IBMDC Article on C Section

C-Section: The Process and Danger

By Ruth Reynolds
Adapted from post on Berner-L
Published with explicit permission of author

In our clinic the dam's welfare takes precedence. Everything is done to preserve her life first. She is induced by injection and goes to sleep rapidly. Her head is elevated, mouth opened and a tube inserted into her trachea. This is called "intubation." The tube has a "inflatable cuff" on it near the end which is in the trachea. There's a small airtube which goes into the cuff. When air is pushed (via an empty syringe) into that cuff, the cuff inflates and little or no anesthetic can leak out around it. The end of the tube comes out the dog's mouth and a hose from the anesthesia machine is attached. The anesthesia is a liquid that is mixed with oxygen in the machine and administered through the hose as a gas. Zzzzzz. The proper oxygen/anesthetic mixture must be maintained during the surgery. It varies from animal to animal and sometimes varies during a surgical procedure.

When that's completed the dog can be prepped for surgery and a heart monitor and pulse and oxygen monitor are applied to the dog via clamps attached 4 places on the dog. Monitors are set and started. The prepping continues with shaving the belly including an area on a large dog which is about 11inches x 16 inches. That is vacuumed to remove tiny hairs; then scrubbed with iodine sudsy scrub 5 times with alcohol scrubs inbetween to remove the iodine. The last scrub is an alcohol scrub. By this point you're glad the dog is out like a light because she has a major razor burn rash in some cases if she has very sensitive skin.

Meanwhile the surgeon has scrubbed. In our clinic the surgeon intubated the patient and scrubbed while the shaving and scrubbing of the dog's belly occurred. Surgeon puts on a gown, opens the sterile instrument pack. He takes a sterile paper drape, cuts a hole in a crease where it is folded for his surgery site and then places the drape over the patient, centering his cut hole where he wants to cut the patient. He clamps the drape to the patient in four places so it doesn't slide around.

The surgeon checks the monitors and checks with the surgical assistant to assure the patient's condition is stable. Then he picks up his scalpel and the actual cutting begins.

My vet wants no more than 7 minutes to have passed from the time he induced to his first cut. Everything you've read above must occur in less than 7 minutes. For the anesthesia we use, this timeframe gives the dam the maximum coverage with no influence on the pups based on research for the drugs we use. All the time the pups remain attached to their mother beyond 7 minutes THEY are receiving anesthesia too. Time is of the essence. Now the REALLY fun part begins.

The surgeon's incision is about four to 5 inches long. Through that hole he will pull the entire uterus though he may have to do so in increments with a large litter. There's not room on the table for 14 puppies and their mother unless some of them are still inside the mother.

Imagine at this point IF the condition of the uterus is compromised and it tears. Now we have an emergency situation...as though we didn't already!

In a case of a smaller litter or where a spay is eminent, the uterus may be pulled out and lain on top of the drape on the bitch's belly. The uterus looks like a large sausage. You don't open the end of the uterus and squeeze them out the end...though that would certainly save time if it could work that way! Typically one hole can be cut in each of the two horns of the uterus and the puppies in each horn "milked" through that hole. Each incision must be sutured closed regardless how many incisions are made.

You can imagine the pressure on the surgery team when there is a large litter. Every moment counts as anesthesia goes into the puppies who will have to struggle to wake up and BREATHE.

Each puppy is extracted, umbilical cord clamped, and DROPPED to an assistant. The surgeon at no time can come into physical contact with objects that are not sterile! So sometimes puppies literally slip and slide and DROP into the world!

Assistants take each pup in a towel and attempt to initiate that first big scream which means "HEY, I'm ALIVE!" Big smiles from everyone present who hears that first cry. The last puppies to plop into towels in a large-litter c-section are often limp and lifeless...too much dope depresses their natural reflexes to live. Sometimes they can be revived and sometimes not.

For me those decisions about who lives and who doesn't are based on which pups are showing me the most promise to make it. I focus on handing those to helpers (if there are any!) and I turn to those who don't want to rouse. I love it when there are helpers who are good at rousing the weak. They are invaluable at such a time. Some assistants are good at just keeping puppies warmed and they are valuable too! In a middle-of-the-night c-section, it's hard to round up lots of helpers! Ideally for an emergency c-section on a 14 puppy litter, there would be 9 people including the surgeon. One assists the surgeon with monitors, and 7 shuffle between reviving 14 drowsy pups....that's two apiece...both hands full!

Few vet clinics have the staff to handle such an emergency so we always make do with the people and resources available to us. Triage, triage, triage.

That it EVER turns out favorably with a healthy mother nursing ALL her c-sectioned litter NEVER ceases to amaze me.

>From the Y2K BMDCA health survey, 1/2 of Bernese dams have a c-section in their careers. I'm amazed our breed survives.

We're still a long way from a nursing mother at home with her babies. At this point we have a mother dog with a hole cut in her abdomen. The surgeon has just plopped the last puppy into an assistant's hands....hopefully there was an assistant on deck to receive it! Next, closing and recuperation.

The surgeon sometimes has no choice but to spay the bitch for her own safety due to the condition of the uterus or time necessary to repair it. I had always been told by other breeders that spaying during a c-section is inadvisable due to the strain it puts on the dam to raise her litter without the benefits of her reproductive organs influence on milk production blah blah blah. I've only had two c-sections in my 24 Berner litters but I've assisted in many c-sections on others' bitches.

In my most recent c-section, the condition of the uterus was compromised and I instructed the surgeon to spay the bitch. She raised a litter of 5 and stilled nursed them at 10 weeks of age. I began weaning the pups at 5 weeks and never supplemented them before that. It's hard for me to imagine not spaying a bitch with a large c-sectioned litter. I would think everyone would stand a much better chance of survival. But, each case is unique and those kind of calls have to be made sometimes at the moment.

The uterus is placed back into the bitch and two suture lines are done to close the abdominal wall first, and then the skin. The assistant discontinues the anesthesia and as the surgeon closes the suture line the bitch inhales only oxygen.

Meanwhile sleepy babies now rest in an incubator. For my own dogs I use a laundry basket with a heat source under a towel. The puppies are most vulnerable now to cold because they cannot regulate their own body temperature.

As the dam rouses, the cuff is deflated and the intubation tube removed. She is breathing on her own now. She will have a bit of a sore throat for a few days and she may cough a little bit due to the irritation of her throat from the tube. She gains consciousness and tries her best to raise her head to look at the source of her pain.

As her consciousness increases we lower her to a blanket on the floor and bring her puppies to her so she can lick and smell them. She is still groggy but her mothering instinct tells her to care for her babies. We'll put the babies each on a nipple and they will suck the colostrum, or first milk which is ladened with antibodies, important to their early immune system development. All is well. We say prayers that it will remain so.