Suctioning
Moderate and heavy meconium staining of the amniotic fluid can lead to the complication of Meconium Aspiration Syndrome (or MAS). This is when the baby inhales the meconium into their lungs at birth. Suctioning the baby's nose, mouth and throat at birth is the most common intervention used by caregivers to prevent this complication.
The suctioning procedure normally entails the baby's nose and mouth being suctioned as soon as the baby's head emerges at birth (either vaginally or through an incision by Caesarean) but before their body is born. This is aimed at clearing the baby's airways of meconium before the baby takes their first breath. The suctioning is then usually repeated after the baby's body is born.
Many caregivers will cut the cord immediately after the birth so that the baby can be passed to the paediatric doctor to suction and check them on the resuscitation table in the birthing room. The paediatric doctor will also often look down the baby's throat with a device called a 'laryngoscope' to see if any meconium has passed down past the baby's vocal cords. This is called 'viewing the cords'.
It used to be common practice for the doctor to pass a tube down past the baby's vocal cord (called 'intubation') to suction the baby's airways at this lower level. This practice is now not recommended unless the baby is unwell, as it can actually increase the incidence of Meconium Aspiration Syndrome.
The caregiver will usually also try to suction any meconium stained fluid from the back of the baby's throat (or pharynx) after birth. This needs to be done carefully to avoid the complication of 'pharyngeal stimulation' (occurring in about 3 to 4% of babies suctioned this way). Pharyngeal stimulation can cause the baby's airways to spasm and possibly trigger abnormal heart rate patterns in the baby, producing a dramatic slowing of the baby's heart rate (known as 'bradycardia').