7. Caesarean (heifer bull)
Once a calf turns one year old, its name changes: it is no longer a calf, but a yearling. As soon as a yearling is big enough, it is covered by a bull or artificially inseminated at the age of fourteen or fifteen months. Following a gestation of nine months, it calves at an age of around two years. The yearling then becomes a heifer. But the heifer is not fully grown at the time of the birth of the first calf. Which is why the calf may not be too large to prevent problems during the delivery.
Bulls that were carried by their mother in the uterus for a period of less than nine months before being born are found to father calves of which the gestation period is also shorter. This results in calves that are less sizeable, allowing for a smoother delivery. And so the sire influences the birth weight of the calves that it begets. Bulls of which the gestation period was shorter are therefore ideal partners for yearlings that have matured enough physically to be covered. Farmers keep this in mind when selecting a heifer bull. Because a bull that fathers heavy calves will cause the heifer problems during delivery. This can considerably run up the veterinary surgeon’s bill. Particularly if a lot of Caesareans are required.
For many farmers, the Caesarean is the measure for the professional skill of the veterinary surgeon: the quicker the procedure is carried out, the more skilled the veterinary surgeon. The surgeon is aware of this and so he hurries: operations sometimes take only thirty minutes. This does not include the preliminary examination and shaving and disinfecting the area to be operated on. The time it takes to sedate the animal and to have the anaesthetic kick in is not taken into account either; nor is the time needed for the surgeon to wash and disinfect his hands and arms. It is solely about the time between the first cut into the skin and the final suture.
But the surgical procedure that is followed can also vary considerably. As a rule, the belly is opened at the left flank. But sometimes it has to be done on the right side. The animal is normally standing during the Caesarean, but there are times when the animal cannot stand or remain standing and so it is lying down during the procedure. The number of separate layers that is sutured can be restricted from seven to four and each layer can be closed with separate sutures or a continuous thread. All this influences the speed of the operation. And so it is a bit simplistic to judge the skill and professionalism of a veterinary surgeon using your wristwatch. Top speed Caesareans mainly take place in Belgium: a veterinary surgeon in that country is reported to have performed no less than seven operations in one night! A professor in obstetrics from Gent told me that once.
In my day, I figured a Caesarean to take an average of two hours: three-quarters of an hour for the examination, anaesthetic, shaving, disinfecting, washing and disinfecting my hands; an hour for cutting and suturing; and fifteen minutes for cleaning up afterwards and loading everything back into the car, plus a cup of coffee. At one time, I had to perform three Caesareans in one night and I have never felt the urge to beat that record.
It is eleven o’clock at night. A call comes in that a heifer is giving birth. The farmer has already attempted to pull the calf out, but there has been no progress. When I arrive, the farmer has already moved the animal from the loose housing to the old stanchion barn next to the farm house. It is warmer there and we are not bothered by curious herd mates. A small table and a construction lamp are nearby, ready for use. Having changed into my work clothing, I check the calf’s eye reflex and swallowing reflex to determine if it is still alive.
The shoulder width is too large in relation to the pelvic bones of the heifer to allow for a normal delivery. And so a Caesarean is required.
The heifer is given an epidural just in front of the tail; this ceases the contractions. But it is essential not to inject too much, as the animal must continue standing during the procedure. An anaesthetic is then administered in the left flank to numb the skin and muscles and I proceed to shave and disinfect the area to be operated on. As I wash my hands and arms with a brush, I observe sawdust that has been scattered on the floor. This to ensure that the spot remains dry and to protect the heifer from slipping. However, sawdust can fly about, penetrate the wound and cause infections. But sweeping up the sawdust now would only make matters worse: among other things, the dust that is then blown about could attach itself to the betadine on the area to be operated on. So it is better to let things be.
The heifer works with me and stands still during the procedure. She drinks and then begins to ruminate. I see the paunch contract in waves in the open belly. She apparently feels at ease and the anaesthetic is doing what it should. If the calf is large, an incision in the uterus of around a half metre is not uncommon. The hind legs appear in the wound and I secure these with a small sterile chain. The farmer can help remove the calf from the belly by pulling the other side. That is no small task: more than forty kilograms beyond your powers. A few minutes later, the calf is lying in the corner of the barn. The farmer uses straw to dry the calf off and it immediately lifts its head.
I suture the uterus twice: I cover the first layer of sutures with a second layer. This reduces the risk of amniotic fluid leaking through. The abdominal cavity is continuously sutured. But surgical knots are used for the thickest muscle layer, as this layer must bear the largest tractions. I also use surgical knots just below the skin to make the wound smaller, resulting in less tension on the edges of the skin wound. Finally, disinfecting spray is applied to the skin sutures and the heifer is administered antibiotics per injection. Done! I leave a bottle of antibiotics behind for the follow-up care and rinse off my equipment and pack everything up. Time for a cup of coffee.
A week later, the wound has become swollen. An abscess develops under the skin and between the muscles. But the heifer is not ill. And the milk production is as can be expected as well. Everything is fine internally. After a week, I open the abscess, allowing the pus to drain off. What went wrong here? There is not always an answer to that question. A few days later, a second heifer faces problems during delivery: it seems this heifer bull was not a good choice. And there are still nine more heifers that it has sired yet to give birth! A colleague is called upon to perform the second Caesarean. Again in the stanchion barn, as everything was still there from the last time. This operation also goes smoothly and without complications.
Still, the wound becomes infected in this case as well and a large abscess develops. We discuss this at the practice. And then I have a lightbulb moment: the sawdust! It was present in both cases. You can never be sure whether or not that is the cause of the abscesses.
After all, sterility during operations on farms is relative in nature in any case. It is actually quite miraculous that so many operations pass off without infections: large spider webs above the open belly of a cow are not uncommon in these low-ceiling, old barns. And that is but one example of the circumstances under which we worked. For that reason, the successful outcome of so many surgical procedures in actual practice is first and foremost a huge compliment for the animal’s immune system. The skills of the veterinary surgeon take a back seat to that.
How it ended
The sawdust was removed from the stanchion barn. I cannot remember how many heifers had to undergo a Caesarean after that. But there were no more abscesses.
© Leo Rogier Verberne