Preparing for a Cesarean Section

The day has come, your queen is due, but there are problems in delivery. It looks like a cesarean section (c-section for short) is needed. I have been through 4 c-sections and can offer some tips to help you, the queen and the kittens get through this ordeal with minimal stress.

When might a queen need a c-section?

These are just a few reasons a c-section might be warranted:

*IF your queen has been in hard labor for more than a couple hours and has not produced a kitten, heads up.
*If your queen starts labor and then has a few kittens and fails to continue labor, mechanical blockage (stuck or deceased kitten—determined by x-ray or ultrasound and sometimes palpitation) has been overruled, oxytocin has not helped and you know there are more kittens inside.
*IF your queen comes past her due date and has one or more of the following: no labor, is antsy, lethargic, running a fever or foul smelling, bloody and/or pussy discharge.
*If your queen is known to be cannibalistic and there is no way for you to get the kittens from her safely.
*Kittens too large or pelvis too small to deliver naturally (determined by x-ray or ultrasound).

Some things to know before administering oxytocin

If there is a problem in delivery, you should always make certain to have a vet examine the queen. If there is mechanical blockage or the kittens or too large to pass naturally, uterine tearing or rupture is high risk.

Always have ultrasound, x-ray or at the very least vet palpitation prior to administering oxytocin, especially in first time queens or excessive straining without producing a kitten in a couple of hours.

Oxytocin works best if used in conjunction with calcium, which aids the oxytocin to contract the uterine walls. Care should be given in administering calcium as too much can kill quickly. Likewise amounts and frequency of oxytocin should be carefully gauged as uterine rupture or tearing can occur if too strong or too many doses have been given.

Reading an x-ray

It is fairly easy to gauge kitten size to pelvis size via x-ray, providing the kitten is in position to measure. It is a matter of measuring the pelvic opening to that of the kittens skull.

Kittens that are in process of being reabsorbed often appear to be indistinct masses, usually these small masses pass okay, but sometimes can present a problem.

You can also tell if kittens are deceased, at least if they have been deceased more than 24-36 hrs and decay is setting in). Deceased kittens can have large dark gas bubbles in the amnion sac, these deceased kittens may also not be curled in fetal position rather having head laid towards top of back or limbs in sprawled or non fetal position. They might appear to be extremely large in outline (bloated), these kittens are hard to pass naturally, especially in first time queens or queens with small pelvic opening.

A Quick Story

I had a first time queen a few years ago, she was medium sized and robust in boning. I thought there would be no troubles in her delivery. Her time came and she did everything just fine, everything was proceeding normally, her discharge was fine, she was laboring and pushing but no kitten. Not a nose, tail or foot to be seen not even a amnion bubble. She begins to pant abnormally and became quite restless and agitated.

I tried to reach my vet but was only able to leave a message. (Yes it was after hours)

I decided to take her to Emergency just down the road, as they did not close until midnight. The first thing they did was a check her vaginally and decided oxytocin was in order. I told them “not without a x-ray”. They reluctantly agreed. When the x-rays were developed they once again said oxytocin. I asked to see the x-rays (thank goodness, my vet has shown me how to read x-rays of pregnant queens!)

Upon looking at the x-ray myself with the internist vet (no “real” vet on hand). I promptly pointed out; one reabsorbing kitten, one bloated kitten and the other two kittens were too large to pass the pelvis. Of course she was amazed, but paid attention to what I pointed out.

Since they had no vet on hand and nearest hospital was an hours drive away we returned home and I tried calling the vet again and the vet techs (isn’t it great? I have all their home numbers!) I was able to get a hold of one of the techs who gave me the phone number for the new vet sharing practice. I called her and she agreed to meet me ASAP at the clinic

We met in about 20 min. I showed her the x-ray and told her what I saw and she too was amazed and I told her my vet had taught me or rather showed me how to read them.

She promptly set up for c-section. All went well. The two overlarge kittens were delivered c-section without incidence. They weighed 4.5 and 4.9oz. The deceased kitten was double the size of the living kittens (bloated) and the other was confirmed in process of being reabsorbed.

Had I listened to the ER vet. I could have lost my queen and the two babies.

Know your Vet

It is important to have a good working relationship with your vet. Talk to him or her before you have to have a c-section. Ask him if you will be allowed to assist (rubbing kittens). Typically if a c-section happens during normal working hours, there are enough techs around to rub the babies, depending upon the size of the litter. After hours, chances are it will be you, the vet and one tech. Not enough hands to rub babies as they are “born”. My husband has been with me and rubbed babies the last 3 c-sections. We even had the one tech phone her husband to come in and help.

The C-section

Your queen will hopefully be anesthetized with Isoflourene gas. Once she is intibated (breathing tube), IV hooked up, and hooked up to the heart/respiratory monitor. The surgery begins. The will make an incision in the abdomen. They will pull out each side of the uterine horns. An incision is then made in the uterine horns, and the kittens are pulled from uterus. The vet then breaks the amnion sac and passes the kitten to the tech or your yourself for rubbing. The umbilicals are clamped and cut. This is repeated until all kittens are out. The vet will then suture the uterine horns, and close the abdomen. Waking up the queen as quickly as possible.

Taking care of kittens

Vigorous rubbing is necessary to get these kittens breathing. Remember they are anesthetized too. They did not receive the stimulation of contractions and moving through the birth canal. It can often take as long as an hour or more to get the kittens breathing stable. The vet may call for a few drops of Dopram on the tongue, this improves circulation and respiration. As Sandra Roan once told me, NEVER give up until you have a warm, dry dead kitten. Watch how the tech rubs the kitten. It may seem rough but you aren’t going to hurt the baby. It is what is required to get them going.

The tech will show you how to feel for the heart beat and that should be checked frequently while rubbing. Be sure you have a clock with a second hand so you can time the gasps and breaths, they should increase. They might start out with a gasp only every 10-15 seconds, as the time between each gasp or breath decreases, you heading towards safety. They may use suction to clear the mouth and nose of amnion fluids. They may offer oxygen. What you are working towards is getting them warm and dry, the circulation going and that breathing stable. That first cry is what you want. Everyone will cheer when the babies start crying. It means they are getting oxygen and the lungs are clear.

When the vet has finished caring for the queen, he will assist with kittens and check them out. He might tube feed warm glucose for a boost, administer more dopram, check the heart rate and respiration of each kitten. My vet once administered atropine to start the heart back up on one of the kittens.

You can expect to loose a kitten or two in a C-section. Because of prolonged labor or deceased kittens, the kittens have already had a hard time of it and are further disadvantaged by the anesthesia. If there are not enough hands to rub all the kittens at once, you might loose one. It is very hard to get one kitten breathing that alone two or more at a time.

Not all are as traumatic. Some kittens take very little rubbing to get breathing and are crying lustily within moments. Others can take an hour so to stabilize. Don'’ give up until the vet says its over! Remember he doesn’t want to loose a patient either.

Going home

Now your kittens are all breathing well and your queen is groggy but awake, its time to go home. It is best to transport the kittens separate from the queen. She is groggy, hurting and confused. She might injure the kittens without meaning too.
Keep mom and kittens warm as possible on the trip home. Often times the vets have left over IV bottles that can be filled with warm water to keep the kittens cozy on the trip home. It wouldn’t hurt to add one to the queen’s carrier too.

Once you are home, get the queen settled in quickly in a warm secure place. You can try to put the kittens on her to suckle, please supervise this carefully. If she is still to out of it or confused by the anesthesia she may injure the kittens. If she is not ready to handle them, bottle-feed the babies the first night. Try the kittens on the queen again in the morning. Do not leave kittens with the queen unsupervised. She might lay on them or be too aggressive in her attentions or pack them around perhaps leaving them here or there chilling them.

I have found that sometime in the middle of the night or in the morning the queen usually accepts them and is a good attentive mom. Be sure she has adequate milk in. If the kittens are crying a lot it’s a sign they are not getting milk, you may have to supplement them until her milk comes fully in.

Be sure to check the Queens sutures frequently. Look for redness, puss or swelling.

Also be sure she is not pulling stitches. I have not a queen yet that has not pulled her stitches. I generally ask for staples, though they seem to be able to pull these as well.

My vet has come up with a pretty good invisible suture style now. There are no visible sutures, so the queen cannot pull them out. They dissolve as the incision heals.

Your queens future

Just because your queen had to have a c-section, depending upon the reasons, does not mean she will always have to have c-sections. Do not let your vet convince you to spay her at the time of the c-section unless the uterus is in bad shape.

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