A C-section is a procedure that is performed in order to retrieve any remaining fetuses from the uterus of a pregnant animal that is unable to deliver them herself. The pregnancy must be very near to the end of the full gestation period in order for the puppies to have a chance of surviving outside the mother.
In many cases, the veterinarian will recommend spaying of the mother while removing the fetuses in order to prevent future dystocia, pyometra and other uterine diseases. The uterus is not necessary for milk production.
The procedure has few complications associated with it and is well tolerated by most animals.
Most C-sections are not planned procedures, as it is unusual for most dogs to have problems delivering. The animal is usually brought to the veterinarian after prolonged straining without delivering, extended duration between deliveries or when a puppy is visibly stuck within the vaginal canal.
Occasionally, the puppy may get stuck within the pelvic canal, and the veterinarian may be able to help the puppy out manually. Digital vaginal palpation may also indicate whether the mother has an abnormal pelvic conformation that prevents proper delivery.
Radiographs (x-rays) of the abdomen are frequently performed to evaluate the number and size of the remaining fetuses, the size and shape of the mother's pelvis in relation to the puppies, and may indicate whether the puppies are viable (still alive).
Sometimes an abdominal ultrasound examination is done to evaluate the viability of the fetuses.
Medical therapy is often attempted before surgery to help the mother deliver the puppies. If the mother has been straining for a long period of time, she may be dehydrated or in shock. Intravenous fluids may be given to rehydrate her and combat the effects of shock.
When the mother's uterus becomes fatigued from excessive straining, injections of oxytocin (a hormone that causes uterine contraction) and/or calcium (an electrolyte necessary for muscle contractions) can increase the force of uterine contraction enough to expel the puppies. It is important that the mother not have an obstruction that is preventing the fetus from exiting or that the puppy is too large to fit through the birth canal before these medical treatments are tried.
When it has been determined that medical treatment will not be successful, the mother must be anesthetized for surgery. The anesthetic drugs that are used must be carefully selected so as to perform major abdominal surgery adequately and safely on the mother while minimally depressing the puppies. Drugs used for the induction of anesthesia include combinations of ketamine and Valium®, or propofol and butorphanol. The animal is then given an inhalant gas anesthetic, such as isoflurane, after a breathing tube is placed into her trachea (windpipe).
The skin incision is on the midline of animal's belly. The uterus is gently elevated out of the abdomen and an incision is made into it. All of the remaining puppies are removed from the uterus and passed to a nurse for resuscitation.
If the dog is not being spayed, the incision in the uterus is sutured back together after the procedure. The abdomen is flushed with sterile saline to remove any uterine fluids that might have leaked from the uterus during surgery. The incision in the body wall and skin are sutured shut. Frequently, the surgeon will avoid using external skin sutures, especially if there are newborns that will be nursing.
In some cases, the dog is spayed following removal of the puppies.
Animals can be painful after any abdominal surgery and the mother may be given analgesics if she is excessively uncomfortable. Many drugs can pass into the mother's milk and into the newborn so most are avoided whenever possible.
As soon as the mother is out of the operating room and recovering from anesthesia, the puppies will be allowed to start nursing.
After discharge from the hospital, the dog must be kept quiet in order to heal properly. Activity must be restricted for a couple of weeks after surgery, which means that the dog should be kept confined to a carrier, crate, or small room whenever she cannot be supervised; she cannot play or rough-house (even if she appears to be feeling well); and she should be confined to a leash when taken outdoors.
The skin incision needs to be monitored daily for signs of excessive swelling or discharge. These can indicate problems with the incision or possibly infection. Contact your veterinarian if these occur.
The mother should be monitored closely. Make sure she continues to eat and drink well and starts feeling better. Signs of lethargy, weakness, or lack of appetite may indicate a problem such as peritonitis caused by infected fluids leaking into the abdomen during surgery. She should be brought to the veterinarian if there is any concern that she is not continuing to improve after surgery.
It is common for animals to have some dark green or bloody vaginal discharge after normal delivery or C-section. This discharge should resolve within several weeks. If it persists, becomes profuse, or becomes fetid, inform your veterinarian.