Dystocia - Difficult Births
By Dr Mackie Hobson BSc(Agric),BVSc

1. Reproduction

With Angora kidding becoming a more intensive farming practice, farmers are now often more involved with the birthing process.

We all recognise the onset of labour with the ewe usually wandering off on its own and the initial signs, which may last 1-8 hours, of uneasiness, kicking, pawing the ground, lying down and getting up frequently, and sporadic urinating or attempts at urination. 

We are also familiar with the second stage of labour including the appearance of the water sac and evidence of a foot exiting the birth canal. This stage last about 1-2 hours (15-30 minutes per kid). Stage 3 involves the placenta being passed about 15 minutes after the kid is born.

The question is when should we intervene and take action and so hopefully save the life a kid when things go wrong?

It is important to know what is normal in order to recognise a problem during parturition (birth).

When to Give Assistance?

• If any of the following occurs:

1. The mother has been straining for 30 minutes .
2. The water sac is observed for longer than 1 hour
3. The ewe is showing signs of severe distress or fatigue, including bleeding from the rectum of the mother or a swollen tongue of the kid.

RULE: Never try to pull kid that is in an abnormal position. The position of the kid must be corrected. Excessive force can result in shock, haemorrhage, trauma, infection, fertility problems, and very possibly an eversion or prolapse of the vagina and uterus.

Causes of Dystocia:

1. Failure of the cervix to completely dilate.
2. A kid that has an extra-large head and shoulders or is just an overall large kid.
3. Twin kids coming simultaneously.
4. A ewe that was disturbed during the initial phases of kidding.
5. A kid that is not in the proper presentation, position, or posture.

What to do when a ewe is having difficulty?

1. Clean the vulva, anus, and surrounding areas .
2. Clean hands and arms with soap and water, and apply a mild antiseptic.
3. Apply liberal amounts of a lubricant to a plastic obstetrical sleeve.  It is almost impossible to use too much lubricant.
4. Shape the hand into a natural wedge, with the fingers tight together. Then insert the hand with gentle force into the vagina and pelvic areas. Any forward movement should be done during the breaks in the uterine contractions. Forcing the hand forward during a contraction or with a significant amount of effort can cause severe injury and possible death to the ewe and kid.
5. Determine the presentation, position, and posture of the kid.
   1. Presentation- This refers to whether the kid is coming head first, backwards or sideways.
   2. Position- This refers to whether the kid is right-side up or upside-down.
   3. Posture- This refers to where the legs of the kid are in relation to its body.

Normal kid: Head first, Right side up (on its chest) with Front legs and head coming first..

6. It should be determined if the front or hind legs are coming through the birth canal
7. Determining if the kid is alive or dead. This is done by performing the following tests:
   1. Pinching between the toes and having the kid pull away.
   2. Placing a finger in the mouth and feeling the kid suckle.
   3. Gently poking the eye – the kid usually moves its head.
   4. Checking rectal tone by placing a finger in the rectum - the tissue around the finger should contract.

Delivery of a kid in normal presentation, position, and posture :

1. Chains or ropes should be placed on both front legs with one loop of the chain/rope above the first joint (fetlock) and a half-hitch between the fetlock and the hoof.
2. If the ewe is down, traction should first be placed on the kid’s lower limb. (If the mother is standing, place traction on either limb.) The shoulder of this limb should be pulled through the birth canal. Traction should then be placed on the opposite leg and the shoulder pulled through the birth canal.
3. Once both shoulders are through the canal, pressure can be placed on both limbs and the kid pulled until the chest is outside of the mother’s pelvis.
4. If the kid is fairly large, it should be rotated 45-90 degrees, allowing the widest part of the kid (the hips from side-to-side) to pass more readily through the widest part of the mother’s pelvis. Rotation of the kid is accomplished by crossing the legs and applying pressure to the upper limb and body while rotating.
5. All traction placed on the kid should coincide with the mother having a contraction and pushing.

If manipulations need to be performed, it is very beneficial to have a spinal block (epidural) administered by a vet.

Abnormal Presentations, Positions, and Postures:

Delivery of a kid that is coming backward, but in normal position and posture:

1.A large kid should be rotated 45-90 degrees before attempting to remove it.

2.Traction should be applied from directly behind the mother in a slightly upward direction (towards the tail of the mother) until the hips of the lamb/kid are removed.

3.At this point the kid can be rotated back to normal and removed routinely.

Normal presentation and position, except one or both front legs are retained:

1.With one hand, try to cup  the end of the hoof on the leg(s) that is retained. This will protect the uterus and allow the limb to be pulled towards the pelvis. Sometimes a chain can be placed on the retained limb for extra control.

2.If more space is required, one hand can be placed on the chest or head of the kid. Then while pushing the lamb/kid back into the pelvis, the other hand can be used to cup and pull the retained limb into the pelvis.

Two front legs are coming through the pelvis, but the head is turned back:

1.The head can be turned to either side, straight behind or even down between the legs. A kid in this position is often dead or very weak.

2.Once the position of the head is identified, the head should be grasped. Often, gently placing the fingers in the eye sockets or mouth of the animal will help give some control. The head can then be manipulated into the proper position.It may also be necessary to push the body of the kid back into the uterus with one hand while positioning the head with the other. This allows that little bit of extra room that is often necessary.

Normal presentation, but upside down and leg(s) retained:

1. Both front legs should be identified and pulled out of the vagina using the techniques found in the previous information.
2. Once the legs are accessible, the kid is rotated to normal position by crossing the legs and placing pressure on the upper leg and shoulders, while rotating.
3. The head should also be held and rotated along with the body.
4. Once the kid is properly positioned, it can be removed routinely.

Backward presentation, upside down, and both legs retained (breech):

1.Attempt to rotate the kid to an upright position. This is done by grasping one side of the kid (hock and/or front leg) and pushing down in a sweeping motion. (In some cases, it may be necessary to get the hind limbs out and use them to rotate the kid.)

2.Once the kid is right-side up, but the legs are still retained, pull the hock of one leg into a flexed position. Then force the hock upwards and forward while cupping the hoof of that leg. Pull the foot towards the middle of the kid and backwards towards the vagina.

Backward presentation and right-side up, but legs retained:

Same as above without rotating the kid.

Four Legs in the Birth Canal:

1.Make sure the legs are all from the same kid.

2.If all 4 limbs are from the same kid, deliver the hind legs first. Delivering the hind legs first will allow the head to follow naturally.

3.Rotate the kid if necessary, using the information found in the previous information.

Delivering Twins: 

With multiple births, it is common to have the legs of one kid and the head of another entering the birth canal at the same time. If front legs and a head are present in the birth canal, gently pull on the legs to make sure that the legs and head are from the same kid. If the legs and head are not from the same kid, take plenty of time to repel (push back) the head of the lamb/kid that is present and follow the legs up to the body of the other kid. Orient the legs and head of the same kid in the normal presentation, position, and posture for delivery. Deliver one kid, and then follow the same steps to deliver the second. If the problem is simultaneous delivery of twins, repel one back into the uterus while holding the other.

Common Mistakes:

1. Allowing the mother to be in labour too long before giving assistance.
2. Trying to deliver a kid that is in an abnormal position without first correcting the problem. Never apply traction to a kid with the head or leg back without first correcting the problem.
3. Applying too much traction. No more force than the equivalent of two people manually pulling should ever be used.

Note: In most cases where assistance has been given, it is beneficial to administer antibiotics to the ewe to help prevent potential bacterial infections.

Ref: infovets.com/books/smrm/C/C460.htm