Cesarean Selection Success
April 28, 2020
Veterinarians have at least eight options for doing a cesarean section (c-section) in cattle, but most rely on only one. Loren Schultz did, too, until it didn’t work.
A mature dairy cow, carrying a dead fetus, had too large an udder for Schultz’s go-to method — a ventral midline celiotomy.
“I couldn’t make a big enough incision to do what I needed to do,” recalls Schultz, DVM and associate teaching veterinarian at the University of Missouri-Columbia.
Schultz says that’s when he realized he needed to be ready to perform c-sections based on more than personal preference alone. Today, he also evaluates the condition of the cow and calf, environmental factors and whether another person is available to assist.
“Knowing the advantages and disadvantages of the various approaches helps you make the best decision,” he says. “Even if you haven’t done a certain approach, we have been trained in all of them, and we have that surgical knowledge.”
Here are some additional considerations that play into Schultz’s decision on which approach to use in a given scenario.
For a standing cow or heifer:
If the fetus is alive and the cow is able to stand, Schultz prefers to use a left side paralumbar celiotomy, the most common approach veterinarians use in uncomplicated c-sections. “It’s easier on the cow, and it’s easier on you as the surgeon,” he says.
Before making a final decision, Schultz rectally palpates the cow to assess the size and the position of the calf.
“There have been many times when I’ve used a left-sided approach, but the calf’s been in the right horn with feet facing to the right side. If it’s a large calf, it’s hard to get that uterus up and out in that situation,” he explains. “So, at times, the right-sided approach is easier. Just be sure you’re prepared to deal with the intestines.”
He also prefers to make an oblique incision, versus a straight up and down incision, because “it follows the uterus more, making it easier to extract the calf.”
For the animal that won’t or can’t stand:
Schultz says his first consideration is whether the animal is a beef or dairy cow. If it’s the latter, and she has a big udder, Schultz says you probably won’t have enough room for a ventral midline c-section.
“You’re probably going to have to do a paramedian or something like that,” he says. “And if you have an emphysematous fetus, it’s easier to exteriorize the uterus through one of those functional approaches to remove it.”
Another factor to consider in this situation is you will likely need help to get the animal down and rolled onto her back.
Schultz says in dorsal recumbency, the cow should be leaning toward the surgeon at a 45-degree angle with both front and hind feet secured by tying them to a gate or wall.
“This positioning is critical,” he says. “If the cow is positioned either in exact dorsal recumbency or leaning away from the surgeon, exteriorization of the uterus becomes problematic, if not impossible.”
If you’re without help, consider using a winch to get the animal into position, advises Keenan Lewis, who says she frequently uses one to do midline c-sections by herself.
“I make an incision from the udder to the head, and when you open it, there’s the uterus and baby,” says Lewis, DVM and owner of Salt Creek Veterinary Hospital in Olney, Texas. “Plus, there are no big muscles to deal with or organs in the way.”
She routinely gives the animal an epidural, which gives her about 30 minutes to complete the task.
“I’ll throw a little towel over her ears, and they’ll begin flopping around when she starts coming out of it,” Lewis adds.
If the animal is severely dehydrated, the American College of Veterinary Surgeons recommends giving IV fluids prior to surgery.
When to assist in delivery:
Schultz makes a practical assessment on whether he can safely pull a live calf.
“My rule of thumb is if I can put my fingers over the top of the head while it’s being pulled into the pelvic canal, without causing pain, then I’m going to have room to get the calf out of there,” he says. “If there’s not room for my fingers, and they’re getting smashed, or I’m concerned I’ll cause the calf or cow trauma, then I’m probably going to move forward with a c-section.”
Lewis says her personal stamina is also a consideration.
“I give myself 30 minutes to pull a calf. If I don’t have the calf on the ground by then, I’m going to cut,” she says.
Early in her career, Lewis says she would try too hard and too long to pull a calf and end up exhausted. Her advice to veterinarians tempted to go down the same path: “Don’t wuss out and waste time.”