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Thursday, 13 August 2015

Leg Back - Carpal Flexion

This position is known as carpal flexion. When the calf is presented forwards (in anterior presentation), the right way up (dorsal position), one or both of the legs is bent in the birth canal – this prevents the calf from being born. In this position, the calf’s leg is bent at the carpus. This joint is the second joint above the hoof. It is shown to be bent back in the picture below, depicted by the red arrow. The green arrow shows the correct position of the leg.



While in this posture, the calf cannot be born. The bent leg makes it unsafe for both the calf (as it could break the leg) and for the cow (due to possible damage of the birth canal) if it were to be forced out through excessive traction. Even if it appears that there might be enough room, remember that the situation of the hind limbs is not known at this point, any further problems could worsen the situation. Therefore, the best, most successful and most safe way to deliver the calf is to mutate (which in this situation, means change posture of) the flexed limb.

How to correct this position…

Essentially, the best way to achieve this is to push the limb up towards the body, bending the higher joints first, and then extending the leg laterally towards the vulva. The pictures below show this in its most simple form.



First of all the leg that is outside the vulva should be secured; this can be done by tying a calving rope around the leg, just above the hoof. Once this is done, the whole calf should be repelled back into the birth canal, until there is enough room around the calf to mutate the bent leg. Once there is enough room, apply generous amounts of lube to your hand and reach inside the birth canal to find the head. Once the head has been found, work your way down the side of the head towards the bent leg. Grab the leg at the carpal region (as shown by red arrow 1 above); pull the leg up towards the body of the calf, causing the shoulder joint to flex. Then, if the hoof can be reached, cusp the hoof in your hand and extend the leg outwards towards the vulva (orange arrow 2). Alternatively, wrap a rope around the hoof and extend outwards if this is possible, that way, the leg can’t slip back into a bent position.
The key concept of safely retrieving the leg is to bend the leg at its highest joints first, then at the carpal joint afterwards. Pulling the leg from the bent position, up towards the pelvis, without bending at the shoulder, can lead to the calf’s hoof damaging the inside of the birth canal as it is pulled upwards – this damage can then lead to infection, infertility and sometimes death.


Leg Back - Shoulder Flexion

This position is known as shoulder flexion. When the calf is being presented forwards (anterior), the right way up (dorsal) with one or both legs bent back inside the birth canal. This particular position, shoulder flexion, consists of the leg being bent back from the shoulder joint (not the carpus as in the above position). Essentially the difference between the two ‘leg back’ positions is that the shoulder flexion consists of the whole leg (from hoof to body) being bent back, whereas carpal flexion only consists of half the leg being bent back. In most respects, carpal flexion is easier to correct.



In order to correct this position, the bent leg must be mutated into the correct leg position, stretching forwards through the birth canal. To do this, the shoulder flexion is converted to a carpal flexion and then into normal position.

How to correct this position…
To ensure a safe delivery of a calf in this situation is important to know and understand the anatomy of the birth canal and the best course of action. The first thing to understand is that, to rotate the leg back into its normal position, there needs to be quite a lot of space inside the birth canal and around the calf.

For this reason, the first thing to do is repel the calf back inside the birth canal so that when the leg is being turned, it does not get lodged or blocked by the pelvis of the cow. Again, remember to put a calving rope onto the foot of the leg that is already in correct position, so that it does not get lost. The most ‘roomy’ part of the birth canal is the uterus – this is where it is easiest to turn the arm. The picture below shows the calf being repelled back to where the arm can be turned. Note that the pelvic bone is shown in the photo (along the bottom of the birth canal), this is the narrowest part of the birth canal and can often cause problems when the arm becomes lodged against it.





Once the calf has been repelled back inside the birth canal, generous lube applied to your hand and the head of the calf should be located with your hand inside the cow. Following down the side of the neck, the shoulder can be found. Following down the shoulder, the carpal region of the leg should be held and twisted towards the body of the calf.
After the leg has been twisted towards the body, the leg should be pushed upwards towards the head of the calf, bending the leg at the shoulder joint as well as the carpus.


The leg can then be extended into the pelvic inlet, while the hoof is being cusped in your hand to prevent damage to the womb.




Hip Flexion

This position consists of the calf being presented backwards (posterior presentation), the right way up (dorsal) with one of the legs in the birth canal (extended towards the vulva) and the other bent inside the uterus, usually locked behind the cow’s pelvic bone.



In order to correct the position, the calf’s leg must be extended into the same position as its other leg, extended towards the vulva. The calf can then be delivered backwards in a safe and healthy manner.

How to correct this position…

First of all, like most position corrections, the calf must be repelled back inside the cow. This position should not require too much repulsion, as the calf will not have gotten very far through the birth canal due to the hock of the bent leg stopping the calf from being pushed too far. To push the calf back, apply a calving rope to the visible normal leg, apply lube to your hand and push on the tailhead/pins of the calf until enough room is estimated. (This is shown in the picture above).


The next thing to do is retrieve the distal limb (the leg that is incorrectly positioned). To do this, find the tail or tailhead of the calf. Follow down the side of the calf to find the hock (which is the middle joint of the hind limbs, between the hoof and rump). 



The next step is to rotate the leg, using the grip on the hock, so that the hock is pushed up towards the tailhead of the calf. Essentially the leg is pushed up towards the body as far as is safely possible, to make room for the rotation of the bottom part of the leg, which needs to be extended through into the birth canal. The picture below shows what the leg should look like after this move has been executed.



Once the hock has been pushed up, the hoof should be within reach. Hoop one of the calving ropes around the foot, just above the hoof. Then place your
 hand back on the hock and push forwards and upwards while simultaneously pulling the rope to rotate the leg around towards the pelvic inlet.



True Breech

This position is generally known as breech or true breech. It consists of the calf in a backwards presentation (posterior), the right way up (dorsal) with only the rear end of the calf (the tailhead region) presented at the pelvic inlet (entrance to the birth canal) with both hind legs tucked/bent towards the head (bilateral hind limb flexion).


In this position, there is no way, at all, that the calf can leave the womb. The cow can’t enter into second stage labor and sometimes the first water bag is not even expelled because of the calf blocking the birth canal. By all accounts this is a difficult situation for the cow, calf and stockperson.
When investigated by examination, usually because the cow has been sat lying down for a long while without any kind of progression, only the tail can be felt at the pelvic inlet. The basic principle of delivering the calf in this situation is bringing the hind legs safely up into the birth canal so that can be extended towards the vulva and the calf can be delivered in normal backward presentation.



How to correct this position…
As you can see from the illustration above, the pelvic bone of the cow is the main obstacle in this position. The first thing to do after applying lube to your hands, is repel the calf back inside the birth canal as far as your reach will allow. This action increases the amount of space the leg has to rotate within; so prevents damage to the cow’s womb and also easing the movement of the calf. The next action is to pull the retrieve one of the calf’s hind legs. Often this is easiest by finding the hock joint. The leg should then be pushed up towards the calf’s body, flexing the hock and stifle joints so the leg is as tightly bent as it can be. This is shown in the illustration below…


The next step is to adjust leg so it can be rotated towards the vulva. This is down by holding the leg between the hock and the hoof and twisting the hoof towards the body of the calf, so that the hoof eventually ends up behind the calf, ready to be extended outwards. In the same movement, pushing the hock end forwards towards the calf’s head. So for example if you are working on the right leg (like the image above), you want to be twisting the hoof to the left so that the leg is bent behind the body. The images below illustrate this (from a viewpoint of behind the cow and side of cow)…





The last action is extending the leg outwards so that it is stretched fully, towards the exit of the birth canal. When performing this final action, ensure that the
hoof is cupped in your hand so that when it is pulled upwards, it does not damage the womb of the cow.
This process must then be repeated with the
other leg. Once the first leg is out, place a calving rope around it and keep it fairly tense so that the leg does not slip back into the position it was in before. The calf can then be born in a normal backwards presentation.
Elbow Lock

Sometimes it may appear that the calf is a normal posture, but traction will prove that there is something limiting the calf’s expulsion. Often this is due to one of the elbows of the calf being caught on the brim of the cow’s pelvis. The problematic elbow will be on the leg that is not fully outstretched. The partly flexed elbow will get caught on the bottom ridge of the pelvic bone.


Luckily it is an easy problem to fix. Gently repelling the calf as traction is applied to the leg that is stuck, should allow the leg to be extended through the pelvis. Normal delivery can then be resumed.


Head Back - Lateral Deviation of the Head

In this posture it is fairly common for the calf to already be dead. This posture consists of the calf coming forwards (anterior presentation) with both forelimbs outstretched towards the vulva, with the head bent backwards in line with the body.

The problem with this posture is that people often mistake the calf for coming backwards – as the head cannot be felt readily. Always, (really, always) check the legs of the calf to see if they are hind limbs or fore limbs. If they are hind limbs, the hocks will be able to be felt. The hocks are the large joint in the hind limbs which bend the opposite way to the hoof. If the calf is coming backwards, the right way up, the hocks will be pointing towards the sky, if the calf is upside down, they will be facing the floor. The fore limbs can be recognised by the fetlock/carpal joint, the elbow joint and absence of the hock; the joints on the fore limbs will bend the same way as the hoof.




Once it has been established that the calf is coming forwards, with the head bent back into the birth canal, the correction can be initiated.




How to correct this position…
The first thing to do is of course apply generous amounts of lubricant inside the birth canal as well as onto your hands/gloves. If the head is bent back into the calf’s right flank, it will be easier to correct using your left hand, and vice-versa.
Apply calving ropes to the two legs that are showing at the vulva, this stops the legs from being lost or changing posture when the calf is being altered. Gentle repulsion of the calf back inside the birth canal is usually necessary to make room for the head to be rotated forwards.

Enter the birth canal with your hand and find the head. If it can be reached, grasp the distal side of the skull, by the eye sockets or muzzle and raise the head while rotating towards the pelvic inlet. Avoid using a chain or rope round the head, especially through the bottom jaw as this can lead to fracture of the jaw bone or the calf becoming wrapped up in the ropes.






Once the head has been straightened and nestled between the two front legs, normal forced extraction can be continued.
It should be noted that calves in this position are often weak even before the procedure has started – even after correction of the head, many calves fail the test for forced extraction and if they are delivered, often do not survive or are weakly growing calves.
Transverse Presentation

Very rarely calves can be in a transverse presentation. Basically what this entails is the calf is ‘sitting upright’ instead of lying in a straight line. The calf present just the tailhead towards the pelvic inlet (breech) or it can present all four limbs towards the pelvic inlet. In this position there is no way the calf can be delivered naturally. Manual intervention is always required and in this situation, the earlier the better because you will need all the time you can get when correcting this position. This is one of the most difficult corrections to make.




How to correct this position…


If you think about it logically, the fore limbs and head require more manoeuvre because there are more parts of the body to move and get into position – therefore it makes more sense to deliver the calf backwards in a normal posterior presentation.
The first thing to do is repel the head and forelimbs away from the pelvic inlet. The hind limbs can then be stretched into the pelvic inlet and through the birth canal to create a horizontal presentation (long and thin ideally). But at this point the calf should not be pulled. The calf needs to be the right way up and at this point, the calf’s belly would be facing the sky; delivery in this position can seriously damage the calf. Applying generous amounts of lube, rotate the hind limbs as they come through the pelvis, then repeat the same degree of rotation in the same direction to rotate the calf into a normal position (with the calf’s spine facing the cow’s spine). This way, the calf is converted into a normal posterior presentation. It can then be delivered by forced extraction.





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