The Pom and the Caesarean Section

"A stitch in time saves lives"
by Carla Timmins

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Ask any breeder what they dread most about bringing little Pomeranian fur babies into the world and chances are you'll be surprised. Is it cleaning up after the pups, leash training or even weaning? No, the answer most probably would be the Caesarean section. Such a worrisome concept, that we don't even dare say the name. We use terms like the Zip, C - Section or THE OP.

Of all the toy breeds I have whelped in the last twenty years, I would have to say the Pom can be one of the most difficult. After all, Chihuahuas and Maltese have been smaller for much longer. Our beloved breed has only been 4-7 lbs. for slightly over a century.

It is most important to know the mechanics of a natural whelping so one can better understand the reasons for a Caesarean. I call these the 5 P's.

They are:

1. PELVIC ROOM

CASE HISTORY: To this day, I have no idea where this man got my phone number from. His command of the English language was poor but I was worried for his bitch and agreed to see them. His bitch had papers, was definitely in whelp and weighed 2.9 lbs. No breeder I know would have given a stud to one so tiny and it seems he had met someone, who knew someone who had a male etc. etc. Don't we all know how that goes. Even though we all try and spay/neuter, contracts can be hard to enforce, they are still our best and only defence against this sort of thing.

The bitch was well cared for and for her weight had MAYBE enough room there were she to deliver more than one pup. Since it was too early to determine heart beats I agreed to give her a trial labour but should a Caesar be necessary she was to be desexed. This was agreed upon in writing, and she was left with me.

When her labor started she was very active at nesting but somewhat distressed (anxiety in a primapara can be quite normal). Her contractions were normal in length and intensity, but soon after transition she started a high pitched screaming (if no part of a pup is presenting such acute distress is not normal). I could feel a pup's nose just beyond the cervix but it was not going to be delivered vaginally. She was delivered by Caesarean of a female pup and desexed. I was able to place this puppy for the owner of the dam into a nice pet home. Had his bitch been delivered normally he may have done it all over again.

2. PASSENGER

This is the number and size of the whelps relative to the dam's size. A litter of 4 or 5 can cause as many problems as a litter of 1.

CASE HISTORY: My Snowy was less than 2 years of age, weighed 6.4 lbs. (she had been 5lbs. prior to conception) and 3 days away from her due date. She also looked like she was going to give birth to a baby hippo! I could hear 4 heartbeats and was watching her closely. She followed me out to the kitchen to cadge something to eat. She wagged her tail and then dropped straight to the floor, unconscious. By the time I got to her she was coming around and wagging her tail again. Something was wrong here! At the vet's she was pronounced well and I was told to feed a light lunch and let her rest. So back at the ranch she was fed, given a bit of glucose and lo and behold, down she goes again! This time she wasn't coming around! She was barely conscious after we had made the 5 minute trip to the vet. In 3 minutes flat (we timed ourselves) she was shaved, IV inserted, masked and the first incision was made. Her gum color was almost white and my vet couldn't see the problem till the uterus was opened. One very large very, dead pup was positioned so as to compromise her heart function. As soon as this whelp was removed her gums started to pink up. 4 more pups followed in rapid succession and all were alive. We were standing around giving ourselves big pats on the back as the indotracheal tube was removed. Well that 'light lunch' came straight back up with her lying on her back. Now she was in grave danger of an inhalation pneumonia. I have never seen my vet move so quickly. Between one second and the next her mouth was cleared and she was left to recover with her head hanging from the table. Time would tell if she had actually inhaled any vomitus. This time the God's were smiling. She made a complete recovery.

3. POWER

This is the strength of the dam. She should not be too old, too fat, too small or irregularly exercised.

CASE HISTORY: 8 years ago I had placed a small female puppy with a lovely elderly lady. We had been in frequent touch over the years and no matter how I tried to convince her she had always been adamant that her 'Sweetie' was too small to be desexed. No discussion, no way. Well, her daughter came to visit with her male Papillon and it happened to coincide with Sweetie's fertile time. She had remembered the mating taking place but thought Sweetie had passed the "menopause" and not given it much thought. Now her stomach was getting bigger, could she be pregnant? Sweetie was fat at 4 lbs, was 8 years old and a primapara (never had a litter before). This was definitely going to be an elective Caesarean but the dates were very vague. Since by looking at her I thought her over 7 weeks gestation, desexing would have been inhumane to the whelp and it was up to the vet and me to determine the best time for a Caesarean delivery.

We determined optimum date for both dam and single pup and went ahead. On shaving of her abdomen I noticed some fresh bleeding on one of her hind teats.. It is not unusual to nick the skin but the bleeding was heavier than this. This was a bitch of 8 years old who had never been desexed and she was a prime candidate for a breast malignancy. We decided to take a needle biopsy since there was a chance it was nothing to worry about and a Caesarean, desexing as well as a double mastectomy was too much for her to be put through at one time. All went well and she came home with me (the pup, for those who are interested, looked like a black, long coat Chihuahua). The biopsy came back positive for malignancy and ten days later she underwent a double mastectomy. She and her pup stayed with me for some time so I could be sure of her recovery. I think this pregnancy saved her life.

4. PLACEMENT

This is the position of the whelps in the uterus. The 2 most common displacements are either a neck/back presentation or 2 pups trying to be born at the same time from the opposite horns of the uterus.

CASE HISTORY: Meet Janie. She's my nurse dog. She has an uncanny ability of being able to let me know if any animal in our household zoo is unwell. Very short coupled, has her very own C.D. and has had 2 prior free whelpings. At her last whelping things were to be different for her. She had been in second stage labor for 2 hours - but no water bag. I wasn't worried, was I ? No, I knew what my Janie girl could do! 2 hours was a bit long for her but she'd get there (start getting worried if no water bag or pup is presenting after 2 hours of visible contractions. This may be left somewhat longer IF you are in constant touch with your vet). In other words I got cocky. It wasn't until I'd let her out to urinate and heard her special alarm bark that it occurred to me to check her cervix. After examining her cervix, I felt a pup all right. I could feel no bottom, no head, no feet. Just a smooth expanse with no definite outline. It had to be a neck or a back! I am ashamed to say that I did not give her this internal until I looked to see all my other dogs were well. I expected her to be on the job when she was whelping and it took me a moment to realize she was asking only for help for herself. During surgery it was found that one little guy was blocking the exit of the others since his neck was stretched forward and back. Because the part of the brain that controls all autonomic functions (heart-beat, breathing) is at the base of the head, a few more minutes of delay and I would have lost this little fellow. Every contraction that the dam had was putting pressure on his brain pan and spine. He was born with a bloody nose and for a few days he would 'forget' to take a breath unless stimulated. He and his sisters prospered but more through his dam's efforts than mine.

5. PRIVACY

This is not the time to teach the kids the facts of life. Quiet and dim lighting are of the utmost importance.

So, somehow one of these 5 criteria have not been met. You MAY have to say the C word. The vet (whom you've personally been in contact with during the last week of gestation) is ready. Here's what happens next:

After examination of the cervix and palpitation of the abdomen an injection of "pitocin" and perhaps calcium may be tried. This stimulates contractions and has full effect in 40 minutes. If no progress is made, the next step is usually a Caesarean. Pitocin can be a wonder drug if the pup is presenting normally and the dam still has uterine tone. DO NOT use this prescription drug without veterinary back up. A ruptured uterus is a life threatening emergency!

Before I go on here, please keep in mind that your vet will have his/her own anaesthetic procedure that they feel most comfortable with. Anaesthesia is a learned art. Unless you have strong feelings about different gases, I would suggest you follow your vet's lead here.

After anaesthesia is induced an I.V. line is usually introduced and the bitch is intubated. She will then be tied to the operating table, clamps are placed on the abdominal skin and the operation begins. A mid-line (less commonly flank) incision is preformed and the abdomen is opened. When the uterus is reached it is carefully incised. If the placental membrane (afterbirth) is still attached to the uterine wall it is peeled gently away and the pup in it's intact (hopefully) sac is lifted out.The pup is then transferred to a box with a heating pad. Make sure you supply them! I remember, full well, once grabbing a bitch and running to the vet in an emergency only to find I'd left my receiving box and heating pad at home. It was nerve racking to try and get pup number 1 breathing, keep pup number 2 on the table (he wanted to go for a walk with his artery forceps attached) and run across the room to take pup number 3 from the vet who was rapidly turning a beautiful shade of blue! This whole litter made it, but I needed to go home to a warm brandy! If a vet has no assistant, you can see how he/she would have a most difficult job of resuscitating the pup, proceeding on to deliver the next one and watching the dam's vital signs as well! During ungodly hours of the early a.m. a vet will often work solo. This is the time your skill at helping a pup to breath will be important. Since Caesarean babies can be quite sleepy and are already under stress from a difficult labour they may need prolonged and almost rough handling to enable them to take their first breath. It bears stating here the process of inducing lung function in the neonate.

The pup should be held head towards floor and shaken; the nostrils and mouth should be wiped. Then stand with the legs apart, the puppy held head towards ceiling, and bring puppy down quickly and forcibly between your legs. Repeat if necessary but also bring the tongue forward as well. Rub puppy vigorously with towelling and if it's still not breathing well, pinch it's skin with your finger nails. The pain reflex will often make a pup attempt to cry and so inflate it's lungs. Adrenalin may be given if no response. DO NOT give up too soon. The color of a pups skin will tell you when it is too late. A very white and flaccid pup has little chance. A 'blue' baby needs urgent attention and they very often make it.

In my experience the Pomeranian has a one in four chance of having a Caesarean. With modern surgical techniques, there is little to fear but loses can occur. This is a major surgical procedure and should not be undertaken lightly. With every litter, be it a natural whelping or a surgical delivery, take notes. Watch your Caesarean numbers; if the ratio starts to exceed 1:4, reassessment may be necessary. Privacy and giving the dam enough time to deliver are major factors. A bitch should NEVER have more than 2 Caesars. There is NO reason for more. I have had major arguments on this one but here I stand firm. I have heard the argument that humans can have more than 2 Caesars; so why not dogs? Apart from the ethical issue (no one makes a woman have a baby) the canine reproductive system is completely different from the human. 2 Caesarean Sections are more than enough. Bitches should not have a 'use by date', they should have a life. Thankfully, most of us allow them that right.

Carla Timmins © 1996

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