Dog C-Sections: Managing Mom and Puppies at C-Section

How do I know my dog is ready for C-section? This webinar with Dr. Marty Greer, DVM will provide you with the tools you need for managing the mom and puppies when a canine c-section is needed. Dr. Greer will discuss the following topics:

  1. Decision making before the dog C-section
  2. When is a C-section recommended?
  3. The emergency C-section for dogs
  4. Dog C-section preparation
  5. Canine cesarean section anesthesia protocol
  6. Canine cesarean section surgical technique
  7. Puppy resuscitation
  8. Going home with the new litter

This webinar on cesarean section in dogs is useful for both the experienced breeder as well as those just getting a breeding program started.

Dog C-Section: Managing Mom and Puppies

Shop This Dog C-Section Webinar

Some of the products Dr. Greer mentions in this webinar include:

Breeder’s Edge Oral Cal Plus gel

Breeder’s Edge Oral Cal Plus powder

ThunderEase Calming Collar

Breeder’s Edge Oxy Momma

Puppywarmer Incubator

Puppywarmer Oxygen Concentrator

DeLee Mucus Trap

Breeder’s Edge Clean Cut Iodine

Breeder’s Edge Clean Cut Umbilical Scissors

Vet Basics ChlorConazole Shampoo

Breeder’s Edge ID Me Collars


Breeder’s Edge Foster Care Canine Milk Replacer

Royal Canine Starter Mousse

Kaolin Pectin Anti-Diarrheal Liquid


Metoclopramide (Reglan)

Canine Reproduction and Neonatology (book)

Are C-sections Risky for Dogs?

Do not be afraid of C-sections for dogs. They are safer now than they’ve ever been. If your veterinary clinic uses IV fluids, there are better, safer and faster anesthetic procedures. The earlier we intervene, the better it goes. We don’t want to wait too long to get into there and help the puppies. Getting more live puppies from a canine C-section than from free whelping is the truth. Remember, at the beginning, don’t cry. Number one, it ruins your make-up. And number two, you can’t see the puppies. It’s the planning of a C-section that really makes a big difference.

How Do I Know My Dog Needs C-section?

Planning for a dog C-section is a lot easier if we’ve done progesterone timing at the time of the breeding. I have a lot of people that are resistant to doing progesterone testing during the breeding because they say they don’t need it. They say, “I’m OK. I know when she needs to be bred. I can get her pregnant.” Remember, it’s not just getting her pregnant, it’s being able to keep her pregnant the right number of days. It’s being able to make sure that we can get her unpregnant at the time that we really need her to be unpregnant. If you have a high-risk pregnancy, it’s really important to know her due date before you get into the middle of the pregnancy.

Do All Dogs Need C-section?

By planning the C-section, by knowing the due date, we can accurately assess if she has pre-term labor, if she’s sick, if something happens to the puppies. We have a pretty good handle on when she’s actually due. It’s really great to plan these C-sections, especially if you have breeds that need to have a scheduled C-section such as the American bulldogs, the bulldogs, the English bulldogs, the pugs, the Frenchies, the Pembroke Welsh corgis, the Bernese mountain dogs. A lot of these breeds end up needing scheduled C-sections.

What Drugs are Used for C-section in Dogs?

At our hospital to improve the quality of our outcomes are 18 to 24 hours before the scheduled C-section, we give Solu-Medrol, which is a steroid. It’s given intravenously as an injection. It improves the ability of the puppies’ lungs to mature so that when they’re born, they have better ability to breathe. We don’t have an artificial surfactant that we can give to premature puppies like they have for premature babies. We’re really stuck with what the puppies have. Using Solu-Medrol gives us the opportunity to mature those puppies’ lungs.

Sometimes we’ll give Reglan, which is also called metoclopramide. That will improve the lactation of the female. If you have a female that needs to have a C-section, the day before she goes into labor like a bulldog or a Frenchie, she’s starting to lactate at the time that we have the puppies born and the time that we need to see them nursing. So, you have colostrum on board at the time of birth.

The day of the C-section, prior to the time that we anesthetize the female, we give atropine, a drug that’s given by injection by veterinarians to keep the puppies’ and the female’s heart rate at a high enough level that they have successful anesthesia. Atropine will cross the placenta.

There is also a drug called glycol pirolate. For those of you on the veterinary team, you may use glycol pirolate to keep the heart rates up, but that does not cross the placenta. I like using atropine because if we have puppies that are starting to get into trouble and their heart rates are dropping, atropine can keep them beating and circulating their blood effectively before we can get them born.

Additionally, we give calcium injections That does two things. One, it improves the contractility of the uterus. At C-section, the uterus contracts down better. We have less bleeding. We have less of a problem with concerns about pieces of placenta that might be getting left behind. It also improves the maternal skills of the female. That seems to make her a better mom when she leaves your hospital. It’s important that we’re giving all these drugs so that we have the female well prepared for going home with her litter of puppies, and the puppies well prepared.

When Should a Dog Have a Planned C-section?

What if we have an unplanned but a scheduled C-section? We have people that come in and they didn’t think they were going to need a C-section, but they come in for their puppy count X-ray and they find out they have 14 puppies. They come in and they find out that the female had something happen, like she injured her back or she injured her neck during her pregnancy. They don’t really want her to go into labor and have to turn and twist and do all the things that females do when they’re in labor and producing puppies. Sometimes we end up doing a scheduled C-section, but it wasn’t planned to be scheduled at the beginning. Without timing, that makes it a little bit more difficult.

One of the things that we use are a reverse progesterone. That’s when we do progesterone is at the end of the pregnancy instead of at the beginning of the heat cycle. We want to see a progesterone lower than three, preferably below two before we start to go to a C-section. That assures us that the puppies will be mature and ready to breathe when they are born.

The other thing we use for timing in our hospital is ultrasound. Ultrasound can be really useful in assessing whether the puppies are mature enough to be born. Progesterone timing can be really helpful at the beginning so that we know exactly when we want to do our C-section, because believe it or not, veterinarians do not have a crystal ball. We know from our progesterone testing that we’ve been doing for over 20 years that timing is everything, not just for getting her pregnant, but for getting her unpregnant as well. If we time from ovulation, we know how many days a female should be pregnant and that’s 63. So, 61 days from ovulation we do our C-sections on our bully breeds, the Frenchies, the English Bulldogs, the short face breeds, and 62 days for everybody else.

If I have a golden retriever with ten puppies, she’s going to be on day 62. If I have a bulldog with two puppies, she’s going to be on day 61 from ovulation, ovulation being progesterone of five. We know reverse progesterone that the C-section should be safe if the progesterone is less than three. A lot of vet clinics now can do progesterone in-house on their own machines, so you can now get results back in less than an hour. We don’t have to send them out at some of the hospitals because about 60% of vet clinics that have the IDEXX Catalyst machine can now run these in-house. We also look at skeletal maturity. If we take a puppy count X-ray, we can see how mature the skeletons look. That can be a key ultrasound, looking at both gut motility and the development of the kidney can be key. Lactation, so if the female is lactating and she’s starting to nest, those are all keys that we’re probably safe to go ahead and go to C-section.

I want as many of these stars to align as possible. I don’t want to just look at a progesterone. I want to look at ultrasound. I want to look at the date that she was bred. I want all this information to make sure that we’re making great choices.

Why Do Breeders Do C-sections?

When is the C-section recommended for dogs? We recommend it if we have large litters, small litters, certain breeds, maternal histories, and previous histories. If we have a large litter, we’re going to recommend a C-section. A large litter in my hospital is anything over nine puppies. Once we get up to ten, 14, 16 puppies, and we do have litters that big, we recommend a C-section. If we wait for all the puppies to be delivered, many times, by the time we get down to puppy number nine or ten, the labor has been prolonged, the uterus has been contracting for a long time. The blood flow is minimal to the puppies that are left behind. They tend to not get the oxygen that they need, and we start to have stillborn puppies. Before waiting until we have stillborn, we like to jump in and get these puppies born as quickly as possible.

If we have a really small litter, then we’ll also recommend a C-section. For instance, we just did a C-section in my hospital. It was a Dachshund, and she was pregnant with two puppies. If she’d had three or four puppies, she probably would have been just fine whelping on her own. But we worry with small litters. Two things. First, the puppies may get too large for her to deliver. Second, she may not go into labor at an appropriate time and the placenta may start to age out and not continue to deliver blood and oxygen to the puppies. The problem with small litters is labor is initiated in the female by the puppies, not by her ovaries, saying it’s time to go into labor. If we have really small litters, they’re not stressed, they don’t have a lot of worry. They just wait in there for the stress levels to start to happen and the placentas can then start to deteriorate. By the time we get to day 64 to 65 from the ovulation, those placentas aren’t carrying blood to the puppies anymore. So, if we have a small litter, we recommend a C-section.

The other reasons that a dog breeder may want to do a C-section would be a maternal history. That would be if the female has a history of not being a good female in labor. I had a client that had a German shepherd. She was the most active German shepherd you could possibly imagine. During her first labor, she delivered four puppies, but quit on number five. We wanted to get number five out. This time she quit after one puppy. I asked him, “Did you give her calcium?” “Yes.” “Have you given oxytocin?” “Yes.” And he said, “You know what? I’m at puppy one. I’ve got five to go. I’m not going to wait. I’m coming now.” I appreciate someone that thinks ahead and realizes that if they have a female that’s just not a good whelper, I mean, she’s fit, she’s active. She’s an amazingly active, athletic dog. Labor is just not her thing. So be able to plan ahead.

If the female has had a pelvic fracture, some kind of trauma, she’s going to have narrowing of her birth canal and not being able to deliver puppies. If she has a vaginal stricture or hyperplasia, those are polyps that protrude from a vagina, those are going to be in the way during labor. So have her checked with a finger exam prior to the time of the breeding and prior to the time of the whelping to see if there’s enough room for a puppy. If you can only get one finger in there, I’m going to guess your puppies are bigger around than that. So, you probably want to start planning for a C-section.

We also recommend C-sections if the semen is very limited, it’s the last frozen semen in existence on a dog. If the female has been diagnosed with herpes during her pregnancy, she’s at increased risk of passing herpes to the puppies if they’re born vaginally. We recommend a C-section. If we look at the size of the puppies on an X-ray or a position of a puppy and it’s really obvious that that puppy is not going to come out through the birth canal, like it’s C-shaped and it’s trying to come out shoulder first, just go to C-section. Don’t think you can reposition the puppy. If the female has been ill with diabetes, or she’s had an injury, or something that could interfere with her ability to have a good, healthy labor, you may want to schedule the C-section.

Dystocia in Dogs

Dystocia is the word that we use, whether it’s a human or an animal. It’s the inability of a female to expel a fetus without assistance. The average number of dogs that have this is about five percent, but we get into English bulldogs, French bulldogs, it’s around 90%. What you do really need to know is that 75% of the time, if we have a dystocia in dogs, it’s due to the female, and 25% is because of the fetus. In maternal causes, it can be that she has uterine inertia-really common in greater Swiss mountain dogs, Bernese mountain dogs and certain other breeds like that German shepherd. Her uterus didn’t contract well. That accounts for almost 50% of the times that we go to a C-section.

Partial uterine inertia accounts for 23%, meaning that she just didn’t have effective contractions and she had some. One percent would be a narrow bony birth canal. So, either she was made funny when she was developing, or she had a pelvic fracture. Uterine torsions account for one percent. That’s when one uterine horn flips over the other and the puppies just can’t get down and engage into the cervix and initiate good labor.

Hydroallantois in Dogs

Hydroallantois is when the female dog has an excessive amount of fluid in her uterus that overstretches the uterus. The uterus can’t effectively contract because it’s so large it doesn’t have good contractions. In those cases, we want to make sure that we take those females. And sometimes you can tell on ultrasound; sometimes you can just tell by looking at the female that the uterus and the belly looks more distended than it should for the number of puppies that are in there.

Vaginal Septum in Dogs

Vaginal septums happen a half of a percent of the time. It’s not very common. But again, that is a possibility that you have something abnormal in the vagina that she has two pups in the vagina or a septum or some stricture in the vagina that interferes with her ability to deliver puppies. So that accounts for 75% of the dystocias.

Puppies Born in Odd Positions

25% of C-sections in dogs are because of the fetus. That’s when a puppy is in an odd position. I’ve had them come out shoulder first. I’ve had them come out where they open their mouths and their jaw is now open, so it catches the jaw on the vagina, and they can’t deliver the puppy. There’s a lot of weird things that puppies can do. Sometimes they’ll come down one horn and instead of coming into the cervix, they’ll take a wrong turn and head back north, so we’ll end up with their head in one uterine horn, in their body in the other and they can’t deliver them shoulder first. Six percent of the time it’s an oversize puppy. That’s a puppy that’s just too large to fit through the birth canal. One percent of the time is a malformation, and that’s when a puppy is maybe a walrus puppy, a puppy that’s got some other defect with the way it’s made and it’s simply not going to fit through the birth canal. It’s not going to be able to come down effectively. One percent of the time the puppies are already dead, and they lose the fluid from around them, and they just don’t have enough lubrication to effectively come through the birth canal. This is all information from Sweden from 1994, some research that was done there, but it gives us a pretty good idea of what all the reasons are. So, there’s oftentimes a reason, but sometimes we cannot diagnose it before we go to surgery. If you end up with dystocia, you can ask your veterinarian if they were able to determine the cause.

Will My Dog Need Another C-section?

If it’s a fetal cause, it probably won’t happen on the next C-section or the next pregnancy. If it’s a maternal cause, she’s still the same dog. If she was a bulldog, when you bred her the first time, she’s still going to be a bulldog the second time, so you’re not going to change that. If that’s the case, you’re going to end up simply doing a C-section every time.

Just because she had a C-section doesn’t mean she has to have one every single time that goes forward. If your veterinarian is careful and puts the incision in the uterus where the female can deliver puppies the next time and it won’t interfere with the development of future pregnancies. You don’t have to necessarily do a C-section every time unless it was a maternal cause. If it was a fetal cause, like the uterine horn had flipped, that’s kind of random. If it’s a malformation of a puppy, an oversize puppy, you’ll probably be OK. And in humans, they call those VBACs. That’s vaginal birth after a C-section VBAC. We can do the same in dogs. They’re not at risk of uterine rupture. It’s OK to go ahead and have a C-section one time and not on the subsequent pregnancies.

Are Breech Puppies Normal?

60% of the time, puppies should come out of the uterus head first. That’s normal. It’s also normal 40% of the time to come back feet first. That is not a breech puppy delivery. A breech puppy delivery is when the tail is coming, and the back feet are forward. You’re getting actually just the rump of the puppy, not the entire rear end of the puppy with legs. That’s a breech. Those are not common. But back feet first is common, 40% of the time. If you look at cows and sheep and horses, they have a narrow head and very long front legs. Those animals have to be born headfirst. But puppies, kittens and pigs are kind of torpedo shaped. They’re rounded on both ends. It’s absolutely normal for 40% of the time them to come out back feet first. That’s not anything to get excited about.

Dorsal Ventral in Puppies

When I say dorsal ventral, that’s when the puppy is being born, instead of belly down toward the floor, it’s belly up. During birth that puppy cannot flex its back and normally come through that birth canal, so frequently we’ll see that created dystocia. Head deviation means that they’re not coming with their head forward, they’re coming with shoulder forward. That doesn’t work really well. Oversize puppies, birth defects, all these are possible causes. So that just gives you an idea of different positions of the puppies.

How Do I Know if My Dog Needs an Emergency C-section?

What happens if we have a dog emergency C-section? What if our female dog is in labor and she either never delivers the first puppy or gets part of the way through the pregnancy and the delivery and doesn’t finish delivering puppies? That’s when we need to do an emergency C-section.

I have clients that will ask me, why are puppies born dead? Like, why was puppy number eight a stillborn? It can be prolonged labor. It can be a dystocia, which meant a female that needed help. It can be a stressed female where she’s just really frantic and there’s poor blood flow to the uterus because she’s running around and she’s upset about the way the position of the puppy is happening, and she’s not able to relax enough to let the blood flow to the uterus.

At the time that they come in for a dystocia all of my females that are in labor go immediately on IV fluids. That helps to improve the blood flow to the uterus and to the puppies. It’s important that we have them on IV fluids during labor. If we’re trying to do a managed delivery at the veterinary clinic or if she goes to C-section, it is really important that we get an IV catheter in and give her fluids. IV fluids are much better than subcutaneous fluids. Don’t forget that that’s really a big difference. If your vet says, I’d like to put in an IV, I’d tell him, Yes, let’s get it out of the way.

When is an emergency C-section needed? If you’re using Whelpwise and they can see that the fetal heart rates are starting to decline below 160, you need a C-section. If you’re using Whelpwise, which is a uterine contraction monitoring service, and they say the uterine contraction patterns are not effective, you need a C-section. If there’s been more than two hours from the last puppy, you need a C-section.

When else is an emergency C-section needed? If you see green vaginal discharge before the first puppy is born, that means there’s placental separation. Now, clearly, after the first puppy, you do have placental separation. So green discharge between puppies is normal. Green discharge before the first puppy-green means GO at my hospital. If you see green, that means you call right now. You come in right now and we’re going to have your dog on the table in 30 minutes. That includes time to get the catheter in and get the blood work done, get the EKG done and get everything prepped and ready to go. You need to have a veterinary clinic that’s able to do this for you.

When else do you need an emergency C-section? If you plan in advance and it fell apart, like she was supposed to have her C-section on Friday, but Thursday she was ready to go into labor, then it’s an emergency. If you have fetal distress or maternal distress, you have an emergency.

I trust my clients. If they have this feeling, they call me and say, “I don’t know, Dr. Greer. I just I just feel like something’s wrong.” I believe them because they know their females. They know what their previous litter was like. If they don’t feel like something’s going the way it should be, I might tell them to get a box for the puppies, get in the car, and come now. I don’t care that you’re in your pajamas. I don’t care that you didn’t have supper. Just get in the car and let’s go.

Is it Common for Puppies to Be Born Dead?

Obviously genetic abnormalities in puppies and inborn defects of metabolism, there’s nothing we can do to prevent those. If we have puppies that have something wrong with them, it’s just the way it is. Sadly, those puppies cannot be saved or revived. And there can be infectious causes. We can see infections like canine herpesvirus that happened to the female during her pregnancy. She may just have mild kennel cough, but the puppies can be profoundly affected and be born dead because of something like herpes. We can see bacterial infections that get up through the cervix and into the uterus and the female can have a septic pregnancy. There are a lot of reasons that puppies are born dead. Some of these we can control, like how long her labor is and how stressed she is and giving her fluids, what kind of anesthetics we use. Some of them we cannot. We do our very best. But sometimes in spite of our best efforts, we don’t always have the great outcomes that we’re hoping for.

If we are doing an emergency C-section, we know that our outcomes are definitely better if the surgery is not an emergency. We know that our outcomes for puppy survival are better if the female is not a brachycephalic, meaning a bulldog, a French bulldog. We know we have better outcomes if there are four puppies or less in the litter, if there are no deformed puppies, if all the puppies breathe spontaneously or one vocalized spontaneously.

If you have puppies that are being born dead, don’t wait for another puppy to be born dead. Go to the vet, get a C-section. Or if you go in and there’s an X-ray or an ultrasound that suggests that there’s a problem with the presentation or the viability of the puppies, get a C-section. Don’t wait until there’s only three dead puppies left. That’s no fun for anybody. It’s not fun for your staff. It’s not fun for the veterinarian. It’s not fun for you. If you get the feeling something’s not right, you need to go in and get these diagnostics done so you know.

What Kind of Anesthesia is Used for C-section in Dogs?

Back in the old days, we used to use methoxyflurane as a gas. That is not recommended. Neither is ketamine, or xylazine/dexdomitor, which is frequently used in other anesthetic protocols, but is never appropriate during a C-section. You want to talk to your veterinarian, if this is somebody you routinely use, before you end up in the middle of the night in a crisis about what anesthetic agents they use, because we’re going to tell you which ones are the best.

As far as anesthetic protocols, we have been using Propofol for many years and about two and a half years ago switched over to Alfaxan. They’re both a very short acting injectable anesthetics. They are super safe for the females, super safe for the puppies. We do that until we get the female under anesthesia, and then we’ll turn on gas anesthesia, either sevoflurane or isoflurane. They’re both good anesthetic drugs.

Your veterinary clinic just really has to avoid the use of Ketamine, the use of Rompun, Domitor, and Dexdomitor, which are alpha-2 antagonists. They need to avoid Methoxyflurane, which is an old anesthetic gas, and they need to avoid using local anesthesia only. Believe it or not, there are still clinics that do C-sections with acepromazine and local anesthesia, and no general anesthesia for the dogs. And that is just medically inappropriate now. We just really need to have better control of our females’ airways and their pain management during the delivery of puppies.

Don’t wait until 15 minutes before your vet clinic closes to call and say, “I think I’m in trouble.” Call them at 1:00 in the afternoon. Don’t wait until quarter to six and say, “You know, you don’t mind if you stay late, do you?” Because you know what? Everybody thinks they have a vet that will be willing to stay late for them. That gets really hard on the staff after a while to stay late every single night. They have families and they have other lives, too. Don’t wait until you’re up against the wall and have no options left.

How to Prepare for a Dog C-section?

The things that you can do as the owner of the dog for preparation for a C-section are going to be knowing her due date based on progesterone timing, giving her baths using chlorhexidine shampoo before the C-section, two or three days before, so that she’s clean and has limited or no bacteria in her skin. You’ve got the fecal material off. Sometimes we have a little bit of shaving done along the mammary chain. If you know you’re going to have a fuzzy dog like a golden retriever or corgi, it can be helpful to get her groomed ahead of time. Have your supplies packed up, the stuff you want to travel with, blankets, DeLee mucus trap, bulb syringe. Don’t wait until you’re calling your vet saying, “I think I’m in trouble.” Have the organizational system that you can throw stuff into a box and be out of your house in 3 minutes. Make sure you have gas in your car. I’ve had clients call me and say, “I may have to stop and buy gas.” Really? You have a pregnant dog and it’s January and you didn’t think having a full tank of gas was a good idea.

You need to plan ahead. Get plenty of sleep so that you’re well rested when you take your dog home. I use a lot of ThunderEase collars. Those are the pheromone collars. They’re not lavender; they’re actually pheromones. They’re the hormone that a female makes in her placental fluids and in her mammary glands. It’s calming to the puppies. It’s calming to the female. Get those collars on them. If I’m scheduling a C-section, I put those on the females three days before they’re due.

Should I Feed My Dog Before C-section?

Make sure she’s fasting. Don’t feed her right up until the minute that she goes into labor if you know her due date is coming. Sometimes you can’t tell, and feeding can be a useful tool in determining if they’re ready to go into labor or not, because some will stop eating. But if you’ve scheduled a C-section, especially if you have a bully breed, don’t feed her right before you go to the vet. Breeder’s Edge® Oxy Momma is an herbal product that helps females lactate. These are some really simple, basic things that you can do at home that are going to make a big difference in your outcomes.

When it comes to how to get a mom to eat after a C-section, that can be a little bit tricky. Pain medication certainly helps. She’s going to feel better if she’s on Rimadyl or Metacam. The Royal Canine® Starter Mousse can be used not just in her drinking water, but it can be used as a top dressing on the food. I feed bratwurst. A lot of females don’t eat really all that well after their C-section or in fact, even after vaginal delivery. I think they’ve been stressed. They’ve eaten some placentas. It’s just a lot going on. So, I do a lot of things with Starter Mousse, with bratwurst, with chicken broth. Get out your instant pot or your crock pot, throw some chicken legs and thighs in the crock pot, cook those up and then offer them to the female so that she has an opportunity to eat something really yummy. Within a day or two they’ll start to eat. Sometimes they don’t want to leave the puppies either. They’re so attached to their brand-new puppies that they’re like, Nope, nope, I’m busy, I can’t eat. Sometimes just taking her out of the whelping box, getting her away from them for a few minutes giving her a place in the kitchen to eat instead of in the kennel can be really helpful as well.

What Happens During a Dog C-section?

At the veterinary clinic they’re going to need to do a blood work and an EKG if they do those at their hospital before she goes to surgery, just to make sure she’s healthy and stable and that the C-section will go well. We’ll do an ultrasound to look at the puppies for maturity and to check heart rates. If puppy heart rates are below 160, I’m running to the surgery room. I’m going to knock everybody else out of the way and say, “I’m sorry. I know you had an appointment for a vaccination this afternoon, but I’m going to take this dog to C-section first.” Because if I know I’m in trouble, I’m going to go.

The female needs to be on IV fluids period. End of discussion. That shouldn’t even be negotiable at your vet clinic. They should put in an IV catheter and start fluids. And you should not complain about that.

For the short phase, dogs sometimes will get some oxygen by facemask in advance of the C-section. Some females will fight that, some tolerate it pretty well. It’s a good way to get better oxygenation to the puppies while she’s in labor. Metoclopramide is Reglan. That will improve not only her lactation, but it’ll also make it less likely that she’ll vomit at the time that she’s put under anesthesia. That can be helpful. Before we put our females under anesthesia, we shave their bellies. I don’t want them on the table under anesthesia any longer than absolutely necessary. As soon as she’s out, I want to start getting puppies delivered. So, I have her shaved in advance. I have a C-section team. I have a group of people on my team that know exactly how they need to work and what they need to do. They’re very skilled in puppy resuscitation. We have checklists in our hospital so that we know exactly what has to be set up in advance. Your veterinary clinic should be fast. They shouldn’t sit there for three or four hours. If you go in and you say, I want a C-section, they should be responsive to that and get things going. You need to make sure your female gets a tube in her trachea at the time she’s anesthetized. There are still clinics that do these without endotracheal tubes. The endotracheal tube does two things. One is it delivers gas and oxygen to the female. And two, it will protect her airway if she does have any vomiting or regurgitation under anesthesia because of the weight of the pregnancy. We don’t want her to aspirate any stomach contents. So, it’s really important that we have an endotracheal tube controlling her airway and keeping it open so that she’s oxygenated.

Can You Do C-section and Spay at Same Time?

We never spay at a C-section. Ever. I would really encourage you to make sure that you’re not approving that, especially at an emergency clinic that doesn’t know you well. They will sometimes have an agenda to say, “If your female couldn’t deliver puppies, she should never be bred again. I’m going to spay her right now.” Don’t let that happen.

Spaying her on the table at a C-section should never, ever happen. It will not affect the production of milk. They don’t need their ovaries to lactate. But it is really important that we don’t take out her uterus. She’s going to lose 30% or more of her blood volume at the time of the C-section if the uterus is taken out and she is spayed at the time. So, it is really, really, really advised against to spay her at C-section.

When it comes to supportive care during the surgical procedure, the female needs to be on a monitor of some type so that you can make sure that she is safe. She’s got a beating heart, she’s got a good SPO2, she’s got good respirations.

I use gauze that has a blue line through it so that if something inadvertently would get left behind, and so far, we’ve never done that, you can see the gauze on X-ray. I count my instruments before and after I’m done with my procedure to make sure nothing got left behind. I want to make sure I have Delee mucus traps available and I have an incubator.

What Does Oxytocin Do For Dogs?

Oxytocin doesn’t just help with milk letdown, it also improves maternal bonding. Females need calcium orally such as Breeder’s Edge Oral Cal Plus gel and oxytocin to improve their ability to be good moms. If we give oxytocin by injection or by nasal spray and we give calcium orally in the gel that you can see in this picture, it’s the most effective and the fastest way to get calcium working other than injectable.

Those two together will improve maternal bonding. Sometimes you’ll have some females that are kind of snarky toward their puppies. I actually had one of my own do that, and the puppies were born vaginally. It doesn’t happen often, but it is important to know how to respond to that if it does occur. So, get calcium into her, get some oxytocin into her.

Do Dogs Need Pain Meds After C-section?

If your dog had a C-section, please, take home pain medication for your dog. Don’t tell your vet you don’t need it. Don’t tell him she’s fine without it. I will tell you, they’re better moms. They’re more relaxed, they lactate better. They let the puppies crawl around on much more effectively if they’ve had a non-steroidal anti-inflammatory or pain medication after her surgery. I always give an injection at the time that the last puppy is born and then we send home a three-day supply with the females. You can use Rimadyl or Metacam. I’ve been using those products for close to 21 years and have never looked back. Every single time I’ve done it, I’ve been glad I have. The females are better moms. I’ve never had a puppy go into kidney failure because of it. I’ve never had a female get into trouble because of it. It makes a huge difference in her ability to be a good mom. So please cast your vote for non-steroidals. A lot of people use either Tramadol or gabapentin. That can make them drowsy and make them more likely to lay on a puppy or step on a puppy. Get a good drug. Rimadyl and Metacam are safe. I’ve used them for two, three, four generations of dogs now. I’m not seeing any negative effects. Ask for those. Females are not euphoric enough to say that they don’t need a pain medication after a C-section.

How Do I Take Care of My Puppy After C-section?

I’m a big fan of the Puppywarmer incubator and the Puppywarmer oxygen concentrator. We have very good success with these, and these are affordable enough that you can purchase these from Revival and have these at your own kennel for raising puppies. Either at the time that they’re born or if they end up with a sick puppy, this is really invaluable in saving puppies.

During resuscitation, you want to keep the puppies warm and safe. Don’t let them roll off the table and onto the floor. Keep them warm with the heating pad or with a hot water bottle. If you’re not sure if the puppies are breathing, grab your stethoscope and if you have a puppy with a curl to the tongue and you can hear a heartbeat, you want to continue to try resuscitative efforts.

If you’re unable to resuscitate with just the DeLee and the bulb syringe, you can use the Gv 26 Acupuncture Point, which you can do with a hypodermic needle. And by stimulating the puppy, by putting the needle into the nostril area, you can get that puppy to start breathing in many cases. If they’re still not breathing at that point, I use caffeine tablets and you can just buy these as Nodoz tablets at any truck stop. We dissolve this into a CC of water, put a drop on the tongue, and then you can repeat it if you need to, if the puppy continues to have irregular respirations. Dopram is an injectable product; it’s a prescription item. It tends to be a little bit controversial. But after 10 minutes if the puppy is still not breathing and you’ve cleared the airway and you’ve done everything else right, then we will do a 10th of a CC injection into the puppy’s tongue. I only do that if it’s a last resort. And if at that point the puppy is still not breathing, then my technician will intubate the puppy.

What is the Apgar Score for a Neonatal Puppy?

We Apgar score all of our puppies. The lowest Apgar score you can get is a zero which means that you don’t have a heartbeat, you don’t have any muscle tone, and the puppy is really flaccid and not breathing and not having a heartbeat, all the way up to a ten Apgar score, which means the puppy was vigorous and was screaming on the way out.

It’s important that you don’t cut corners at C-section. There are no bargains in parachutes and C-sections. Don’t buy a discount parachute and don’t buy a discount dog C-section. It doesn’t come cheap to get IV fluids to have great staff, to have enough staff, to have the right anesthetic and to have appropriate drugs and anesthesia in post-op. Make sure that you know that a C-section isn’t going to be the cheapest surgery you’ve ever had done, but done well, it can be really, really important.

We do encourage our puppies to nurse before they leave our hospital. If your females are not eating and drinking well after their C-section, they’re not going to lactate well. Royal Canin® Starter Mousse can be really helpful in getting her to drink. You can mix that with a bucket of water. You can give her subcutaneous fluids to help encourage her to lactate. We also know that bratwurst, oatmeal, and sweet potatoes are used on the human side to improve lactation. Breeder’s Edge Oxy Momma is another great product that will improve lactation.

I want to really emphasize the importance of oral calcium and injectable calcium not only to improve delivery of the puppies, but to reduce the risk of eclampsia, which is low calcium in the female after she’s had a litter of puppies and is nursing, to reduce her aggression toward her puppies and to reduce her aggression toward visitors.

What Can You Do With a Dog’s Placenta?

I save some of the placenta fluid in a bowl at the C-section and put it in a bottle to send home and put on the puppy’s head and rump so that the female recognizes those as her puppies. Some of our inexperienced females will be aggressive toward their own puppies. Sometimes you simply have to physically separate the female and put her in a muzzle when she’s with the puppies. You may just absolutely have to do that to keep the puppies safe. This is really tragic when it happens. So don’t let her hurt her puppies. Be with her as long as you don’t think she’s safe. Make sure you don’t overstress her by too many people and too many animals staring at her. Give her space because postpartum stress can be really upsetting to the female. I just want you to all have really good outcomes with C-sections, really good outcomes with vaginal deliveries.

I let my females eat one or two placentas during whelping, but if she’s halfway through labor and you end up having to go in and have a C-section, I’ve actually had females vomit up their placentas at the induction of anesthesia before the C-section so I tend to be pretty conservative and try to maybe let them eat one or two, but not all of them. If she has 14 placentas, she’s, she’s going to be a sick girl she’s going to end up with diarrhea. She’s likely to vomit. Try to limit it to just a little bit. They really don’t need them nutritionally. If you’re feeding an appropriate diet of puppy food or performance food, they’re going to get plenty of nutrients. Remember, females ate their placentas to keep predators from coming along and finding their puppies in the den. And I’m guessing most of you don’t have a wolf walking through your kennel. I think that it’s probably pretty safe if you just take the placentas and throw them out. But one or two at the most is all I’d let a female have.

How Do I Get My Dog to Produce Milk After a C-section?

Breeder’s Edge Oxy Momma is an herbal supplement. It combines fenugreek with some other herbal ingredients that improves lactation. I’ll generally start it if I have a female or a line of females I know that aren’t great lactating females, I’ll start at two or three days before they’re due if they tend to already have enough mammary development. You don’t want her dripping all her colostrum out before she delivers. It’s going to depend a little bit on the dog. There’s not a hard and fast answer. But if she’s been on progesterone to keep her pregnant, if she’s a female from a line of dogs that doesn’t lactate well, if you don’t think she’s going to eat well, then I would start the Oxy Momma a day or two before she’s due. They come as a chewable with a molasses base. And I’ll tell you, my dogs would eat the entire bottle. So don’t turn your back because if you open it, she knocks it on the floor and starts to get to it, she’ll eat the whole thing if you give her a chance to. I’ll often give those to the female, even though I have my females fasting at C-section, I often give one or two to the large females and let them chew one before we go to surgery if they’re not lactating well and we’re doing a planned C-section. I want them lactating when they wake up.

If you have any questions on a canine C-section or need help, call us at 800.786.4751.

Written by: Marty Greer, DVM

Director of Veterinary Services

Marty Greer, Doctor of Veterinary Medicine, has 40+ years’ experience in veterinary medicine, with special interests in canine reproduction and pediatrics. She received her Doctor of Veterinary Medicine from Iowa State University in 1981. She’s served as Revival’s Director of Veterinary Services since 2019. In 2023, Dr. Greer was named the Westminster Kennel Club Veterinarian of the Year.

If you need help, call us at 800.786.4751.