Caesarean Section as an Alternative to Natural Whelping


I remember when Janice was pregnant with her first litter. I was a total mess the whole time, reading compulsively about nutrition for the pregnant bitch, taking her temperature practically every five minutes, checking on her repeatedly through the night, never letting her out of my sight, setting up the whelping pen and changing the blankets every day – and this was just during the first week!

I know that sounds pretty crazy, but it wasn’t just her first litter – it was mine too! This was my first foray into breeding Boxers, and I was determined to get everything right. As time progressed, I started reading up on whelping, and of course the Internet was a veritable treasure trove of horror stories – tales of puppies in bad positions, dead puppies preventing others from moving through the birth canal, bitches dying in labor, retained placentas, post-partum infections – you name it. And then, of course, there was always the possibility that Janice would be unable to give birth naturally, and would need a C-section.

Then, of course, there were all the well-meaning idiots who happily provided me with horror stories of their own, as if I wasn’t getting enough online. The stories were usually accompanied with “helpful” warnings to the effect that no one in their right mind, who loved their dog, would ever consider having her bred.

From everything I was hearing, you would have thought that no bitch had ever delivered a litter of puppies without complications. You wouldn’t believe how many times I asked myself if maybe I was a total idiot, thinking that breeding her was a good idea. What was I gearing up to subject her to?

I watched Janice day after day, and as she grew bigger, I began to worry that maybe she had a few too many puppies inside her – she was getting huge! And I knew that a bitch can conceive several times over the course of her heat (I talked about this in If You Can’t Stand the Heat…). Small litters are generally the result of brief exposure to the male, and large litters that of repeated exposure. Of course the puppies are all born at the same time – the smaller ones are generally the ones that are conceived during the latter part of the heat. Well, Janice and Leroy obviously live together, and I wasn’t inclined to separate them for part of her heat. So believe me, there was a lot of exposure. Alot alot alot. Boxers can have up to 12 puppies in the litter, so I was starting to get a little concerned. Would it be too much for her? I started reading in earnest about C-sections for dogs, and I learned a lot.

Most of the time, your dog will birth perfectly well without the need for a C-section. But you want to be prepared for any eventuality, so with that in mind, let’s talk about complications in whelping, and when your dog might require a C-section.

Neonatal Mortality

There are few things more heartbreaking than losing a litter, or even one puppy out of a litter. What causes neonatal mortality? Prolonged labor is one cause. Another is hypoxia, a condition where not enough oxygen is delivered via the blood to the puppy. Dystocia is a catch-all phrase to refer to difficult birthing, with causes sometimes related to fetal health, and in others to the health of the bitch.

Studies have shown that anywhere from 20% to 30% of puppies that are born alive will die before the age of 6 months, usually due to neonatal complications. So, it falls on the breeder to be highly vigilant to anything that could be wrong. You don’t have to know for certain that something is not as it should be – suspicion alone is more than enough cause for a trip to the vet. I probably drove Dr. Stephen nuts a few times with panicked phone calls and requests for an immediate appointment, saying things like, “I don’t know, Steve, she just looks un-Janice-like.

I guess what I’m trying to say is, go with your gut. We have that “sixth sense,” our intuition, for a reason, and if our gut is telling us that something is off, there’s a pretty good indication that something is. Think of it this way – when was the last time you said to yourself, “Wow, I’m really glad I didn’t listen to my gut that time!”? Most of the time I was worrying needlessly, but I don’t regret my multiple calls to my vet, or my multiple visits.

Knowing When a C-Section May Be Needed

Watch your dog for any signs of anxiety or pain. This can be a tip-off that the labor is not going as it should, and the last thing you want is a prolonged labor. Maternal stress can be very harmful to the unborn puppies, so she has to be calm and relaxed. Don’t worry about some panting; it’s perfectly normal. If she seems to be hyperventilating, or has a weak pulse, then it’s time for a trip to the vet – or, if possible, a house call. Some vets won’t do house calls. Steve will, and that’s one of the reasons he’s my vet.

Now, one thing you need to know about how a veterinarian is going to approach the idea of a C-section for your dog, is that he or she is not likely to come right out and recommend it. This is because, like any surgical procedure, a C-section is not without risk, or the chance of post-surgical complications. If a vet tells someone that their dog needs a C-section, and something goes wrong, then grieving owners sometimes feel that they weren’t offered any other options, or didn’t get enough information, and then the vet ends up being sued.

Your vet is more likely to suggest that you know your dog best, and ask you if you want him or her to do a C-section. Then you will be expected to sign a form consenting to the surgery, and absolving the vet from liability if anything should go wrong. The consent form may even include a clause stating that you will absolve the vet from liability even if he has screwed up. This is one clause that will never stand up in court, though, because under civil law, no one can indemnify themselves against their own negligence.

Steve is one vet who never comes right out and recommends any particular treatment. Rather, he tells me what my options are, and then leaves it up to me. As I said, this is what most vets do, but Steve and I have devised a bit of a work-around. When I want a recommendation, I simply ask, “If Janice were your dog, what would you do?” If you take this approach, I am certain that your vet will give you an honest answer.

Why a C-Section?

First, let’s talk about when a C-section is not warranted. Most of the time, the gestation period is 63 days. This is not, however, etched in stone. If you’re at day 64, 65, 66 – or sometimes even longer – it’s not time to panic. Your dog can still give birth naturally. However, if you no longer feel movement from the puppies, or of your dog is ridiculously overdue, then it’s time to talk with your vet about the possibility of a C-section. A C-section should never be performed before the actual due date.

If the puppies cannot be delivered naturally, for any reason – perhaps the puppies are too big for the bitch to deliver comfortably, or her pelvis is unusually small, or if there is a puppy in a breech position, then a C-section must be done speedily in order to save the litter.

Uterine inertia – a condition where the uterus is not contracting strongly enough to send the puppies on their way down the birth canal – is another reason why a C-section may be warranted. If the puppies are not born when they are ready to be born, then this causes fetal distress and can lead to pre-natal mortality. One sign of fetal distress can be a discharge (black, green or red). This indicates a detached placenta.

One thing you need to know is that you should never be afraid of a C-section. It is not a procedure that is undertaken lightly, but when needed, it can save the lives of the puppies, and the bitch as well.

Drugs for C-Section

If your dog needs a C-section, your vet will be very careful about the drugs that he will give her. This is because before the puppies are delivered, anything that is given to the dam is still going to be delivered to the litter through the placentas. So, the vet will give just enough medication to ensure that the bitch is relaxed and comfortable, but will not harm the puppies.

The anesthetic that your vet will use is likely to be propofol (and yes, that is what killed Michael Jackson, but remember, he was self-administering under the so-called supervision of an obviously inept doctor). Of course I continued to plague Dr. Stephen throughout Janice’s pregnancy, thanks to my new-found knowledge about all matters related to a successful whelping. I made sure to tell him, “Steve, if she needs a C-section, don’t use ketamine valium, because—“ and then he picked right up with “—It goes right into the puppies, and then you need about 20 minutes to revive them, and that’s not good.”

Propofol is much better, because it lasts for a very short time, dissipating quickly. It is used in conjunction with an ice-o-florine mask, which is used just until the dog falls asleep. The pups come out crying, not unconscious. Isoflurane is another safe anesthetic, because it is more easily metabolized than methoxyflurane or halothane. The wakeup time following the surgery is practically instant.

Before delivering the anesthetic, the vet will give your dog some medication to relax her. Atropine sulfate is very effective, and does not adversely affect the fetal heart rate. It is administered intravenously, usually via a front leg. Your dog may also receive fluids to keep her well-hydrated and maintain her proper blood pressure.

Final Preparation for the C-Section

The next step is to have your dog cleaned and shaved, and then cleaned again just before the surgery. Then the vet will mark the incision area, and administer the anesthetic.

The Surgery

The vet will make an incision extending from the pubis to the umbilicus. If the uterus is very large (usually indicating that your dog is carrying some pretty big puppies), the incision may be a bit longer. Your dog will be covered so that the exposed areas are limited and she stays warm. This is important, because if the uterus is too exposed, she could develop hypothermia. It’s even more important if she’s already chilled due to stress.

Now, here is where you have to stand back and mind your own business. Steve and I have a really good relationship, but when I asked him, “Steve, if Janice needs a C-section, can I be in the operating room with her?” his response was a very firm “No.” He pointed out that he and his staff would have their hands full with Janice, and I’d be in the way. He said he’d allowed it once, against his better judgment, and would never do it again. Apparently the doggie daddy panicked at the first sight of blood, and he had to be escorted from the room. “Steve,” I protested, “You know I wouldn’t do anything like that!”

“I’m pretty sure you wouldn’t,” he said, “But you’d still be in the way. And the more people in the room, the greater the chance of contamination, no matter how well we scrub up.” I saw the wisdom in what he was saying, and backed off.

You’re thinking “More people in the room?” Yes. Your vet won’t be the only one. There will be the vet and an assistant, and believe me, they’re going to be busy. Once the puppies have been delivered, they have to be sure that they’ve removed every bit of placental tissue. Then they’ll close the incision, and make sure that your dog’s milk flow hasn’t been compromised by the surgery and that your dog will be able to have more litters. There will also be a “puppy catcher” stationed at the OR door to revive them if necessary, and then to attend to their immediate needs.

Sometimes, puppies delivered by C-section come around slowly. This relates to the stress level, and various other circumstances. As they come out, the revival staff will cut cords, remove sacs, and may do CPR, rub-downs or artificial respiration to get them breathing. They will also use warm towels to maintain a good body temperature. Sometimes, it can take as much as half an hour to get them breathing on their own. But there is no happier moment than when a revived puppy breathes and starts to cry.


Okay, this is where you can (and should) stick your nose in, but do it before the surgery. Ask your vet how he plans to sew up your dog following the C-section. There are different ways of stitching, and there have been complications with external stitching. Although not common, sometimes the bitch will pull at external stitches until they come out – at which point, so do their insides. As you can imagine, this is almost always fatal. Steve uses internal stitches to prevent this from happening.

Seeing Your Dog Again

Once the surgery is done, and the puppies are all breathing and crying, the vet will check your dog to make sure that her temperature is good and her gums are pink. As soon as she can hold her head up, the vet will bring her out to you, and you can take her and her litter home.

Home Care

Once you get your dog and the litter home, you are going to have to do a lot of supervision. What this means, is that if your dog has had a C-section, you should plan on at least a week off from work, or at the very least make sure that there is someone who knows dogs, and whom you trust to decide if the vet needs to be called, at all times when you are not able to be present.

You will want to be sure that the puppies are being nursed. This is for two reasons – obviously, because the puppies need nourishment, but also because nursing causes hormones to be released from your dog’s brain, stimulating her to be a good mother. Weigh the puppies frequently, if you notice one dropping weight or just holding steady, hold them on the mother and allow them to suck until they no longer want to do so. If this isn’t possible, you will probably need to bottle-feed using milk replacer, but this should be a last resort – mother’s milk is always best.

Make sure that the bitch has fresh water at all times. If she seems displeased with water, try low-sodium chicken or beef broth. If you absolutely must, syringe liquids into her.

When Mom Won’t Nurse

You might think that your dog is instinctively going to know that she has to feed her babies. With a natural birth, this is usually the case. However, with a C-section, she may not connect with the puppies – after all, she didn’t see them being born, so how does she know that they’re hers? You may have to put them, one by one, on her teats, and let her get a good sniff of them. You may even have to hold her down. Be patient, though – she’ll get the idea pretty quickly, once all those “feel-good mommy hormones” start flowing once the puppies begin to suck. Sometimes it can take up to 48 hours, though, and in the meantime you will have to be vigilant.

Soon, though, the hormones will kick in. Keep in mind that your dog is not trying to be a bad mother – it’s just that she’s missed out on several steps that she would experience if she had given birth naturally – she hasn’t seen the babies arrive, she hasn’t licked off the membrane, and she hasn’t eaten the placenta. These are all important parts of whelping, and what helps to form the bond between the mother and the pups.

In rare cases, some dogs have been known to completely reject their pups, killing and even eating them if they don’t get to go through a normal birth. This is more common in some breeds than in others. However, rejection in the form of refusing to feed can occur in any breed. So be vigilant – you may have to help your dog learn how to become a good mother.

As well, don’t leave the puppies alone with her for the first little while after you bring her home – she’ll still be a bit drugged up from the surgery, and especially if she is a big dog, she could roll over and suffocate a puppy without even realizing.


You may never find yourself in the position of having to consider a C-section for your dog. If you do, though, don’t be afraid. It’s a way of ensuring that her litter is delivered safely and alive. Yes, there could be complications, and there will be a need for after-care, but most likely it will go off without a hitch. And it’s certainly a better alternative than just waiting and hoping that whatever is going wrong will somehow magically correct itself – it won’t.

So, what happened with Janice? She had a natural birth, and delivered eight adorable little Boxers. Then, instead of obsessing over what might happen if she should need a C-section, I was able to channel my energies into obsessing over finding just the right homes for the little charmers!