Every mother longs to hear her newborn baby's first cry.
But the birth of Ms Michelle Kee's first-born, Vera, was met with a deafening silence.
"My baby didn't even cry when the doctor tried giving her oxygen to help her breathe. Her skin was all blue (from the lack of oxygen)," said the 30-year-old nurse, who was a first-time mother then.
Having breathed in some meconium before birth, Vera was taken to the neonatal intensive care unit even before Ms Kee could hold her.
Meconium is the sticky greenish- black stool that a newborn baby first passes after birth.
The faeces had entered Vera's airways and lungs.
Most babies pass their first stools in the first 24 hours after delivery, said Dr Joseph Manuel Gomez, head and senior consultant at the neonatal intensive care unit at KK Women's and Children's Hospital.
But some babies who experience stress before or during birth may pass meconium into the amniotic fluid before they are born, he said.
Amniotic fluid is the clear, colourless liquid surrounding the baby in the womb.
The stress can also cause the unborn baby to produce gasping movements while in the womb or when she is about to be born, said Dr Gomez.
As a result, she may breathe in the contaminated amniotic fluid. This condition is known as meconium aspiration syndrome.
How to prevent it
Your unborn baby can experience stress before or during birth. This can occur when the amount of oxygen she receives via the placenta drops, said Dr Joseph Manuel Gomez from KK Women's and Children's Hospital. To prevent this:
•Get early treatment for any medical conditions such as high blood pressure and diabetes, or respiratory diseases like asthma.
•Your pregnancy should not progress beyond 41 weeks.
•Ensure that a medical team trained in newborn resuscitation is present.
IT FELT LIKE A BAD DREAM
Ms Kee's first labour had seemed plain sailing until the midwife broke her water bag during her final stage of labour and discovered faeces in the amniotic fluid.
What happened next felt like a bad dream, she said. Her uneventful 12-hour labour suddenly became a medical emergency.
As Ms Kee struggled to push her baby out, Vera's heartrate plummeted, indicating that she was in distress. To speed up the birth process, the doctor used forceps.
"At that time, I didn't know that it was possible for an unborn baby to pass her first stool and that it was a serious matter," she said.
Meconium aspiration syndrome is dangerous to a newborn baby as it interferes with breathing, said Dr Gomez. Complications can set in, resulting in low oxygen levels.
A lack of oxygen to the brain can have devastating consequences, including death and developmental delay.
According to Dr Gomez, babies with serious meconium aspiration syndrome require the aid of breathing machines.
About 5 per cent go on to develop chronic lung disease, a condition linked to an increased risk of wheezing and chest infections in the first year of life.
These babies will require long- term follow-up to check on their growth and development, he said.
Exhausted from the long labour, a traumatised Ms Kee could barely comprehend what had happened.
The reality that she had almost lost her baby sank in only 15 minutes later, when her husband returned from the neonatal intensive care unit.
Thankfully, by then, the medical team had successfully cleared Vera's lungs and airways.
"I cried, first from the shock of the whole saga, then from feeling lost and helpless. Imagine not hearing your baby cry after pushing her out and not knowing what's going to happen to her," said Ms Kee.
CRIES OF RELIEF
Mother and baby were reunited three hours later. And for Ms Kee, it was an emotional moment.
She said: "It was the first time I could see my baby's face and carry her. I was so happy and relieved to hear her crying although she had tubes going in and out of her tiny body," she said.
Until today, Ms Kee does not know what caused the labour complication. "My doctor said overdue babies have a higher risk of this complication, but I was only at 38 weeks when I went into labour naturally," she said.
(A full-term pregnancy usually lasts 37 to 40 weeks.)
Treated with antibiotics and oxy- gen therapy, Vera was discharged with a clean bill of health after a six-day hospital stay.
With prompt treatment, most of these babies usually recover without any long-term complications, said Dr Gomez.
Now almost two, Vera is meeting all her developmental milestones and has become a big sister.
Ms Kee gave birth to her second baby last December. This time, the natural delivery went off without a hitch and she could hold her baby and breastfeed immediately.
Although Vera escaped unscathed from the incident, Ms Kee found herself worrying about her second-time labour and delivery.
"It didn't put me off having another child so soon, but it taught me not to take things for granted, even when a pregnancy seems to be going well," she said.
"Now that the baby is born and certified healthy, I can stop worrying."
•This article first appeared in Young Parents magazine. Young Parents, published by SPH Magazines, is available in both digital and print formats. Go to www.youngparents.com.sg to subscribe and for more parenting stories.