Canine cesarean section

What is a cesarean section?

A cesarean section (also known as a c-section) is the surgical delivery of puppies, through a procedure called hysterotomy. 

When is a cesarean section performed?

A cesarean can be performed as an elective procedure, or may be performed in response to a medical emergency.

Why would a cesarean section be performed?

Cesarean sections may be proactive (i.e., planned for) in the case where there may be difficulties with parturition (labor) or a high likelihood of dystocia, as is the case in some brachycephalic (flat-faced) breeds. Cesareans can also be performed due to an emergency situation, such as ongoing dystocia. Around 58% of cesareans are performed on an emergency basis.

Dystocia

Dystocia means “difficult labor.” There are several reasons your dog might be having difficulties during labor, including the size of the litter, the size and position of the fetuses, and a small birth canal, among others. Signs of dystocia include a dog in active labor who is not delivering puppies, green or black vaginal discharge before any pups are born, and prolonged gestation. Dogs with a history of previous dystocia are at higher risk of future episodes.

When is dystocia an emergency?

The website Well Bred Vet has an excellent guide to whelping and when to seek medical help. 

If your dog:

• has been in labor for more than 12 hours
• has been actively pushing for more than 30 minutes without having a puppy
• is weak, lethargic, and past her due date 

seek help from a veterinarian as soon as possible. 

Dogs give birth between 58 and 68 days after breeding. If the time of ovulation was pinpointed during the breeding period, then you can determine your dog’s due date (around 63 days after ovulation). If your dog is 68 days past breeding, consult with your veterinarian.

How is a cesarean section performed?

The goals of a successful c-section are to:

• Deliver healthy puppies
• Minimize stress on the dam throughout
• Minimize the time that the dam is under anesthesia
• Minimize puppy exposure to anesthetics
• Provide appropriate pain control (analgesia)

Ideally, a cesarean section is performed as close as possible to when puppies are full term. The dam is prepared for surgery and if needed, she may be given IV fluids and antibiotics. Once under anesthesia, the abdomen and uterus are opened, and the puppies are carefully removed. After all puppies are removed, the placentas can also be extracted. In some cases, they may be left in place to be naturally expelled or resorbed in the next few days. 

As puppies are removed, they are cleaned, and the throat is cleared of any secretions. Puppies are provided with gentle rubbing and, if necessary, oxygen to support breathing. Their umbilical cords are clamped, and they are kept warm while the dam is cared for. 

An ovariohysterectomy (spay) may be done at the time of cesarean section. When procedures are complete, the uterus and abdomen will be sutured. The dam will be given appropriate support as she wakes up from anesthesia, which includes pain control and antibiotics (if any puppies have died or there is evidence of infection).

Is cesarean section preferable to natural birth?

Your veterinarian may recommend a scheduled cesarean section for one of many reasons, including to prevent dystocia, or if your dog is only carrying a single puppy. If a dog has had difficulties giving birth in the past, or is a breed of high risk for dystocia, then a c-section may be safer than natural birth.

What about the puppies?

Although survival rates are generally high (approximately 80% or higher), emergency c-sections are associated with a higher mortality rate among puppies. This is typically because there are complications or pre-existing risk factors, which are compounded by the potential distress in the bitch. Brachycephalic puppies are at even higher risk of difficult birth and early death, and are more likely to have cesarean sections compared to other breeds. 

What is recovery from a cesarean section like for my dog?

A cesarean section is major surgery with anesthesia, so your dog will need time and support to recuperate. Giving her a quiet, calm place to rest, away from other adult animals, will keep her stress level low and give her time to bond with her puppies.

She will have some pain control medication that you will have to administer, and she may be given oxytocin to promote milk let-down, and if necessary, to allow the passage of any placentas that were left in the uterus. Some dogs also receive probiotics or other medications to promote lactation. Your veterinarian will provide you with a full plan for your dog’s care as she recovers.

You will likely be asked to closely monitor your dam’s incision site and mammary glands for any signs of infection. Follow up closely with your veterinarian if her sutures or mammary glands seem swollen, red, or hot to the touch.

A c-section (even if your dog was spayed during the procedure) will not prevent your dog from successfully nursing. Watch mom and puppies closely for the first few days to ensure that your dam’s maternal instincts have kicked in. You may need to separate mom from her pups between feedings if she seems aggressive or stressed by them. You can encourage puppies to nurse by gently placing them near her nipples and waiting. 

If the puppies aren’t nursing and consistently gaining weight, speak with your veterinarian. You may have to supplementally tube feed your puppies and stimulate them to eliminate if your dam is not.

What about future pregnancies?

Cesarean sections make future pregnancies more risky and are associated with dam and pup mortality. A dog who has had a cesarean section in the past may need them for future pregnancies. Depending on your dog’s history, uterine health, and the risk to future pregnancies, your veterinarian may recommend that your dog be spayed rather than breed again. 

You can have your dog spayed at the same time as the cesarean section; the primary benefit to this is that your dam will already be under anesthesia, reducing the number of anesthetic events and surgeries she needs. 

However, performing a spay at the same time as the c-section is not a decision that should be taken lightly. During pregnancy there is increased blood flow and volume to the uterus, and its removal at this time can lead to significant blood loss in the bitch. The additional procedure also increases surgery and recovery time for your dog, delaying uniting mom with her puppies. 

Your veterinarian can help you make the best decision for your dog’s safety and for your breeding program.

Resources

VCA: Caesarean Sections in Dogs - Post-Operative Instructions

VIN: Dystocia, Caesarean Section and Resuscitation of Neonates

Well Bred Vet: https://wellbredvet.com/

Bergström, A., NØDtvedt, A. N. E., LAGERSTEDT, A. S., & Egenvall, A. (2006). Incidence and breed predilection for dystocia and risk factors for cesarean section in a Swedish population of insured dogs. Veterinary Surgery, 35(8), 786-791.

Moon, P. F., Erb, H. N., Ludders, J. W., Gleed, R. D., & Pascoe, P. J. (2000). Perioperative risk factors for puppies delivered by cesarean section in the United States and Canada. Journal of the American Animal Hospital Association, 36(4), 359-368.

Moon-Massat, P. F., & Erb, H. N. (2002). Perioperative factors associated with puppy vigor after delivery by cesarean section. Journal of the American Animal Hospital Association, 38(1), 90-96.

Ryan, S. D., & Wagner, A. E. (2006). Cesarean section in dogs: Physiology and perioperative considerations. Compendium on Continuing Education for the Practicing Veterinarian, 28(1), 34-43.

Wagner, A., Harari, J., & Ryan, S. (2006). An In-Depth Look: Cesarean Section in Dogs: Physiology and Perioperative Considerations. Compendium, 28(1).