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Bitter Sweet Caesarean

Vets have very different opinions on many things but I’d like to bet that pretty much all but the most disillusioned agree about caesarean section operations. These operations usually come our way in the evening or at night because mother nature likes her offspring to pop out at the most inconvenient times but having said that I think we all would agree that this is one operation that is always worth getting out of bed for. Surgically they are pretty simple, physically they can be very easy in the case of a slim cat or very hard in the case of a wild, beef heifer and mentally they can be one of the most glorious things we are lucky enough to have at work.

I know I sound quite evangelical about this but there are few things to beat it in my mind. Knowing all this I wasn’t annoyed to hear that I was going to be very late home from work last week because a man had rung to say that his bitch had been whelping all day but now seemed to be having difficulty and a greenish discharge had appeared. This did not sound like good news but I was excited nonetheless.

It was right at the end of evening surgery when Nellie the bull terrier arrived in some distress with her owner and a small cardboard box which turned out to have her four very cute puppies in it wrapped in a towel and cuddled together.

Her owner put her on the table and she immediately started straining and desperately trying to turn round and see what was appearing at her rear end. She and her owner were covered in a large amount of greenish slime and there was a lot of fluid pouring out of her every time she strained and heaved. It wasn’t her first litter and she had never had any problems before.

I had a feel inside and the problem was immediately apparent. Just over the brim of her pelvis all I could feel was a little, thin tail and a bottom. The puppy was coming backwards. This is not always a problem and puppies are often born this way with no difficulty whatsoever. The problem for Nellie was that his legs had not come up and he was wedged in the canal backwards. Try as I might I just couldn’t reach far enough to unhook his back legs. My major concern was the colour of her discharge. Once this goes green it is a sign that there is placental separation occurring and this can mean the remaining puppies are in danger of having their oxygen supply cut off. Nellie had been straining for about an hour by the time we saw here and she was also clearly getting very tired.

It was an easy decision to make to have her straight in and get the rest of the puppies out, hopefully before it was too late. Her owner agreed and then the first sad thing of the episode happened. He asked me to just have a quick look at one of the puppies she had already had because he was concerned it might have a cleft palate. As I opened its mouth an awful sight met me. This darling little thing had a huge deficit down the whole length of its hard palate. There was no way it would survive. As we admitted Nellie we kept this pup too to do the kindest but hardest thing and put him to sleep.

We gave Nellie some pain relief and rapidly prepared theatre. Once asleep we set about getting her cleaned up and ready for surgery. It was clear from her belly that there was at least another two pups inside but I couldn’t tell from the outside whether they were still moving or not especially with the anaesthetic on board.

I quickly made my incision and started to ease her massive uterus up to the outside so that we could start extracting the pups. The first to come out was the one that had caused all the trouble. His placenta had detached already and he looked like he had been dead for some time. Another blow but there were more important matters in seeing whether we could save the others. I ‘milked’ the next pup down to the hole I had made in the uterus, cleared the sac and clamped the cord. I could feel a good heart beat and passed it straight to Jo our nurse to start the process of resuscitation. This I repeated with another two. While the puppies were rubbed and dried and virtually willed to live I sutured the uterus back up and started to close Nellie’s abdomen.

All the time I was waiting for the most incredible sound that I love more than anything; the first cry of one of the pups. Whatever creature it is this first noise still makes me beam from ear to ear even after ten years. The room was worryingly quiet. After what seemed like an eternity Sandra and Jo passed on the news that they were all in fact going well despite their apparent reluctance to scream for their first meal and their mum.

It was then that the next crushing blow came. In all the flurry of activity to try and get the puppies warm and dry and breathing no one had checked them for the deformity that their litter mate had. Jo was devastated to find that one of the pups she had worked hard to bring to life was just the same; a huge portion of the palate was missing. As we examined the doomed puppy it was clear that he wasn’t right at all and had bent little legs and was much smaller than the others. We put him to sleep straight away.

Nellie recovered very quickly and was keen to be reunited with her owner and her pups; she is a cracking mum and blissfully will have no idea that there were three more that she could have had. Caesareans offer a whole spectrum of possibilities from sheer delight to utter disaster. Maybe it is the unpredictable, bitter sweet nature of them that keeps them so special to me.

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