Bluebell was brought to us by one of those selfless ladies who devote so much life and love to rescueing abandoned cats. She was tiny when she arrived, with a big pregnant belly - all babies and bones. She had been living in an abandoned lot, fed daily in the bluebells by her rescuer. When it was obvious she was pregnant, she was trapped. We were able to offer her a space to call home to have her kittens (rather than pregnancy termination). A darling little kitten herself, everyone who met her fell in love instantly. Radiographs on arrival showed four kittens. We waited breathlessly for the event. Bluebell went through a growth spurt and lost her ribs and protruding spine. Weeks went by! One Friday afternoon, she became restless, and started a uterine discharge. My first thought was that it the wrong colour. We observed her that night, and
through a somewhat prolonged labour, she produced one immature weak black kitten. After the birth of the little fading kitten, Bluebell stopped having uterine contractions and there was no further discharge. Some cats do this - take a little break between kittens, especially if they feel insecure or disturbed. We left her alone the rest of the night and next day. On Saturday evening, Bluebell was comfortable, in no distress but we were concerned. Her labour times had been much longer than normal, and the discharge and placental remains just didn't look right. She kept trying to bury her little fading kitten. The tiny thing could not use its back legs at all, and it never managed to feed. It had no suckle reflex even immediately after birth. Bluebell was eating with her normal voracious appetite, and living in that hormonal heaven of birth, purring her way through pain and wanting belly rubs and attention. Occasionaly she would try to show the kitten, but mostly when we checked it would be buried under the towels. An ultrasound that evening showed only one beating kitten heart, with normal undistressed rate and rythm. On Sunday morning, I tried to stimulate uterine contractions with oxytocin, but despite lots of discharge (which Bluebell immediately ate - this is part of the clean nesting instinct so that predators are not attracted to the site by the smell), nothing resembling normal birth process was happening. An hour later, with the help of Thomas and volunteer Linda, I delivered a live kitten by Caesarian section. What a scene that was. Thomas and Linda had to be schooled in kitten receiving and rescuscitation mode, without disturbing my aseptic surgical field. Bluebell could get only a minimum of drugs because I didnt want to anaesthetise the kitten too deeply, and I had to work as quickly as possible to limit the aneasthetic time. Everything, all potential complications, had to be thought off and prepared for before I scrubbed up. Once Bluebell had her premedication injection, Thomas timed me. Ten minutes later, I placed the IV catheter and Bluebell was placed under general anaesthetic. As she was stabilising on isoflurane, I did a quick shave of her entire belly, top to very bottom and at least an inch either side of her nipple line. Then a proper surgical scrub and over to the OR, where she was set on her back on the table and I made sure all the monitoring equipment was beeping happily before I scrubbed up. Cap, mask, scrub, gown, gloves.
Two long steps back into OR, where Thomas stood ready to open drapes and packs. Drape, take a deep breath and cut. And identify tissues, avoid that big blood vessel going to her breast there, and find under that fatty breast tissue the linea alba. Lift the abdominal tisuue, slip the scalpel in, and open up. Carefully. Everything leaps out of that overfilled abdomen. In her case, colon first. I extended the incision, gently put the colon back (she could have gone to the bathroom before, but holding in, we discovered, is a trick of hers) and started to lift out the uterus. First side out was the post-partum fleshy unfilled left side, with it's huge purply-red blood vessels and tiny ovary, followed with a little "plip" as it escaped the abdomial incion into the free green world of the surgical drape, the still full right uterus. The kitten in its sac, with the dark placental band like a boxer's belt around the middle, is surprisingly large. Quickly, I identified a realatively less vascularised portio, and incised. Then milked the kitten, sac and all out of the opening. Pus flowed past onto the drape.I opened the sac, opened the kitten's airway, heard and saw the first gasp of air. Gave a dose of opiod antagonist to the umbilical blood vessels. Then I clamped the cord, cut between the clamps and passed the kitten to Linda. That the kitten was alive and apparently unaffected by her surroundings was amazing (but that is why each kitten has their own little sac and placenta), because Bluebell's other kittens had died in utero, each at different ages, and were in different stages of decompostion in that uterus. Kittens that die in uterus often resorb without incident, but Bluebell had a uterine infection and her whole uterus was absolutely rotten and filled with pus.I had to perform an ovariohysterectomy (spay) immediately, because there was no way I could put that rotten tissue back in that cat and have her live. I worked carefully with additional drapes and fresh gloves so as not to contaminate her with any of that icky rot. Whilst I was doing surgery, Thomas was monitoring Bluebell's anaesthetic and Linda had the kitten first in oxygen and warming her up. Bluebell was a trooper through all this and didn't have any of the expected complications during surgery - when I removed that uterus, I would have removed almost a third of her circulating blood supply. That is SHOCK. She had IV fluids running at shock rates, and Thomas had been primed with an array of rescue drugs to place IV at my command if necessary.
