I am not a vet nor even work in a vet's office. Please take this info and go over it with your vet and get their point of view. I think every pup born should have the best care and chance to become a healthy and happy puppy. I hope you will never have to use any type of intensive care but it's better to know about it and not use it than need to know it and don't know what to do.
Help from your Veterinarian
Talk with your veterinarian before your pups are due. Ask what to do for a sick puppy and when to call them. Ask who do you call after office hours and where to go. Sometimes you may have to go to another vet's office and it's good to know how to get to their office. Some places have 24 hour vet office, they may be alittle more than your vet but what will you do to save a pups life? You may even want to check out other vet offices and check on their office hours and how they could help you if you should need to use their office.
Sometimes (most of the time..LOL) we need our vet when pups are born on holidays, weekend, middle of the night or during weather that prevents you from going to your vet's office. I will cover some of the things you can do till you can get to your vet's office. Most of the supplies you can get with out your vet's assistance and some may require a prescription from your vet and I hope your vet will help you with making sure all of your pups have the best chances of making it.
Let Mother Nature take her course...BULL
I think the saying Let Mother Nature take her course is alot of Bull. Sometimes a puppy will have what I call a bad placement within the womb. Every time a dam has a litter of pups she will have scares where the pups were in the womb so when another puppy has placement at the scared area that puppy will not get the blood supply from the dam. So that's why some pups are smaller than others. Other things can cause a pup to be fading at birth such as the placenta tore away from his/her's body minutes before being born and has been de-oxygenated for too long and will require resuscitation more than the other pups. Both placement and placenta tore away do not have anything to do with genetics. Nor does excessive fluid in the lungs. You will have to work hard to make sure the pup makes it. I call these problems an environmental factor and not a genetic factor. If your pup gets chilled your dam may push him/her away. Warm the pup up before placing with the dam. You can do so by placing your pup into your shirt and let your body heat warm the pup. If you warm the pup up to fast or to hot you could be doing more harm than good. This is again an environmental factor.
Sometimes a pup is just to sick and you can't do much to save them. But try anyway sometimes the little sick ones pull right out and become very strong pups. But if they don't and you have done all you can and they don't make it don't feel bad. About 10% pups die for one reason or another.
Puppy Intensive Care Unit
1. Plastic storage box with a lid. Get one that will be a size for your breed's size of pups. a 40 quart size is good for most breeds. 2. Heating pad one with out an automatic shut off feature. Leave half of the warming box unheated. Use the lowest setting and check the temperature of the box. You never want to over heat a pup. The temperature should be 95 degrees.
3. The below is a list of supplies and equipment most you can store in your New Born Intensive Care Unit.
Supplies and equipment
1. Feeding tubes size 8 French or size 10 for larger pups. 2. Syringes to be used with feeding tubes. 3. IV fluid with 1L Lactated Ringers(your vet may want you to use another type). 4. Syringes and needles for sub-cutaneous hydration with 3/4" or 1" needle,20-22 gauge. 5. Oxygen regulator. 6. Oxygen tank full and ready to use. 7. Thermometer to check the box temperature. 8. Two or three white bath towels to be place over pad that's over the heating pad. 9. Bulb syringe. I use the one that comes with the ear wax remove kit. But you may need a larger one for the larger pups. 10. Black marker to make marks on feeding tube. 11. Puppy Milk substitute. The ready mix is the best. Keeping it in the box will warm the milk. 12. Pediatric(human) electrolyte replacement fluid. 13. Cord care supplies: Betadine , dental floss, surgical scissors. 14. Wash clothes for small pups and hand towels for larger pups. It's good to have two per pup. 15. Extension cord for the heating pad. Other supplies nice to have: 1. Power inverter(plugs into a cigarette lighter so you can plug in your heating pad if you need to make a trip to your vet with the pup.) 2. Colace for constipation(the pup not you...LOL) 3. Kaeopectate for emergency. 4. Dopram(you need a prescription for this.). 5. DiaScreen urine test strips. 6. Rectal thermometer to take pups temps. 7. Disposable latex gloves to handle a sick puppy and make sure you wash your hands before picking up the other pups. 8. Keflex(antibiotic) talk with your vet, he may want you to use another type. 9. Nutra Stat nutritional substitute. 10. Karo syrup(clear). 11. Scale to take the pups weight. This way you can see if the pup is putting on weight. If not and sometimes a sick puppy will not gain weight or may even start to drop in weight. You need to know this so you know what to do next to save the puppy.
How to use a bulb syringe.
When your pup is born the contractions will have a squeezing effect on the puppy pushing out the fluid and as long as the delivery goes along well the puppy will take his/her first breathe without any assistance. But if the puppy appears to be slow to breathe or gasping for air you will have to help him/her. First use a bulb syringe. I use one out of a ear wax remove kit for tots and toys. For the larger pups one from the baby section will do.
Your goal is to remove the fluids from the throat and nostrils not to push the fluids back into the lungs. Before placing the bulb syringe press all the air out till it's flatten and then place into the pups throat and then release. Take the bulb syringe and push the fluid out. You may have to do this a few times. If it has been more than an hour between birth of pups you may want to open the pups mouth upon delivery and syringe the back of the throat. If a puppy has sat to long in the birth canal he/she may not get the full benefits of the squeezing effects of the contractions that help remove some of the fluids. NEVER use the bulb syringe on the nostrils first. This will cause the puppy to take a breath and will inhale fluids into the lungs. ALWAYS do the throat first. Reach back into the throat and suction the fluids out. Then suction the nostrils if you see fluids coming out of them. Use your washcloths to see how much fluid is coming out and as long as you see fluid you know you are doing it right also you will see your puppy getting pinker and a regular breathing pattern.
Sometimes you may have to give a pup that is slow to breathe or pink up and you have used the bulb syringe mouth to mouth. Put your mouth over the puppys nose and mouth making a tight seal, give puppy a couple very very gentle puffs. Check puppy and if you need to give a few more gentle puffs. Gently massage pups chest while holding pup in a head down position letting the gravity assist in getting the fluid out of the lungs. Keep the puppy warm by using the wash cloths you have in the intensive care unit. NEVER swing your puppy to remove fluids from the lungs. Many breeders and I did at one time did this. But now I know this can and will do some type of brain damage just like a human baby would suffer if shaken. Just don't do it. Oxygen can help. Use the blow by method. Ask your vet for a prescription for Dopram and how to use it before you need to. This will often stimulate a puppy to start breathing. Make sure you remove all the fluids from the lungs before using Dopram or your puppy will very well end up inhaling fluids back into the lungs. I hope that this is all you have to do and wish you luck with your new born pups.
If you are lucky, mom will deliver her pups and lick off the amnioctic sack and neatly chew the cord off and stimulate the baby while you watch TV. But in the real world not all moms will do this and may need assistance. According to the books the cord care is best done by the mom who uses a chewing and gnawing action that will seal off the vessels in the umbilical cord. But in the real world some moms will not do this and will need some help. I love my dogs and their new born pups but will not start chewing on the cord for them. So my advise is buy a nice pair of surgical scissors, some dental floss and and silver nitrate sticks(to stop bleeding). Keep it all in a zip closed plastic bag in your warming box. Helping Mom with cord care. Some moms will get energetic about cord chewing and will not leave it alone until she has eviscerated the puppy. You may have to take the puppy away from her and move pup to the warming box and take care of cord yourself.. What to do? Hold the placenta up off the puppy and using a milking kind of action strip the blood in the cord down toward the puppy. Cord blood has stem cells that are very beneficial to the puppy which can assist the immune system. Tie off cord as close to the puppy with dental floss or you could use small hemo clamps. Leave a stump about an inch or so. Use the silver nitrate stick to stop blood. you can also use Betadine to aid in germ killing . Leave pup in warming box at least long enough for the silver nitrate to dry. You must watch new moms to make sure they do not cause umbilcal hernias. From what I know and able to read about this there are two types .. umbilical hernias and inherited. They terms I want you to know is reducible and non reducible. Reducible hernias require surgery and non reducible hernias do not. The most common type of umbilical hernia is not reducible and will not require surgery. The non reducible hernia the little ball of tissue on the tummy can't be pushed back into the abdomen. It feels firm to the touch and can only be moved around a little bit within the skin. With this type of hernia the muscle wall closed over while the puppy was still young trapping a small piece of fatty tissue outside the muscle. This type of hernia is harmless. You can have this repaired but will pay for it. Most vets will not charge much while having your female fixed. A hernia that is reducible is a true umbilical hernia and will need surgery. When you push on the small piece of tissue at the cord site your finger will go into the abdomen. You may reduce the size by pushing it back into the abdomen. The little lump of tissue is extremely soft and if you put a stethoscope to it you will be able to hear bowel sounds. This type of hernia must be repaired if not the little loop of bowel may become entrapped in the skin and tissue and become infected with nectrotic or gangrenous. It will not heal on it's own. If it becomes entrapped or strangulated it will become life threatening and will require emergency care.
Colostrum the immune system of your puppy
Colostrum is present in the mild when it first comes in. It is similar to mile but has a differnet chemical and molecular structure. It contains life-saving antibodies and nutrients that stimulte the synthesis of protein. It increases the utilization of fat, promotes cell growth and supports the immune system. All of mom's immunities will be passed to the puppy . From what I have researched there has been a slight difference of opinion about when colostrum should be ingested to provide maximum protection. Some say within the fist 12 hours and some say with in the first 24 hours. But all are in agreement that it's less effective or not effective at all after 24 hours. You should make sure your puppies ingest colostrum or substritue within the first 12 to 24 hours to ensure you loss rate will be low.
There are times when your puppies simply cannot get colostrum without assistance. Sometimes pups are born prematurely and their suck reflex isn't present and can't nurse. Many vets will recommend to stip colostrum from the mom's breast. This can be quite difficult. This requires massaging and milking type of action. You will require at least 1 cc per puppy for a toy size breed and up to 4 ccs for larger breeds. I have never done this but would think it would be like how one would milk a cow and harder than it looks. I would look more into a substitutes for colostrum. The first method is take mom to vet and have the blood drawn from mom and have the vet spin it down to a clear serum and inject the serum into the intraperitonel cavity of the puppy's abdomen. This will work as well as colostrum. Your vet will know the correct amount needed for your specific breed. The warming box is ideal way to transport your pup or pups to the vet. You can purchase in advance of Fresh frozen plasma or FFP from Hemopet , hemopet.org . They regularly get donated blood from greyhounds witch have univeral canine blood type and will contain immunities for all major things that a pup would get such as parvo or distemper and a large amount of larger diseasess. For more info visit hemopet.org. FFP is given oral to pup. You must warm it up slowly by holding it next to your body. You can use the same syringe for an entire litter and not worry about cross contamination. Several milk replacement products say that they contain colostrum. The thing is they are talking about colostrum from a cow cattle don't have the parvo or distemper as dogs do. The only way for your puppy to get colostrum is: 1. The real thing from Mom. 2. Clear serum from mom's blood injected into the puppy. 3. FFP ingested orally within the first 12 to 24 hours of life with one dose each day for the following two days, a total of 3 doses given over 3 days.