Meconium in Labour: What Are Your Options?

Meconium in Labour: What Are Your Options?

You’ve planned your birth, you’ve visualised the flow, and now you’re in the moment—then someone mentions meconium in your waters. Suddenly, everything feels a little less steady. So what does it actually mean? What are your real options when this comes up?

Let’s talk about it.

First, what is meconium?

Meconium is your baby’s first poop—a thick, greenish-black substance made up of things like amniotic fluid, skin cells, and lanugo. It’s normal for babies to pass meconium after birth, but sometimes it shows up in the waters during labour. That’s called meconium-stained amniotic fluid.

What does the system say?

In many hospital settings, meconium triggers a chain reaction. It’s often treated as a potential emergency because of the risk of Meconium Aspiration Syndrome (MAS)—when a baby inhales meconium into their lungs. While MAS can be serious, it’s also rare and often treatable. Still, its possibility tends to lead to:

• Increased monitoring (continuous CTG rather than intermittent Doppler)

• Potential recommendation for transfer (if birthing at home or in a birth centre)

• A “time limit” on labour progress

• Possible pressure toward interventions like artificial rupture of membranes, syntocinon drip, or even cesarean birth

But what’s the reality?

The presence of meconium doesn’t always mean something is wrong. It can be a sign of maturity, especially in babies who are past 40 weeks. It may simply mean your baby had a little bowel movement, possibly from the intensity of contractions.

The key here is context. Meconium with other signs of concern (like a consistently abnormal fetal heart rate) may indicate baby is struggling. But meconium on its own is not always an emergency.

As a doula, I’ve seen care providers handle meconium in very different ways—from calm monitoring and reassurance, to immediate escalation and interventions. The difference often comes down to the provider’s training, hospital policy, and your ability to advocate (or have someone advocate) for your preferences.

So what are your options?

• Ask questions. Is the meconium thick or light? Is baby coping well? How urgent is this really?

• Stay mobile and upright (if safe)—this helps baby navigate the pelvis efficiently.

• Request intermittent monitoring, or discuss the risks and benefits of continuous monitoring with your care team.

• Decline interventions unless medically necessary, and ask for time to discuss each option.

• Use your BRAIN acronym: Benefits, Risks, Alternatives, Intuition, Nothing.

The most powerful thing you can do is understand the system and your choices before labour begins.

And for that, I highly recommend diving into Rachel Reed’s Meconium in Labour. She’s a midwife, researcher, and straight-talking birth nerd who breaks down the science, the system, and the stories with such clarity. You’ll walk away with confidence and context.

Your birth. Your baby. Your body. Your choices.

And yes, even with meconium, you still have options.

If you want to talk through your birth plan or explore what these options could look like for your situation, I’m here. Always.