We had our canine obstetrics lecture recently. After learning about equine obstetrics and bovine obstetrics, I was really glad to get a chance to hear about dogs. Our lecturer was Dr. George, who is an emergency and critical care (ECC) specialist who has particular knowledge of this subject area because he is also a dog breeder.
So you’re an ER vet, and an owner brings her bitch in. The bitch was in stage II (active) labor for an hour, produced one puppy, had contractions for three more hours, and now has stopped having contractions. What do you do?
Your two choices are to perform an immediate C-section, or to give oxytocin to get the contractions restarted. There is no downside to the C-section; it is very safe for mom, and definitely the safest course for the puppies. However, it is very expensive. The oxytocin route is much less expensive, but it may result in some dead puppies, and if it doesn’t work you’ll end up having to do a C-section anyways. Dr. George noted that the most frustrating case is the one in which you give oxytocin and manage to get all but one puppy out, and after five hours of letting her push puppies you finally have to give up and do the C-section after all. So what issues do you take into account when you’re working through these options with the owner?
First, how many more puppies do you expect? Sometimes owners have had radiographs (x-rays) taken and know the minimum number that are in there. (Of course, sometimes puppies hide on radiographs — Dr. George doesn’t know where — and you are likely to get more than you expect.) If you expect a lot more, do the C-section, because you’re fairly likely to end up having to go that route anyways. If you only expect one or two, oxytocin might be a better option.
Second, what are the owner’s constraints and expectations? Dr. George says he gets two kinds of obstetrics emergencies: the chihuahua from the streets of Worcester (i.e., a dog from a low-income area), and the golden retriever from Westborough (i.e., a dog from a high-income area). In the case of the golden from Westborough, the owners are likely to be willing to pay quite a bit to ensure the safety of the puppies, so the C-section is the best option. In the case of the chihuahua from Worcester, the owners may just not have the money, and may not have planned the pregnancy anyways. In that case, go with the oxytocin; the puppies may not survive, but if the alternative is euthanasia because the owners can’t afford the C-section, you’re still doing some good. Dr. George says he will be very frank with owners, asking them to tell him their goals up front. Are we just trying to save mom, or are we doing everything we can for everybody?
I have been really enjoying the canine theriogenology (breeding and obstetrics) section. I’m considering doing some elective time during my clinical months at a practice that specializes in this stuff. What better way to learn more about dog breeds and their genetic problems?
This week’s exam: Our test this Friday is our second Large Animal Medicine and Surgery exam. Cows, cows, cows! After this we are done with cows; the rest of that course will focus on horses. That will be very different, as horse owners’ goals tend to be very different from cow owners’ goals. However, this test looks like a rough one, so I am head-down studying this week.