Solving the Mysteries of Obstetrics, Part 2 of 5
Assisting Dystocia

Maxine Kinne

       Many variables can cause dystocia. Some of them are preventable and some are not. Let's just hope you get to enjoy some normal births first. When you encounter problems, these articles should help you resolve most of them in a timely manner to get live, vigorous kids.
       Suspect a problem when contractions stop with no fetal part visible, or when part of the fetus is partially out but cannot advance. The sooner you intervene, the more likely you can correct something before it becomes life-threatening. It can be very difficult to diagnose a problem during stage one labor, as this stage can last for many hours, and the signs are not very definite. Failure of the cervix to dilate, either due to a malpositioned fetus or hormone insufficiency, a ruptured uterus, or metabolic disorders (ketosis and milk fever) do not allow the doe to go into stage two and forceful contractions. These problems during the preparatory stage one are better understood in hindsight.

Obstetric Terminology

Presentation is the relationship between fetal length and the birth canal
   Anterior - front limbs and/or head coming first
   Posterior - rear legs or rump coming first
   Transverse - vertical or crosswise to the pelvic inlet
       Dorsotransverse - spine presented first, in any degree of rotation
       Ventrotransverse - abdomen and 3 or 4 legs presented first, in any degree of rotation

Position indicates which side of the fetus is closest to the dam's spine
   Dorsal: the correct position, with the fetal spine closest to the dam's spine
   Ventral: (upside-down) fetal spine closest to the dam's abdomen
   Lateral: fetus rotated right or left, with the fetal spine closest to the dam's side

Posture is the arrangement of the fetal head and limbs
   Legs may be folded at any joint or deviated into awkward positions
   Head may be retained along either side or under the chest

       Presentation is the end of the fetus that is coming first, the front (anterior) or the rear (posterior). In rare transverse cases, either the spine (dorsotransverse) or all four feet and the head (ventrotransverse) are presented at once. (I had one of these in which I felt two sets of front legs, one set of hind legs and two heads - the first kid was transverse and the other was trying to come over the top of it.)
       Normal position features the fetal spine toward the mother's spine. In any presentation, the fetus may be fully or partially rotated sideways or upside down.
       Posture involves the head and/or legs. Flexion means a bent/folded or limb joint, i.e., neck flexion, carpal flexion, hock flexion, hip flexion.

Manual Examination

       The first dystocia you assist, 99.9% of the time, will be after midnight on Saturday. You can either be brave and try or stand around biting your fingernails until the kids are dead and the doe is in bad shape. If you fix it yourself, you will feel like a hero.
       Manually examine the doe manually when you think there is a problem. Wash the doe's perineum, then wash and lubricate your hand. Hold her tail up with the other hand while you insert two clean, lubricated fingers into the vagina to try to identify a body part. This exam may stimulate contractions. If you cannot identify a problem now, gently insert your hand into the birth canal. Press your fingertips together to make a gradual entry, and gently advance your hand until it is inside the uterus. The doe will probably push and bellow as you do. Go slowly and stop during contractions.
       If the doe's pelvic capacity is inadequate or she has excessive pelvic fat, you will not be able to reach the uterus, even though an open cervix. It is unlikely that this doe can deliver vaginally. Call your veterinarian, and expect a C-section.
       An incompletely dilated cervix will prevent you from getting into the uterus. Most likely, there is probably a malpresented fetus just inside that is not putting enough pressure on the cervix to dilate it. However, cervical failure can also be due to intrinsic hormone deficiency in the doe. If this is the case, she will have the same problem, called ringwomb, in all future kiddings. Unless you know what you are doing, do not attempt to dilate the cervix as manual dilation may result in permanent damage. Call your veterinarian.
       Once you are in the uterus, relax, close your eyes and identify what you feel - maybe soft tissue, an intact membrane (balloon) or part of a fetus.
       In the uterus you should feel the fetus or the balloon-like amnionic membrane. Break the membrane to determine the fetal position. At this point, you have up to about two hours to extract a live kid, unless the doe has been in labor for a while.

       Fetuses can be arranged in any imaginable way. Figure it out by identifying body parts. The head is the hardest. Teeth are on the bottom jaw. A front leg is differentiated from a hind leg by feeling up to the second joint - the front leg's pastern and knee both bend the same direction, and the rear leg's pastern and hock bend opposite directions. You may feel a spine, a pointy hock, ribs, or the larger mass of a rump, thigh, neck, abdomen, et cetera. Correct and deliver the malpositioned kid or call for help.

 

Correcting Malpresentations

       Obstetric maneuvers consist of retropulsion, reposition and traction, in that order. It is often necessary to gently push back a fetus to have room to reposition it. It can be very helpful to stand the doe to do this. Traction (pulling) can be done with your hand or obstetric equipment, depending on the type of dystocia. Attempts to identify the fetal parts and position should not exceed a few minutes.
       It is often necessary to push the fetus back into the uterus to gain enough room to reposition it. This is done with firm, gentle pressure. It is very helpful to stand the doe to let gravity help you. It is nearly impossible to push a head back inside the doe; if the head is out, that's what you have to deal with.
       Before using a lamb snare or piglet puller, read the instruction sheet! A loop is taken into the uterus and positioned behind both ears and under the chin to hold the head in line with the birth canal. When it is placed, your free hand pulls back on it gently to keep the head in position. Now you may either find a front leg or deliver it by the head. (I've delivered many kids by the head alone.) Pull slowly on the leg(s) with one hand, and on the snared head with the other, and maneuver the fetus into and through the birth canal. If  traction pulls the fetal muzzle into the top of the vagina, stand the doe for a better delivery angle. An assistant may lift the doe's abdomen to position the fetus better. The fetus MUST be in line with the birth canal to extract it! Forcible traction can damage any portion of the dam's reproductive tract or  cause nerve damage.

Important Rules 

Manually examine the doe internally 20 minutes after her water breaks, if she has not delivered a kid or parts of one that can be delivered (a head or two hind feet).
Always trace both legs and the head to the body to verify that they belong to the same fetus.

You must know whether you have hold of front legs or back legs before pulling.
     Front leg:  - the pastern and knee both bend in the same direction.
     Back leg - the pastern and hock bend in opposite directions.

Summon help if you cannot identify and correct a problem and within 15-20 minutes

If you manually extract a kid, go back in for all the rest. This is variable and depends on the doe's exhaustion and the extent of manipulations so far. With quick, minor assistance, it's all right to give the doe 20-30 minutes to see if labor is going to continue

Always pull kids in an arc, toward the mother's hocks. This accommodates the natural curves of both the pelvic brim and the kid's spine.

Retained Head and Front Legs
       Veterinarians often insist that the head and both front legs be present for birth to continue. There are at least two reasons they want it this way. They are experienced in delivering cows and mares whose fetopelvic relationship is much more exact than it is in ewes and does. Also, the shoulders and chest are bulky, and extending both front legs slims the heart girth. The size differential between the fetus and pelvic size in does and ewes is less precise, especially when there are multiples in the litter, so getting both feet with the head is not nearly as important. One front leg is usually all you need to accompany the head, and many times a kid can be pulled by the head alone.
       One or both front legs appear with no head. In most cases the head is deviated to one side, but the head can be deviated forward between the front legs. Follow the neck - if it's not on either side, it's down below. Repel the fetus to gain enough room to position the head in line with the birth canal. Cup your hand over the muzzle to prevent sharp teeth from scraping the uterus. Some deviated heads are more easily held in line with a lamb puller or snare.
       When you pull on the head alone with moderate traction and no progress, try to slightly rotate the kid - as the pelvic opening is slightly larger on the diagonal. If this does not work, go in for one leg. If a retained foot is pointed into the uterine wall, you might pull it through the uterine wall. (This is another reason vets want both front legs accounted for.)
       With the head slightly deviated downward, you will feel the top of the head. Get a finger under the lower jaw and raise the muzzle in line with the birth canal.

Impaction
       A fetus may become lodged in the birth canal with a leg displaced over the top of its head, making the shoulders too bulky. Insert a finger beside the head and push the leg around where it belongs. For one front leg and the head, if you feel the other foot far back in the birth canal, grasp and extend it. When you have two front legs with the head and the kid does not advance, in some cases it is better to put one front leg back in, aligned alongside the fetus, and work with one leg and the head.
       There may be a head and one or two front feet trying to enter the birth canal, but it does not advance. The elbows are probably bent and create too much bulk. Repel the fetus slightly and extend the front legs into the birth canal. The head should follow, if you haven't pushed it too far back.
       Sometimes two kids are simultaneously presented and get stuck. Stand the doe so her contractions don't continue to force both of them toward you. Repel both kids. Deliver a posterior kid first, if you are lucky enough to have one, as that is always the easiest.

Retained Back Legs (Breech Presentation)
       This is a common and easily corrected malpresentation. You must have both rear legs to deliver a backward kid. The rear legs and feet can often be located and repositioned together, but sometimes they have to be done separately. Slip your hand underneath the feet and cup them in your hand to protect the uterine wall. Fold the leg joints, point the hocks toward the doe's spine as you move the legs up and toward you in a circular motion. This compacts the motion to protect the uterus. Continue to pull the kid all the way out. If it gets stuck at the chest, hook a finger around one front leg to work it out. Deliver backward kids quickly to avoid aspiration of uterine fluid (pneumonia or drowning).

Transverse Presentations
       Either the stomach or the back is presented first. These can be tricky to figure out and correct. To figure this out, trace each leg back to the body to make sure all the legs belong to the same fetus. If the spine is presented, repel the fetus until you can reach and raise the rear end, then deliver it backward. If the stomach is presented, repel the front half, rotate the fetus into position and deliver hind feet first.
       While it is very rare, a fetus may occupy the body of the uterus instead of a uterine horn during gestation. There is little or no room to reposition the kid, and it is usually delivered by C-section.

Upside Down
       Grasp the front or back half to manually turn the body into position. Once you get the half of the body closest to you turned right-side up, the rest of it should follow as you extract it.

Pain Management & Mismothering

Some assisted does experience a lot of pain, leading to disinterest or aggression with their new kids. Consult your veterinarian for pain medication. (I like Banamine, an injectable that works within an hour of administration.) The sooner her pain is reduced, the more likely the new mother will display good mothering skills. Mothering instinct can also be stimulated by rubbing the placenta on the doe's nose, muzzle and inside her mouth, although you have to wait a while for the placenta to pass. Mommie Dearest is about poor mothering and various techniques you can use to get a new mother to accept her kids.

Preventing Common Dystocias

Adrenalin
When a doe is in stage one labor, it is very disruptive to move her to a different area from where she's chosen to deliver. Stress from isolation, excessive noise or other unusual events causes the release of adrenalin which interrupts the labor process. (Adrenalin cancels the activity of oxytocin.) If a doe must be moved, do it very close to the time she is going to enter hard labor. Does can be preconditioned to a kidding stall by placing them there for the night for about two weeks prior to the due date. It may also help to house her mother or a daughter with her. Keep visitors to a minimum, and keep them quiet.

Fat
Excessive body condition interferes with kidding in two different ways. Hormonal signals travel poorly through fat. And ketosis also produces sluggish labor. Related reading:  Body Condition Scoring System,  The Ins and Outs of Body Condition, Feeding the West African Dwarf Goat During Pregnancy.

Insufficient Pelvic Size
It is very easy to breed small or deformed pelvises into a herd. All you have to do is continue to breed a doe with these problems and/or continue to use her sire and/or her sons. If you  have this problem, look seriously at your genetics. Do not sell animals with these problems! Related reading:  Pelvic Structure and Capacity.

Absolute Fetal Oversize
Absolute fetal oversize means that the doe's pelvis is adequate but the fetus is too large. Generally speaking, if a size 7 or larger hand can get into the uterus, pelvic size is adequate. Single kids are larger than multiples, and males are larger than females. Related reading:  One + One Shouldn't = One, Old vs New: A Comparison of Style.


Hypocalcemia (milk fever)
Too little serum calcium before birth is usually due to improper nutrition during the dry period within the last two months of gestation. High levels of calcium (alfalfa) throughout pregnancy prevents adequate calcium mobilization at parturition and for about a month afterward. Hypocalcemia is most usually a problem of very high milk-producing does. Labor is very sluggish with this condition, and the treatment is intravenous administration of calcium by a veterinarian.

Solving the Mysteries of Obstetrics

1   Normal Birth
2   Recognizing and Assisting Dystocia
3   Special Pregnancy Problems
4   Hereditary and Congenital Defects

5   Causes of Dystocia Chart



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