Re: [ozmidwifery] Homebirth experiences with Mec liquor

[Marilyn Kleidon]

Ok, I'll dabble. When I was practising as a homebirth midwife in the state of Washington, USA, if there was mec liqour then we did suction mouth and nose on the perineum usually with a De Lee trap. Baby wasn't stimulated to cry until we were satisfied with suctioning. All such babies i attended were vigorous at birth (no stim necessary)and so no further action was needed. Indeed it was hospital practice in the hospital where we had privileges that vigorous babies did not receive deep, vigorous suction. Because of this, if we had thick mec in 1st stage it was our policy to transfer to the hospital in case the baby was not vigorous. We were a conservative practice and  this was disclosed to women on first interview. Those that were born through mec had membranes rupture just prior to birth.   It was deemed that vigorous suctioning could lead to a vasovagal response in the babe leading to a cascade of interventions such as intubation which apart from this response were not necessary. This was a change to Neonatal Resuscation Guidelines in Washington (and maybe nationally, not sure there) in 2001, there was a study which indicated that the rate of MAS was 6% in babies born through thick meconium regardless of whether they were intubated or not. It seemed to confirm the idea that mec in the lungs was a result of a secondary apneic gasp inutero. Sorry, but I can't provide the reference. Shall look though, and get back if I find it.   marilyn ----- Original Message ----- From: mmhh To: [EMAIL PROTECTED] Sent: Sunday, June 01, 2003 9:14 PM Subject: Re: [ozmidwifery] Homebirth experiences with Mec liquor I'm not a homebirth midwife but this is a subject I'm keenly interested in after seeing many mabies subjected to incredibly invasive suction and 'resuscitation', even when kicking and screaming. The australian neonatal resuscitation guidelines,  which were adopted from the WHO infant resuss guidelines and are in common use all over the world, suggest orophanyngeal suctioning on the peri in the presence of mec liquor (not going right down to the stomach or as far down the bronchial tree as can be managed which has been an ongoing problem where I work) and direct inspection of the chords and suction only in the case of thick meconium or an unresponsive infant with any meconium. It has taken a lot of reiteration and bringing this to the attention of our paediatric staff who often seem to think of a mec delivery as the chance to improve their intubation skills. When we are able to enforce this and only suction mouth and nose most babies seem to be born very vigorous and in need of little other intervention. As an aside to another thread, I was also taught that babies entering secondary apnoea gave a gasp whether they were born or still inutero and haveseen numerous babies who most definitely did not breathe after birth before being suctioned, who developed MAS. I don't know how this works with the closed glottis. Maybe the extreme insult causing the secondary apnoea overcomes it? I've also washed and dressed stillborn babies who have drained copious amounts of thick mec from mouth and nose, clearly more than the volume that can be held in a baby's upper resp. tract. More than could be accounted for by the altered muscle resistance after fetal death. mariette ----- Original Message ----- From: Graham & Helen To: [EMAIL PROTECTED] Sent: Monday, June 02, 2003 10:44 AM Subject: [ozmidwifery] Homebirth experiences with Mec. liquor Dear List   As a midwife with only hospital based past experiences, I would be interested to hear from the homebirth midwives on the list whether they recommend anything differently when attending a woman at homebirth with mec. liquor.  i.e. any oropharyngeal suction on the peri?  and the subsequent outcomes....( I think I know the answers I am going to get!)    It seems that in a hospital situation everything is so rigid and I for one am not prepared to deviate from the policies set by the paediatricians/obs. on such issues, (especially as I only work on a casual basis)  but my feeling from the discussions on this list of late is that peri suctioning is an unnecessary trauma inflicted on a lot of babies with no benefit.   I have to admit that I haven't researched this topic on line but would value your previous experiences on the subject.   Thanks   Helen Cahill