History and situation in Belgium

Marcel Van Aert

Different “historical” tales in Western and non-Western cultures about caesarian section

Even in Greek mythology Apollo removed Asclepius (god of medicine) from his mother’s womb by SC

The origine of the word “caesarian” is doubtful

“Caesarean”: surgical birth “caesones”

Julius Caesar(Plinius) and other” viri illustri”

At that time procedure only performed as alast resort when the mother was dying or death

Roman law “Lex Regia” :” Negat lex regia quae preagnans motua sit, humari” forbidden to bury a dead pregnant woman before the fetus has been removed

Section”=> Jacques Guillimeau (1598)

Similar terminology is used in other languages

“Kaiserschnitt” in German

“Emperor’s section” in English

“Keizersnede” in Dutch

Caedere = ‘to cut’ Caesones => children born by post-mortem

operations

Indications changed during the years

attempts to save (the soul) of the fetus when the mother was dying

occasionally trying to save the mother

19th century => mother’s health in danger

20th century => fetus became a patient

1480 southern Germany => first explicit instructions

midwife

anesthesia/analgesie: wine

incision around the pubic bone

let the uterus open

wound closure with 3-4 ligatures with silk

plaster: eggs, hemp, Armenian clay

1500: Switzerland

Jacob Nufer (pig gelder) => permission (from the religious authorithies)to operate his wife

Wife survived => gave birth to five other children

Child alive

Technique described by missionary Felkin (Uganda, 1879) anesthesia => banana-wine

antiseptic => banana-wine

midline incision

uterus was squeezed until contracted

red hot iron was used for hemorrhaging

cervix was dilated from inside to allow lochia to escape

peritoneum, muscles and skin => closed together with sharp spikes

root past on the wound + bandage

Material anesthesia

▪ Alcohol or botanical preparations

▪ Diethyl ether (1846) or chloroform

1860 => antiseptic (carbolic acid)

1928 => Penicilline Technique

First the uterus was left open ▪ afraid of infection of sutures

▪ had to remove the sutures (not possible)

▪ contraction/ relaxation of the uterus will make sutures ineffective

First operations performed on motheranimals in agonie to save the live of the foetus

First attempts to save also the motheranimal’s live

in 1813(Morange) by a cow

In 1815(Gohier) by a ewe

Following years by different animal species (dog 1878, sow 1920)

More knowledge about asepsis antisepsis, anesthesia

Great break-trough during and after WWII

Better anesthetic products and techniques

Discovery of sulfonamides and antibiotics: penicilline

+/- 1940 in US on “veterinary schools” many Sc with success

First Caesarean Section in Belgium (Faculty of Veterinary Medicine) 1949 prof. Vandeplassche M. and co-operators

Cows brought to the veterinary faculty:

dead calf: foetotomie, living calf :sectio caesarea

Standing position,afterwards mostly in lying position(pressing during operation,tired animals, longtime in labor, big foetus, involuated uterus)

Results better and better

Since 1950 SC performed in the field +/- 1960 => Operation procedure changed in

practice from lying to standing position Zoötechnique changes

Double purpose breed(Middle - High Belgium) more and more selection to double muscled animals(Belgian Blue)(Southern part Belgium)

Results after SC very good, safest way to be born for a (dm)calf, relatily cheap(low vet-cost)

1984 Introduction milkquotum

Small dairyfarms changed to meatproduction local breed crossbreed with BB(milkquotum sold)

Larger dairy farms more selection to milkproduction(friesian holstein )

In northern part of Belgium also a lot of BB

2008: 700.000 Belgian Blue cows 700.000 Dairy cows(F-H) cows Crossbreed FH and BB: better price calf

left

Technical procedure

=> good technique and good habits can prevent a lot of complications

Necessary for the preservation of the Belgian Blue breed

High % SC in BB => critized in Europe (specialy Scandinavian countries) animal welfare

Special Belgian situation:

small distance between farm and vet- practice

ideal climate(soft winter )

many trained veterinarians

(to)low price(+/-100 euro) of CS :vets- competition(plethora)

2008 difficult economic situation in meat

production

Advantage:

docile character of the animal

low percentage retained placenta

mostly carrying in the right horn

a lot of farms well equiped => CS-box

+/- planned operations

Poor contamination uteruscontent

Advantage

CS early in parturition (planned CS)

▪ low prevalence of perinatal death after CS

▪ relaxed uteruswall

▪ Only small risk for pressing during CS

High quality chirurgical suture-materials

Experienced vets

Disadvantage: BB have elective CS in 95-99%

permanent monitoring necessary(day/night) ▪ temperature method can be a good help

sometimes too late => calf already dead => no profits

multiple CS: adhesions, scar tissue

heavy calves

inbreeding => neonatal defects

Advantage non, always emergency solution still it is better to perform a good CS than a complicated

extraction

Disadvantage long time in parturition => animals are tired contamination of the uteruscontent more muscle bleeding already involution of the uterus higher risk for pressing during CS higher risk for lying down during CS

In Belgium a lot of CS are performed due to the creation of a artificial cattlebreed: the double muscled“Belgian Blue”

This is only possible in Belgium (intensive beefcattlefarming),

Animal welfare problem :“local”, never “worldwide” problem

BB often used in crossbreed programs Risk for higher % of SC

Sectio caesarea is a good and practical chirurgical technique to solve obstetrical problems

Knowledge, training and experience(= sum of

all mistakes) is necessary to avoid complications and to become a good outcome and better animal welfare

Thanks to my colleague Iris Kolkman and all my

co-operators from our department

marcel.vanaert@UGent.be DVM Ambulatory clinic Department of Reproduction, Obstetrics and

Herd Health Faculty of Veterinary Medicine Ghent University Salisburylaan 133, B-9820 Merelbeke,

Belgium