Elective (Planned) C-Section
By Richard Wheeler, DVM
How do you make a million dollars breeding dogs? Start with 2 million dollars. J . Breeding dogs is not cheap…monetarily, emotionally, or with the amount of time invested. Precious lives are involved. Please breed responsibly.
This is the first of a three part series on C-section delivery in the bitch. My intention is to discuss here the options of Elective (Planned) C-Sections. Next month I will cover Emergency C-sections, deciding to proceed to surgery, risks, consequences, and alternatives. And finally, I will discuss the C-section itself, anesthesia, and neonatal resuscitation.
The origin of the Cesarean Operation, Cesarean Section, or C-section is veiled in historic uncertainty. The procedure is alluded to in Greek Mythology as Apollos delivers Asclepius from the abdomen of his mother. And Romans claim the term in memorializing the birth of Julius Caesar. However, the expression most likely derives from the Latin “caedare: to cut”. Originally, the procedure was performed on dead or dying women, sacrificing the life of the mother in an attempt to save the baby. The woman, who would eventually die if she was unable to deliver the baby, subsequently died do to hemorrhage or massive infection before the advent of sterile surgery or antibiotics.
In the bitch, c-sections are done with the intention of saving the life of the bitch and as many puppies as possible. Most often, dystocia (complicated delivery) necessitates an emergency c-section. By this time one or more of the fetuses may be dead or compromised and the mother weak or debilitated. 1.) Predicting dystocia, 2.) Predicting the due date, and 3.) Planning a Cesarean section can prevent fetal or maternal loss; and can eliminate midnight emergency calls to the veterinarian.
I am not a prophet nor am I a gypsy; and I do not profess to predict the future. However, I do confess an occasional novena to the gods of probability. Playing the odds, Brachycephalic breeds (breeds with shortened heads/faces such as Bulldogs and Boston Terriers) are at greater risk of dystocia then other breeds. The head of the fetus is often too large to pass through the pelvis of the dam, and lacks the traditional missile-shape which helps to direct the fetus through the cervix and the pelvis.
If I were a betting man, I might also wager that a bitch which has had a previous c-section will likely fail to deliver subsequent litters naturally. So-called “V-BAC” (Vaginal Birth After C-section) in human medicine is discouraged in canine obstetrics. Post-surgical adhesions and scar tissue may inhibit normal uterine contraction, preventing fetal expulsion. Further, we anticipate that the cause of the initial dystocia may recur during future pregnancies. This is especially true of “failure to initiate labor” (technically, Primary uterine inertia), or a developmental abnormality of the bitch’s reproductive tract which obstructs passage of the fetus (e.g. broken pelvis, vaginal stricture, vaginal scarring, etc.).
Occasionally very large litters will be surgically delivered to eliminate the risk of maternal exhaustion and failure to deliver all of the puppies (technically, Secondary uterine inertia). Conversely, breeders faced with very small or single pup litters may elect for cesarean delivery to prevent potential dystocia and loss of very valuable pups.
Predicting the Due Date:
Puppies require very precise determination of the due date for survival. They will not survive if they are born even 2 days prematurely
Again, I do not possess a crystal ball. Accurate prediction of the due date relies on hormonal evaluation of the bitch BEFORE BREEDING. If an owner determines for any of the above reasons that the bitch will require a cesarean delivery, they should consult a veterinarian to coordinate the breeding with hormone and cytologic evaluation. Serial blood progesterone or blood lutenizing hormone (LH) measurements allow accurate prediction of whelping date. Whelping occurs 65 days after the LH peak, with a variability of 1 day. Armed with this information, your veterinarian can confidently schedule a daytime surgery and safely deliver the pups.
If the rise in LH was not determined, it is impossible to safely schedule a planned c-section. That is not to say, however, that the bitch must commence labor before surgery. Your veterinarian can roughly estimate the due date based strictly on cytology, determining the first day of Diestrus (last day of heat). Whelping will occur 57 days after the change in cytology with a variability of 3 days (outside the safety range of 2 days to surgically deliver viable pups). Fetal gestational age can also be calculated by ultrasound measurements during early pregnancy (~day 25-35); again, variability is at least 3 days. As the estimated due date approaches, the breeder must monitor the bitch’s progress through pregnancy, mammary development, nesting behavior, drop in temperature, and loss of appetite. Then blood progesterone level can be evaluated. When it drops below 2 ng/ml it is safe to proceed to c-section.
Less preferably, a “planned” c-section can be initiated when the first signs of labor are detected. However, it now becomes an unscheduled, emergency c-section. Failure to initiate labor or delay in performing the c-section risks the loss of part or all of the litter.
Obviously, a little forethought provides a greater safety net and ultimately less stress for the breeder, the surgeon, and the mother-to-be.
C-section circumvents the risk of dystocia during vaginal delivery, all but guaranteeing the safe delivery of the entire litter. The bitch enjoys decreased duration of labor, decreased physical exertion, and the benefits of analgesia. The breeder forgoes whelping anxieties. And cost-benefit analysis will reveal that preventing the loss of even one puppy compensates the expense of the timing and the surgery.
Given all these wonderful benefits, why aren’t all whelpings scheduled for elective c-section?
The answer to that question is a moral conundrum. Once the monetary component is eliminated, it becomes a question of ethical consideration. 90% of natural deliveries progress without complications. Therefore, elective C-section of all pregnant bitches necessitates 90% of the bitches enduring unnecessary surgery. Is it worth the risks of surgery to avoid potential complications in 10% of pregnancies? Bulldog breeders have determined that elective c-sections are essential to the breed, their dystocia rate, however, exceeds the 10% natural average.
Scheduled C-sections are often a feasible and economic option to guarantee delivery of the greatest number of healthy, viable puppies and preserving the life of the dam. A well established veterinary-client relationship should be developed, and forethought and excellent breeding management should be followed to ensure the greatest success.