Every breeder has likely experienced the uncertainty of trying to decide whether to seek emergency veterinary care for a female whose labor and delivery are going awry or to try and manage the problem at home.
“Knowing when to intervene and understanding what things can be treated at home and what needs veterinary assistance can help maximize a breeder’s success,” says Carla Barstow, DVM, MS, DACT, a board-certified veterinary reproduction specialist who practices at the Highland Pet Hospital in Lakeland, Florida.
“This allows breeders to evaluate their female and seek care sooner before problems become worse,” Dr. Barstow recently told breeders during a Good Dog webinar on common reproductive emergencies.
Her discussion of dystocia provided insights about recognizing potential problems. Although the circumstances that lead to dystocia vary, the end result is the same: A female is unable to deliver her puppies without difficulty or assistance.
“Roughly, 23.8 percent of pregnancies result in dystocia,” Dr. Barstow says.
“The most common cause of dystocia is uterine inertia, primary or secondary, in which contractions fail to deliver the fetus,” she says. “Feto-maternal disproportion, the second leading cause of dystocia, involves an oversized fetus and/or mother dog with a small pelvis.”
In females with primary uterine inertia, the myometrium, the muscular middle layer of the uterus responsible for uterine contractions during pregnancy and whelping, does not initiate contractions or the contractions are too weak to progress to labor.
“They basically just don’t go into labor,” Dr. Barstow says.
In contrast, “secondary uterine inertia occurs after normal contractions but the contractions have become weaker or cease,” she says. “A female with 10 to 12 puppies that has been having puppies every two hours is exhausted after 20-plus hours of labor. She doesn’t have the energy to deliver the last puppies, or she has been pushing against a stuck puppy, thereby exhausting her muscles.”
Feto-maternal disproportion is attributed to: breed predisposition whereby brachycephalic breeds may get stuck in the birth canal; oversized fetuses in a small litter or a large singleton puppy; and anasarca, or “water puppy syndrome,” a usually fatal fetal condition depicted by excessive fluid buildup in the body.
“A proper diagnosis is important in deciding whether to medically manage a female in dystocia or go straight to a C-section.” – Dr. Carla Barstow
“I start with a digital vaginal exam,” she says. “This is a finger exam where I try to determine if there is an abnormality such as a puppy stuck in the birth canal.
“If the mom has not had any puppies and I see a dark green vaginal discharge, I am a bit concerned about the possibility of placental separation, which means the puppies are not getting oxygen. If she’s had one or two puppies, the green discharge can no longer be used as a dystocia indicator.”
To determine if a female is able to have contractions, Barstow will feather the vagina to check her Ferguson reflex, a neuroendocrine reaction that is triggered when a puppy descends into the birth canal and presses against the cervix. This sends signals to the brain that release the hormone oxytocin, stimulating the uterus to contract more strongly and facilitating the birth of puppies.
“Radiographs, or X-rays, are taken to determine the number of puppies yet to be born, their position and if they are stuck or malpositioned,” Dr. Barstow says.
“If there are more than two puppies, I usually recommend a C-section, as it is highly likely the already tired mother will struggle to deliver them,” she says. “If there are fewer than two puppies, I consider medical management as long as a puppy is not stuck, in which case we need to go straight to a C-section.”
“An ultrasound can be performed to learn the viability of fetuses,” Dr. Barstow says.
“If we are considering medical management, we have to know if there is fetal stress. A normal fetal heart rate is 200 beats per minute, a stressed heart rate is around 180 beats per minute, and a heart rate of 160 beats per minute or less indicates surgery is needed now,” she says.
Medical management generally involves giving a female oxytocin in combination with calcium to increase the power and strength of uterine contractions.
“Oxytocin can be repeated two times from 15 to 20 minutes apart,” Dr. Barstow says.
“Calcium is given intravenously 10 minutes before oxytocin. Oxytocin and calcium can work synergistically when given appropriately.
“If you go to a C-section because there are a large number of puppies or the puppies are stressed, it is not a wrong decision,” she says. “Importantly, just because a female has had one emergency C-section, doesn’t mean you can’t try to free whelp with her the next time.
“However, if we’ve had two emergency or planned C-sections, I prefer a female to have nothing but C-sections for the life of her breeding career because there are two potential weak spots in the uterus that can set her up for failure.”
Breeders who are cautiously prepared to recognize the signs of dystocia are more likely to have a good outcome. As Dr. Barstow has described, with prompt diagnosis and treatment, the prognosis for dystocia is generally good.
Red Flag Postpartum Complications
Postpartum complications can be challenging and even life-threatening to the dam and her neonatal puppies. Here, Dr. Barstow provides a snapshot of three conditions that require prompt veterinary medical attention.
An Infection of the Uterus
Metritis is a postpartum bacterial infection of the uterus that can be caused by prolonged labor or dystocia. It occurs two to three days after a female delivers puppies.
“Fortunately, less than 10 percent of dams develop metritis,” Dr. Barstow says.
Fever, anorexia, depression, inability to care for puppies and a foul-smelling purulent discharge are common clinical signs. The uterus may be distended, and there may be a red vaginal discharge.
“The clinical signs are similar to pyometra, an infection of the uterus that occurs four to six weeks after a female’s estrus cycle,” Dr. Barstow says. “Importantly, metritis occurs after giving birth, so it is absolutely not a pyometra.”
In diagnosing metritis, “it is important to rule out a retained fetus,” she says. “This can be determined by an X-ray.”
A veterinarian may treat metritis by prescribing an antibiotic and an anti-inflammatory to reduce fever. An oxytocin injection serves as a clean-up shot to force expulsion of the uterine’s contents, or alternatively, if puppies are able to nurse, this may cause uterine contractions with the same effect. Severe cases of metritis may need to be hospitalized.
Painful Nursing Due to Infection
Mastitis is a bacterial infection of the mammary gland that occurs at the peak of lactation, three to four weeks after whelping. Unequal nursing, puppy death and even excessive human manipulation can cause milk buildup in the mammary gland that triggers the inflammatory, painful condition.
“Mastitis affects about 13 percent of nursing dams,” Dr. Barstow says.
“Purulent milk that is cloudy and thick indicates an infection related to mastitis,” she says.
“Hot compresses may help soften the mammary gland. An antibiotic and anti-inflammatory may help break fever. It also may help to let the strongest puppy nurse to help open the gland.
“Cold laser can be used to speed the healing process. It may force the gland to rupture sooner than it would have on its own.”
Low Calcium Emergency Alert
Hypocalcemia, or eclampsia, is a dangerously low calcium level that can become an emergency veterinary medical condition. Sometimes called “milk fever,” eclampsia occurs in nursing females two to three weeks postpartum. A life-threatening drop in the blood calcium level can be fatal, if not treated properly.
“Eclampsia happens when a nursing female can’t keep up with the demands of milk production,” Dr. Barstow explains. “It is seen in about 20 percent of small-breed dogs with large litters.”
Clinical signs include restlessness, drooling, panting, vomiting, stiff gait, changes in behavior and inability to stand. If seizures occur, a female should be taken immediately for veterinary care with intravenous calcium.
“Once she is stable, she can go home and the breeder can use an oral calcium product,” Dr. Barstow says. “Breeders may want to consider weaning puppies early to reduce the drain on the dam, and puppies may need supplements so the mom is not having to work as much to nurse.”
