s pretty damn prevalent. Looking around at the decay of society, which is the result in part to disconnect between women and children, overwhelming depression, economic and educational lapses, unwanted pregnancies, etc. … is it any wonder we see craziness everywhere we look? Healing the world is awfully hard when we’ve done all that we can to disrupt the natural hormonal and physiological beginnings of almost every new life entering this world.

Modern life and modern conveniences are not foolproof. We’ve made a trade-off when we’ve attempted to mechanize birth in lieu of comprehending birth mechanics.

There’s a reason for the phrase “peace on Earth begins with birth”. I take it quite literally. Helping others to understand it from this angle is my little part in trying to illuminate a pathway to more healing on this planet.

Tackling the Newbie Q: “COULD You Freebirth?”

Allow me to be blunt. Of course you could. Anybody could. Let’s be clear– birth isn’t something that requires permission of a man in a white coat. Birth just happens. If you relax your body and mind, it can happen quite gracefully. Most women try desperately to stave off birth until Mr. Dr. White Coat can green-light them, but he is not the magical birth fairy,  his presence does not automatically sanction your labor or save the day, and in fact may be detrimental. (In general:) You were never in any danger, but you increase your risk of this when you add more dimensions, more complications, to the essentially simplistic birth process. This is a mental and physical panic you will cause yourself (perhaps without knowing), and the surgeon will be happy to make himself useful and do what surgeons do best– medically manipulate using drugs and instruments.

Don’t need that? Not an emergency? Welcome to Freebirth.

It’s called “free” not because it doesn’t cost you anything (which is nice, too), but because you are doing it on your own. It’s a liberation. Liberation from a system. A system which is fairly new in our society, is founded on misogyny and business acumen (#1 reason to go to hospitals today in the US), and does not have your best interests at heart.

The very position they have you deliver in is an illustration of this. They aren’t doing these things for you, they are doing it for them. And, it is hurting women and babies every day.

Need examples? Here are a few from one of my favorite sites (myobsaidwhat.com). I want you to keep in mind that this is common stuff happening to women every day.

In fact, you probably have your own examples, if you’ve ever been pregnant. (Feel free to share them if you like.)

Unless you are having an honest to God emergency (which are rare, mind you), ask yourself– do you really need a hospital or a doctor? Or will childbirth happen with or without their say so? Hospitals and doctors are for sick people. Obstetricians are surgeons; surgeons perform surgery. Pregnancy is not an illness, and labor is not a complex procedure. It is an act of nature, or God, if you will.

I know a lot of women feel strongly that they need to deliver in a hospital “just in case”, but how much of that is conditioning? The conditioning being, that is, that it is almost inevitable that we will need outside help from some authority figure. Are we experiencing our own form of being “institutionalized”? I urge women to start seriously considering if this is our reality today.

It’s a false sense of security, seeing as how most interventions and just medical presence in general is a hindrance on normal physiological birth. It interferes with your primal state and puts your body in a panic mode, stalling or prolonging labor and creating more pain. That’s just the way of childbirth, naturally. We never get taught this, however. We only get taught to walk into the hospital and put it all in someone else’s hands. Then if something goes wrong, we don’t have to be held responsible. Seldom do we know that walking in the door was the first thing to cause a series of bad events, and the catalyst for possible crisis in any birth situation. Losing your responsibility is an illusion, and a doctor being your savior is an illusion and a false sense of security, in an environment that your primal and birthing mind feels more endangered within.

We stay at home because we want to play it safe. Know where the real dangers lie. De-condition your mind. Free birth from a freed mind.

We turn to UC, many of us, after learning the hard way. I myself have had 2 managed births, and 1 freebirth. We wish you could learn from our experiences. We honor our knowing. We have awakened. Honor your knowing.