The ABCs of C-Sections
What is a C-section?
A C-section, or Cesarean section, is an operation done either as an emergency or electively scheduled surgery to deliver puppies from the uterus of a pregnant female. Breeds that have trouble delivering puppies naturally or bitches that have had problems with previous litters usually opt for C-sections performed just before the time they are ready to give birth. This can eliminate a difficult labor and the loss of puppies.
C-sections are also done as emergency surgery when the bitch is unable to deliver the puppies. The term for a dog having trouble giving birth is dystocia. Dystocia happens for a number of reasons. The puppy may have a birth defect or be too large to fit through the birth canal. The puppy may not be in the right position within the birth canal — forward or backward (breech) is usually all right, but when they get wedged sideways, they are unable to advance.
A blockage of the birth canal will result in dystocia. This may be caused by a dead puppy or an old fracture of the pelvis. Uterine inertia is when the uterus does not start or stops contracting, and the puppies are not delivered. Problems with the uterus, including a tear in the uterine wall or too much or too little fluid, will prevent the bitch from whelping normally.
Why is it important?
Labor that is not able to proceed normally can result in the death of the puppies, and even the mother herself.
The placenta is the sac attaching the puppy to the mother’s uterus. The puppy receives oxygen from the mother’s blood. When the placenta separates from the uterus, the puppy needs to come out and start breathing oxygen from the air as soon as possible. A Cesarean section can be an emergency, life-saving operation.
Why is it called a “Cesarean”?
The term “Cesarean” is believed to be derived from the surgical birth of Julius Caesar. However, this seems unlikely, since Caesar’s mother lived to an old age. At that time, the procedure was performed only when the mother was dead or dying as an attempt to save the child. Roman law decreed that all women who had problematic childbirths must be cut open to deliver the child, and this became known as “Cesarean” birth.
Other possible Latin origins include the verb “caedare,” which means to cut, and the term “caesones,” which was applied to infants born by surgery after their mother had died. This was a measure of last resort, and the operation was not intended to save the mother’s life. It was not until the 19th Century that medicine improved to the point where both the mother and the baby could be saved.
What is the risk?
If the placenta separates and the puppy is not delivered in a timely fashion, the puppy will die from lack of oxygen. Puppies that die inside the mother can cause a serious, potentially deadly infection in the uterus. Dystocia is an emergency that requires immediate medical assistance.
A Cesarean section also has risks. When the veterinarians put the mother under anesthesia, the puppies are still attached to the mother’s blood supply. The puppies may be affected by the drugs given to the mother to sedate her. It is important for the veterinarians to use certain anesthetic protocols that will safely anesthetize the mother for surgery without depressing the heart rates and breathing of the puppies.
What happens when I take my dog to the veterinarian?
Your veterinarian will examine your bitch and try to determine why her labor is not progressing. He or she will check to see if any puppies are stuck in the birth canal by inserting a lubricated, gloved finger into the vagina. If the bitch is shaking, trembling or confused, she may be showing signs of low blood calcium. Your veterinarian will check her blood-calcium level and administer an injection of calcium if needed.
A blood test to measure the level of progesterone can be run. Progesterone is a hormone that maintains pregnancy. It rises during ovulation and stays elevated for nine weeks whether the bitch is bred or not. When a pregnant bitch’s progesterone drops to 2.0 ng/dL or lower, labor should start in 12 to 24 hours. When the progesterone level is 2.0 ng/dL or lower, it is safe to do a C-section without risking premature puppies.
Sometimes a maiden bitch who is delivering her first litter, or a bitch who is trying to deliver a large litter, will become tired, and the uterus may need help to continue contracting and expel the puppies. In this case, the veterinarian will give an injection of oxytocin to help stimulate contractions of the uterus.
An ultrasound examination of the puppies in the uterus can be performed to determine if a C-section is necessary. If everything is normal, the puppies’ heart rates should be roughly twice the mother’s heart rate. If the puppies are showing signs of stress, their heart rates start to drop, and an emergency C-section is indicated.
How is the surgery performed?
A Cesarean section is performed under general anesthesia. The bitch is started on intravenous fluids and given a sedative that will not cross the placenta and sedate the puppies. Propofol is the drug most commonly used for this step. The patient is then intubated and placed on an inhalant anesthetic for the surgery, usually isoflurane.
The pregnant mother is prepped for surgery. The surgeon makes a large incision on the center line of the belly and carefully lifts the uterus out of the abdomen. The uterus is a Y-shaped organ with puppies attached to their placental sites on both uterine “horns.” An incision is made into the central “body” of the uterus, and the puppies are milked down each horn and delivered one by one.
At this point, it is “all hands on deck,” and the veterinary technicians will take the puppies out of their sacs, tie off the umbilical cords, remove the fluid from the puppies’ airways with a soft, rubber aspirator, and gently rub the puppies with towels to stimulate them to take their first breaths.
Once all the puppies have been removed, the uterus is sutured closed, replaced in the abdomen, and the abdomen is sutured closed. The hungry newborn puppies can be bottle-fed while the mother recovers from the anesthesia. Putting the puppies with the mother too soon can be stressful for the bitch and she may harm the puppies. It is best to wait until she is awake and relaxed before attempting to nurse the puppies. Good pain medication is also recommended.
If a bitch has a C-section for one litter, will she always need one for future litters?
This depends on the reason she needed the C-section. If she had a very large singleton puppy, she may not need surgery if her next litter has multiple normal-sized puppies. When the pelvic canal is too small to deliver puppies naturally, as is the case for most French Bulldogs, the bitch should have a scheduled C-section before problems develop.
If the mother had uterine inertia in which the uterus was not contracting strongly enough, then she will most likely need a C-section for future litters. A puppy that got stuck sideways and required surgery to remove would probably not happen in subsequent litters. However, breeders know every litter is different, anything can happen, and you need to be prepared. A Cesarean section, whether scheduled or emergency, is an expensive procedure that not all veterinarians are equipped to handle.