C-Section

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A  Caesarean Section (abbreviated as C-Section) is derived from the latin word “caedare”, which means to cut. It is believed that Julius Caesar was the first to be born this way when his mother died during childbirth. Most scholars of ancient history believe this was done long before Julius Caesar was born. Either way, the name sticks.

Our patient is a female dog that was able to deliver 2 pups normally. When we examined her and palpated her abdomen we could feel another puppy. She is exhausted, and has what is called uterine inertia. Her uterus does not have the strength to deliver the last pup.

Her 3rd one was stubborn though and did not want to come out, so we had to go in and convince him the time had come to meet his siblings. We routinely perform a spay (OVH) on these dogs after we remove the pup.

Graphic photos of an actual surgery are on this page. 

Radiograph-pregnant dog lateral

We took a radiograph to confirm the size of the pup and look for any problems

Pup-nursing help

The two that were born naturally had one last meal from their mother before we brought her into surgery

Pups-sleeping in carrier

After their meal they were cozied up with blankets and a hot water bottle (at the bottom of the photo) since they cannot regulate their temperature at this stage

Pups-sleeping

We know they were content because they fell asleep. Now we could concentrate on their mother and the remaining pup

It was time for the C-section. After we gave the mother a thorough pre-anesthetic exam, and administered intravenous fluids, she was ready for surgery. In this procedure we move fast, real fast, so the remaining pup is not depressed by the anesthesia we give the mother for the C-section. While the surgeons are scrubbing in and preparing their instruments we are preparing the mother for surgery.

Joel-mother

After she was clipped Joel brought her in to start the anesthesia

Mother-onside

She is getting sleepy as we administer her anesthetic. As soon as she is out we move her into surgery. Her abdomen has alreadly been clipped, and a local anesthetic has been infused into her abdomen where we will make our incision. This allows us to give her less general anesthetic and not depress the remaining puppy.

Hands

While our patient is being anesthetized our surgeons are scrubbing up

Instruments

As soon as the surgeon’s are gloved and gowned they go right into the surgery suite to get the instruments ready. We do not want our patient waiting for the surgeons, we want the surgeons waiting for the patient.

Surgivet

Our patient is immediately hooked up to our anesthetic machine when brought into the surgery suite. When stable we can start the surgery.

Surgeon-draping

Dr. Wood, our first surgeon, wastes no time draping our patient for the procedure once our anesthetist confirms our patient is stable

Doctor-draping

At this point, our 2nd surgeon, Dr. ridgeway, is scrubbing in and will be in the surgery suite in a few seconds

Doctor-surgery team

We don’t technically need 2 surgeons for this procedure. We do it because we can get the puppy out of the uterus faster this way, which is of utmost importance to us for a pup that has been in the uterus longer than it should be and could be struggling.

Pup- in uterus

This is what the pup looks like in the uterus

Uterus-incision

A quick incision in the uterus, taking care not to cut the puppy

Uterus-pup out

Out he (it’s a boy!) comes covered in a protective membrane

Pup-umbilicus clamp

Once we remove the membrane the first thing we do is clamp and cut his umbilical cord

Pup-suction

We immediately suction out any fluid from his mouth so he can get some air into his lungs

Pup-nurse suction

Then it’s a quick hand-off to our nurses who are eagerly waiting for him with a warm towel and more suctioning

Over several minutes we gently suction out mucous from the nose and mouth

After we are sure the breathing passages are clear we stimulate him to breathe by gently rubbing him

Pup-eating

His mom is still in surgery, so we give him a quick meal until he can nurse. Nursing is important because the milk the mother produces contains antibodies he needs to prevent common diseases like Distemper. He cannot produce these antibodies just yet.

Pups-feeding

While our doctors are finishing the surgery our nursings staff goes to work making sure these puppies are fed and kept warm until the mother is fully recovered and able to nurse all of them


Whitepup-feeding

The nursing instinct is strong and the puppies greedily suck down the milk

Nurse assist feeeding puppy

Pups-resting

After nice meal all 3 of them take a well deserved nap


Mother-recovering

We let the mother recover completely before we let the pups nurse. She is exhausted from trying to get this last puppy out and needs some time to rest.


CSection-surgeons

Once mom was out of surgery and stable our surgeons could not resist, and had to hold the puppies

This was Dr. Wood’s first C-section, and she did a wonderful job! Next time she has to do one in the middle of the night she won’t need to call Dr. P or Dr. R to help her!

Here is a C-Section we did many years ago:

One of the most rewarding surgeries we perform is a Cesarean Section. Usually it is performed on small breed dogs because their pelvic canals are just too small to handle the size of the pups for a natural birth. This is the story of Margarita, a Chihuahua that had 4 large pups in her tank.

The gestation length in most domestic dogs is 63-65 days. When Margarita first came to us one week before she was due we knew a C-Section would be needed from her size and her radiograph.

How many pups do you see in Margarita’s abdomen? The answer to this question will become apparent later on.

On the appointed day Margarita was brought to our hospital for a C-Section by Dr. Palazzolo. On a dog that is this small, and has this many large puppies in its uterus, preanesthetic preparation is important. This consisted of a preanesthetic blood paneland intravenous fluids prior to and during surgery.

We keep a close tab on important physiologic parameters for all of our surgeries. Monitors like this give us an early warning of an impending problem.

Surgery-Monitor

Once our surgeon has scrubbed up and is  in sterile gown, gloves, and mask, the surgery begins

_D2A8630

Here she is on the surgery table. You can see the green tape covering her IV catheter and if you look closely you might be able to tell that her abdomen has already been shaved. She has also been given a local anesthetic where her incision will be. All of these things are done prior to any anesthesia. They will allow us to use less anesthesia for the actual procedure which is important to minimize any anesthesia that depresses the pups.

At this point things start moving fast. Margarita has been given an IV sedative to relax her, the final surgical prep has been applied, and a breathing tube (called an endotracheal tube) is in her windpipe giving her 100% oxygen. Once she is intubated we move fast, and in the next 5 minutes all of the pups will be out of her uterus. While her anesthesia is being monitored the rest of the team is preparing to receive the pups.

She is draped and a rapid incision is made in her skin. By giving her the local anesthetic earlier she does not feel the skin incision and we can keep the anesthetic level to a minimum.

The uterus is rapidly located and gently squeezed out of her incision. We make the incision in her abdomen just big enough to gently exteriorize the uterus because she will heal faster and nurse her pups better with a smaller incision. This is where the experience of our surgeon, Dr. Palazzolo, comes into play.

This is one horn of the uterus and contains 2 of the pups. The other horn of the uterus can be visualized running horizontally at the bottom of the picture.

A scissors is used to cut into the uterus. Special care is taken not to cut the pups,which could be moving in the uterus.

The first pup is gently removed with his umbilical cord still attached.

You can get a better idea of the amniotic sac that completely covers the pups.

The first things our nurses do upon receiving the pups is to rub them gently yet vigorously in a towel. This stimulates them to breathe. They also gently shake them to remove fluid from their lungs.

The nurses use a special bulb syringe to suction fluids from pups that aren’t eliminating fluid from shaking and rubbing.

Any pup that is still not breathing well at this point is giving a drop of respiratory stimulant on the top of its tongue.

Once our nurses feel the pup is breathing on its own they tie its umbilical cord.

After all 4 pups are stable they are put under a heat lamp since at this early stage in their lives they do not have a very strong ability to regulate their body temperature.

Meanwhile back in surgery Dr. P is checking the abdomen to make sure there is no bleeding prior to suturing the abdomen. In Margarita’s case she was also spayed.

Her muscle layer is carefully sewn back together. These sutures are critical to prevent a hernia from occurring, especially when pups vigorously nurse.

With her skin sutures complete Margarita is now taken off the anesthetic machine and a pain injection is given to her.

Our nurses take care of the feeding while Margarita rests and recuperates. We won’t let 4 hungry pups nurse until she is strong enough.

Here are our 4 little piggies all in a row sleeping after their ordeal and their first meal. Their tummies are full and they are keeping each other warm.

In a surgery like this there needs to be close coordination between the surgeon, anesthetist, and nursing staff. You can see how much time and attention our nurses put into doting over these puppies.

Time for a little shut eye, we had a big day!

This is one of those pups several months later with her proud mom! Can you guess which of the above 4 puppies this one is? (Hint-look at the white spot on the forehead).