Sara needs
a Caesarean Section

Veterinarians frequently perform C-sections on dogs and cats that are unable to delivery naturally. Perhaps one of the most challenging breeds that often require this surgery is the English Bulldog.

Dr. Lemieux, CVT Cathy Hall and assistant Terry Eucker "discuss" the procedure with Sara.

Bulldogs are wonderful but their large heads and narrow pelvises make labor very difficult and natural delivery frequently impossible. Many bulldogs have difficulty breathing and this further increases the risk and stress of labor. Without question a bulldog caesarean is a high risk procedure and every veterinary hospital develops their protocols for this type of surgery. Sara is a second generation caesarean at BVH. She was born here by C-section and now she was about to have her first litter. Sara is a small and very compact bulldog and it looked like she was going to have a large litter. Sara was sixty days pregnant and very, very, heavy. Her owner has a lot of "bulldog" experience and she knew that it was time. Sara was very uncomfortable, having difficulty breathing, and in short looked like she was about to explode.

As Cathy Hall completes preoxygenation Dr. Lemieux administers the induction anesthetic.

Because all sedatives and anesthetics will have some effect on the cardiovascular and respiratory systems it is important to select agents that will have the widest margin of safety and that have the least impact on the puppies. Bulldogs have the added complication of difficult respiration and it is necessary to use fast acting anesthetics to facilitate rapid intubation once they are anesthetized. Once a tracheal tube is in place, oxygen and anesthetics can be safely administered. The length of time between induction of anesthesia and delivery of the puppies is another critical factor. The longer this period the more likely the puppies cardiovascular system will be depressed.

To shorten the predelivery anesthetic time we try to do as much in advance as possible. Sara's IV catheter was in place, her abdomen was shaved and a preliminary surgical prep was done prior to the administration of anesthesia.

The surgical prep is complete and Sara is ready to be moved to the surgery room.

She was pre-oxygenated and then a rapid anesthetic induction agent was administered intravenously. She was quickly intubated and maintained on a fast but short-acting inhalation anesthetic. To help monitor Sara and reduce her surgical risk several standard operating room procedures would be in place. Her body temperature would be maintained with a circulating warm water blanket. She would be on IV fluids to help maintain her blood pressure during anesthesia and surgery. Compatible packed red blood cells would be available for transfusion in the event of unexpected blood loss. She would have continuous monitoring of her heart rate, blood pressure, and blood oxygen saturation throughout the surgery.

As Dr. Gerry Lemieux performed the surgery, the support team prepared for the very important task of caring for the newborn puppies. Drs. Lyn Lemieux and Michael King, technician Cathy Hall and assistant Terry Eucker were ready.

Sara is attached to surgical monitors and surgery is about to begin

Sara's very large uterus is carefully exteriorized.

One puppy after another was removed from Sara's uterus. Before we were done ten puppies had arrived. The support crew was very busy. Puppies were vigourously stimulated, their throats were cleared, placentas removed, umbilical cords tied, and they were warmed with a circulating warm water table. All ten puppies were strong and doing well soon after their delivery.

Ten very warm and content puppies

Sara's surgery had gone very well. She was stable throughout the procedure. Blood loss had been minimal but ten placental attachment sites provide the opportunity for substantial post surgical blood loss and the decision was made to give Sara the benefit of a packed red blood cell transfusion.

Assistant Terry Eucher monitors the family as Sara recieves her packed red blood cell transfusion

Within twenty-four hours of her surgery, Sara and her puppies were ready to leave the hospital. Her proud and happy owners knew there was a lot of work ahead to help Sara raise this very large family. With supplements in hand and round the clock home care the puppies thrived. They are pictured below when they returned to BVH at six weeks of age.

The entire litter at six weeks of age with their "second mom"