There are a lot of things new parents are surprised by in the first days and weeks of parenthood. Baby’s first poo, called meconium, is one of them. Meconium is unlike any poo you’ve ever seen, and can be quite a surprise if you’re not prepared for it. (And you thought pregnancy was weird!)
What is meconium?
Meconium is the very first stool that your baby passes. It’s thought that meconium is sterile (unlike other baby poo, which is colonized by colostrum and breastmilk), which is why this first poo doesn’t have any smell.
For the past few months, your baby has been swallowing amniotic fluid in preparation for breastfeeding. The by-product of this is an intestinal secretion we call meconium. Meconium is made up of bile salts, bile acids, lanugo, and other debris, and starts forming at 16 weeks gestation.
Do all babies have meconium?
Yep, all babies have it. Meconium is a normal part of pregnancy. It doesn’t matter if you have a healthy pregnancy, or if there are any other issues with the baby.
Meconium is a place holder, keeping the large intestine open during growth in the womb.
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What does meconium look like?
Meconium starts off thick, black, and tar-like, just like this:
After a few days, baby’s poop changes color.
- In breast-fed babies, it morphs into a dark green stool, and then resembles Dijon mustard with a seedy appearance.
- Formula-fed babies have tarry black, then green, then more of a pasty, tan-colored stool.
So what causes this color change?
Once air enters the GI tract, the bacteria E. coli colonizes the bowel, making stool become brownish yellow and smelly. ?
You may see some variations in color, but as long as baby’s poop is an “earth tone” like green, yellow, or brown, then there’s no need to worry. If, however, baby’s poop is white or red, then it could be an indication that there’s a problem.
Here’s more info on baby poop, what’s normal and what’s not.
When does meconium pass?
Black meconium passes within the first 24 hours after birth for 99% of healthy full-term babies.
Sometimes passage of meconium takes up to 48–72 hours before it changes to dark green, and then yellow as mentioned above.
Premature babies take longer to pass meconium, with 32% on average taking longer than 48 hours to pass meconium.
If meconium isn’t passed in this time frame, baby may experience jaundice. Jaundice affects nearly all infants, but some babies get a particularly severe case which may need to be treated.
To help baby pass her meconium as soon as possible (and avoid jaundice), be sure to begin skin to skin contact and nursing as soon as possible after birth. The more baby nurses, the faster the meconium will pass.
What causes meconium not to pass?
If it’s been 48 hours and meconium hasn’t passed, call your pediatrician. It could mean that baby is suffering from a bowel obstruction, Hirschsprung’s disease, Meconium plug syndrome, Meconium ileus, Anorectal malformation, or one of the much more rare conditions.
Keep in mind that babies born before their due date typically take longer to pass meconium, so there may not be reason for concern yet. Watch out for poor feeding, vomiting, and/or diarrhea, which could indicate a systemic infection.
What is meconium ileus and who is at risk?
Meconium ileus occurs when meconium is blocking the lower part of baby’s colon, known as the ileus. The meconium is thicker and stickier than usual, and can cause a distended abdomen. Almost all babies who have this condition have cystic fibrosis, a genetic condition that causes chronic constipation and abdominal pain. About 20% of all babies with cystic fibrosis have meconium ileus.
This condition can be detected through radiography, or sometimes through an ultrasound before birth. Severe cases may require surgery, though a simple enema is the first option and is what’s used by children’s hospitals. If baby was found to have this disease, she will also be tested for cystic fibrosis.
Not to be confused with a mucus plug, a meconium plug is where the meconium is plugging part of the colon instead of the lower ileus. It occurs in 1 in 500 to 1 in 1,000 live births.
If baby hasn’t passed meconium in 24–36 hours and is experiencing abdominal distention, refusal to eat, and vomiting with green bile, then s/he should be checked for a meconium plug. Depending on the particular case, it can be detected through radiography or an ultrasound. Your doctor should also use a contrast enema or rectal biopsy to actually diagnose the issue.
It may also be caused by an abnormally small left colon, which is more common in mamas who have diabetes or gestational diabetes. Thankfully, the small colon will develop normally after the initial blockage is removed. Sometimes babies with a meconium plug have Hirschsprung’s disease.
Meconium plug caused by Hirschprung’s disease
Hirschsprung’s disease occurs in about 1 out of every 5,000 live births and accounts for 20–25% of bowel obstructions in newborns. Babies who have this condition have a hard time passing stool. It can be detected from radiography and a contrast enema, but will need to be confirmed by a rectal biopsy. This genetic condition usually requires surgery.
How to deal with meconium poops
Meconium is surprisingly sticky. Here are some tips for dealing with this new-to-you kind of poop.
- Many midwives swear by olive oil for easy meconium clean up. If meconium is stuck to baby’s skin, use olive oil to wipe it off. You can even apply olive oil before the first poop for easy clean up (of course, it’s OK to just snuggle with your new little one too).
- Many new parents decide to skip the cloth diapers for the first few days to avoid dealing with trying to wash away sticky meconium. Natural diapers are a good alternative during this time.
- If you want to stick with cloth from the get go, there are some natural stain removers that can help get the meconium stains out of diapers and clothing:
- Biokleen Bac-Out
- A mixture of peroxide and baking soda in the wash
- Dry them in the sun!
Also keep in mind that a stained diaper is not a dirty diaper and can still be used (and who will see it?).
The final word on meconium
Meconium is the normal first poop of an infant. Meconium usually passes in the first day or two, but may not due to an obstruction or complication. Meconium may cause stains on clothing, but can usually be treated with natural stain removers. Just think of it as your introduction to the weird and wacky land of parenthood! ?
- Fraser, D., Cooper, M. A., & Myles, M. F. (2003). Myles textbook for midwives. Edinburgh: Churchill Livingstone.