Your baby’s first stool is called “meconium.” Normally, the first bowel movement occurs after baby is born. Meconium is a thick, tar-like, blackish-green in color, that begins to form in baby’s intestines during your third month of pregnancy. It is made up of old cells from the intestines, skin, hair, amniotic fluid, and bile. During the first trimester of pregnancy (first 12 weeks), your baby passes small amounts of meconium stool. After your 16th week of pregnancy, the passage of meconium stool slows down. By the 20th week of pregnancy, your baby rarely passes meconium. This is due to the fact that his anal sphincter is functioning and able to hold the stool in the intestines.1

When a baby passes his first stool before birth, the amniotic fluid will be tinted green, or yellow. When this occurs, the amniotic fluid is called “meconium-stained.” This occurs when the baby has experienced some type of stress before birth. Babies that are overdue have a greater chance of passing meconium before birth. Because of this fact, it is a warning sign for physicians, midwives, and nurses that care for women in labor. Most babies have no complications despite the fact that meconium was present in the amniotic fluid, but the well-being of these babies must be closely monitored throughout the course of labor.

Serious complications caused by meconium

When a baby passes his first stool before birth, there is a risk that some of the meconium will enter his lungs when he takes his first breath after birth. This is due to the fact that some of the meconium may be in his mouth, or throat. When it occurs, it is called Meconium Aspiration Syndrome. Most babies that pass meconium before birth do not suffer from meconium aspiration. They begin to cry within seconds after birth, and the meconium is cleared from their mouths.

The greatest risk for meconium aspiration occurs in babies that have not received enough oxygen. Before he/she is born, oxygen is supplied by the blood that flows through the umbilical cord. If the flow of blood is interrupted, less oxygen is delivered to the baby. If this has occurred, he/she may not be able to cry within seconds after birth. His/Her first attempts at breathing may be in the form of gasping. This gasping increases the risk of the meconium entering the lungs. The meconium that enters the lungs may cause problems, such as infection and lung disease.

There used to be a number of steps for doctors, nurses or midwives to take if meconium-stained amniotic fluid was present. Many of them no longer apply. If your baby is born with meconium-stained amniotic fluid and is not breathing, he/she should receive the same care to help him/her to breathe that a baby born without meconium-stained fluid would:2 namely, that a baby with no signs of aspiration right after birth may not need additional treatment, only additional monitoring. While the baby is in the hospital, he/she will be monitored more closely. The blood sugar may be checked to make sure that it is in the normal range, and the baby’s temperature may be taken every four hours for a period of time.

If your baby shows signs of meconium aspiration syndrome at birth, he or she may need help with breathing, as well as other specialized care that is given in a Neonatal Intensive Care Unit. The doctor may also prescribe other medications, such as antibiotics. If the hospital where your baby is delivered does not have a NICU, your child may be transferred to a hospital that does.

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  1. Cunningham, F., Leveno, K., Bloom, S., Spong, C., Dashe, J., Hoffman, B., Casey, M., & Sheffield, J. (2013). Williams obstetrics (24th ed.). New York, NY: McGraw-Hill
  2. Garcia-Prate, J. (2016). Clinical features and diagnosis of meconium aspiration syndrome. UpToDate. Retrieved from https://www.uptodate.com/clinical-features-and-diagnosis-of-meconium-aspiration-syndrome