Birth and Difficult birth

Author: Dr. med. vet. Gisa Löwe | Last modified: 17.02.2026
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Kitten born by cesarean section

Birth
Birth is the physiological process of expelling puppies and afterbirth / placenta through labor. It becomes an emergency if there is birth arrest, heavy Bleeding, persistent pushing contractions without a puppy or clear weakness of the dog. Complications can acutely endanger the mother and puppies.

Dog and cat puppies are born 58 to 67 days, in rare cases up to 72 days after mating. In approx. 3 to 6% of births, Difficult birth (dystocia) occurs, and a cesarean section is often necessary. It makes sense to introduce your cat or dog to a veterinarian before an expected birth date. At such an appointment after the 50th day of pregnancy, an X-ray can be used to determine how many puppies are expected. Difficult birth (dystocia) in dogs and cats refers to all conditions that hinder or make impossible the normal course of a birth. Normal birth (eutocia) proceeds in three phases: the opening phase, the expulsion phase and the afterbirth / placenta phase. The gestation period in bitches and cats is between 58 and 67 days, in rare cases up to 72 days after mating. Complications requiring veterinary assistance occur in approximately 3–6% of all births. In certain breeds, this rate can be significantly higher. For example, in brachycephalic (short-headed) dog breeds such as French Bulldogs or Pugs, Difficult birth with a frequency of up to 80% is not uncommon. In Devon Rex cats, the rate is about 18%. The timely detection and treatment of Difficult birth is crucial for the survival of the mother and her puppies or kittens.

Causes

The causes of Difficult birth can be divided into maternal (maternal) and fetal (relating to the fetus) factors:

Maternal factors include primary and secondary uterine inertia, anatomical abnormalities of the birth canal, torsion or rupture of the uterus, and systemic diseases of the mother. Primary uterine inertia can be caused by calcium deficiency (hypocalcemia), hormonal disorders or genetic predisposition. Secondary uterine inertia is caused by exhaustion of the uterine muscles after prolonged unsuccessful labor. Especially in brachycephalic breeds, there is often a mismatch between the head circumference of the puppies and the maternal pelvis. Singleton pregnancies or very few fetuses also significantly increase the risk of Difficult birth, as disproportionately large puppies often grow here.

Fetal factors include malpresentation, malposition or malformation 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 womb. A common malpresentation is transverse lie, in which the puppy lies transversely to the uterine axis and cannot enter the birth canal. Malpositions such as angled limbs or a bent-back head can also block the birth process.

In addition, factors such as the age of the mother (very young or older animals have a higher risk), Overweight, lack of physical fitness and previous birth complications play an important role in the development of Difficult birth.

Symptoms

Difficult birth (dystocia) in dogs and cats

Typical Symptoms:

  • Straining without a puppy/kitten, Restlessness, Panting
  • Long pauses between births, exhausted mother
  • Weak/absent urge to push despite known pregnancy

Alarm signs:

  • Strong straining > 20–30 min without progress
  • > 2 hours between young animals when further offspring are expected
  • Green/black discharge before first pup (suspected placental abruption)
  • Bleeding heavily, collapse, Fever (over 39.5 °C), extreme Pain
  • Puppy/kitten visible, stuck

Escalation/course:

  • Increasing exhaustion, apathy → uterine atony, risk of fetal Death
  • Long labor (> 12–24 h) → Sepsis/metritis risk increases
  • After an apparent pause, sudden apathy/signs of shock → highly critical

 

If the contractions are frequent, regular and strong and no puppy is born in 15 to 30 minutes, or if no puppy has been born after 2 hours with changing contractions, a birth disorder is likely present. The dog or cat should be taken to a veterinarian. Special attention should be paid if a puppy is partially visible in the birth canal but does not advance further. A dark green vaginal discharge (lochia) before the first puppy is normal and indicates the beginning of placental abruption. This discharge should be followed by the first puppy within the next 5 to 10 minutes. However, heavy Bleeding requires immediate veterinary examination as it may indicate an injury to the uterus. In cats, the entire birth of all kittens can take up to 24 hours. In some, especially young bitches or cats, a dangerous calcium deficiency in the blood can occur, leading to a life-threatening metabolic disorder known as eclampsia (—>eclampsia). Symptoms of eclampsia include muscle tremors, difficulty walking, Coordination disorders and, in advanced stages, Seizures. In these cases, immediate veterinary care is necessary.

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 uncommon and not necessarily a sign of complications.

First Aid

  1. Prepare a clean, warm and easy-to-clean area for the birth. Puppy rails on the edges of whelping boxes are lifesavers for puppies.
  2. Check the mother frequently without disturbing the process. Repeated interruptions only delay the birth.
  3. If a puppy is visible in the birth canal and is stuck, gently grasp its feet with a clean cloth and try to assist the puppy’s birth by gently pulling in sync with a contraction.
  4. Do not pull on the head. If the puppy does not come out easily, take your animal to a veterinarian.
  5. When the puppy is born, it is usually still covered by the fetal membranes. If the mother does not remove them herself immediately, open them in the head region of the puppy so that it can breathe.
  6. 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 abdomen. Then cut the umbilical cord with scissors, a short distance from the tying point outwards.
  7. Apply 2% iodine tincture to the entire navel (buy this beforehand, just in case).
  8. Keep the puppies warm. It is best to leave them with their mother.
  9. Sometimes the mother does not stay with the puppies. Use a hot water bottle or a controllable heating pad, but never a red light radiator.
  10. The less you deal with the mother, the more likely she will stay with her puppies.
  11. Allow the puppies to move away from the heat source.

What you should not do

  1. Do not reach into the birth canal. You could introduce germs and cause an infection.
  2. Do not forcibly remove puppies from the birth canal. This could lead to injuries to the uterus and heavy Bleeding. There are large blood vessels in this region, so your animal could bleed to Death.
  3. Do not pull on the head or umbilical cord of the puppy.
  4. Do not lift the puppy by the umbilical cord.
  5. Do not disturb the mother. Especially young animals must first establish Contact with their puppies. Leave the mother with her puppies to herself and observe the events only from a distance.
  6. Do not forbid the mother from eating the afterbirth / placenta. But make sure that the number of afterbirth / placenta matches the number of puppies born.

If the birth does not progress or a puppy is stuck in the birth canal, wrap the puppies warmly (hot water bottle) and present the mother to a veterinarian.
A cesarean section may be necessary.
After the birth
If the dog or cat feels unwell after the birth or if her condition gradually worsens, present your animal to a veterinarian. There may still be a puppy or an afterbirth / placenta in the uterus.
Bloody-brown discharge may persist for a long time. However, it must not become purulent. Then present your animal to a veterinarian.
Decreasing milk production can also be a sign of disorders requiring treatment.
Further measures
The veterinarian can optimally assess the condition within a birth process and possible reasons for a disorder in the birth process.
A radiological examination is usually also recommended.
Depending on the specific situation, intervention will be expectant, medication-supportive or surgical.

When should you see a vet sooner?

→ Red for severe Bleeding, collapse, strong straining with no progress, green-black discharge without birth, or if a puppy/kitten is stuck.

Diagnosis

The diagnosis of Difficult birth begins with a thorough medical history and clinical examination by the veterinarian. Important information includes the time of mating, the course of the pregnancy, previous births and their complications, and the previous course of the birth.

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

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

The 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 stress and may be an indication for an emergency C-section. In addition, the ultrasound can provide information about placental blood flow and possible detachments.

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

If a 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 Difficult birth depends on the cause and severity of the complication. In principle, conservative and surgical therapy options are available.

In the case of primary uterine inertia due to calcium deficiency, the intravenous administration of calcium solutions can improve uterine activity. This must be done under veterinary supervision, as too rapid an infusion can lead to Cardiac arrhythmia. Labor-inducing drugs such as oxytocin can be used for secondary uterine inertia, but only if it is ensured that there is no mechanical obstruction. The dosage must be carefully adjusted to avoid overstimulation of the uterus.

In the case of malpresentation or malposition of the puppies, manual obstetrics can be attempted by the veterinarian. The puppies are carefully placed in 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 if conservative measures are not successful, in the case of absolute birth obstructions such as puppies that are too large or pelvic abnormalities, in the case of torsion or rupture of the uterus, and in the case of clear signs of fetal stress. In 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 for too long, as the chances of survival for the mother and puppies decrease with increasing duration of the birth disorder. Modern anesthesia procedures enable the safe performance of the procedure with minimal risks for the newborns.

After a cesarean section, careful monitoring of the mother is necessary, especially with regard to postpartal Bleeding and infections. The puppies must be kept warm and put to the mother’s teats to suckle as soon as she has woken up from the anesthesia.

Prognosis and aftercare

The prognosis for difficult birth depends largely on early detection and treatment. With timely intervention, the prognosis for the mother is usually good. However, the survival rate of the puppies can vary depending on the duration of the complications and the type of dystocia.

After the birth, careful aftercare is crucial. The mother should be regularly checked 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 smell foul. The body temperature should be checked daily, as fever may indicate a uterine infection (metritis) or mammary gland inflammation (mastitis).

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

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

The puppies must be weighed regularly to ensure that they are getting enough food 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 C-section. The surgical wound must be checked for signs of infection or suture dehiscence. The mother should be kept quiet in the first few days after the operation to promote wound healing.

In female dogs or cats who have had difficult birth several times, castration / neutering should be considered to avoid future risks.

Summary

Difficult birth in dogs and cats is a medical emergency that requires rapid action. The causes can be both in the mother (uterine inertia, anatomical abnormalities) and in the puppies (malpresentation, excessive size). Certain breeds, especially brachycephalic dogs and some cat breeds such as Devon Rex, have an increased risk of birth complications.

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

The therapy ranges from drug support to manual obstetrics and cesarean section. The decision for the appropriate treatment method must be made individually and depends on the type of dystocia, the condition of the mother and the vitality of the puppies.

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

Before planning to breed, pet owners should be aware of the breed-specific risks and ideally consult a veterinarian before the expected date of birth to anticipate possible complications and create an emergency plan.

Outlook on current research

Research in the field of obstetrics in small animals is constantly evolving. Current studies focus on improving prenatal diagnostics to predict and avoid difficult birth early on.

Advances in imaging diagnostics enable a more accurate assessment of the relationship between the size of the puppies and the maternal pelvis. Three-dimensional ultrasound techniques and MRI examinations can provide detailed information about the anatomy of the birth canal and possible obstacles. These methods are increasingly used to better assess the need for an elective cesarean section in high-risk patients.

In the field of anesthesia, continuously safer protocols are being developed for C-sections, which improve puppy survival rates. Modern anesthetics with a short duration of action and low placental transfer reduce negative effects on newborns.

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

Telemedical approaches are becoming increasingly important in providing pet owners in remote areas with rapid access to expert advice. Mobile apps and online platforms can provide valuable support in monitoring pregnancy and detecting warning signs.

The exploration of biomarkers in the blood or urine of pregnant animals could help to predict difficult birth in the future before clinical symptoms occur. Such tests could be used particularly in high-risk patients to determine the optimal time for an elective cesarean section.

Frequently asked questions (FAQs)

  1. How do I know that my animal’s birth is imminent?
    The first signs are a drop in body temperature of about 1 °C (to below 38 °C), Restlessness, nesting behavior and sometimes loss of appetite. The birth typically begins with Panting and visible contractions of the abdomen.
  2. What is the maximum length of a birth pause between two puppies?
    In dogs, the interval between two puppies should not be longer than 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 is associated with an increased risk. The decision should be made individually, taking into account the cause of the previous cesarean section, the animal’s constitution and the current pregnancy.
  4. What emergency equipment should I have ready 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. The telephone number of an emergency service is also important.
  5. How can I tell if all the puppies have been born?
    A previous X-ray examination provides information about the expected number of puppies. After the birth, the number of afterbirth / placenta should match the number of puppies. Persistent contractions or Restlessness after the supposedly last birth may indicate further puppies.
  6. What to do if a puppy is not breathing?
    Gently 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 with its head down and gently 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 useful after a difficult birth?
    Sterilization should be performed no earlier than 2–3 months after the birth, when the body has fully recovered. In the case of severe birth complications, anatomical abnormalities or genetic risk factors, sterilization is recommended to avoid future risks.
  8. How do I support a mother who does not accept her puppies after a cesarean section?
    Give the mother time to recover from the anesthesia. Place the puppies on the teats to suckle 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 Difficult birth through nutrition during pregnancy?
    A balanced but not excessive diet during pregnancy can help to avoid excessive growth of the puppies. Especially in the second half of pregnancy, attention should be paid to an adequate calcium supply without supplementing. Overfeeding can lead to larger puppies and thus to Difficult birth.

Literature

  • Löwe, G. and Löwe, O. (2021). Emergencies in dogs and cats – A veterinary Guide. Kynos-Verlag. 208 pp.
  • 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 Prognose of operative obstetrics in dogs. Vet-Med Diss Justus-Liebig-Universität 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