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“So, a Surgeon Walks Into a Zoo…” – A Wild Delivery Story That’s No Joke

On Friday, June 2, an unlikely group of local medical professionals assembled Avengers-style at the Philadelphia Zoo to bring its newest addition into the world. Crammed into a small operating room, the multidisciplinary group combined their unique veterinary, surgical, obstetric, and anesthesiology skills to successfully deliver a five pound baby western lowland gorilla following a difficult – and nearly life-threatening – labor. On the scene was Sean P. Harbison, MD, chief of General Surgery at Penn Presbyterian Medical Center.

While it sounds like a bizarre scenario, Harbison was hardly fazed. After all, his connection to the Philadelphia Zoo, and specifically to the gorilla troops, goes back a decade.

“In 2007, the Zoo’s head vet reached out to me,” he recalls. “They’d found that another gorilla had a mass growing on her uterus, and so they asked if I’d work with the [animal care] team for the hysterectomy." Harbison soon became a key member of the standby emergency team. When the Zoo restarted its primate breeding program in 2009, for example, the veterinary and zookeeper staff maintained their relationship with Harbison, giving him plenty of notice about the ensuing orangutan and gorilla pregnancies “just in case,” though fortunately, both progressed without issue.

Given his casual account of these experiences, I asked if we can safely assume that gorilla care has become routine for him at this point. Laughing, he insists that it “definitely doesn’t count as a normal day,” but his longtime association with the Zoo has made him comfortable in the setting.

When keepers suspected 17-year old Kira was pregnant last fall, the Zoo once again reached out to Harbison as a precaution. Andrew Baker, PhD, the Philadelphia Zoo’s chief operating officer, explains in a keeper’s blog post that the veterinary team is “always prepared for scenarios like this” and that they often draw from the expertise of partnered health systems in the city “to optimize health care for our animals.”

On Thursday, June 1, Kira’s handlers finally began seeing the subtle signs of gorilla labor. Gorilla births typically last only six to 12 hours, and they also tend to be rather uneventful. There’s no yelling in pain, no rhythmic breathing techniques, no indication at all that the day is anything other than normal – one moment there’s one gorilla, and the next there are two. Kira, however, was approaching the 24th hour of her labor. She had stopped squatting and stretching her arms over her head – typical behaviors of a gorilla in labor – and instead had become listless, disinterested in food, and appeared ill. When it became clear that the labor was not progressing normally, the Zoo staff contacted the pre-planned team.

“They had called me on Thursday to ask whether or not I was in town because they thought that she’d gone into labor,” Harbison said. “Then I got another call the next morning. They said, ‘Don’t go far. We might need to do a C-section.’”

When Harbison arrived on Friday, he found that Kira had been moved from her enclosure to a nearby veterinary building. Though it was still unclear if a C-section would be required, the team of vets and zookeepers had decided to sedate the distressed and fully dilated gorilla so they could perform an ultrasound. After removing some of her fur (a step that is, you know, not typically required) they discovered the source of Kira’s troubles: the baby was facing the wrong way.

In addition to Harbison, Penn anesthesiology resident Keisha Dodman, MD, and Penn chief surgical resident Reilly Hobbs, MD, MBS, staff from the University of Pennsylvania School of Veterinary Medicine and Thomas Jefferson University Hospital had also joined the group. As the size of the crowd in the OR continued to grow, so did anxieties about the potential C-section. With fewer than 100,000 left in the wild, western lowland gorillas are critically endangered – a fact that increased pressure on the team to ensure that the delivery was as safe as possible for both Kira and her baby. While the mom-to-be would not have been the first gorilla to deliver this way, the keepers knew it would be difficult to keep her sedentary enough to monitor her afterwards. They were also concerned about the recovery process being detrimental to the bonding between mother and child.

Ultimately, it was decided that an episiotomy – a cut made at the opening of the vagina to help with a difficult delivery and prevent rupture of tissues – would allow the team to pull the baby out through an assisted vaginal delivery. After Kira’s bladder was drained, Harbison sprung to action, making a nick in her perineum. Though gorillas have wider pelvises than humans, and the size of the baby compared to the mother is proportionally smaller, he wanted to ensure there was plenty of room for the baby to maneuver.

One firm pull later, there was a squirmy, newborn male gorilla in the room, looking up with polite interest at the pale, masked creatures surrounding him. As the rest of the team worked quickly to clean him (with resident Dodman, the daughter of a vet, cutting the cord), Harbison attended to the Zoo’s newest mother, stitching her up as the baby was gently placed on her still-snoozing chest.

ajabu-gorilla-philly

Over the years, Harbison has delivered a number of emergency babies and has often been called in the case of hemorrhaging. Aside from the fact that his patient was rather hairier and less communicative than usual, Harbison said the situation did not pose too great of a challenge. Gorillas are among our closest relatives (after chimpanzees and bonobos) with 95 to 99 percent of shared DNA, which meant he was able to translate his skills easily. “In terms of the size, the anatomy, the surgical procedures, the tools…you know, it was actually a pretty typical day,” he said.

Still, the sheer coolness of it all hasn’t been lost on him. After all, it’s not every day that “exotic animal surgeon” becomes your temporary job title. “Afterward, I couldn’t stop thinking, ‘This was so awesome! I can’t believe we just did that!’” he said, his voice bubbling with enthusiasm. “It was such a positive, exciting experience. There were a lot of people in that room, and every one of us was just so into it and so happy to be a part of this opportunity.”

Since the delivery, Kira and her newly-named son Ajabu – “miracle” in Swahili, and hand-picked by mom – have been doing well and are inseparable. Visitors can get a glimpse of them, dad Motuba, and their other troop-mates in the PECO Primate Reserve. For more information (and adorable photos), check out the Philadelphia Zoo's gorilla page.

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