New Zealand Veterinary Journal

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Potential benefit of a thoracic squeeze technique

in two newborn calves delivered by caesarean
section

G Stilwell, DJ Mellor & SE Holdsworth

To cite this article: G Stilwell, DJ Mellor & SE Holdsworth (2019): Potential benefit of a thoracic
squeeze technique in two newborn calves delivered by caesarean section, New Zealand Veterinary
Journal, DOI: 10.1080/00480169.2019.1670115

To link to this article: https://doi.org/10.1080/00480169.2019.1670115

Accepted author version posted online: 25

Sep 2019.
Published online: 13 Oct 2019.

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NEW ZEALAND VETERINARY JOURNAL
https://doi.org/10.1080/00480169.2019.1670115

CLINICAL COMMUNICATION

Potential benefit of a thoracic squeeze technique in two newborn calves

delivered by caesarean section
G Stilwella,c, DJ Mellorb and SE Holdsworthb
a
Farm Services Clinic, School of Veterinary Science, Massey University, Palmerston North, New Zealand; bAnimal Welfare Science and
Bioethics Centre, School of Veterinary Science, Massey University, Palmerston North, New Zealand

ABSTRACT ARTICLE HISTORY

Case History: Two calves delivered following elective caesarean section showed behaviour Received 27 February 2019
typical of neonatal maladjustment syndrome described in foals, i.e., indifference to Accepted 12 September 2019
environmental stimuli, lack of affinity for the dam, failure to find the udder, refusal to suck, Published online 25
aimless wandering or motionless standing. Calves were subjected to a clinical examination September 2019
immediate after delivery and there were no signs of defects, illness, pain, dehydration, KEYWORDS
hypoxia, acidaemia or other causes for the unresponsive behaviour. Thoracic squeeze; neonatal
Clinical Findings and Treatment: Both calves were subjected to the thoracic squeeze maladjustment syndrome;
technique, one at 6 hours and the other at 20 hours after delivery. A soft rope was looped dummy calves; caesarean
around the thorax and gentle pressure was applied to the free end of the rope, squeezing section
the calf’s chest for 20 minutes. Both calves exhibited a sleep-like state manifested by closed
eyes, no body movements, slow breathing and a decrease in heart rate, for the entire
squeezing period. When the rope was removed the calves woke up immediately, rose and
walked towards the dam. When led to the dam’s udder, the weaker calf began to suck. Both
were reported, by the stockperson, to follow the dam and suck normally the following day.
Clinical Relevance: Provided all other disease processes are excluded, very young calves that
exhibit indifference to environmental stimuli and lack of affinity for the dam may be good
candidates for application of the thoracic squeeze technique that has been demonstrated to
have clinical efficacy in foals with neonatal maladjustment syndrome.

Abbreviations: NMS: Neonatal maladjustment syndrome

Introduction This natural compression appears to have two key

A postnatal thoracic squeeze technique (also known
as the Madigan thoracic squeeze) is a procedure by
which firm squeezing of the thorax has been
reported to aid the recovery of newborn foals with
neonatal maladjustment syndrome (NMS) (Aleman
et al. 2017). In foals with NMS, sedative-like com-
pounds involved in intrauterine neuroinhibition
appear to persist after birth, delaying the transition
to alert awareness (Nguyen et al. 2003; Diesch and
Mellor 2013). Unlike healthy vigorous foals, those
with NMS show incoordination, indifference towards
the dam, inability to suck from the udder and
aimless wandering for hours, or even days, after
birth (Hess-Dudan and Rossdale 1996; Aleman et al.
2013; Diesch and Mellor 2013). Postnatal application
of the squeeze technique, which involves passing
three loops of soft rope around the thorax and apply-
ing pressure for 20 minutes (Toth et al. 2012), is con-
sidered to replicate the natural compression of a
foal’s body during its passage through the birth
canal prior to delivery (Aleman et al. 2017).
actions (Mellor 2017). Firstly it reinforces fetal states
of sleep-like unconsciousness that have been demon-
strated to be maintained in utero by a unique suite of
other neuroinhibitory factors (Mellor et al. 2005;
Mellor and Diesch 2006, 2007; Mellor 2010); and con-
tributes to a reduction in fetal movements (Mellor
2017) that occurs during the second stage of labour
(Mellor 2010), thereby minimising the risk of maternal
injury. Secondly, at the same time, this natural com-
pression stimulates widespread noradrenergic acti-
vation within the brain (Berridge and Waterhouse
2003). This together with other neuroactivators
(McEwen 2002; Mellor and Gregory 2003), primes the
brain and thereby contributes to the onset of con-
sciousness once the compression-induced neuroinhibi-
tion and other neuroinhibitory factors are withdrawn
after delivery (Mellor and Diesch 2006, 2007; Mellor
2010, 2017). Thus, the compression-induced neuroinhi-
bition and neuroactivatory priming, which occur
immediately prior to birth, contribute to multifaceted
mechanisms that regulate the transition from fetal
unconsciousness and relative inactivity to postnatal

CONTACT G Stilwell stilwell@fmv.ulisboa.pt

c
Current address: Animal Behaviour and Welfare Laboratory, Centre of Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, Lisbon
University, Lisbon, Portugal.
© 2019 New Zealand Veterinary Association
2 G. STILWELL ET AL.
consciousness associated with the marked activity. This
rapid transition in the newborn is essential in preco-
cious species that must exhibit behaviours critical to
survival soon after birth, including bonding with and
nursing from the dam, escaping predators and
responding to their unpredictable extrauterine
environment (Mellor and Gregory 2003; Mellor and
Lentle 2015).
Application of the postnatal thoracic squeeze has
been reported to rapidly induce sleep-like unconscious-
ness in healthy, vigorous foals, which persists until the
squeeze is discontinued. The foal then returns to con-
sciousness and normal behavioural interactions with the
dam (Toth et al. 2012). The postnatal thoracic squeeze
is, in fact, a slight modification to the original Reuff
method of casting cattle (Divers and Peek 2008). Use of
this squeeze technique has been reported to have been
successful in the treatment of foals with NMS. After
removal of the rope, foals rapidly exhibit alert conscious-
ness and maternally directed behaviours that were not
originally present (Aleman et al. 2017). The above physio-
logical explanation provides a basis for understanding
why the postnatal thoracic squeeze in foals with NMS is
effective.
Published references to NMS-like calves are very rare
and none suggest the mechanisms now described for
newborn foals with NMS. Mee (2008) describes a
weak calf syndrome in which calves show weakness
and difficulty in rising, standing or sucking, eventually
dying after a few days. Although in most cases the
cause for this syndrome has not been determined, it
is generally thought to be related to brain hypoxia or
acidaemia due to prolonged calving, premature pla-
cental separation, premature labour, twinning, harsh
environmental conditions (e.g. very cold weather),
infections, nitrate toxicity, accidents or congenital
defects (Mee 2008). Implicated here are pathophysiolo-
gical impediments to survival that are not primarily
associated with mechanisms regulating the transition
from prenatal unconsciousness to postnatal conscious-
ness (Diesch and Mellor 2013). However we have also
observed newborn calves that stand and move
around, but that do not show normal teat-seeking
and teat-sucking reflexes, which suggest a possible
equivalence to NMS. To date, evidence that the
squeeze technique works in such NMS-like or weak,
newborn calves have been lacking. In this article we
describe the beneficial effect of using the thoracic
squeeze in two calves showing signs typical of NMS.
Case history
The calves reported here were two of 10 calves deliv-
ered over a 5-week period as part of a teaching exercise
on caesarean section methodology for veterinary stu-
dents at Massey University (Palmerston North, NZ).
The plan and aims of these teaching sessions were
approved by the Massey University Animal Ethics Com-
mittee (# 17/94) and included post-delivery resuscita-
tion of the calves using standard methods.
Elective caesarean sections were conducted approxi-
mately 24 hours after labour was induced by I/M injec-
tion of 25 mg dexamethasone (Dexa 0.2; Phoenix
Pharm, Auckland, NZ). The surgical approach was via
the left flank under proximal paravertebral anaesthesia
that desensitises the dorsal and ventral nerve roots of
the last thoracic and first and second lumbar spinal
nerves as they emerge from the intervertebral foramina
(Edmondson 2008). No sedation was required for the
cow. All calves in these teaching sessions were assisted
by veterinary technicians immediately after delivery
and examined by an experienced veterinarian after
breathing started. No signs of distress, hypoxia or
depression were detected in any of the calves. All
calves were given 2 L of warm colostrum by bottle, or
intubation if they refused to drink, soon after delivery.
Clinical findings and treatment
Two of the 10 calves showed behaviour typical of NMS,
i.e. indifference to environmental stimuli, lack of affinity
for the dam, failure to find the udder, refusal to suck
even when helped by putting the teat in their mouths,
aimless wandering or motionless standing. A thorough
clinical examination of these calves by an experienced
veterinarian (GS) ruled out congenital defects, illness,
pain, dehydration, or other causes for unresponsive
behaviour, such as hypoxia/acidaemia (Szenci et al.
1989). Because these behaviours continued for several
hours after delivery by caesarean section, a decision
was made to apply the thoracic squeeze technique
(Toth et al. 2012; Aleman et al. 2017).
Both calves were subjected to the squeeze tech-
nique, for approximately 20 minutes; calf A at approxi-
mately 20 hours and calf B at approximately 6 hours
after delivery. A soft cotton rope, approximately 3 cm
in diameter, was looped around the thorax of the calf
three times and pressure was applied to the loose
end of the rope (Figure 1). The calf was then lowered
into lateral recumbency while the loops of rope
around the thorax were gently tightened. After strug-
gling briefly, which was gently managed by one
person at the head, the calves exhibited a sleep-like
state manifested by closed eyes, absence of leg or
other body movements, slow breathing and reduced
heart rate assessed by regular auscultation. Loud
noises, wind or human presence did not seem to
affect the calves which did not move, apart from
breathing, for the entire period of the squeeze. When
the rope was removed the calves woke up immedi-
ately. They rose after several seconds and walked
towards the dam. Calf B was very weak so it was
taken to its mother, which was restrained in a race,
and directed towards the udder. It accepted the teat

Figure 1. Photograph of a newborn calf delivered via caesar-
ean section which exhibited signs similar to neonatal malad-
justment syndrome, showing the three loops of soft fabric
rope around the thorax of the calf which were used to apply
the thoracic squeeze technique.
Figure 2. Photograph of calf B which had previously exhibited
behaviour similar to neonatal maladjustment syndrome,
sucking from its dam several minutes after the thoracic
squeeze technique was applied for 20 minutes.
and began to suck without much difficulty (Figure 2).
Calf A did not require further assistance. The calves’
behaviour was monitored by a stockperson during
the subsequent hours, who confirmed that both were
lively and soon began to follow the dam and continued
to suck. The calves stayed with their mothers in a
grazing paddock until weaning approximately 3
months later, and no further problems were reported.
Discussion
The therapeutic application of the postnatal thoracic
squeeze was apparently effective in the two calves
NEW ZEALAND VETERINARY JOURNAL 3
reported here, which were born via caesarean section
and exhibited signs of NMS after birth. No signs of
pain or discomfort were shown by the calves during
application of the squeeze. If these behaviours were
to occur then tightening should be discontinued and
a thorough clinical examination should be performed
to rule out trauma, such as fractured ribs.
With reference to the physiological mechanisms of
natural thoracic compression during labour described
in the introduction, and the likely explanation of why
the actions of the postnatal thoracic squeeze were
apparently effective for the calves described here,
three points can be highlighted. Firstly, delivery of
these calves by caesarean section, which eliminated
the natural thoracic compression during the second
stage of labour, may have been a factor in the aetiology
of their NMS-like behaviour. It should be noted, however,
that there is no published evidence of increased suscep-
tibility of animals born via caesarean section to NMS. Sec-
ondly, the efficacy of the postnatal squeeze in these
calves suggests that the mechanisms of action of
natural compression during labour may be a general
phenomenon in neurologically precocious mammalian
fetuses (Mellor 2017). Thirdly, provided other forms of
pathophysiology can be excluded (Hess-Dudan and
Rossdale 1996; Diesch and Mellor 2013), conscious
newborn or very young calves that exhibit indifference
to environmental stimuli, lack of affinity for the dam,
failure to find the udder, refusal to suck even when
assisted, and which aimlessly wander or stand motion-
less, may be good candidates for application of the
thoracic squeeze technique. This may be especially the
case if such behaviour is exhibited by calves delivered
by caesarean section using paravertebral anaesthesia.
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