Today, I was presented with a cow that that was having difficulties calving. Most cows are able to have a calf without any assistance. But, if anything goes wrong during the birthing processes, then they will need help calving. The farmer had already attempted to help the cow but the couldn’t feel the head of the calf!! I got all gowned up and reached in to get an idea of what the farmer was feeling.
Calves are suppose to come out of the cow like a swimmer that going to dive into water - head/nose first with their front legs stretched out above their head and their feet with its palms down. In this case, the calf did have a head but its head and neck was twisted back and to the side. With the calf in this position, it was unable to get into the cows pelvis and be birthed through the vagina. If something is enabling the baby from getting into the pelvis, this is called a dystocia (Hopefully that makes sense, it was difficult to explain).
After confirming the head was really there and just in the wrong position, I was arms deep trying to get the calf into the right position. I gave the cow epinephrine IV to help relax the uterus so I could move the calf around a bit more. FINALLY, after several attempts I was able to get the head into the right position. I attached chains to the calves legs and we began to pull to help the cow birth the calf. BUT, the calves head kept twisting back into an abnormal position. At this point, I decided the calf was probably too big for the cows pelvis and it was time to go to cesarean section to the get the calf out as soon as possible.
Cows stay standing for majority of c-sections and I try to do a left paralumbar fossa surgical approach. This cows left abdomen was shaved and scrubbed clean with surgical scrub. A paravertebral block was done to freeze sensation to the surgical area. I did this by using a 10cm 18 gauge spinal needle and injecting lidocaine between the transverse processes of the lumbar vertebrae to block nerves coming out of the spinal cord. The cow really wanted to kick me during this part. The cow was given an injectable antibiotic and anti-inflammatory. The surgical area was rescrubbed and the block was tested. A sterile drape was placed over the surgical area. I put on sterile gloves and clean gown to do surgery.
As you can see I do not wear a cap, face shield, or mask. WHY? We attempt to do these surgeries in as clean of environment as possible. But, we also have to be realistic and sometimes the surgeries are done on farm. In comparison to the environment the surgeries are often performed in and where the cows recover, a surgical mask and cap are going to do very minimal to reduce the risk of contamination.
BACK TO THE SURGERY! I used a large scalpel blade to made a 15 inch incision into the body wall. I cut through the skin, 3 muscle layers, and the peritoneum to get into the abdomen. Once in, I pushed the stomach forward, found the uterus, and grabbed on to the calfs back leg. With gentle traction, I pulled the calfs back leg up to the incision and cut into the uterus. I had my vet tech wrap clean chains onto the calfs leg and hold the calf out as I elongated the incision in the uterus. The calf was pulled out and was ALIVE but having difficulties breathing. My tech and the farmer continued to stimulate her to breath.
I closed the uterus with two suture layers to provide a ‘water tight seal’ with suture that will dissolve on its own. I closed each layer of muscle of the abdomen with the same suture but a different suture pattern. Finally, I closed the skin with multiple single sutures that will need to be removed in 2-3 weeks. The cow was milked and then calf was fed the colostrum to ensure that she gets immunity protection from her mom.
It was a tough couple hours for that baby. Fingers crossed she continues to fight!