http://www.youtube.com/watch?v=O-OqnqfHQ2Q
https://www.youtube.com/watch?v=Bk0nLRlFbrQ
As explained in these youtubes, I have been preventing all meconium aspiration by delivery on hands and knees, and waiting a minute or more between delivery of head and body. This gives a minute for meconium and vernix to drain from the lungs, trachea and nose. By the time the body is delivered, the lungs and trachea are clear of all meconium.
Article What (not) to do at and after delivery? Prevention and manag...
Suction should not be used routinely because it pushes vernix and meconium further down into the lungs making things worse:
A 2009 review of RCT trials(1) found pulmonary hypertension and asphyxia, and NOT meconium are now considered to be the important risk factors for Meconium Aspiration Syndrome MAS. It is likely that perinatal distress and aspiration of meconium occur earlier in the pregnancy, not at birth, which is why suctioning or cesarean delivery does not improve outcomes. Universal intrapartum suction of infants with meconium stained amniotic fluid has been proven to be a useless protocol . Instead, endotracheal intubation and suctioning are currently recommended only for nonvigorous infants. Respiratory failure in infants with MAS is treated initially with mechanical ventilation and surfactant administration.
1. Vain NE, Szyld EG, Prudent LM, Aguilar AM. What (not) to do at and after delivery? Prevention and management of meconium aspiration syndrome. Early Hum Dev. 2009;85(10):621-6.
As you stated above, we are only intervening if the baby is nonvigorous. Then we do not stimulate, but entubate and suction. If the cords are clear, there is no suctioning. If the baby is not vigorous after suctioning, we follow AAP NRP guidelines (http://www2.aap.org/nrp/) and then dry, stimulate, and provide ventilation as needed.
http://www2.aap.org/nrp/
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