D. E. Larsen, DVM
Mrs. Rose was our middle daughter’s first-grade teacher. She was a little gray-haired lady who was very prim and proper. Mrs. Rose was adored by her students and by their parents. She was an old-time teacher, very much into the three Rs. She kept a tight rein on her classroom, ruling it with a tender heart.
Of our four kids, Amy took the most interest in the goings-on at the clinic. She liked the people and the animals and showed compassion for both. When I had an evening call for a basset hound in labor, Amy was ready to go to the clinic with me in a second.
I took care of quite a few basset hounds for a large group of ladies who showed these dogs. They were relatively valuable dogs, and the ladies wanted meticulous veterinary care. This bitch (female dog) had been in labor for nearly 3 hours. Her owner, Sandi, had been through this on multiple deliveries. Three hours of contractions without a pup was cause for intervention, and with each passing minute, the puppies were more at risk. The options, following an unremarkable vaginal exam, were to try some Oxytocin to stimulate contractions or to do a C-section.
The Oxytocin injections could work magic, but it could also mean a long night. When bassets had large litters, you could end up with a C-section for the last pup or two because the uterus ran out of strength for continued contractions. With the extended time of labor, those remaining puppies were often lost. I enjoyed working with Sandi on these deliveries because she would always be quick to elect a C-section. I agreed with her in most of the cases. It made for a shorter night for me and usually a more successful delivery.
This evening was no exception. The size of Betty’s belly said large litter. The vaginal exam was unremarkable, and no puppy was in the birth canal. I started talking about options, and Sandi cut me off short.
“Let’s not spend all night here. Let’s just go to a C-section, and everyone will be better for it,” she said.
I called Dixie, my right hand at the clinic, to come help. Sandi had a couple of friends in tow. That would mean we had 4 gals to tend to the puppies, plus Amy. Sounds okay, but my guess was over 10 pups, maybe 12 or 13. We were going to be very busy for a few minutes when I started handing out puppies.
While I was waiting for Dixie, I got the surgery room set up, drew up a dozen doses of Naloxone for morphine reversal on the pups and I was able to get Betty onto her back, so I could clip her abdomen and do a preliminary prep. I got an IV catheter placed and started IV fluids at a slow drip.
As soon as Dixie arrived, we moved Betty into the surgery room and gave her a dose of IV Innovar, a morphine combination drug. This provided strong sedation, and we secured her to the surgery table and did a surgical prep on the abdomen. Then we used Lidocaine for local anesthesia at the incision line. This would allow us to deliver the pups with the least depression from anesthesia and with a small dose of reversal agent they would wake rapidly.
This all done, I prepped myself for surgery. Speed was the keyword at this point. After I scrubbed, gowned and gloved, I draped Betty’s abdomen. There was going to be a lot of fluid, I sent Amy for towels to spread on the floor. If she was excited, it did not show.
Starting an inch below the umbilicus, I made an incision about 5 inches long. Then I dissected through the subcutaneous tissues and exposed the linea alba, that center line of connective tissues where all the abdominal muscles came together. I incised through the linea alba and opened the abdomen. Almost no blood is lost with this approach. This abdomen is full, the very gravid uterus leaving little room for normal gut function.
I started pulling the uterus out of the abdomen, one pup at a time. I laid it out across the drape on moistened towels. One puppy, then the next, and it kept coming. Finally, I had it all out, twelve pups, 6 in each uterine horn. This uterus, which is the size of a pencil in its non-pregnant state, laid out on the drape and towels it was too large to stay up on the abdomen. Several puppy segments hung over the abdomen on each side, reaching the surface of the surgery table. Quite a remarkable organ, the uterus.
The book talks about delivering pups through one incision in the body of the uterus. I always found it a better approach, and faster, to deliver pups through an incision in each uterine horn. I made the first incision over the pup nearest the uterine body on the left uterine horn. Then I would squeeze a pup through this incision, clamp the umbilical cord, severe the cord, clean the airway and hand the pup to Dixie. Dixie would give a dose of reversal agent and hand the pup off to the waiting hands, Sandi was the first in line. By this time, I had removed the placenta and pushed the next puppy out the incision. Handing Dixie the next pup, the whole process repeated. This continues, and finally, Amy is the only set of hands, she catches the pup in a towel and follows the girls to puppy basket as if it is nothing out of the ordinary. This was sort of an assembly line when a pup was revived and breathing there was the next pup to catch as I handed it off. This is a rapid, chaotic time for a few minutes. Amy was a real trooper through the whole process. Finally, the last pup is delivered. I double-checked the birth canal to make sure there is not a pup hiding somewhere. There was fluid covering the table, and the floor was soaked. My tennis shoes will be retired to the work shoe shelf. The towels that Amy laid on the floor have soaked up most of the fluid. At least nobody slipped on the floor, time to relax a little. Twelve live pups, Sandi and her friends are pleased.
I start Betty on some gas anesthesia via a mask, and then I change gloves. I close the two uterine incisions with a Utrecht pattern using 00 Maxon. Then I return the uterus to normal position in the abdomen. Now we clean up, we remove the drapes and carefully prep the abdomen again. I change my gown and gloves and open a new surgery pack. I remove the drape and towels which are soaked with fluids, and then I drape the incision with a new drape. Now I can close the abdomen with as little contamination as possible. I suture the linea alba with interrupted sutures. Once the linea alba is closed, we give Betty a dose of reversal drug, we are now on gas anesthesia only. This way, she will recover rapidly. I finish closure of the subcutaneous tissues and skin. We take her off the gas and clean her up the best we can. We return her to the kennel, and she is awake before we know it. She is an experienced mother, and she takes the pups as soon as we show them to her.
We send Sandi, Betty, and pups home as soon and Betty can stand. She and her puppies will do better at home under Sandi’s watchful eyes. I relax a little and asked Amy what she thought of all of that commotion. With a nonchalance that she probably got from me, she just shrugs it off.
That became almost a forgotten evening until we went to a parent-teacher conference some weeks later. Mrs. Rose went over Amy’s progress, which was exceptional, and then looked at us with a wry smile.
“A few weeks ago, the whole class had quite a learning experience about where puppies come from and how they get here. Amy was very excited about her experience and very descriptive to the class. I don’t worry about discussing the birds and the bees in my classes. Your daughter sort of changed all of that.” She said.
Memoirs of a Country Vet 