Caesarean section

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What is it?

A caesarean section, or C-section, is an emergency operation required when a female dog is having difficulty giving birth, a situation known as dystocia. Dystocia happens for a number of reasons, including:

  • A puppy with a birth defect
  • A puppy that is not in the right position within the birth canal (forwards or backwards usually OK, sideways is not)
  • Puppies that are too large to fit through the birth canal
  • A blockage of the birth canal, for example a dead puppy or an old fracture to the pelvis
  • First time breeding females may become tired (uterine inertia) during labour
  • Certain breeds have an unusually steep pelvic floor, for example Bulldogs
  • Problems with the uterus, for example a tear, or too much or too little fluid

  • Why is it important?

    Labour that is not able to proceed normally can result in the death of the puppies, and even the mother herself. When the placenta (the sac attaching the puppy to the mother's uterus) separates, the puppy needs to come out and start breathing oxygen from the air as soon as possible. A caesarean section is an emergency, life saving operation.

    What is the risk?

    If the placenta separates and the puppy is still inside the uterus, it can drown. Puppies that die inside the mother have a high risk of causing serious, life threatening infection inside the uterus. A mother that is having trouble giving birth should be seen by your vet as an emergency.

    A caesarean operation is not without its risks. When the vets put the mother under anaesthetic, the puppies are still attached to the mother’s blood supply and they are affected by the anaesthetic drugs. For this reason they will work as quickly as they can to get the mother under anaesthetic and ready for surgery.

    What happens to the dog?

    Your vet will examine her in the clinic to try and work out why labour has stopped. Often, they will perform a physical examination, and check for any puppies blocking the birth canal by inserting a gloved finger into the vagina. If the bitch is showing signs of low blood calcium (shaking, tremors or confusion) they will check her blood calcium and if needed give her calcium directly into her vein. Sometimes a bitch who is pregnant with her first litter will become tired and the uterus needs help to contract and expel the puppies. In this case, the vet may give a hormone called oxytocin by injection to help her with her contractions, and perform an ultrasound scan to check the puppies and decide if a caesarean is necessary.

    How does the vet know what is going on?

    They will perform an ultrasound scan to check the puppies in the uterus. This is done to check that their hearts are beating strongly and they are not showing signs of stress. The puppies' heart rates should be roughly twice the mother's heart rate if everything is normal. If the puppies are showing signs of stress, their heart rates start to drop, and an emergency caesarean is indicated.

    Sometimes, X-rays may be needed as well. This is because it is very hard to get an accurate count of puppies inside the womb using the ultrasound scanner. However, at this stage of pregnancy, a single X-ray won’t harm them and will tell the vets how many puppies there are to come out.

    What can be done?

    A caesarean section is performed under a general anaesthetic. The vet will give the mother an anaesthetic, prepare her for surgery and she is moved to theatre. They will then carefully enter the abdomen and bring the uterus to the outside. The surgeon makes a cut into the uterus and removes the puppies one by one. At this point it is all hands on deck, and the nurses will help by removing fluid from the puppies' airways, and gently rubbing them with towels to stimulate them to take those vital first breaths. It is always a very special moment as a surgeon to hear the first calls of the puppies as they make their way into the world. They are reminding us that they need their first feed as soon as possible after birth.

    If the mother is to have another litter of puppies, they will place stitches in the uterus to close it and stitch up the surgical wound. If she is not to be bred again, the vet can spay her by removing the uterus and ovaries at this point, before closing the surgical wound. In either case, the vet will make sure she receives pain relief before she wakes up so she isn’t too uncomfortable to care for the pups. Finally, they will let mother and pups bond as soon as she is awake from surgery.

    How can I protect my pet?

  • Consider carefully whether you are equipped to breed a litter. A caesarean section is an emergency operation and it involves a significant cost, especially if needed in the middle of the night.
  • Be prepared for labour – have a comfortable whelping (birthing) box where the mother can make her nest, have lubricant, towels and a hot water bottle ready.
  • Be aware of the signs of a problem – forceful straining that does not produce a puppy within half an hour, green vaginal discharge but no puppy appearing, more than 2 hours between puppies, bloody or foul smelling vaginal discharge, visible blockage of the birth canal, or if the mother is very depressed or lethargic
  • Have your vets’ emergency number to hand – they will always be happy to advise if you have any concerns during the birthing process.