C-Section[1]

If piglets are still viable, a combination of epidural lidocaine, local lidocaine, a systemic benzodiazepine, plus or minus oxygen supplementation if the sow appears apneic is the anesthetic plan of choice. Gas anesthesia can depress the piglets and decrease their postnatal viability. If the sow is still fractious another injectable anesthetic can be added, low dose alfaxalone is good for C-sections as well, an ET tube and oxygen supplementation should be ready.

Once the benzodiazepine and lidocaine have taken effect, the sow should be placed in right lateral recumbency. The left flank should be aseptically prepared for surgery. The incision should be located 10-20cm posterior to the last rib, and long enough to reach in and exteriorize both uterine horns. This location is preferred because it is far from the teat line and has decent holding capacity. Incisional pain near the teat line increases the chances that the sow will reject the piglets, and the piglets may chew on the suture line. Once in the abdominal cavity, locate and exteriorize the uterine horns. Locate the uterine body and make a 3” longitudinal incision on the dorsal aspect of the body just posterior to the bifurcation. To deliver piglets deep in the uterine horns, a uterine vulsellum or Allis tissue forceps can be passed through the incision to gently grasp the piglets and remove them from the uterus. Once all piglets are out, gently remove the placenta, if the much resistance or hemorrhage is encountered, leave it in. An OHE can be performed at this time if desired or if the uterus is gangrenous or severely damaged.