There are two types of c-sections. Planned and emergency. Both are performed the same way, using same general techniques and instruments but the outcome for each is often different.
When going into a planned c-section the bitch is rested, puppies are intact with their placentas in place and the outcome is frequently a positive one with resulting in live puppies and a bitch who will recover quickly.
Some breeds like Bulldogs or Boston Terriers may require a c-section due to the heads of the puppies are too large to pass through the pelvis. In human medicine that is called cephalo-pelvic disproportion or CPD. This would be considered a valid reason for a scheduled c-section. For small breeds you may want x-ray your bitch around 50 days into her pregnancy to make sure her puppies will pass through her pelvis.
Your vet may also recommend planning a c-section if your bitch has an unusually large litter for your bitch or a history of lost litters during the whelping process. Even if you plan a c-section your vet may give you instructions to allow the bitch to begin the laboring process before coming in for the surgery. First time moms may require some labor to allow the normal “hormone shower” to occur. This will help prepare your bitch for motherhood and insure that her parenting skills are triggered. Follow your vets instructions as to the timing of the surgery.
Avoid using vets who recommend spaying a bitch during a c-section. A breeder vet will recognize that each of your bitches are important to your breeding program and will assist you in the breeding and delivery of her puppies. Unless is a specific need to, such as a ruptured uterus, do not agree to a spay during a c-section even if you know that this is her last litter of puppies. The risk of bleeding increases significantly if a bitch is spayed during a c-section. The cost for a spaying later is relatively inexpensive and the life of your bitch is worth much more. Do not place your bitch in a position of unnecessary risk for excessive bleeding unless you have no other option. The removal of the uterus does not affect the production of milk, nor does a single c-section mean that your bitch will have to have repeat c-section. In the future. Most reproduction vets do not recommend that a bitch be sectioned more than three times in her lifetime.
If your bitch has labored or you know a puppy is stuck and emergency c-section is required, you may find the out come not a positive as if the c-section was planned. Your bitch will be exhausted going into a major surgery. She may not have eaten or had any fluids for several hours and may be dehydrated with her electrolytes out of balance. Placentas may have already separated from the uterine will during the laboring process and there may be dead pups. The emergency c-section may save the life of the remaining puppies but you need to be aware that both mom and puppies are compromised when the surgery is done under emergency circumstances. If you are unable to see your regular vet your bitch and puppies may be further compromised because emergency veterinary clinics do not see a lot of repro cases and are often not as skilled as you would think. This is not a reflection on the skills and abilities of the emergency vet but is simply a statement of fact. My experience has been they simply do not move fast enough and they do not listen to you. I had taken one of my bitches that had a puppy stuck, poor puppy had her head out but the body was too large to pass through to an emergency veterinary for a c-section. After waiting for about one hour they wanted to do some blood testing to see if the bitch was in good health for the c-section and it would take one hour to complete testing. All I could do was ask them and if the test comes back that she is not in good health what you are not going to do the c-section. The vet said no, we are going to do the c-section. I told her NO BLOOD TEST, just do the c-section. I was not clear to the vet about the c-section and she did spay her during the c-section. So make sure you make it clear not to spay your bitch during the c-section. By the way by not having the blood work it saved us close to 500.00 for a test that was not needed. Another thing they may not be ready to care for puppies born during an emergency c-section and you could loose some if not all your puppies.
Each vet have their preferences regarding the procedure of the surgery. Large and small dogs may be handled differently simply because of the size and manageability issue. Talk with your vet about their preferences prior to the c-section. Sometimes a vet will prefer to premedicate the bitch with sedating drug such as valium prior to intubation while others will simply use a gas mask to put your bitch to sleep and then intubate her. Two of the safer gases used are Sevoflurane and Isofluorane. Your vet will have preferences, but you should take a pro-active role and ask in advance which gases will be used during surgery. These two are highly desirable because they will leave the systems of the mother and puppies more quickly.
The bitch must be intubated for two reasons. One, intubation will protect her airway and make sure she is receiving oxygen during surgery. Two, the gases used to anesthetize the bitch during the surgery will be passed by way of the intubation tube to the lungs. One thing is certain, it is necessary to use general anesthesia for a c-section on your bitch. Do not ask your vet about local anesthesia or epidurals for use on your bitch. Your bitch must be kept quiet and still during the surgery and general anesthetic is the method used to accomplish that.
Once your bitch has been anesthetized and intubated she will be prepped for surgery. Her abdomen will be shaved, an IV will be started and then she will be placed in a positioning tray on the surgical table. The surgeon and assistant will scrub up, gown and glove prior to the surgery. You may be allowed to watch from the door way, but usually your vet will want to maintain the sterile field and may not allow you to approach the surgical area. The surgical field will be draped with sterile paper drapes and you may not be able to see anything but the actual surgical site and the head of your bitch. Even if you are not allowed to watch the actual surgery, your services may be needed to stimulate and rub puppies as they are delivered. If you know that you have a large litter you may want to bring experienced people to assist in this process. Take a warming box with you.
The surgery will begin with an incision in the middle of the abdomen starting at the umbilicus and ending at the pubis. Once the surgeon has cut through the different layers of skin, underlying tissues and muscle, the uterus can be seen. The two uterine horns are then brought out of the body of the bitch. They will hang over her sides onto the drapes. The surgeon will then make an incision in the body of the uterus being careful not to cut into the puppies inside. The goal will be to remove all the puppies through the single incision, but in an emergency, other incisions may be made quickly to remove the puppies.
After the puppies have been removed from the uterine horns, they will be handed off to vet techs, the breeder or anyone else who can assist with resuscitation of the puppies. The puppies will be under the influence of the anesthesia and will be lethargic. They will require vigorous rubbing, resuscitation and work. Vet techs who work with repro vets are wonderful in these situations and can be trusted to know how to care for your puppies. The umbilical cords will be trimmed, tied and swabbed with Betadyne or another sterilizing agent. Once the puppies are well resuscitated they will be weighed and tube fed to make sure that their glucose levels are appropriate.
As the puppies are being resuscitated the surgeon will begin closure of the wound. The uterine horns and any other abdominal structures may have been contaminated with fetal fluids and will be flushed with normal saline and placed back into the abdomen. The surgeon will close the wound in layers, with the interior layers being closed with suture material that will dissolve as the wound heals. The exterior stitches will require removal in 10 to 14 days. Don’t confuse the removal of the stitches on the canine with what is done with a human c-section. A woman who has had a c-section can have her stitches removed in 3 to 5 days and replaced with Steri Strips. The center of gravity for the bitch is quite different because she walks on all four legs with the entire weight of her abdomen on those stitches. The wound must be completely healed before the stitches can be removed. What you will need to do is carefully watch and take care of the wound area during the 10 to 14 days and watch for any signs and symptoms of infection.
Fever: Take her temperature each day for at least 10 days.
Watch for redness at the wound site.
Feel for warmth at the wound site.
Watch for smelling discharge coming from wound site or the vulva.
Clean the surgical incision site daily with hydrogen peroxide and Q-tips or cotton balls. Check carefully to make sure that hair and debris does not get into the wound area. Use clean tweezers to remove any debris that may be caught in the wound. Contact your vet if any of the signs above occur. Copious amounts of clear, pinkish or yellow fluids seeping from the wound for days after the surgery is a sign that the wound is not healing and will require a vet’s exam. If the wound is seeping large amounts of fluid and you can easily hear the bowel sounds coming from the abdomen, the interior incision of the wound may have come apart. Call your vet and describe what you are seeing and hearing. Be specific. Try to describe exactly how much fluid is seeping from the wound. What color it is, how it smells and how many little gauze pads are necessary to absorb the fluids are the things your vet will need to hear. Remember, the wound should be dry and anything else should be reported to your vet.
Your bitch will usually be able to go home with you once she is fully recovered and has been given enough IV fluids to replace everything that might have been lost during surgery. Your vet will want to make sure she is awake and the puppies do not appear to be in distress before releasing her to go home. You can almost take her home within hours following surgery. Be very wary if your vet insists on keeping your bitch and her puppies at the vet hospital. Ask questions: Who will be there with her? What is the purpose of leaving her? You know that you will be able to give her excellent care at home and unless there is a very good reason for to spend the night in the vet hospital do not allow her to do so. She may not immediately begin to lick her puppies and may not want to lie down and allow them to nurse. You may need to make a bed near her and stay with her for several hours in order to help her get settled with her new puppies. Full term puppies can usually nurse without assistance as long as you can keep the mom quiet and calm. She didn’t have the advantage of the hormonal reactions to labor and delivery of the whelps that she would have had with a vaginal delivery and she is still under the influence of the anesthesia. Stay with her and after a short period of time she will allow the puppies to nurse. After 12 to 24 hours she will begin to assume her parenting duties without your support and assistance. The bitch will have often been given a pain medication at the vet’s office and won’t require anything to be given to her for pain once she is home. Remember that most pain meds will cross the barrier into the breast milk and your puppies will receive it too, at a time when they need to be vigorously learning to nurse. First time moms may take longer to come around than an experienced mom, but most will resume the normal care of the puppies within 24 hours.
If your vet does not send you home with an antibiotic for the bitch, be sure to ask for some. It is generally accepted practice anytime following surgery in human medicine for antibiotics to be given as a prophylactic measure and can safely given to a bitch following her c-section. Ask for it as a prophylactic measure. If you are giving an antibiotic to the mom, give it exactly as ordered and give mom a small amount of plain, live-culture yogurt each day she is on the antibiotic. Put a small amount on your fingertip and give it to the pups as well each day that the mom is given the antibiotic. Antibiotics will often kill the “good” bacteria in the gut and the addition of even small amounts of live culture yogurt can replace the bacteria each day.
Following surgery your bitch may have a picky appetite for a day or so. Don’t worry too much about it at this point. Feed her foods that you know are her favorites and she will slowly being to eat normally. A little pampering now won’t create bad habits for later and mom deserves it.