It is not uncommon for a baby to have its first bowel movement before birth. This is known as meconium and it is a sign that the baby’s digestive system is mature and functioning properly. Meconium is a dark green, tarry, sticky substance that accumulates in the intestines as the baby develops in the womb. Here is a quick overview of what you need to know about meconium in newborns:
What is meconium?
Meconium is the baby’s first stool, or poop. It is made up of materials ingested during the time the baby spends in the uterus: intestinal epithelial cells, lanugo, mucus, amniotic fluid, bile and water. Meconium accumulates in the bowels starting around week 12 of gestation as the digestive system begins to function. It is sticky and thick because it contains high amounts of bilirubin, which is a byproduct of the breakdown of red blood cells. The high bilirubin concentration gives meconium its characteristic dark green/black color.
When does meconium form?
Meconium starts to accumulate in the baby’s intestines around 12 weeks of gestation as the digestive system starts functioning. The meconium accumulates throughout the remainder of the pregnancy. By the time the baby is ready to be born, their intestines can contain up to 200 grams of meconium.
Is meconium normal?
Yes, it is completely normal for a baby to have meconium. In fact, over 90% of babies will pass meconium in the first few days after birth. Meconium is a sign that the baby’s digestive system developed and functioned properly in the womb. Having meconium also helps stimulate peristalsis after birth, which helps the baby pass their first stools and clear the meconium from their system.
When does meconium pass?
Most babies will pass meconium within the first 48 hours after birth. Term babies tend to pass meconium in the first 24 hours. Premature babies may take a little longer, closer to 48 hours. Most babies will pass the meconium contained in their intestines after birth in their first few soiled diapers. It is also common for babies to pass meconium while still in the womb during labor.
What does it mean if a baby passes meconium before birth?
It is very common for babies to pass meconium either right before or during labor and delivery. This is known as meconium staining of amniotic fluid. When the baby’s abdomen and intestines get compressed from contractions during labor, it can cause some of the meconium to be expelled into the amniotic fluid. Meconium staining happens in about 10-15% of full-term births and up to 30% of post-term deliveries. Small amounts of meconium in the amniotic fluid is a normal occurrence and not a major concern. Often times the meconium will be suctioned out after the water breaks or delivery of the head so the baby does not inhale it. However, large amounts of thick meconium or meconium stained amniotic fluid may indicate potential fetal distress and the baby should be monitored closely.
Causes of meconium passage before birth
- Compression of the abdomen from contractions during labor
- Baby experiencing stress or distress in the womb
- Post-maturity after 40+ weeks gestation
- Infection in the amniotic fluid
Risks of meconium passage before birth
- Potential aspiration into the baby’s lungs leading to respiratory problems
- Meconium aspiration syndrome
- Infection from meconium exposure
- Need for neonatal resuscitation at delivery
How is meconium managed during labor?
If meconium staining is detected in the amniotic fluid, additional steps will be taken to manage it and prevent risks to the baby:
- Fetal monitoring – A fetal monitor will track the baby’s heart rate for signs of distress.
- Amnioinfusion – Sterile fluid is infused into the uterus to dilute the meconium.
- Suctioning at delivery – The doctor will suction the baby’s mouth and nose as soon as the head is delivered to remove meconium before the first breath.
- Neonatal team presence – A special pediatric team may be present at delivery to immediately assess and treat the baby if meconium aspiration occurs.
How is meconium treated after birth?
If the baby was exposed to meconium staining during labor, they will be monitored closely after birth for any signs of respiratory distress. If the baby has any trouble breathing, tests and treatments may include:
- Suctioning of the mouth and throat
- Endotracheal intubation to suction meconium from the lungs
- Chest x-rays to check for meconium aspiration syndrome
- Oxygen support or mechanical ventilation if needed
- Antibiotics if infection develops
The vast majority of the time, meconium is expelled harmlessly by the baby after birth and does not cause any major issues. With proper monitoring and management, even babies exposed to meconium stained fluid often transition without problems. Only rarely does meconium lead to serious complications like meconium aspiration syndrome requiring intensive treatment.
When to be concerned about meconium?
Small amounts of meconium staining are common and not too concerning. However, you should let your doctor know if:
- The fluid is very dark and thick with meconium
- Meconium staining happens well before labor starts
- You have decreased fetal movement along with meconium stained fluid
- You have any risk factors like post-dates pregnancy, infection, high blood pressure, etc.
- Your baby has an abnormal heart rate pattern on monitoring
These could be signs your baby is experiencing some distress and the meconium passage may not be harmless. Your doctor will monitor the situation closely.
How to help a baby pass meconium after birth
Here are some tips to help your newborn pass their first meconium stools:
- Breastfeed frequently – Colostrum acts as a natural laxative.
- Gently massage their abdomen with your fingers in a bicycling motion
- Give them a warm bath – This can help relax their abdomen.
- Hydrate adequately but avoid overfeeding
- Change diapers frequently
- Notify your doctor if no meconium after 24 hours
While meconium can be alarming at first glance, it is most often a normal part of your baby’s development. With the proper monitoring and care during and after labor, most babies transition without issues despite meconium staining. Only rarely does meconium lead to serious complications requiring intensive treatment. So take a deep breath – seeing meconium is common and you and your baby will likely be just fine!
Frequently Asked Questions
Is it bad if my water breaks and it is brown or green?
Some amount of meconium staining in the amniotic fluid is common and not too concerning. Thick, dark green fluid could indicate potential fetal distress and you should let your doctor know right away. They will monitor you and baby closely.
Does meconium in the fluid mean the baby is in distress?
Not always. Some light meconium staining just means the baby has matured enough to have a bowel movement in utero. However, large amounts can indicate potential distress as the baby passes stool in response to complications. Your doctor will monitor the situation closely if heavy meconium staining is present.
What are the signs of meconium aspiration syndrome?
Signs include respiratory distress shortly after birth, low Apgar scores, oxygen desaturation, breathing problems like retractions or grunting, and abnormal chest x-rays. Meconium aspiration is rare but requires prompt treatment like oxygen, suctioning, ventilation and antibiotics.
How long until a newborn passes meconium?
Most term babies will pass their first meconium stool within the first 24-48 hours after birth. Premature babies may take a little longer. If your baby has not passed meconium after 24 hours, let your pediatrician know. This could indicate an intestinal obstruction.
What does meconium look like?
Meconium is thick, sticky and dark green, black or brownish in color. It has a tar-like, odorless appearance. You will see it in your baby’s first soiled diapers, usually within the first couple days after birth. The first few stools will be meconium before transitioning to the typical mustard-yellow breastfed stool.
Conclusion
Meconium is the baby’s first intestinal discharge during pregnancy or labor. Although meconium is a normal part of your baby’s development, heavy meconium staining or passage may indicate potential fetal distress. However, with proper monitoring and management, most babies do fine despite meconium exposure. Meconium is common, so try not to panic if you see your baby’s first black, tarry stools. Your medical team will ensure your baby transitions smoothly. With some patience and cleansing breaths, you will both get through this important milestone!