I don't normally work on Sundays, but today was filling in for a doctor at one of our hospitals (the practice I work for has multiple locations). The day started off pretty slow, which wasn't surprising for a holiday Sunday. Late morning a very pregnant maltese came in. She had been seen over the last couple of weeks for assessment as she came closer to full term. A week ago x-rays showed that there were two large puppies, and that they were possibly too large to give birth to. We found this to be true today, as a repeat of the x-rays showed slightly larger puppies than a week ago. She had been actively contracting for at least six hours without any puppies being born. My usual rule-of-thumb is that if there are contractions for more than an hour without any birth, the dog may be in trouble.
The owner agreed to the cesarian section, and we began rescheduling appointments and preparing for surgery. As we began to induce anesthesia part of the fetal sac started coming out. I quickly felt her belly, and I could feel the puppy's head near but not in the birth canal; I knew I had to get in there immediately.
The next several minutes were pretty fast and furious as I hurried through the abdominal incision, brought the uterus out of the belly and cut the first puppy out. I handed it over to one of my techs to begin stimulating it to breath. For those who haven't been involved in this, it involves vigorously rubbing the puppy, then carefully but firmly slinging the puppy head-first almost between your legs. This helps to force the fluid from the lungs and mouth. While one person was working on the first puppy I quickly removed the other one and handed it off to the next assistant. While they worked on recovery of the puppies, I spayed the mother (removing her uterus and ovaries), and quickly closed her up. For the mother's part, the surgery from that point was quick and uneventful.
The first puppy did very well, began breathing, and was very strong and vigorous. Unfortunately, the second puppy did not do as well, and never breathed on its own. With my instructions (I was the only doctor on duty and was busy in the middle of surgery on the seven-pound mother) they tried hard to save the second one, but in the ende we lost her.
The mother recovered quickly and well, but never seemed to accept the puppy. We tried putting them together, but the mother simply ignored her (it's a little girl). That means that the owners are likely going to have to bottle-feed this newborn for the next five weeks. But thankfully both the mother and puppy went home in very good condition. As long as the puppy can be fed well, I anticipate both to do great.
Not bad for a Sunday afternoon, huh? Oh, and this another reason to spay your dogs. Malteses don't commonly need cesarian sections, but anything can happen. The owner's total bill was a little over $1000, and they would have lost the mother if they hadn't agreed to the surgery. It's much cheaper, easier, and safer to simply have your dog spayed. This kind of problem is one of the risks that anyone takes when they breed dogs.
And this also illustrates one of the hallmarks of veterinary medicine. You really never know what will come through your door or what you will need to be doing at any given time.