Scroll down for lots of ACTION photos of the caesarian surgery - NOTE that these are graphic .. but none-the-less exciting!
Bella had previously suffered pelvic injuries from being hit by a car...and this resulted in a very high risk of her not being able to give birth naturally (vaginally) due to a compromised birth canal. But this doesn't mean she can't have a family!
Bella's owners were fully aware of the necessity of the expectant mum having a caesarian - both for her puppies' safety, and for her own. We had calculated the exact day we should perform the caesarian to maximise the safety of the puppies, and thereby ensure their greatest chance of both survival and being healthy. Likewise, it was the best time for Bella also.
Bella's tummy was becoming HUMONGUS! (scientific term adequately inferring both an enormous size, AND ITS TIME TO GET THOSE PUPS OUT OF THERE!!!). It was day 63 after her mating. The time was right...
The average length of a dog's pregnancy is 63 to 65 days. The actual birthing process is stimulated when the size and number of puppies eventually becomes too much for the placenta (after birth) to cope with. The placenta is the tissue that grows on the uterine wall and supplies all of the needs (oxygen and nutrients) to the developing puppies via a complex network of blood vessels attached to the uterus wall. The placenta delivers the oxygen and nutrients to the puppies via the umbilical cord.
When the puppies' total mass (effectively the number of puppies multiplied by the size of the puppies) becomes too great for the placentae to adequately deliver the necessary oxygen and nutrients that the rapidly growing puppies require, the puppies actually start to show signs of stress. Stress causes the release of specific hormones that pass back up the umbilical cord (in the returning blood) to the placentae, and pass across to enter the mother's blood in her uterine blood vessels.
The effect on the mother is DRAMATIC...to say the least!
These hormones communicate to the mother's body that IT IS TIME! And there is NO STOPPING what happens next...just ask anyone who has had a baby! Birth. In dogs it is called whelping.
Bella had a FULL belly of puppies. The MORE puppies that are present, the less time it takes for these puppies to reach the point of stressing out and triggering birth. Therefore they'll be born slightly younger in their development, but smaller, than if only one or two puppies are present. These puppies grow much bigger, and are therefore a little older, before their total mass initiates the stress response responsible for birth. Therefore the risk of complications due to size increases a lot when there are fewer puppies and especially in the smaller breeds.
In Bella's case, the number of puppies was irrelevant due to the previous damage and compromise to her pelvis and birth canal. To minimise the likelihood of her going into labour before surgery, we scheduled her caesar on day 63.
The preparation on the day of surgery for a caesarian is very important.
The difference between great success and the loss of one or more (or all) the puppies is mostly dependent on the surgeon and nurses and their preparation of the patient, and the methods utilised during the caesarian. Little things make a great deal of difference.
To avoid depressing the puppies while in the uterus, no premedication is given to the mother prior to the surgery. For ALL other surgeries we give a premedication injection (called a Premed) 30 to 60 minutes before surgery starts. This injection is a combination of drugs that calm the patient down providing sedation, and includes a narcotic pain relief. These drugs have effects that last around 4-6 hours and also ensure that as the patient is coming out of the anaesthetic, the sedation keeps them calm as they wake up, so they have a smooth, stress-free recovery.
Unfortunately these drugs greatly depress the puppies' responses and must not be given before the puppies are safely delivered! However, once the puppies are delivered, we were able to give these drugs so that Bella had the benefit of minimal pain and remained calm during her anaesthetic recovery.
We placed Bella on IV fluids prior to the the operation to ensure her excellent hydration. This further enhances the safety of both the anaesthetic, but also is very important in caesarians as it maintains Bella's blood volume and blood pressure which otherwise drops during anaesthesia. If her blood pressure drops, it can initiate stress in the pups due to reduced blood flow - not good! It can also cause mum to stop producing her milk - not good! And low blood pressure compromises the function of the kidneys and liver (among all other organs!) and this will result in a slow recovery form anaesthtic and potentially damage these organs. We kept Bella on IV fluids throughout her recovery also, to ensure excellent milk production and a more rapid and complete recovery from the anaesthetic.
The type and dose of the anaesthetic drug is highly important. Whatever 'knocks out' the expectant mumm ALSO KNOCKS OUT THE PUPS!!! We use a more expensive but extremely rapid acting anaesthetic (Propofol) that can be given 'to effect' (that is we give it into her IV drip line until she is just enough asleep to allow us to place the ET tube (endotracheal tube) into her wind pipe). The absolute minimum dose is given and the she is placed on 'Gas', which is a mixture of oxygen and Isofluorane anaesthetic. The Propofol dose barely gives us enough time to place her ET tube and get her onto Iso and oxygen, before the Propofol wears off!!!
IT IS TIME FOR ACTION !!!
BEFORE her anaesthetic we have already shaved her ample belly and cleaned it with a surgical prep solution. This is to reduce the time it takes for us to get her puppies out. We place a mask over her face and let her breathe pure oxygen for a short time before the anaesthetic is given, so that there is minimal chance of any drop in her oxygen delivery to her pups as the anaesthetic is given.
As soon as Bella is anaesthetised, she is placed on her back and the final surgical prep applied to sterilise her skin where we are going to operate. The surgeon has been getting ready during this time - he/she is now scrubbed and gloved, the surgical pack is open and ready, scalpel is in hand! With in a few minutes of Bella having her anaesthetic, the caesarian begins...
AND WITHIN TWO MINUTES OF THE INCISION BEING MADE, THE FIRST OF HER PUPS IS 'BORN'!
The birth sac is torn open, its umbilical cord is clamped and within 2-3 seconds the first breath and 'Squawk' is heard! The waiting vet nurse takes pup number one, sucks/aspirates any fluid out of the mouth and gently dries the pup's coat. This handling further stimulates the pup and mimicks the mother's normal behaviour of licking the birth fluids from the pup. There is NO messy green meconium (when a puppy undergoes stress it defaecates a lot of dark green poo which remains in the birth sac, covering the puppy's hair and they can even get it in their mouths and inhale it at birth with their first breaths) which means we have minimised the stress so far on the pups.
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1) Bella's uterus is lifted clear of her abdomen. This part only contains ONE of her puppies !
2) Bella's first puppy is removed from the uterus, still enclosed in it's foetal sac. before it is cut.
3) The sac is quickly cut and removed, and the umbilical cord is clamped ... time to pass the new born onto our awaiting nurses!
We have plenty of vet nurses on hand with towels to take each puppy from me, and Amy (a year 10 student from Maitland) is our photographer to document the first moments of Bella's puppies' lives! It is ALL ACTION, and VERY EXCITING! Within several minutes ALL SIX PUPPIES are delivered safe, well and already thriving! They are placed into a warmed cage (on a heating pad) with warmed heat sacs to snuggle up with. Clamps still on their cords.
Another section of Bella's uterus is exposed containing two more puppies. The next one out is a tan puppy.
Without proper preparation, stringent anaesthetic techniques, competent surgeon and vet nurses, puppies take a long time to get breathing, or worse. It is a wonderful thing to be a part of a fast acting team - it is ALL GO - and the results bring a smile to us all!
The mewing and squeaks/sqawks of newborn pups greeting their new world settles as they snuggle up to each other in a ball of silky smooth fur and fall asleep.
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1) Amy, our work experience student from Maitland, takes time out from being our photographer to have her picture taken with one of Bella's beautiful pups.
2) Bella shows excellent milk 'let-down', andwithin 2 hours is happily suckling her litter of puppies.
Bella's owners have decided that one litter is enough for her and have decided that she be desexed, so the surgery continues into an ovariohysterectomy (the surgical removal of both ovaries and her uterus). Bella's abdominal incision is closed in 3 layers, with the skin layer being an interlocking continuous pattern ('blanket' stitch) to provide an even tension along her wound to minimise discomfort, and reduce the number of loose ends of the stitches. We check her mammary glands for milk 'let-down' and are pleased to see she is a good producer.
The vet nurses placed her puppies onto her teats after a couple of hours and they all perform well - suckling strongly - and Bella already is acting the loving mother!
A great success all around, and her puppies continue to GROW FAST and do well!