Episode 165: Helping with Whelping

Dr. Kristina Belton gives an overview of the whelping process with an emphasis on ways responsible breeders can provide support, as well as techniques to identify when intervention is needed.

This episode is an audio version of a webinar. To watch the video version, click here.

Transcript

Nicole Engelman  00:04

Welcome to the Good Dog Pod. Join us every other Wednesday when we discuss all things dogs, from health and veterinary care, to training and behavior science, as well as the ins and outs of Good Dog and how our platform can help you successfully run your breeding program. Follow us and join Good Dog’s mission to build a better world for our dogs and the people who love them. Hi, everyone, and welcome back to another episode of The Good Dog Pod where we discuss all things related to Canine health research, how Good Dog helps breeders run their breeding programs, and so much more. I'm Nicole, the breeder community Lead here at Good Dog and your host for this week's episode. Today I'm so excited we are joined by our guests Dr. Christina Belton, who is going to be bringing us through an overview of the welding process. And talking about the ways responsible breeders can provide support, as well as techniques to identify when intervention is needed. So I imagine this is going to be super helpful for all of our listeners. So with that, I'm going to pass things over to Dr. Belton to get things started.

Dr. Kristina Belton  01:07

I am so excited to be here. I'm so excited to give this presentation to you all. Helping people with the welding procedure is a huge part of what I do as a veterinarian. And it's really at the core of why I started my blog, which is the well bred vet.com. When I first became a veterinarian, there was a case that came in. It was a terrible situation, the dog should not have been pregnant, right? It was a nine month old mixed breed puppy who had been bred by a housemate and it was a disaster. But the person who brought the dog in was this teenage girl, her parents had refused to come into the exam room with her. And so she was there by herself. And I had done an ultrasound to confirm pregnancy. And after I was like, okay, she's pregnant, this girl looked at me and said, “What do I do now?" And I just had this moment where I was like, I need to tell this girl everything that's in my brain about how to Welp, a bitch and like what to do in case this happens. And that happens. And I just started word vomiting all over her. And her eyes glazed over and I was like, I need more, I need more to be able to help people. And so that was really the origin of Well Bred Vet, of me starting with blogging and creating materials. And so I am super excited that Good Dog asked me to participate. I'm very honored that they asked me to participate in this, and especially that I was able to talk about whelping, because that really is the area that I have spent a lot of time trying to teach people. So we're going to talk about helping with whelping right, so we've got basically three segments. So we have how to prepare for whelping when you as the breeder can step in, to help to assist. And when it's time for you to get help, right, get veterinary help, essentially. So those are the three sections. So we're gonna start off with how you can prepare for wellbeing. If we're breaking it down into the absolute core things, if you are preparing for whelping there are three pieces that I consider the most critical, right? So one is knowing your due date. And we will talk more about each of these. Number two is gathering your supplies and there can be a lot. So we've got some resources to help you with that. And then the third, which I consider essential is obtaining a puppy count. So we'll go over each of those in turn. Alright, first up is calculating your due date, it is so important to know the due date because that is how you will determine Okay, is it fine that she hasn't given birth yet? Or do we need to be seeing the vet or do we need to be worried that something's happening? There are several different methods to calculate the due date. So I know many people that are on here may use calculating from your breeding date. There's also the option or the possibility of calculating from LH surge. LH is luteinizing hormone. Then there is calculating from ovulation. And I'm going to talk about the relationship between those two briefly in just a moment. You can also calculate due date or a veterinarian can calculate due date based on ultrasound, and to a certain extent X-ray as well. So we'll talk about each of these. And I'm going to kind of start with the relationship between luteinizing hormone and progesterone and ovulation. 

Dr. Kristina Belton  04:35

So in a very basic sense, obviously, like I'm super minimizing this and looking at only these two hormones, so luteinizing hormone and progesterone. So at the very beginning, you have luteinizing hormone in green and progesterone in blue. And they both start basically down at baseline. as they're going along. luteinizing hormone will have a peak, and then progesterone rises rises rise And then plateaus later on in pregnancy, right around the time that the luteinizing hormone peak happens, if you're measuring progesterone, progesterone is going to be approximately two nanograms per milliliter. And then progesterone continues rising. And ovulation happens approximately two days later. So you can see on the timeline of days, approximately two days later, when progesterone is going to be approximately five to 10 nanograms per mil. So there's a couple key pieces in that. So the first one is that luteinizing hormone tells ovulation to happen, but it takes about 48 hours before it actually happens. The other thing to know about this is that dogs in particular, when they ovulate, they are ovulating, an immature egg, so the egg cannot be fertilized. Right? When it is ovulated. It takes about another two days, right about another 48 hours in order for that egg to go through its final stages of development and to be able to be fertilized. And so you'll see like ovulation I have here at Day Zero I have marked ovulation as day zero, there are some systems that would do luteinizing hormone is day zero. But the point is that after ovulation, about two days later, is when your fertile period begins. And it lasts for approximately four days, right? With the highest fertility being kind of in the beginning middle ish. Okay, so why am I going into all of this other than the fact that I think endocrinology is really super exciting because I'm a nerd like that. So when you're calculating the due date the most precise way is to know the LH surge and ovulation. Right. So if you're able to use progesterone, and or luteinizing hormone testing, to calculate when those time points happen, you can have a very specific window of when the due date is due date is going to be 63 days plus or minus one from ovulation, or 65 days, plus or minus one from luteinizing hormone peak. And that's a very tight window plus or minus one. So that is the most specific timeframe that we can get if we use that testing. If you are using from breeding date, you'll notice that the range is 59 to 72 days. So the reason that it's such a wide range, technically, from 59 to 72 days, is a couple of different factors. So some bitches will stand for breeding for many, many days, even when they might not be fertile, some pitches won't stand at all. So that's one factor. And then the male factor is part of that range as well. Once semen reaches the female reproductive tract, it can stay viable for up to about six days. Now we don't usually use that when we're actually breeding on purpose, we usually use about 48 hours, but technically, it can still fertilize an egg for almost up to a week. And so if you have no timing, it's a very wide range, essentially, because of those two things that overlap. Now you'll notice that 63 days is in the middle, roughly 59 to 72. And so it's a bell curve. So most of the time, it's around 63 days for breeding, but sometimes it's not. And so, I know that many people out there are probably using 63 days from breeding as their due date. And if you do that, then think that that's okay. I just also recommend having a secondary method like ultrasound or X ray to confirm. 

Dr. Kristina Belton  08:37

So I'm gonna address a couple of the questions. So Meghan asks, Is LH testing part of progesterone testing? Maybe, maybe not. So they're not inherently the same tests. They are testing for two different hormones. And so it would be something that, like they're two separate tests that you would do together. Sheena asks, Would Day Zero be the first day or day before they start bleeding? So in this particular timescale, Day Zero is the day of ovulation, on average, that is approximately day 11 to 13. From the day that they start bleeding, but again, that's average. And so to answer your secondary question, technically, you would not know what day she ovulates without testing for progesterone. So you can also calculate the due date from ultrasound and X ray ultrasound is most accurate, around 30 days when we are able to measure the diameter of the entire sack. But that is another way if you wanted to like we can measure that and then give Okay, based on this and the breeding date putting that information together. This is our estimated due date. And that can kind of narrow your window from the 59 to 72 days, and then x ray. So the puppy's bones ossify in a specific order. And so if you do an x-ray and for example you can see the pelvis that tells you We'll approximate gestational age. It's a question if you only test one is LH or progesterone better to guess breeding date? Progesterone 100%. Progesterone. The reason for that is that luteinizing hormone is a very small window, it often is only like a 12 hour window. And so it's very easy to miss that peak, the LH peak. So progesterone will give you it's more forgiving a little bit because you can get whether, like if you only did one progesterone, which really like when I'm managing a bitch in her breeding management, we usually do every 48 to 72 hours to track her cycle. But even if you only do one, and like on that day, like let's say progesterone is three that helps you pinpoint likely that the LH peak was maybe the day before or an ovulation hasn't happened yet. So it kind of can give you a little bit more. It's progesterone testing only found through blood that is how we do it. Yes, through blood. Would you recommend any tests you can run in house as sending to a lab room slate results. Okay, so once you've pinpointed your due date, you're going to gather your supplies. So I've got a basic list here of some supplies that you might need, I have a document on my website, so on well bred that.com. That's called The Ultimate Guide to building your whelping kit. And so if you do want the full document, it has a written description of each of the things that I recommend and why I recommend them. So that is free to download on my website, if you want the full picture, that whole document. This is kind of a list of what are the most essential things right. Some of these are probably pretty obvious, right? So you need a welding box or an area. It doesn't have to be a prefabricated whelping box, it can be something like an oval bed, there's hundreds of different ways that you can make it work. But the essential things are that it is warm and secure, and provides the female with a place to be safe and 12 safely. Other things are probably exam gloves. If you're managing a whelping at some point you're going to be doing a vaginal exam most likely, I do recommend wearing exam gloves when you're doing a vaginal exam to prevent introduction of outside bacteria into the vagina to try to keep things clean. Have I done a vaginal exam without examples before? Yes, I have. But I do recommend it to try to keep everything as clean as possible. water based lube lots and lots of towels. Something to protect your floor, a disinfectant to keep everything clean, we are going to talk more. So I've got bulb syringes, Delee Mucus Traps. I've found that a lot of people haven't heard of Delee Mucus Trap. Hemostats are for clamping off the umbilical cord. If there's bleeding, you can also use other things. There are clips that are specifically made for clamping off the umbilicus. So hemostats or something that's to clamp off the umbilical cord, medical scissors, suture or dental floss again to tie off the umbilical cord. Iodine or betadine to dip the umbilical cords, gauze and cotton balls to help you accomplish that. A scale that weighs in ounces or grams. This is actually for measuring the puppies weights at birth, and then every 12 hours for several, usually for the first week is what I recommend. If you are not weighing your puppies, that is one of the first things that I will recommend that you start doing. Because consistent weight gain and or lack thereof is one of the most sensitive indicators of whether the puppies are doing well. Id bands or some other way to tell the pups apart. So depending on your breed, if they have a distinct coat pattern, you might not have to have anything, if they have something where the coats are very similar. You can use non toxic like children's nail polish, put a little dab of that on their hind end or whatnot to tell them apart. Or you can use ID bands. There are velcro ones that loosen the caution with ID bands to make sure that they don't get caught anything and they don't cause a risk of strangling the puppy heating implements. Again. Another thing that we're gonna talk more about people to help you is always very helpful. So if you have friends or neighbors or a mentor that can help you with the welding process that is always great. The basket or box is part of what I consider your emergency kit. So let's say that two puppies have arrived, you know that there are some more in there, but things aren't going well. So you have to go to the vet in an emergency situation. Your basket or box is going to be there to help transport the puppies that have already been born. And the last thing that you want to be doing in you know it's probably going to be three in the morning and you're going to be sleepy and you're trying to find a basket or box so just Have your emergency plan ready from the beginning? A thermometer for rectal temperatures, a thermometer for the room temperature calcium sources, which I did see a question fly by about recommended calcium sources. And we are going to talk more about those a little bit later. So stay tuned for that. And then a couple other things right your vets number on speed dial. 

Dr. Kristina Belton  15:19

I know that there are many of you that are probably a long distance from your reproductive vet or maybe there isn't one in your town or there isn't one even a close distance. But if you are able to have your vet in the loop, I always find it really, really helpful. When my clients just let me know like, hey, like, I don't think I'm going to need any help. But I just wanted to let you know that she started stage one labor, right? I really appreciate that. Because then I know if I don't hear anything else, the next day to check in and say hey, everything go okay. So keeping that communication going is really awesome.  Vehicle with full gas tank again, in case you need to leave for emergency, I saw some questions about the coffee, and the ice cream. So the coffee is for the breeder. It's for the human, not for the dog. But the ice cream can be for both you and the bitch I do recommend vanilla for her. Whatever flavor you want is fine, but keep it kind of like plain vanilla. If she does okay with dairy. And then the last few things on there are other things that are I do have templates for again, on my website, the emergency flowchart, we're actually going to go over later on in the presentation. And the letter whelping record, I do have a template of that. But essentially, that's just whatever method you use to record information about the individual puppy, so tracking their weights is the most important thing, but also noting any other abnormalities or any other problems. So these are my couple like separate things. So Delee Mucus Trap, if you have not heard of them, this is a suction device, you can use a bulb syringe for suction as well. However, I have personally found that the Delee Mucus Trap is more thorough. So essentially what happens is, the small end goes into the puppy's mouth, right and into their respiratory system, the other end goes into your mouth. And so you stuck on the one end, and it causes a vacuum in the little tube. And then it's suctions all of the poop and mucus out of the puppies respiratory system, the same way that a bulb syringe would I have found, I've had a couple of cases where we've bulb syringe puppies and they're not really responding then we do a mucus trap and then all of a sudden, they are pink and screaming. And so I have become a believer in the chili noodle strap. Okay, and then I wanted to spend another minute talking about heating implements. There's so many different ways that you can keep these puppies warm, right, and they all have pros and cons. So I put a couple of different things up here. So we have the first one on the side that looks like a chocolate chip cookie called the snuggle safe so it has this pink disc on the inside. You microwave the disc and then you put the little cover over and then it stays warm for quite a while. Heating pads, I do absolutely recommend that you have one with an adjustable heat on them like not just one heat and that you almost always keep it at low. There's very few situations where I will put it higher than low unless I have multiple towels on top of it because puppies are very prone to getting burned. And so if you have a puppy that gets stuck in the middle of your heating pad, they very well could get burned if the heating pads on too high. And again, this should be like under the towels right? So you want a warm environment, but you want to have protection between the thing creating the heat and the puppy itself. We have the little rice sock down here. So if you are stuck in a pinch, for some reason, you can put just plain regular white rice in a sock, tie it off, put it in the microwave, microwave it, it will keep pretty well. Again, same thing you want to make sure that you are protecting the puppy and make sure that they are not getting too hot clamp on heat lamps. These make me really nervous but I have seen them used very effectively. The biggest thing that you need to make sure is I don't trust the clamp. I always want to see it secured by some type of secondary means right whether it's a zip tie or another way of attaching but the last thing you want is a heat lamp falling and getting bumped and then falling on top of a puppy. I know that there are lots of people that use them and I have seen them used effectively but just be very careful. And you do want to make sure that the heat lamp is, if you are using one, only on one corner so that there's a gradient so that the puppies can wiggle closer or farther away depending on how warm they are. So yeah, one of my really good friends breeds miniature toxins and she uses them on hers too. And like everything's like she's been totally fine, but does have like a secondary clamp to make sure that it doesn't fall. And then the thermometer so for these room thermometers, I love the thermometers that have this like, extendable probe, so you can put it on the wall or wherever, and then you can have the room temperature. And then you can also have the probe down like under the first layer of blankets. And then you can have information about the temperature like at Puppy level so that you know exactly how warm it is the whole room and then also at Puppy level. Yes, Tammy the water and a surgical glove and he in the microwave, I almost put that one on here. But then I stuck with the sock instead. But yeah, that is also a great method that we use at the hospital a lot if we need extra heating implements. 

Dr. Kristina Belton  20:53

Okay, and then your last part of preparation is obtaining your puppy count. So my recommended method for doing that is having a puppy count X-ray. I really think that these are essential because it lets you know how many puppies are in there. So you know when she's done. This photo is actually from my good friend who breeds miniature toxins. This is a large litter for a miniature dachshund, I think the largest litter that she's had in years. And so if she hadn't done this X-ray ahead of time, then she might have thought, you know, it was done at, you know, like, most of her letters are like three to five, like five is like Ooh, got a big letter, but she might have felt that she was done. Now granted, she's an experienced breeder and she knows to like palpate the abdomen and feel. But it's really helpful to see there, there were seven, the final number of puppies that were in this litter. So the public count extra, I do recommend doing it at about 56 to 58 days, you can see skeletons starting as early as 45 days, that is when they start ossifying but they are not consistently ossified at 45 days, and you are not going to get an accurate count that early. So you want to wait pretty close to the due date because the closer you are obviously like, the brighter, the skeletons will show up. And then my other tip is I do recommend now, my friend did not actually do this in this photo. So you can kind of see like along the top there's you can see your colon with poop in it. I do recommend that the witch be fasted the night before. And then encourage her to poop in the morning so that you can try to have as little poop in the picture as possible. There's so many times I can't even tell you how many times when we're staring at it and we're like, is that a puppy? Or is that just a pile of poop? I don't know. So having minimal poop is helpful. So I'm gonna go back to Sheena's question about X-Rays when humans are pregnant, they can't have an x-ray. How do we know X-Rays are safe for the pups? This is a great question. So we have relatively limited data about this right? It's very difficult from us designing a study standpoint, to know, you know, this bitch had X-Rays, and then did the puppies like we just don't have that kind of data at this point. That being said, it unfortunately comes down to the average life expectancy of a dog. So in humans, we don't do X-Rays in pregnant humans, because we anticipate that a human will live 80 something years in dogs, they're not going to live 80 something years. And so the amount of X ray exposure, in most cases, I only do one view. And with digital X Ray Now, the amount of radiation that is exposed is a lot less than it used to be with the manual X-Rays. So the amount of exposure of radiation exposure that happens while taking this picture is minimal. We don't have any evidence that it causes problems. Now granted, we again, we don't have good studies showing either way. But because their life expectancy is not anticipated to be long enough to make a difference. So how often is the X ray count at 52 to 54 days off by a puppy or two? Super depends on the litter. So X ray, if you have a big litter and you have lots of puppies on top of each other, it gets more complicated. It gets harder to see the skulls. I do try to wait like I said 56 to 58 so that we have the least chance that we can. So how often I mean, I don't know statistically speaking like how often I would say it's not super uncommon, but that's why I kind of like to wait as late as possible. Sheena, how accurate is ultrasound puppy count not very accurate at all. So ultrasound basically we can either say with an experienced ultrasonographer right so like when I'm doing pregnancy confirmation ultrasounds. I'm usually accurate within one to two if there are like five or fewer, but especially if the litter is larger than five. There's so many puppies on top of each other, ultrasound is not a good way to account. So all we can really say is, there are multiple.

Dr. Kristina Belton  25:07

So when to step in, I am definitely of the school that we want to allow her to do as much as she will on her own. And that is variable, right depending on the individual bits. So, my own border collie has no interest in being pregnant and does not want to do anything on her own. Some are obviously completely independent, and will do as much as they can on their own. And then, in general, if she is resting comfortably, she's not pushing, and the timeline is safe, which we'll talk more about what that means in the like when you need to go to the vet. Like if it's been between puppies, and it's safe, like, let her rest, labor and delivery is a marathon, not a sprint, for sure. So we're gonna go through a couple of different scenarios of something that could be happening, and then some interventions that are safe for you to try at home. Scenario number one is she's not pushing, or she's having only very weak contractions. And this is in the timeline she should be pushing. So again, the timeline of the normal, she shouldn't be pushing, and she's not. So what we can do in this situation is an intervention that's called feathering, I'm sure many people have done this before. But essentially what this does is this takes advantage of a reflex. It's called the Ferguson reflex. But essentially, the idea behind the Ferguson reflex is that in the birth canal, there are pressure sensors that have a positive feedback loop. So once the baby, whichever species it is, this is true in humans and horses and cats, like pretty much everything. Once the baby is in the birth canal and is causing pressure on the walls of the birth canal, it sends a message to the brain to send a message to the uterus to squeeze harder, right? Because it's like, hey, the baby's in the birth canal, you got to get that thing out. So they'll feel the pressure in the birth canal, and then it squeezes. So you can simulate that by doing feathering. So basically, what you're going to do, again, I do recommend wearing exam gloves when you're going to be doing a vaginal exam. But with your example of you're going to move your hand into the vagina. And then once you have your finger and or fingers, depending on how large of breed you're talking about, you can do what's called a competitor motion, right? So, it's like, come here, right? So you're basically trying to stimulate that area on the top of the vagina to stimulate that Ferguson reflex, you don't always have to do like exactly the computer, you can just kind of rub the area you can depending again on the size of the breed, you can hold your hand in there, you can, you know, whatever you need to do. This is the first intervention. Feathering stimulates the Ferguson reflex, it will cause the uterus to have more contractions. And so you should Yes, roll it around, whatever it takes. And so you should start to feel her push against you. If you're doing this, and you do not feel her pushing. That is a problem. So scenario number two is you do your vaginal exam, and you can feel a copy at like the tip of your finger. You're like I can feel it in there. But I can't cook it, I can't grab it. And then like maybe you wait 10 minutes, and then you test again. And you feel and you can still feel at the tip of your finger hasn't moved anywhere. Maybe she is pushing, but it's just not getting closer. So a lot of times when this happens when you know that there's a puppy right there, but it's just not quite in the birth canal. There is something going on that is a misalignment of the relationship between the bitches pelvis and the puppy. And so the first thing that you want to try is to do whatever you can with those three different interventions to talk about here to try to change that relationship between the pelvis and the puppy, right and the puppy's body. So first thing, you might take her for a brisk walk. Alright, let her go out, let her go pee, get things moving around. And you know, let her try again. That's option number one. Option number two is called the wheelbarrow, which as it is actually named, you stand the bitch on her four limbs, you can put her hind legs on a chair up the stairs, you can hold her whatever you need to do. The idea behind this position is that you are hoping that the puppy or puppies, the gravity will kind of pull them forward in the abdomen, which again will allow a rearrangement of the alignment between the pelvis and the puppy so that they can come at it again. So basically when the puppy comes to the edge of the birth canal again, hopefully things have moved round enough that they can come out. Then the last one is called the woods maneuver. So this one is one which is a little bit hard to draw. But so essentially what you're gonna do is you're lying her on her back, you take her rear legs, you move them apart, and then kind of fold them up towards her head. And so basically what you're trying to do is you're trying to expand her pelvis, and basically like, opened up her pelvis more so that hopefully, if the puppy is stuck on the pelvic brim, again, the relationship between the pelvis and the puppy changes, and they can get over the pelvic rim. And people aren't, there's a really cool YouTube video of the woods maneuver. If you just YouTube search, once maneuver, there's a great video of it on there. And then we're gonna go to the next step. Okay, so scenario three, is you do your vaginal exam, and you can feel part of the puppy is in the birth canal, right? So you can feel the puppies head. Or maybe you can feel the head and a limb, or you can feel, yes, some combination of the property that is actually in the birth canal, but the puppies are not coming forward. So you check again, in 10 minutes, that puppy is still there, it's still in the birth canal. One thing that is worth talking about is if the puppy is far enough, along in the birth canal, that you are able to gently grasp the head, something like that, you can help move the puppy forward, it's a little bit risky, because it's very easy to pull too hard and cause injury to the puppy. But especially if she is pushing, you can help, you know, maybe add some more lube in there, and help the puppy come out if she just needs a little bit more traction. So that's one thing. But let's say that that is not working, even if you do the kind of attempt that can't get the puppies head to come forward. So you're going to do the same techniques that we did for Scenario two. But the first technique that you're going to do is retro pulsing the puppy. So this is a little bit counterintuitive. But essentially, what you're going to do is you're going to take that puppies head. And again, with your gloved hand, you're going to push the puppy back into the abdomen. So you're going to push them out of the birth canal and back into the abdomen. And so the idea behind that is if the puppy is jammed, then the idea is that you're going to try to put the puppy back into the abdomen so that when they come out again, maybe they'll come out perhaps the head and like one leg was out, right, and then it was stuck on the shoulder. So if you push them back in, then they might be able to come out with both feet forward and actually make it out the last litter that my own vich had her first puppy, I did this on and it worked like magic. So those are different little scenarios on how you can intervene. Other ways that you can support her during this welding process. So oral calcium, so giving her calcium by mouth, there are a lot of different forms, the ones that I use in a veterinary setting either counselor or a cow plus just depending on what isn't on backorder and what's available. You can also give Tums and then ice cream and yogurt. I know that some people like to give ice cream and yogurt. And those are fine. Keep in mind that they actually, I mean, they have calcium, but they don't have that much calcium. And some dogs have lots of diarrhea from dairy. So just know your female on whether or not they're going to handle that. And then also providing her with glucose and electrolytes. 

Dr. Kristina Belton  33:31

Again, whelping is a marathon, not a sprint. And so you want to be able to provide her with either neutral cow or puppy food giving her Pedialyte for electrolytes. The ice cream obviously does have glucose, but try to keep her body supplied with calcium. Calcium is an important component of enabling strong uterine contractions. So that's why you want to make sure that she has a good calcium supply. And then I have on here help with puppy cleaning and resuscitation. So this lecture specifically is not about puppy resuscitation, so I didn't go too far into that detail. But I have you know, rubbed vigorously suction airways tie off umbilical cord. So I'm focusing more on hers.

Dr. Kristina Belton  34:14

Okay, when to seek veterinary help. All right. So I've got a couple different things. I have this flowchart that I have made to kind of help work through when it's too long. And so we're gonna go through the flowchart. The short version is that these are the things that are concerning to me. So if at any point she's showing weakness, she's showing mental changes where she's not mentally appropriate. She has bright red green discharge, dark green discharge before any well, like any puppies have been born more than 68 days since breeding, if she is actively pushing, actively pushing more than 30 minutes, if there's been more than two hours in between puppies, which I'm going to talk more about that specific thing as we're going through that aren't. And then if she's in labor for more than 12 hours. So on this flowchart, you're going to start at the start here. And so obviously, like, if any of these initial things are wrong, you're gonna go to the vet now. If not, then is she actively pushing? If she's actively pushing, how long has she been actively pushing? If it's been more than 30 minutes, I recommend having her evaluated by the vet. And this includes like, like, let's say that she has been actively pushing. And maybe you've done a couple interventions, and she's still pushing and nothing is progressing. That's when you would want to go to the vet, if it hasn't been 30 minutes yet, then you're going to look at how long has she had a puppy yet has she not had a puppy yet. So anytime she's actively pushing, or we're looking at 30 minutes, if she's not actively pushing, if she is resting comfortably, not stressed, not pushing, then I'm fine with her resting for two hours, I used to say, four hours. So this number used to be four hours for me. The reason that I changed it to two hours in my flowchart is because there was a study that I believe was out of Cornell, that showed that if the time between puppies extends more than two hours, then overall fetal mortality increases, and survival was still 63%. And so like in nature, it is very normal for dogs to go more than two hours in between puppies. But in nature, dogs are litter bearing species because they're anticipating a 10%, or possibly more mortality rate in the litter. That's why dogs are litter bearing species because they are evolutionarily anticipating the loss of some puppies. I don't want to lose puppies. So I don't like for her to wait any more than two hours. The other reason that I think that updating it to two hours is really helpful is that if my breeder client is waiting two hours, it's still going to be probably at least three hours before I get to help intervene. Because we have to pack up the bitch, pack up any puppies that are born, put them in the car, drive to the clinic, do the intake. And so it's usually been at least an hour before all of that has happened. And worst case scenario, there's probably more in the car with the bumpy road protocol. And so that can definitely be an okay thing. I would rather have people on their way to meet than not. So if you're trying to make that decision, do I need to go to the vet? Do I not need to go to the vet? It just kind of depends on Are you okay, with losing a puppy? And the answer may be yes, or maybe no. And it's just a very individual thing for each person. And then has she been in labor for more than 12 hours. This is again, indicating like the overall time that she's in labor also, again, increases the risk of copy mortality. And so if she's been laboring for 12 hours, like, let's just give her a break and let her be done is kind of my standpoint on that, because if it is martial arts, we lose puppies. Okay, so this flowchart here is on my website, as well. Okay, so that is the end of my presentation. And so I think we have just a couple minutes for some q&a. I know that there have been a ton of questions, and I want to answer them all. But I know that we don't have time to do that. So maybe, Mikel, if you guys want to do a curated question and answer.

Mikel Delgado, PhD  38:31

Yes, we have done our best to go through the I mean, it's so great to be engaged. It was a fantastic talk, by the way. I laughed a few times when appropriate, and enjoyed learning a lot. And I look forward to a couple of questions for you but we are close to the end of our session. So we'll just do a couple. We, of course, always get calcium questions, and we got a few today. So we've got one question, which is if a dog was fed a great diet, they don't need calcium supplements. Is this true? And then we also get a question, Should you get extra calcium before labor?

Dr. Kristina Belton  39:03

Okay, great questions. So if she is fed a good diet, she does not need additional supplementation of calcium during pregnancy. And in fact, it can be very dangerous to supplement calcium, because it can create a negative feedback loop where her body does not respond correctly to normal physiological amounts of calcium. So before whelping right during pregnancy, I do not recommend I absolutely destroy recommend supplementing calcium and having her on a general all life stages or puppy food to support her but no additional calcium supplementation when she is actually in labor, then in that case, oftentimes it is helpful for her to have calcium supplementation. And the reason for that is that the process of labor burns through her calcium. If our calcium runs low, we're not going to have strong uterine contractions. And there are also some differences if you get really low calcium, you can have some mental changes as well. So during labor, yes, I typically do like a dose of oral calcium between like after each puppy. But providing her with calcium support during is helpful. And then what was the other part of that question? 

Mikel Delgado, PhD  40:27

Whether or not they should only wait, if there's a delay? 

Dr. Kristina Belton  40:30

Okay, yeah, by default, I would provide calcium during labor. Anytime that there's a delay, I'm going to default to that flowchart that I have. So I don't think that it's appropriate to just supplement calcium instead of seeking care if that timeline is off according to the flowchart. 

Mikel Delgado, PhD  40:49

Yeah, the flow chart is a great resource, everyone should print it out in their whelping area and refer to it. Okay, we got a couple of questions about progesterone testing. One person asked if my vet does not do progesterone testing, what day would you start testing, if it takes an average of 24 hours, I guess that means it takes 24 hours to get the results back.

41:11

I recommend that we start progesterone testing around day seven, day seven from when she came into heat. And typically I recommend day seven, regardless of whether you're doing in house or you're doing send out, it does kind of make a difference on what the semen is like, is it live cover? Is it frozen? Is it being shipped? Like that kind of changes my answer slightly, just that like, if you're using live cover with a male that's proven, you have a lot more give, and it's a lot easier to do. So now testing where the turnaround time is going for hours.  Yes, it's day seven from the first sign of bleeding.

Mikel Delgado, PhD  41:57

We got a couple of questions about what to do if the sac was ruptured? Can you just address that real quickly? Like what that means and to people?

Dr. Kristina Belton  42:07

You should never panic. So panic doesn't help. Yeah, it's definitely panic. Where are they? So if the stack is ruptured, the puppy really does need to come out, like ASAP. And so for example, like if the sack is ruptured, I might be a little bit more aggressive than I otherwise would be about trying to reach into grab the puppies head to like help maneuver the puppy out, adding more lube. So don't panic, but also do whatever you can to get the puppy out quickly. Because once they're no longer in that fluid sack, they are going to start trying to breathe, and you want them to not be inside her when they do that.

Mikel Delgado, PhD  42:46

Great, thank you. Okay, we are over time, I want to say thank you again to everyone who attended and for some fantastic engagement. Really nice to see so many questions and positive comments. I hope you all love Dr. Belton's presentation as much as I did. And I want to go over a couple things real quick, again, thanking our sponsors, Microchip ID system, Paw Print Genetics and Revival Animal Health. I think this content has been amazing. So happy to have Dr. Belton here. Going to be back again. Thank you. Thank you. Thank you. 

Dr. Kristina Belton  43:18

You're very welcome. Thank you so much for asking me to do this. I had a great time.

Mikel Delgado, PhD  43:22

Good everybody go to wellbredvet.com to see Dr. Belton's amazing content, because there's lots of great stuff there.

Nicole Engelman  43:28

So that wraps up this week's episode of The Good Dog Pod. We hope you learned a lot from this episode and that it's going to be a helpful resource for you, your breeding programs and most importantly, your dogs. Thank you again for tuning in. And we'll see you right back here on June 12 For our next episode. Thank you for listening to the Good Dog Pod. We'll be back in two weeks with another episode so be sure to subscribe to the Good Dog Pod on your favorite podcast platform.