The Stages of Labor in Dogs with Dr. Hutchison, DVM
In this webinar, Dr. Hutchison, DVM will walk you through the stages of labor in dogs, from early signs of labor to whelping progression.
Transcript
Cat Matloub [0:02] First of all, thank you so, so much everybody for joining us today. We are just absolutely over the moon to be back here with our favorite webinar guest—sorry, everybody else!—Dr. Hutch to talk about the stages of labor. I won’t talk too much because I know we’re all eager to dive into things with Dr. Hutch. A couple of shoutouts, just things to note: One is we’ve been getting targeted by scammers going after our ads on Facebook about this event, so everybody, we never ask for credit card information. We never ask for bank account information or any other financial information to attend these events. So if anything is doing that, please don’t click on it. That’s it. So, welcome, welcome, welcome to our Good Breeders. Welcome to folks who are not yet in our community; we’re thrilled to have you join us and encourage you to check out GoodDog.com/join if you are interested in more amazing events like this. Without any further ado, I turn it over to Judi and Dr. Hutch.
Dr. Judi Stella [1:14] Good afternoon, everyone! As Cat said, we’re very excited to welcome Dr. Hutchinson, world renowned canine reproduction veterinarian and, lucky for us, a Good Dog Expert Advisor. He’s here today to talk about the stages of labor. We’re going to leave plenty of time for questions, so please put your questions in the chat or in the Q&A and we will get to as many as possible in the time that we have. With that, I’m going to turn it over to Dr. Hutchinson. If you could please just walk us through the stages of labor, things that breeders should be looking out for, both normal and abnormal. Take it away!
Dr. Robert Hutchinson [1:54] Thank you. It’s good to be back again. First of all, I want to start by saying hello to all my friends I’ve known who have been to my seminars. A number of you have been on the cruises where I spoke—just all a great friendship. I guess for those of you I haven’t met, I have something to look forward to. I just wanted to greet everybody today. I’m going to put my thinking cap on here so that we can go ahead and talk about labor today. Let me preface this. Maybe one of the things that’s motivated me in my life: I remember as a young veterinarian, I was at a veterinary meeting, and a representative from the American Kennel Club at the time was speaking. He was talking to veterinarians and saying, “You have to let breeders know that they get a litter because they should expect to lose some puppies.” I thought: Man, that’s different than what the people I deal with want to talk about. So then I went and did some studying. There’s been numerous studies, and the last one was done at Louisiana State University, that prove that almost 25% of the puppies that reach term aren’t alive at 6 months of age. It just blew my mind, because it seems like that shouldn’t be factual. But the number one cause of lost puppies is nothing more than prolonged labor. The uterus getting tired, the puppies not getting out through the birth canal. Many times, breeders will say, “I don’t even bother to do necropsies on my puppies when they were born dead, because you never find anything.” That is probably factual because there probably is nothing wrong with that puppy. That puppy on the bitch’s side of the pelvis was a healthy puppy. The puppy was ready to be somebody’s pet, ready to be somebody’s companion. But because there had been 8 puppies ahead of us, the uterus got tired. Maybe this puppy got his shoulder first. These are some of the things that we want to talk about, not only understanding the stages of labor but by understanding the stages of labor, hopefully we can intervene so that we can start making the percentage come down. As I look at these puppies, the main causes of puppies being lost at birth—number one is the puppies being stuck, the uterus getting tired, things like that. Second of all: we need to be sure that the puppies are ready to be born, that’s if we were planning on doing a C-section or you have a breed that needs a C-section. Back in the old, old days where we used to try to plan them based on breeding days—we now know that breeding days have nothing to do with the due date. Now that we do progesterone testing, both to know when the bitch ovulates—and remember, the bitch’s due date (and I think we said this before) is 63 days from the day she ovulates, not the breeding date. Breeding date has nothing to do with due date, other than you have to breed them to get the puppies, of course. As we start to look at this bitch, and she’s pregnant and you’re looking at your bitch right there beside you now that’s due Saturday or Sunday, you’re saying, “What’s keeping those puppies alive in that bitch? Are they just running around finding things to eat? What keeps the puppies alive in the uterus?” There’s really two major factors. One is the blood supply to the uterus from the bitch. It’s interesting that a pregnant bitch actually has a higher blood pressure than a non-pregnant bitch. Therefore, the body is geared up to be pumping oxygen, pumping blood through the placenta and into the uterus to get the puppies’ oxygenated. The other thing that keeps the puppies alive in the uterus is their heart rate. They do not have the ability for their blood vessels (as adults do) to constrict and dilate to control blood pressure and blood flow. Basically what you have keeping that puppy alive in the uterus is the blood pressure pushing that blood through the placenta, into the puppy, in this tiny little pump and this puppy’s heart just beating away at 200 times a minute. That’s what keeps the puppies alive.
As we’re talking about stages of labor and successfully getting more alive puppies, two of the big things that we have to be aware of is 1) You would never do anything to the bitch that would lower her blood pressure. What would lower her blood pressure: tranquilizers, so if you’re going in for a C-section, you would hope your veterinarian wouldn’t pre-treat with some tranquilizer or something. Bitches that actually would have some type of blood loss or something—anything that would lower the blood pressure to the uterus suddenly jeopardizes the puppies. From my standpoint, where I live, that ultrasound is just invaluable because if you bring in a bitch and you say, “Geez, she’s had 3 puppies. It’s been a couple of hours.” (We’ll talk about what my criteria are in a minute.) “Do we need to run into a C-section?” One of the first things I’ll do is I’ll put the ultrasound on the puppy’s heart—not the bitch’s heart. We’re actually looking at this little, tiny pump just beating away inside the puppy. If that heart rate is still 200 beats a minute, I may be tempted to say, “Let’s give her a little more time.” Maybe I would suggest giving her an injection of oxytocin, see if we can move it along. On the flipside of that, if we go and put the probe on the fetal heart rate and it’s down to like 260 beats a minute, then you and I are not walking, we’re not stepping, we’re running to surgery because that puppy is in the process of dying from lack of oxygen. A couple of things just right there that we could do: maintaining the blood pressure. That’s why, when you have a C-section, the bitch is always on intravenous fluids, because we’re doing everything we can to keep that blood pressure up. If we start to see the blood pressure coming down, there’s actually medications we give to keep it up. That’s a critical thing, as far as getting live puppies.
Our bitch now is coming along and is getting close to the day that we think she’s due. There are actually, in the bitch, 3 distinct stages of labor. The first stage of labor, I’m convinced is to do nothing but drive you crazy. This is when the bitch is panting. She’s nesting, she’s hiding, she’s not eating. And she’s not having the puppies. Well, what’s wrong with my bitch? Nothing. But as you’re looking at this first stage of labor, this is when the progesterone is starting to drop. The progesterone is starting to drop, causing the cervix to start to dilate. You may see a little more mucus from the vaginal tract—clear mucus. We’re not talking about that black, dark green, or dark red, which are signs of a problem. But you may have a little more mucus. The body is ready to lubricate the birth canal for the puppies to be born, things like that. But one of the things I’m having you do three times a day is taking your bitch’s temperature. What is the temperature drop? Why are we looking for that? That’s what we’re looking for: the temperature to go down. It’s not to go up. As you’re well aware, a normal body temperature is 101-102 degrees. Well, a fact is that in a pregnant bitch, the progesterone is actually raising the bitch’s body temperature. So if there wasn’t some adjustment that took place on this, the bitch—while she’s pregnant—would have a body temperature of 105-106. Not healthy or conducive to life. What happens is the body needs the progesterone so the body lowers the core temperature, and the core temperature is usually lowered down to around 98-99 degrees. As you are taking the body temperature and the progesterone is dropping, the body temperature drops because you’re not having the progesterone elevating it and you get down to what the core temperature has been lowered to. Taking your temperature—believe me!—there is not a reason to do it every 15 minutes. I have some clients, I believe their hobby is taking their bitch’s temperature. Doing it 3 times a day is more than enough. What you also want to be doing is writing it down, because it’s going to stair-step down. It’ll be lower in the morning, and then through muscle activity, it’ll be a little higher in the afternoon, and then it’ll be a little lower and just around the time it gets to 99, it kind of hangs there. I’m talking Fahrenheit: 99, 98, and it hangs there. Just when you think it’s never going to go lower, BOOM! It drops down. So you’re down and you have a temperature of 98 degrees. I did a C-section this morning on a bitch; her temperature was 98.6. She was prime, ready to go. Anyway, is this when the bitch should be having puppies? The answer is no. I’ll explain in a second why not. Your temperature is down, your bitch is not eating. She’s panting. How long can a bitch go with her temperature down before you panic and run to the veterinarian? The answer is: there is no answer. You don’t worry about that. It seems like the less litters a bitch has had, the longer that first stage is. She’s saying, “Holy cow! I don’t understand what’s going on either.”
But we then move into what’s called the second stage of labor. The first part is the dropping of the progesterone along with the dropping of temperature; she’s starting to get milk, she’s starting to show all the signs we’ve described, and she’s got the little mucus discharge. But then when the second stage of labor takes place, this is when she actually starts to have the puppies. A critical thing takes place. The hypothalamus part of the brain readjusts the thermostat, and her temperature goes back up over 100 degrees. When that happens, you should have puppies within 4-6 hours. To me, one of the first signs of uterine inertia is the temperature going back up to normal and no sign of progression of labor. That would be one of the reasons that you might have the puppies evaluated for their heart rates and maybe consider having them looked at. The second stage of labor is the one of actively having the puppies. Temperature goes back up over 100 degrees, she starts panting. The puppy, then, as it moves down through the cervix and stretches the cervix, that is what causes her to bear down and push. That’s why in that first stage of labor, there’s no external contractions because we have no puppies dilating the cervix. Then as that puppy dilates the cervix, the bitch pushes. Forty percent of all puppies come backwards. When a puppy’s head or back end starts to appear, you should have a head and two legs, you should have a tail and two legs. The bitch pushes. She takes a little bit of a rest. The puppy goes in a little bit. Then she pushes again and poof! Out comes the puppy. Hopefully, the placenta’s attached. But one thing I just wanted to mention right now—a question I get a lot: Retained placentas in the bitch is not a concern at all. Certain farm animals? Big concern. Mares, for example. But retained placentas in the bitch is not a worry at all. If you want to count the placentas or whatever, but if there’s one missing, it is not a big deal.
Then as that puppy’s passed and the placenta’s passed, then we move to what’s called stage three labor. This is when everything’s starting to recoil. We’re starting to get the uterus getting ready to give another push to move a puppy down. It is going to slide into the birth canal and stretch the cervix, and then we move back into stage two labor, and we revolve between stage two and stage three until the last puppy is born. How do you know when stage three labor is over? I’m a huge advocate of X-raying bitches to find out how many puppies they have coming. In my lifetime, by knowing puppies were coming and they didn’t show up, we’ve probably made a number of beautiful litters by saving those puppies. The other alternative that you don’t want is the bitch three days later having a temperature of 106 and rotten, foul discharge, and you take an X-ray, and there’s still one or two puppies in there and now you’re trying to spay the bitch to save her life. By knowing how many puppies are coming and knowing when that last one is done, when you high-five and say, “Wow, we got all bitches this time! I’m glad we took all those deposits on boys,” (and that’s the only way I know how to get bitch puppies, is to take deposits on boys)—anyway, it’s a relief. There are just certain stages you need to go to.
How do you tell? What are the things that would be signs that the bitch is having problems and not moving in a forward direction? I always like to say that we’re seeing progress. You don’t like a lot of downtime and regression. It’s a gradual procedure, yet you want to make sure you still feel like you’re moving in that direction. Things that, to me, would be a worry… Let’s even back up. Let’s say the last two times she had puppies, she had 8 puppies and after the third one you were already pumping her with oxytocin and after the fifth one, you had to have a C-section—maybe that’s not a bitch you want to think about free whelping. There are certain bitches that maybe you want to say, “Am I better off doing a C-section?” Second of all, bitches that are having some problems (bitches that maybe had some of the pregnancy toxemia, pregnancy diabetes, some of these)—they’re not real common, but they surely do occur—some of those bitches might be better off having a C-section rather than going through the stresses of labor. Other things that I look for: If you start having any black, or especially that dark green discharge, for any puppies that are born. If you’ve ever looked at a placenta… or after this is over, Google what a canine placenta looks like. On the outside, there’s two green rims that are called peripheral hematomas, and when the uterus and the placenta separate, these peripheral hematomas rupture and that’s where the green discharge comes from. If you’ve had no puppies, and you’re already getting dark green discharge, this indicates that you have placental separation occurring, and if that placenta’s pulling away and that puppy is not being born, where’s the oxygen going to come from? It’s not. Where’s the puppy going to go? To heaven. There are certain signs you look at that you sometimes will say, “Maybe I’ll give it a little more time.” A lot of dark green, dark black discharge before any puppies are born is one of the textbook signs in my book that you really need to get out there and maybe do some intervening.
I like to see progress. If I have a bitch really bearing down, pushing hard, and nothing happens within a half hour or 45 minutes, you’ve got to be concerned. If it hasn’t produced a puppy in 45 minutes, what’s going to change that’s going to make a difference? Also, don’t hesitate. You can put a glove on and stick your finger up the vaginal tract and feel the puppy. Is his head big? Is there only a front leg coming? Get some idea of what’s going on so if you call your veterinarian, don’t be afraid to check and see what’s going on there. Sometimes, you can even push the puppy back. Maybe line it up and help it slide out. If there’s any secrets that you’re going to get from this today: If you have a puppy and you’re needing to help pull that puppy and deliver that puppy, you’re much better off with your finger in the bitch’s rectum than you are in the bitch’s vaginal tract. Because in the vaginal tract, you’re reaching up and the bitch is pushing out, it’s like trying to pull a ball out of the throat. She’s pushing, you’re pushing and getting nowhere. Yet, if you go rectally, you can get above the puppy’s head and push down. If the puppy’s coming backwards, you get above the pelvis and push down with your other hand, and you can grab it in the vaginal tract and help pull the puppy out. I’ve probably delivered more puppies vaginally with my finger rectally pushing down on them than I ever have just reaching up and trying to pull them out. That’s something always to remember. Don’t hesitate to check things out.
Other things that do worry me: If we start going longer than three hours between puppies, then I’m starting to think, boy, especially if you have four or five or six puppies left, if that uterus is getting that inefficient that it’s taking four hours or more to recoil, that’s probably a time you ought to be trying oxytocin, maybe? Or maybe a little calcium. Or, considering: If I have five or six puppies in there, there’s no way you’re going to deliver the rest of that litter with oxytocin. You’re probably going to get more alive puppies going in and doing a C-section.
What is the status on oxytocin? I mean, oxytocin is a dangerous drug. You can use too much of it. If you give too strong a dose, you actually shrink-wrap the puppies. The uterus just clamps down on them, and you have to go and almost pry the uterus off of them. So what is the dose? If you are going to use oxytocin, when do you use it? If you’ve gone more than two and a half or three hours without any signs of active labor, it would be a time to give a dose of oxytocin. This is with no active labor, because you could actually rupture a uterus if there’s a puppy and she’s pushing and you give her oxytocin. The dose you would use, most small-animal oxytocin is 20 units per ml or 20 units per cc. The dose I use—what did the bitch weigh before she was bred? I give 2 units per 10 pounds of body weight pre-breeding. A 10-pound Poodle would probably only get 1/10 of an ml of oxytocin. Again, if you give too much, you’re not going to get the puppy pushed out. You’re going to get it shrink-wrapped in the uterus. Even if I get up to a Mastiff, I probably would never give more than 1 ml of oxytocin. You don’t need more than that. Oxytocin—you give subcutaneously, you give intramuscularly, you give it IV if you needed to. The first dose actually increases the blood flow to the uterus, which (as we started our discussion today) is what? A positive effect to the puppies and the bitch. If nothing happens from the first dose within 20 minutes, of the same volume you gave before, you give a second dose. That also probably strengthens some of the uterine blood flow. After two doses, if you’re not getting any progress, you do not give dose three, dose five. I consulted on a case a long time ago of which over three days, a veterinarian had given 37 injections of oxytocin, only to then do a C-section to remove the dead puppies. Two is your maximum. If you start giving more oxytocin, that causes the blood vessels to dilate to the uterus, which lowers the blood pressure.
How does oxytocin work? It actually causes calcium to go into the cells. Actually, myself and a theriogenologist or canine reproductive specialist at Missouri—we actually tried giving just calcium, saying: Is it the oxytocin or would we be better off just giving calcium so they start to move into the cells? And we did not have anywhere near as good luck as we did just giving oxytocin. Back probably 30 years ago, we always gave calcium with oxytocin. Calcium itself is a dangerous drug. You can kill an individual with calcium if you give too much, its effect on the heart. But now that we can measure what’s called ionized calcium—actually, how much calcium’s in the bloodstream available to use? I don’t know that supplementing calcium is much needed anymore. It’s really pretty, pretty, pretty rare to find a bitch that actually has a truly low calcium. A lot of the things that we used to blame on lack of calcium, not taking care of the puppies, all of this, not wanting to be with them—it seemed like anything the bitch did abnormally, we blamed on lack of calcium. Now that we’re checking it, calcium deficiency is really pretty rare. In my recommendations, if you have a bitch and you’re going longer than two and a half or three hours between puppies, maybe a dose or two of oxytocin, but I’m probably more apt to say, “Let’s get those puppies out. Let’s put them on the ground.” That way, we have the ability to be getting live puppies. I also refer back to the Cornell study that was done, looking at whelpings from all over North America. They were looking at free whelping, C-sections, how many pups were born alive, how many puppies were born live after that, were still going a week later, etc. One of the most glaring things I think that came from that Cornell study was the fact that you get more live puppies from a C-section. Because they want to avoid that number one cause of loss puppies: prolonged labor, lack of oxygen. Now that we can time the due date so well, we’re doing a lot of planned C-sections, and planned C-sections (or any C-sections) does not reduce the number of breedings a bitch can have. You don’t even have to skip the next cycle after the C-section. The one I did this morning was an English Bulldog. She was not in active labor; she was just ready. Uterus was beautiful. There wasn’t even a bruise on it. I took the puppies out of one incision. By the time the uterus shrank down, my incision was probably about an inch and a half long. If they’re going to breed her next time, you wouldn’t hesitate to do it again.
The things we’re looking at when you need to be contacting a veterinarian, to sum it up: if the temperature has gone back up to normal and no puppies within 4-6 hours; black, dark red, dark green discharge before any puppies are born; pushing longer than 45 minutes without producing a puppy, especially if you put your finger in there and feel only the nose and the head can’t even get through because it’s so big. We also are looking at the length of the time between puppies (knowing when we should have them all on the ground because we took a radiograph) and non-response to oxytocin. You don’t get a response to two doses of oxytocin, more is not going to make a difference, and the whole goal is to get as many live puppies as we can. That’s, as I say, what I think we should be all striving for.
The one thing that really complicates things is if you have a bitch who’s going to have one puppy or two puppy litter. Because all the things we’ve talked about (the temperature drop, the panting, and all that) probably is not going to occur. What actually triggers the bitch to go into labor (even though we know the due date)—what really causes the whole process to begin—is the amount of cortisol that the puppies put out. As they put out cortisol, this caused the release of a hormone called prostaglandins, which is what some of you used to treat bitches with with pyometritus—that’s a type of prostaglandin. Well, then that prostaglandin presses the source of the progesterone on the ovary. The progesterone drops, the temperature drops, the cervix dilates, and boom we have puppies. When you have one or two puppies, you don’t get that, and it really can be difficult if you don’t know the ovulation date. Many singleton litters are from being bred too early or too late, based on ovulation. When you have a one or two puppy litter, this really does take some care and almost some really tiptoeing along, trying to find out when is the puppy mature enough to possibly have a C-section (because most of them end up having a C-section because they have no competition for space, no competition for nutrition, so they tend to get larger). Plus, they aren’t triggering the bitch to go into labor. But in the old days, how long would you wait for a bitch to have a puppy? We used to say, “Why are you worried? You’ve never seen a bitch with a full-grown dog inside her. She’ll have them eventually.” That’s true, but many times, that eventual having the puppy is not delivering a live puppy, because there comes a time when the puppy starts to outgrow the placenta’s ability to support it. Actually, then the puppy starts to reabsorb back through the placenta into the bitch and actually ends up killing the puppy. We use different things, like the ultrasound that can detect by looking at the fetal intestines. There’s intestinal movement that tells me the puppy is mature. Can I see the architecture of the kidneys? Again, another thing that tells me these puppies are probably mature enough to live outside the bitch. That is a really difficult situation to monitor, when you’ve got that one puppy in there because it’s not going to get any of the other typical signs as if you had a six puppy litter.
Interesting for some of the studies that were done by the seeing eye people—they found that if you have less than three puppies, greater than eight puppies, your chances of free whelping them all alive are reduced. It’s not zero, but it’s reduced. So if you have a 13 puppy litter coming, it might be something to talk to your veterinarian about. Are we better off doing a C-section? Because what happens? Think about it. If you have 13 puppies, it’s like going to the gym and doing 13 deadbar lifts (or whatever they’re called; I’m not a gym rat). Anyway, the uterus tires out. It’s just a big muscle. On the other hand, as we say, if you have a small litter or a tiny litter (one or two puppies), they’re probably not going to trigger the bitch to go into labor and have a tendency to outgrow the placentas.
I’ll tell you: Every puppy counts. I’m puppy greedy. I’m not one that says, “Great, we had nine. We only lost three.” That’s not success. If you have 12 puppies coming, I want you to say, “We have 12 puppies, and I love them all, and they’re the cutest ones you’ve ever seen!” Sometimes being a little proactive and just playing the odds makes things veer off in your favor.
I know a lot of you have some questions. That’s kind of the warm-up as to how I handle my everyday life when a bitch comes in. Trying to determine if she’s in labor. Should she be having the puppies? When do I intervene? Do I use oxytocin? Occasionally. But I’ll tell you what: I can think back 30 years ago, sitting up all night with a bitch trying to get her to have two puppies. We gave oxytocin. We gave calcium. We walked her, feathered her. When you’ve had your finger up the vaginal tract, stroking the roof of the vaginal tract (feathering), that is actually causing oxytocin release. That’s what you’re doing, when you’re feathering the bitch, you’re actually stimulating oxytocin release. That’s why she bears down. Anyway, I look back now and I think: I would know more than to sit up all night with two puppies. I’d be up there having the C-section. The puppies would be nursing. We’d all be back home in bed. Instead of these puppies ending up being born dead because of the fact that we didn’t get them out. Anyway, I do use some, but I’m nowhere as near the oxytocin advocate that maybe I was 30 years ago. So, what do we have on the boards here?
Dr. Judi Stella [33:02] Lots of questions. I’m going to start with a lot of the follow-up questions, because they’re ones that came in pre-webinar. You covered everything really, really well. There are still a lot of questions about supplementing calcium, so I know you went over a lot but: when do give it or not give it during pregnancy?
Dr. Robert Hutchinson [33:24] I’m glad you brought that back up. A lot of bitches don’t need calcium. But if you are going to use calcium—and I am speaking to you, as me; this is what I do. I’m not a person that says, “You do this, I do that.” I no longer use any type of injectable calcium. I’m not a cow guy either, but when we used to have downer cows in school, you have one guy holding the calcium bottle up, and the other guy that has the stethoscope on the heart, waiting to see if the heart slowed down enough that it’s going to kill the cow. You can’t suck out calcium. The thing with calcium—what may be an underdose on a Dachshund may be an overdose on a German Shepherd. Calcium is really a difficult drug to dose. So, I am a strong, strong advocate: If you are going to use supplemental calcium, I use Calsorb, the oral calcium gel. They don’t like the taste of it, but I can give small amounts more frequently. Since we don’t supplement calcium before whelping like we did back in the ’70s and ’80s, we don’t see anywhere near the amount of puerperal tetany, milk fever, eclampsia—all the terms that are associated with it from the body not mobilizing calcium. Even now, if I have one of those bitches that has the milk fever, instead of the old days where we used to wean the puppies, now we just use Calsorb and give her small amounts throughout the day and keep the puppies on. If I’m using calcium, I’m using Calsorb. It’s an oral gel. It comes in a syringe. I give small amounts more frequently. Maybe give some when I’m giving the oxytocin. But again, I’m only giving 2 oxytocins. I’m not using more. I think maybe the thing that changed me a little bit is the study I alluded to, because it seems like if calcium deficiency was the problem, giving calcium should do the same thing that giving oxytocin does. If we’re assuming a calcium deficiency, and we replace the calcium, why do we need to give oxytocin? The body’s producing it. It looks like, as they say in the study, that I just didn’t get the response I thought I was going to. Another thing I think: If you’re giving calcium, use the calcium gel, but I don’t think it’s the big secret or big need, maybe, that we thought it was 30 years ago.
Dr. Judi Stella [36:04] What about afterwards? Like, when they’re lactating? We’ve had several questions about post-delivery, bitches being agitated, frantic-minded, panting. What is the cause of that, and what is the best way to help her return to normal?
Dr. Robert Hutchinson [36:18] There’s a couple of things. Some bitches are just riled up, especially first-time bitches. We used to think that was calcium, but now that we run calcium, these bitches have normal calcium. Probably the biggest thing that I do on those bitches that are agitated/unstrung: make sure that the whelping box at home does not have supplemented heat. That is one of the biggest things, and we go back and people just want to believe a whelping box has to be 90 degrees. That's a total fallacy. It needs to be—what’s this room? 70 degrees. That’s perfect. You do not need supplemented heat. Many times, I’ll get a call, and the bitch goes in, she lays down, she starts panting, she gets up, she goes and digs at the door, wants to go out. My reply is, “What is the room temperature? 85 or 90?” They say, “90, just like the book says.” Turn the temperature down to 70 degrees, and mom becomes great. If there’s not an overheating problem where the bitch is being kept, I have become a huge fan of the dap plug-ins, the dap collars, the dog-appeasing pheromones. I think Dr. Greer is a big proponent of that also. This is the odor, the pheromones, that the bitch gives off to help soothe the puppies. The minute these bitches are agitated, that really does a good job. In a last resort, you could actually use a product like trazodone. You could use that in a bitch who’s agitated, nursing puppies. If you can determine the cause: it’s overheated, you put the whelping box in the middle of the kitchen where all the neighbors are plodding through. You’re so proud of seeing your puppies. Think of how it goes in the wild. Does a bitch say, “I’m getting ready to have puppies? Where is the most trafficked area I can lay down and have my puppies?” Or does she say, “I might be better off finding a cave or digging a hole under a bush to have my puppies out of the way?” Some bitches are agitated just because of the amount of traffic, the people, kids screaming, bringing their friends in. Look for the cause. But the dap plug-ins, the dap collars are great products. The trazodone, as I say, you could use if you needed to.
Another thing is that milk production in the bitch oftentimes can be an issue, especially in some of the first-time bitches. You have to determine: Is your problem milk production or is it the milk letdown? An agitated bitch maybe is producing milk but she’s so stressed out, she’s not relaxing and letting the milk out. The way you determine that is you basically give an injection of oxytocin, and if after 15 minutes, suddenly there’s milk dripping, it’s a letdown problem. And then you can either give further oxytocin or use the dap collars. You can actually pick up from human pharmacies an oxytocin nasal spray. If you give the oxytocin and there is no letdown, it probably goes back to a production problem. There’s a couple of products. There’s one called Reglan, which we also use in bitches that vomit. It works on the brain. It’s called a dopamine antagonist. There’s also another product we use for mares called Equidone. This works on the brain to maybe start milk production. In the future, if a bitch didn’t have milk this time, oftentimes you’ll start the Reglan or the Equidone even the week before her due date. But it really comes down to you having to determine (or your veterinarian): Is it a milk production problem? If so, use Reglan or Equidone. If it’s a milk letdown problem, then use oxytocin.
Dr. Judi Stella [40:30] We had a couple of questions about C-sections, especially milk production after C-sections. Is there something that they’re missing? Do you need to give oxytocin or something to get that milk to come down?
Dr. Robert Hutchinson [40:42] Love that question! You got an A+ for the day. I get this so much on the Internet. It says: Bitches that have C-sections don’t take care of their puppies. The bitches that have C-sections don’t have milk. Bitches that have C-sections tend to bleed more vaginally. Bitches that have C-sections sometimes tend to attack the puppies. There’s one common denominator in that whole thing. The answer is: You probably did the C-section too early. What causes milk production, what causes maternal instincts, what causes the uterus to contract is the progesterone being baseline. That’s one of the reasons we’ll do a progesterone on the bitch before a C-section in many cases, and if the progesterone is still up (let’s say it comes back 3.9 nanograms; it drops below 2.5 nanograms when the bitch is in active labor)—the puppies will probably be fine. But at 3.9, she’s going to have minimal milk. Remember, the colostrum they get, that first 16 hours, they take their first sip of something, and for the next 16 hours, they can absorb colostrum. That’s the protection that’s going to last them, in many cases, their whole life. It stimulates their intestines to develop their own immune system. Puppies that don’t get colostrum actually have a shorter life expectancy. Many times, if I hold off a C-section for a day, it’s not because I don’t think the puppies are ready, it’s because if the progesterone is still up, the bitch isn’t going to have milk or colostrum. The uterus will not contract when it’s under the effects of progesterone. That’s why you cannot initiate labor with oxytocin. That’s why you can give a bitch with a closed cervix pyometritis Lutalyse and not have the uterus rupture. The uterus will not contract under the effects of progesterone. But as these placental sites pull off from that C-section, they’re bleeding. The placentas are deeply attached to the bitch. So these bitches, after the C-section, are bleeding so much, the veterinarian is thinking, “Holy cow! Does she need a blood transfusion? Do we need to go in and spay her?” She doesn’t have milk at all—95% of those times is because the C-section was done too early and the progesterone was not down.
Dr. Judi Stella [43:28] To follow up with that, people are asking what should the progesterone be to do the C-section?
Dr. Robert Hutchinson [43:34] Basically around 2.5 and below, the bitch is in active labor. Typically, if I’m looking at a bitch and her progesterone is like 2.7-2.8, I’ll go ahead and do it. If it’s 3.5 or higher, I probably will delay her for a day. The one I did today—just an example of my life, just to show you I’m not blowing smoke; I’m actually talking truth!—her progesterone yesterday was 2.9. We chose to wait till today. Today her temperature was 98.8. It was a perfect C-section. If it’s below 2.5, you can confidently do the C-section because she actually is in the first stages of labor.
Dr. Judi Stella [44:21] We’ve had several questions about mastitis. Any advice to prevent mastitis?
Dr. Robert Hutchinson [44:28] Absolutely. The number one cause of mastitis is banging the glands, bruising of the glands, jumping in and out of the whelping box, being a Basset Hound, going up and down the steps. Mastitis is a nasty disease. It is probably, in my mind, one of the scariest diseases I work with. You want to watch because these bitches, many times, will run a fever the day before you even find a gland that’s hard and hot. If your bitch is not acting right, you take her temperature and it’s 105 and everything feels good—guaranteed: tomorrow she’ll probably break with mastitis. The biggest thing is if you can stop these bitches from banging the glands, getting in and out of the whelping box, going up and down the steps—that’s a big step in avoiding mastitis. How we treat mastitis is a couple of ways. One is we will go ahead and use one of the non-steroidals. You can Rimadyl. Rimadyl does not pass through the milk to the puppies, so it’s a safe product. It reduces the inflammation. I’ll oftentimes ultrasound to see if I can see a pocket of fluid. Many times, it hasn’t organized yet. If the gland is hot, I’ll use cold packs, I’ll use cold water, hydrotherapy. Some people get the cabbage leaves and freeze them and then wrap the gland in the frozen cabbage leaves—anything to take the heat out. If, on the other hand, I see it starting to come to a head, then I’ll go ahead and hot pack it, trying to draw it like you would an abscess. Many of these glands blow out, and they scare you. You’re seeing the inside of the gland. It’s gross. But that’s probably the best thing that can happen in the bitch. Many times, in that case, we’ll go in and give her a little sedative, trim it up, put a drain in, put in some staples. Sometimes, that’s really what you’re hoping for. As far as the antibiotics for mastitis, I’ll sometimes take a look just at the milk and we’ll do what’s called a gram stain. In my lab, they’ll look and see: Does it look like a staph strep? Does it look like an E. coli? Could it be an anaerobe? A non-oxygen-growing bacteria? We’ll choose our antibiotics based on that. Probably the two main one that I use, if it looks like it’s a staph strep or an anaerobe, I’ll use Clavamox. Clavamox is safe for the puppies, even though any time a bitch is on antibiotics, you want to have the puppies on some form of lactobacillus substitute Bene-Bac, any Fastrack, any of those. About 1-2% of everything that goes in the bitch comes out through the milk. So if you’re giving any antibiotic, you’re sterilizing the puppies’ guts, they get the diarrhea. If it looks like I’ve got an E. coli, or I’m suspicious of mastitis, then I’ll use Baytril. Baytril is very, very safe to use in nursing bitches. But mastitis—if you ever see it and you keep your eye on that gland, and it’s red and inflamed and it’s painful but we’re treating it—if it ever gets a subtle grey appearance to it, that’s when it’s starting to get gangrene. That is a life endangering event. You are racing to the veterinarian’s to get that bitch in there, because if you start to see that greyness in the gland, that has a potential of being absolutely fatal.
Dr. Judi Stella [48:12] Following that, there’s a couple of questions about if you have a bitch that has mastitis, should she be bred again? And is it something that’s going to be passed on to the pups?
Dr. Robert Hutchinson [48:22] I do not believe there’s a genetic aspect to mastitis. But on the other hand, if a bitch has had mastitis once, usually because of the fibrosis, maybe some scarring in the gland that plugs the ducts, she could be more prone to it next time. For some of the bitches, what we’ll do is maybe pre-treat them with a little anti-inflammatory. We keep a closer eye on it. But like so many other things with breeding a bitch, you have to decide. What outweighs the others? If you say, “Geez, my bitch had mastitis. We treated it. It was no big deal. After 3-4 days, she was back to normal,” absolutely, I would breed that bitch again. On the other hand, if you said, “It was the worst thing I’d ever been through. My veterinarian thought she was going to die,” then you’d probably say, “I don’t know if it’s wise to breed that bitch.” Probably if that were the case, you probably would consider doing a mastectomy on that gland and just get it out of the events, rather than maybe spaying the bitch too. You have to decide what the bitch has to give to the breed overall to determine whether she should be bred or not. But mastitis is the one thing—I just don’t like them because they can be so, so painful, so nasty and so tough to treat.
Dr. Judi Stella [49:48] We have an interesting question about blood clots during C-sections. Do you see that a lot?
Dr. Robert Hutchinson [49:57] Sure! You mean just blood clots from the uterus?
Dr. Judi Stella [50:00] It doesn’t really say.
Dr. Robert Hutchinson [50:05] If you do a C-section, especially if your progesterone is down, that uterus is contracting hard. You may see blood, blood clots. You may see some for a day or two. But bitches that are pregnant do have a little bit of an increased plate synap. If it’s something from the uterus, from the placental sites pulling off, not a worry. On the other hand, if it’s blood clotting somewhere else, that’s not a real common issue, so I guess I’d need to know more about it.
Dr. Judi Stella [50:41] She lost a bitch 20 hours after the C-section from a clot.
Dr. Robert Hutchinson [50:54] Well, did they confirm it was a clot? Or is that just the working diagnosis? Sometimes, even in people, if you have a death for an unknown reason and you didn’t do a necropsy, was it really a blood clot? I guess that would be a possibility, but it sure, sure is not something that we don’t put bitches on aspirin after C-sections. It just isn’t that big an issue. One of the things that maybe we should talk about is: Is it wise to spay a bitch at the time of a C-section? Because, remember, there are some other changes already taking place in that bitch. There is an anemia pregnancy. The bitch makes more fluid than she does blood cells. The percentage of red cells in the bloodstream to fluid in a non-pregnant bitch is around 43-45%. In a pregnant bitch, it’s about 37%, so pregnant bitches are already starting out anemic. Second of all, you will see an increase of white cells because bone marrow is responding to this anemia. Don’t be fooled. When do you a blood count on the bitch and say, “Wow! She’s got an 18,000 white count. She’s got an infection. She needs to be on antibiotics.” No. That is not true. That is just normal. If you have a bitch already starting out anemic, and you look at that uterus and it’s swollen, there’s nine puppies that just came out of there, it’s bruised—you question whether it would be wise to spay that bitch. On the other hand, if you go in and it’s a Yorkie with one puppy, there’s probably reason not to. Whether we spay at the time of a C-section in my practice is the decision we make at the time we have the uterus in our hands. We make a big decision: Is this in the bitch’s best interest? Many times, it isn’t, especially also now that we do most of our spays laparoscopically. It’s not a big deal down the road to go in and pop the ovaries out. To answer the question, who was obviously in a drastic, deadly situation—that is not a real common problem, and I guess you could have a blood clot if you had bone surgery or if you had a bruise to the leg or anything, too. That’s not something that is a normal issue.
Dr. Judi Stella [53:21] We do have several questions about monitoring fetal heart rates, which I think are good. Do you recommend using WhelpWise? Do you have any tips for hearing the puppies’ heart rate, not mom’s heartbeat?
Dr. Robert Hutchinson [53:37] First of all, Karen and her group out there with WhelpWise have been around for a long time. I also, though, caution people that they are responding to things that are transmitted to them, but they are not seeing the patient. It’s just like somebody calls me and says, “Hey, I’m seeing my bitch this, this, and what do you think?” Well, I’d give an opinion, but it’s not like the patient is in front of me. That’s the same thing with the people from WhelpWise. They’re not seeing the patient. They’re responding to things that are transmitted to them. Sometimes, they have a tendency (honestly) to overdiagnose disasters. On the flip side of that, they’ve also saved a number of puppies’ lives. The problem with hearing a fetal heart rate is the placenta in the bitch wraps all the way around the puppy. Sometimes it’s hard to get to where the puppy is in the area where you can put your doppler on and hear the puppy and not be hearing the blood flow going through the placenta, which is what most people have a tendency to hear. Sometimes it’s the luck of the draw. Sometimes it depends on the number of puppies and their positioning. It’s helpful if you are just wanting to hear the puppies’ heart rates. But if you’re trying to make the decision at home, with a handheld doppler, that my puppies’ heart rates are slowing down enough and I need to race to the veterinarian—I probably don’t think you’re wise. I think you’re better off putting the doppler away and getting to the veterinarian. The one advantage with an ultrasound machine: I am visually seeing the heart rate. Sometimes it’s not the easiest thing in the world, with the big ultrasound machines that we have. But then I can put my doppler on the ultrasound machine, over the heart rate, and we can get an actual time. But I think trying to determine if your bitch is having whelping issues with a handheld doppler at home probably is putting too much pressure on yourself.
Dr. Judi Stella [55:50] That’s great. One more quick one, because we’re getting near the end of our time here.
Dr. Robert Hutchinson [55:56] Can’t be! Can’t be! How does time go so quickly?
Dr. Judi Stella [55:59] What is the best time to do an X-ray for count? And is that dangerous to the puppies?
Dr. Robert Hutchinson [56:03] No. First of all, that’s a great question. I used to wonder that. I talked to my radiologist, and he said, “A bitch walking around your family room with the television on is getting as much radiation as one film.” Especially now with digital radiography, it does no danger to pups. It doesn’t cause cataracts, all these things you read back in the ’80s. I usually do our puppy counts around day 56 from ovulation. That’s a week before the puppies are due. By that point, I can usually see the teeth buds on the puppies, making sure the maturity looks right. You can get some idea as to the size of the puppies, but especially by then, they’re calcified enough that it should be an actual count. By day 56 is best. Also, a bitch is not going to go into labor a week early (or she shouldn’t be going in a week early) so you’re not worried about, “Wow, am I a day late or something?” By day 56 from ovulation would be my recommendation.
Dr. Judi Stella [57:07] Great. With that, unfortunately, our time is up! Thank you so much, Dr. Hutchinson. This has been great, as always. We love this because we learn so much as well. And thank you everyone for joining! Hope to see you again soon.
Dr. Robert Hutchinson [57:25] Hopefully my thinking cap helped today.
Cat Matloub [57:30] Thank you so, so much! Thank you everyone for your amazing questions. Next steps for us: get thinking caps for everybody. We’ll send around an email with a link to the recording and we’ll be in touch, and we hope to see you very soon back here. Thank you all, and thank you Dr. Hutch.
Dr. Robert Hutchinson [57:53] Hopefully everybody enjoyed it!
Cat Matloub [57:56] An understatement! Thank you all so much.
Dr. Robert Hutchinson [58:02] Take care!
