Birth and Birth Difficulties

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Puppies and kittens are born 58 to 67 days, in rare cases up to 72 days after mating.
In about 3 to 6% of births, birthing difficulties (dystocia) occur, and a cesarean section is often necessary.
It is advisable to present your cat or dog to a veterinarian before an expected due date. At such an appointment after the 50th day of pregnancy, an X-ray can be used to determine how many puppies or kittens are expected.

Birthing difficulties (dystocia) in dogs and cats refer to all conditions that hinder or make impossible the normal course of birth. Normal birth (eutocia) occurs in three phases: the opening phase, the expulsion phase, and the afterbirth phase. The gestation period for dogs and cats is between 58 and 67 days, in rare cases up to 72 days after mating. Complications requiring veterinary assistance occur in about 3-6% of all births. For certain breeds, this rate can be significantly higher. For example, in brachycephalic (short-headed) dog breeds such as French Bulldogs or Pugs, birthing difficulties are not uncommon with a frequency of up to 80%. In Devon Rex cats, the rate is about 18%. Timely recognition and treatment of birthing difficulties is crucial for the survival of the mother and her puppies or kittens.

Causes

The causes of birth difficulties can be divided into maternal and fetal factors:

Maternal factors include primary and secondary uterine inertia, anatomical anomalies of the birth canal, uterine torsion or rupture, and systemic diseases of the mother. Primary uterine inertia can be caused by calcium deficiency (hypocalcemia), hormonal disorders, or genetic predisposition. Secondary uterine inertia results from exhaustion of the uterine muscles after prolonged unsuccessful labor. Especially in brachycephalic breeds, there is often a disproportion between the head circumference of the puppies and the maternal pelvis. Single pregnancies or very few fetuses also significantly increase the risk of dystocia, as oversized puppies often develop in these cases.

Fetal factors include malpresentation, malposition, or malposture of the puppies, excessive size of the puppies in relation to the birth canal, as well as malformations or death of the puppies in the uterus. A common malpresentation is the transverse lie, where the puppy lies across the uterine axis and cannot enter the birth canal. Malpostures such as bent limbs or a backward-bent head can also block the birthing process.

Additionally, factors such as the mother’s age (very young or older animals have a higher risk), obesity, lack of physical fitness, and previous birth complications play an important role in the development of birth difficulties.

Symptoms

  • If contractions are frequent, regular, and strong and no puppy is born within 15 to 30 minutes, or if no puppy is born after 2 hours of intermittent contractions, the dog or cat should be taken to a veterinarian.
  • Dark green vaginal discharge (lochia) before the first puppy is normal. The first puppy should follow this discharge within the next 5 to 10 minutes.
  • However, heavy bleeding requires immediate veterinary examination.
  • In cats, the entire birth of all kittens can take up to 24 hours.
  • In some, especially young female dogs or cats, a dangerous calcium deficiency in the blood can occur, leading to a life-threatening metabolic disorder called eclampsia (—>Eclampsia).
  • Symptoms of eclampsia include muscle tremors, difficulty walking, and seizures. In these cases, immediate veterinary care is necessary.

Recognizing birth difficulties requires careful observation of the birthing process. The following signs indicate complications:

With normal contractions, a puppy should be born within 15-30 minutes. If no puppy is born during this time despite strong and regular contractions, or if no puppy appears after 2 hours of intermittent contractions, a birthing disorder is likely. Special attention is required if a puppy is partially visible in the birth canal but does not progress further.

Dark green vaginal discharge (lochia) before the birth of the first puppy is normal and indicates the beginning of placental detachment. The first puppy should follow this discharge within 5-10 minutes. Heavy bleeding, however, is always a warning sign and requires immediate veterinary assistance, as it may indicate injury to the uterus.

In cats, the entire birth of all kittens can extend over a period of up to 24 hours, with longer pauses between individual births. This is not unusual and not necessarily a sign of complications.

A dangerous condition, especially in young female dogs and cats, is eclampsia – a life-threatening calcium deficiency in the blood. Symptoms include muscle tremors, coordination problems, difficulty walking, and in advanced stages, seizures. This metabolic disorder requires immediate veterinary treatment.

Other warning signs include persistent severe pain, exhaustion, fever (above 39.5°C), lethargy, refusal to care for the puppies, foul-smelling discharge, and visible straining without birthing progress.

First Aid

  • Prepare a clean, warm, and easily cleanable area for the birth. Puppy rails on the edges of whelping boxes are lifesavers for puppies.
  • Check on the mother frequently without disturbing the process. Repeated interruptions only delay the birth.
  • If a puppy is visible in the birth canal and stuck, carefully grasp the feet with a clean cloth and try to assist the birth of the puppy by gently pulling in sync with a contraction.
  • Do not pull on the head. If the puppy does not come out easily, take your pet to a veterinarian.
  • When the puppy is born, it is usually still covered by the fetal membranes. If the mother does not remove these immediately, open them in the head region of the puppy so that it can breathe.
  • If the mother does not bite through and remove the umbilical cord, tie it off yourself with a piece of string or dental floss a few centimeters from the puppy’s belly. Then cut the umbilical cord with scissors, a bit away from the tied-off area.
  • Apply 2% iodine tincture to the entire navel area (buy this beforehand, just in case).
  • Keep the puppies warm. It is best to leave them with their mother.
  • Sometimes the mother does not stay with the puppies. Use a hot water bottle or an adjustable heating pad, but never use a red light heater.
  • The less you interfere with the mother, the more likely she is to stay with her puppies.
  • Allow the puppies to move away from the heat source.

What You Should Not Do

  • Do not reach into the birth canal. You could introduce germs and cause an infection.
  • Do not forcibly remove puppies from the birth canal. This could cause injuries to the uterus and lead to severe bleeding. Large blood vessels are located in this area, so your pet could bleed to death.
  • Do not pull on the puppy’s head or umbilical cord.
  • Do not lift the puppy by the umbilical cord.
  • Do not disturb the mother. Especially young animals need to build a bond with their puppies. Leave the mother alone with her puppies and observe from a distance.
  • Do not forbid the mother from eating the afterbirth. However, make sure that the number of afterbirths matches the number of puppies born.

If the birth is not progressing or a puppy is stuck in the birth canal, wrap the puppies warmly (hot water bottle) and take the mother to a veterinarian.
A cesarean section may be necessary.
After the Birth
If the dog or cat is unwell after giving birth or her condition gradually worsens, take your pet to a veterinarian. There could still be a puppy or afterbirth in the uterus.
Bloody-brown discharge may persist for some time. However, it should not become purulent. If it does, take your pet to a veterinarian.
Decreasing milk production can also be a sign of disorders requiring treatment.
Further Measures
The veterinarian can best assess the condition during the birth process and possible reasons for a disruption in the birth process.
A radiological examination is often recommended.
Depending on the specific situation, a wait-and-see approach, medicinal support, or surgical intervention may be necessary.

Diagnosis

The diagnosis of birthing difficulties begins with a thorough anamnesis and clinical examination by the veterinarian. Important information includes the time of mating, the course of pregnancy, previous births and their complications, as well as the current progress of labor.

During the clinical examination, vital parameters such as temperature, pulse, and respiration are checked. A vaginal examination can provide information about the state of dilation of the birth canal and possible obstacles. This examination must be performed under strictly sterile conditions to prevent infections.

Imaging procedures play a central role in diagnostics. An X-ray examination allows counting of the remaining puppies, assessment of their size and position, as well as detection of malformations or already deceased puppies. Ideally, an X-ray should be taken before the expected due date, around the 50th day of pregnancy, to determine the number of expected puppies.

Ultrasound examination provides valuable information about the vitality of the puppies by assessing the fetal heart rate. A heart rate below 180 beats per minute in puppies or below 200 beats per minute in kittens indicates fetal distress and may be an indication for an emergency cesarean section. Additionally, ultrasound can provide information about placental blood flow and possible detachments.

Laboratory tests, especially the determination of calcium levels in the blood, are important to rule out hypocalcemia as a cause of weak contractions. Other parameters such as glucose, electrolytes, and blood count can also be helpful in assessing the general condition of the mother.

If uterine infection (metritis) is suspected, a bacteriological examination of the vaginal discharge can be performed to identify the pathogen and initiate targeted antibiotic therapy.

Further veterinary measures

The treatment of birthing difficulties depends on the cause and severity of the complication. Fundamentally, conservative and surgical therapy options are available.

In cases of primary uterine inertia due to calcium deficiency, intravenous administration of calcium solutions can improve uterine contractions. This must be done under veterinary supervision, as too rapid infusion can lead to cardiac arrhythmias. Oxytocin-like drugs that stimulate contractions can be used for secondary uterine inertia, but only if it is certain that no mechanical obstruction is present. The dosage must be carefully adjusted to avoid overstimulation of the uterus.

In cases of malpresentation or malposition of puppies, manual obstetric assistance by the veterinarian can be attempted. The puppies are carefully brought into the correct position and gently pulled through the birth canal. This requires a lot of experience and must be done under sterile conditions to avoid injuries and infections.

A cesarean section (sectio caesarea) is indicated when conservative measures are not successful, in cases of absolute birth obstacles such as oversized puppies or pelvic anomalies, uterine torsion or rupture, and clear signs of fetal distress. For certain breeds such as French Bulldogs or Pugs, an elective cesarean section is often planned to prevent complications.

The decision for a cesarean section should not be delayed too long, as the survival chances for mother and puppies decrease with increasing duration of dystocia. Modern anesthesia techniques allow for safe performance of the procedure with minimal risks for the newborns.

After a cesarean section, careful monitoring of the mother is necessary, particularly regarding postpartum hemorrhage and infections. The puppies must be kept warm and placed to nurse on the mother as soon as she awakens from anesthesia.

Prognosis and aftercare

The prognosis for birthing difficulties depends significantly on early detection and treatment. With timely intervention, the prognosis for the mother is generally good. However, the survival rate of the puppies can vary depending on the duration of complications and the type of birthing disorder.

After birth, careful aftercare is crucial. The mother should be regularly examined for signs of postpartum bleeding, infections, or milk stasis. A bloody-brown discharge (lochia) is normal in the first few days after birth but should not become purulent or foul-smelling. Body temperature should be checked daily, as fever may indicate uterine inflammation (metritis) or mastitis.

It is important to ensure that all placentas have been expelled. The number of placentas should match the number of puppies born. Retained placentas can lead to infections and may need to be removed medically or surgically if necessary.

The mother’s milk production should be monitored. Decreasing milk production can be a sign of disorders requiring treatment. If milk production is insufficient, supplementary feeding with milk replacer preparations may be necessary.

The puppies must be weighed regularly to ensure they are receiving sufficient nutrition and thriving. A healthy puppy should gain weight daily. Stagnation or weight loss are warning signs that require veterinary attention.

Special care is required after a cesarean section. The surgical wound must be checked for signs of infection or suture dehiscence. The mother should be kept calm in the first few days after surgery to promote wound healing.

For female dogs or cats that have already experienced multiple birthing difficulties, spaying should be considered to avoid future risks.

Summary

Birthing difficulties in dogs and cats constitute a medical emergency that requires prompt action. The causes can be related to both the mother (weak contractions, anatomical anomalies) and the puppies (malpositioning, excessive size). Certain breeds, especially brachycephalic dogs and some cat breeds like Devon Rex, have an increased risk of birth complications.

Early recognition of warning signs such as prolonged labor without birth progress, severe bleeding, or signs of eclampsia is crucial for successful treatment. Diagnostic measures include clinical examination, imaging, and laboratory tests.

Treatment ranges from medication support to manual obstetric assistance to cesarean section. The decision for the appropriate treatment method must be made individually and depends on the type of birthing disorder, the mother’s condition, and the vitality of the puppies.

Careful postpartum care is important to detect and treat complications such as infections or milk stasis early. With timely intervention, the prognosis for the mother is generally good, while the survival rate of the puppies depends on various factors.

Pet owners should be aware of breed-specific risks before planned breeding and ideally consult a veterinarian before the expected due date to anticipate possible complications and create an emergency plan.

Outlook on current research

Research in the field of obstetrics for small animals continues to evolve. Current studies focus on improving prenatal diagnostics to predict and prevent birthing difficulties early.

Advances in diagnostic imaging allow for more accurate assessment of the relationship between puppy size and maternal pelvis. Three-dimensional ultrasound techniques and MRI examinations can provide detailed information about the anatomy of the birth canal and potential obstacles. These methods are increasingly being used to better assess the need for elective cesarean sections in high-risk patients.

In the field of anesthesia, safer protocols for cesarean sections are continuously being developed to improve the survival rate of puppies. Modern anesthetics with short duration of action and low placental transfer reduce the negative effects on newborns.

Genetic research aims to identify hereditary factors that contribute to birthing difficulties. In the long term, this could lead to more targeted breeding programs that reduce the risk of dystocia. Particularly in brachycephalic breeds, efforts are being made to mitigate the extreme anatomical features that lead to birthing problems through selective breeding.

Telemedicine approaches are gaining importance in providing pet owners in remote areas with quick access to expert advice. Mobile apps and online platforms can offer valuable support in monitoring pregnancy and recognizing warning signs.

Research into biomarkers in the blood or urine of pregnant animals could help predict birthing difficulties in the future before clinical symptoms appear. Such tests could be particularly useful in high-risk patients to determine the optimal timing for an elective cesarean section.

Frequently asked questions (FAQs)

  1. How can I tell that my pet is about to give birth?
    The first signs are a drop in body temperature by about 1°C (to below 38°C), restlessness, nesting behavior, and sometimes loss of appetite. Labor typically begins with panting and visible contractions of the abdomen.
  2. What is the maximum duration of a pause between the birth of two puppies?
    In dogs, the interval between two puppies should not exceed 2 hours. In cats, the pauses can be longer but should not exceed 4 hours. If there are active pushing contractions without the birth of a puppy within 30 minutes, a veterinarian should be consulted.
  3. Is a natural birth possible after a previous cesarean section?
    Yes, a natural birth after a cesarean section is generally possible, but it comes with increased risk. The decision should be made individually, considering the cause of the previous cesarean section, the animal’s constitution, and the current pregnancy.
  4. What emergency equipment should I have on hand for a possible home birth?
    An emergency kit should include clean towels, sterile gloves, disinfectant, a heat source for the puppies, an umbilical cord clamp or dental floss, clean scissors, and 2% iodine tincture. It’s also important to have the phone number of an emergency veterinary service.
  5. How can I determine if all puppies have been born?
    A prior X-ray examination provides information about the expected number of puppies. After birth, the number of placentas should match the number of puppies. Persistent contractions or restlessness after the supposedly last birth may indicate more puppies.
  6. What should I do if a puppy is not breathing?
    Carefully remove the fetal membranes and mucus from the nose and mouth. Gently rub the puppy with a dry towel to stimulate breathing. If necessary, you can hold the puppy head down and carefully swing it to remove fluid from the airways. Do not perform mouth-to-nose resuscitation, as this can damage the lungs.
  7. When is a planned sterilization after a difficult birth advisable?
    Sterilization should be performed no earlier than 2-3 months after birth, when the body has fully recovered. In cases of severe birth complications, anatomical anomalies, or genetic risk factors, sterilization is recommended to avoid future risks.
  8. How do I support a mother who doesn’t accept her puppies after a cesarean section?
    Give the mother time to recover from anesthesia. Place the puppies to nurse at the teats while the mother is still drowsy. The smell of the puppies and the suckling stimulate the maternal instinct. Avoid frequent disturbances and create a quiet, warm environment.
  9. What signs indicate eclampsia and how urgent is the treatment?
    Symptoms of eclampsia include restlessness, panting, muscle tremors, stiff gait, and in advanced stages, seizures. This is a life-threatening emergency that requires immediate veterinary treatment, ideally within 30-60 minutes.
  10. Can I prevent birthing difficulties through nutrition during pregnancy?
    A balanced but not excessive diet during pregnancy can help prevent excessive growth of puppies. Especially in the second half of pregnancy, adequate calcium intake should be ensured without supplementation. Overfeeding can lead to larger puppies and thus to birthing difficulties.

Literature

  • Löwe, G. and Löwe, O. (2021). Emergencies in Dogs and Cats – A Veterinary Guide. Kynos-Verlag. 208 p.
  • Axel Wehrend, A, F Röcken, H Bostedt et al.: Cesarean section in dogs and cats Recommendations for birth management in dogs and cats. Deutsches Tierärzteblatt 2/2011, 186–190
  • Fux, V: Evidence-based evaluation and clinical studies on the implementation and prognosis of operative obstetrics in dogs. Vet-Med Diss Justus-Liebig-University Giessen, 2016
  • Davidson, A.P. and Macintire, D.K. (2019). Clinical Management of Pregnancy and Dystocia in Small Animals. Veterinary Clinics of North America: Small Animal Practice, 49(3), 547-562. https://doi.org/10.1016/j.cvsm.2019.02.001
  • Smith, F.O. (2021). Challenges in small animal parturition—Timing elective and emergency cesarean sections. Theriogenology, 150, 466-471. https://doi.org/10.1016/j.theriogenology.2020.04.031
  • O “Neill, D.G., O” Sullivan, A.M., Manson, E.A., Church, D.B., Boag, A.K., McGreevy, P.D. and Brodbelt, D.C. (2019). Canine dystocia in 50 UK first-opinion emergency care veterinary practices: prevalence and risk factors. Veterinary Record, 184(13), 409. https://doi.org/10.1136/vr.104944
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Kitten born by cesarean section