Dystokia
Dystokia is the inability of the bitch to expel the foetus through the birth canal without assistance. The incidence in the bitch is 5% but in certain breeds it can be 90% e.g. in bulldogs. 75% of cases are of maternal origin and 25% are of foetal origin.

Maternal causes
1. Uterine inertia accounts for 72% of all cases of dystokia. In primary uterine inertia the uterus fails to contract when there is only one or two pups because there is insufficient stimulation to initiate labour or because of over-stretching of the myometrium (muscle layer of the uterus) in large litters. Feeding calcium during pregnancy can predispose to primary uterine inertia because it may depress parathyroid gland function and prevent mobilization of calcium at whelping.
Calcium is required for muscle contraction. Secondary uterine inertia is when whelping has started but stops due to exhaustion of the myometrium caused by obstruction of the birth canal.

Treatment regime:
i. Walk the bitch and stroke the top of the vaginal wall (Fergusion reflex). This may stimulate contractions.
ii. Take to Veterinary Surgeon who can give 10% calcium gluconate, 0.5-1.5ml/kg (2-20mls) by slow intravenous injection. After 10 minutes give oxytocin.
iii. Wait 30 minutes, repeat above if necessary.
If after another 30 minutes nothing has happened a caesarian is required.
2. Maternal causes of obstruction of the birth canal include uterine torsion, uterine rupture, congenital malformations of the uterus, neoplasm's, vaginal septa or fibrosis and those bitch's with a narrow pelvic canal. These are all very rare accounting for 3% of all causes of dystokia.

Foetal causes
Malpresentations account for 15% of cases of dystokia. This is when the pup cannot come through the birth canal because it is in the wrong position. This includes the head pointing downwards or to one side
or the breech presentation. This is when the bum comes first but the hindlimbs are flexed forward (Fig1)towards the head and under the stomach. On vaginal examination one can feel a tail but no hindlimbs.

  Fig 1 Fig 2

This is different from the posterior position where the bum is presented first with the hindlimbs pointing backwards. (Fig 2) The posterior presentation accounts for 40% of all births and is considered to be a normal presentation. Malformed foetuses account for 1.6%, oversized foetuses 6.6% and dead foetuses 1.5% of cases of dystocia.
For correcting malpresentations I don't use obstetrical forceps for fear of damaging the pup or the bitch. I use lots of Lubrel jelly and my fingers. First, we assess the position of the pup and try to correct any malpresentation. The pup can be grasped with two fingers behind its ears or in front of the hip joint depending if it is presented head or bum first respectively. It sometimes helps if another person lifts the
bitch's front limbs in the air thus, allowing gravity to pull the pup downwards towards the vagina. The pup is gently pulled in a backwards-downward ark coinciding with the bitch's contractions.
65% of cases require a caesarian section.
Foetal death increases from 6% in bitch's
brought in within 1-4.5 hours after the
beginning of second stage labour to 14%
in the period between 5 ind 24 hours.

Caesarian section
Indications
1. Primary uterine inertia
2. Secondary uterine inertia
3. Unrelieved obstructive dystokia
4. Foetal death with putrification
5. Toxaemia of pregnancy and illness of the bitch
6. Prophylaxis (bulldogs ?ethical)
7. Prolonged gestation >70 days
The survival rates of pups delivered by caesarian section were 92% at birth, 87% after 2 hours and 80% after I week. Only 9 out of 808 bitches in the study died. The comparable figures for pups born naturally were 86,83 and 75% thus, less than those born by caesarian section. Thismay because the pups are born more quickly when a caesarian is performed.

Newborn pups
Following a delivery per vaginum, the bitch should;
1. Lick the foetal membranes (sac that pup is born in) away from the mouth and nose
2. Lick and nuzzle the pup to maintain its body temperature. The pup has just come from a stable warm environment inside the bitch to the outside world.
3. Bite off the umbilical cord
4. Encourage the pup to suckle

If the bitch fails to do one or all of these steps then assistance is required. The foetal membranes can be removed by hand or with a towel. The umbilical cord should be clamped with a pair of sterile forceps 3cms from the belly of the pup and torn. Care should be taken so as not to cause an umbilical hernia. The pup should be rubbed in a towel to stimulate it to breath. Fluid should be removed from the mouth and nose using a towel, blowing air into the mouth and nose and by swinging the pup upwards and
downwards with its head facing downwards. The head should be held carefully. If the pup appears not to be breathing carry on trying to resuscitate it for at least 15 minutes. Don't give up too soon. It has been known for pups to take up to 20 minutes to start to breathe. It is important to dry the pup because the newborn pup has no control over its own temperature. Hypothermia quickly kills newborn pups. The environmental temperature should be 30 degrees C for the first 24 hours, decreasing to 26-30
degrees C over the following few days.
Once dry and breathing the pup should find a teat on its own and suckle. If one has difficulty suckling, its mouth should be placed over the teat. By pressing on either side of the teat with a finger and
massaging the mammary gland, milk is released and the pup will be able to feed.
If the bitch rejects a pup then rubbing the afterbirth on it may help her to recognize it as her own. If the bitch attacks a pup she may need sedating or muzzling for a short period of time until the problem of
rejection is overcome. I have known bitch's to kill pups so be very careful.
A pup is stimulated to urinate and defecate by the bitch licking these areas.
When hand rearing pups this is performed using cotton wool soaked in warm water. At 2-3 weeks of age the pup begins to urinate and defecate voluntarily.

All pups should be checked for hare lip, cleft palate, limb deformity or atresia ani (this is were there is no rectum). If a pup has any of these conditions it should be taken to your veterinary surgeon. I believe
it is kinder to put pups down if they have a cleft palate as they rarely survive. The pup should have no discharge from its eyes, ears or nose. It should be alert and able to crawl. A crying pup is a hungry
pup. A crying pup that is not crawling is an ill pup and should be fed straight away.

Newborn and young pups vitals

1. Temperature - 36 degrees C at birth to 30 degrees C within a few hours and then increases to 38 degrees C by 7 days.
2. Respiration rate - 15-40 per minute with no noise
3. A healthy pup will increase its body weight by 5-10% per day. Therefore, weighing pups is very important. Failure to gain weight may be the first sign of disease or fading puppy syndrome.
4. A pup can stand after 10 days and will begin to walk after 3 weeks.
5. It opens its eyes after 10-14 days. Note, the cornea may be cloudy but this clears after 2 weeks.
6. The pup can hear after about 2 weeks.

Hand rearing pups
I have successfully hand reared 8 pups so, I know how demanding and rewarding it can be. Welpi and Lactol are two commercial canine milk substitutes.
However, I prefer Pedigree Instant Milk substitute from Pedigree Petfoods because you don't have to feed the pups every 2 hours. With this milk powder you feed the pups every 3 hours until they have
doubled their birth weight then 6 times daily, reducing to 4-5 times daily. Use a bottle and teat to feed the pups. Sterilize them after each feed. Don't squeeze the milk into the pup as the milk can go into
the nose or into the lungs. Generally, a pup will stop sucking when it has had enough. A common problem is diarrhoea which is usually an indication of overfeeding. After 2 weeks Pedigree's early weaning diet can be introduced decreasing the number of milk feeds.
Worm the pups at 2 and 5 weeks with Panacur liquid or the new paste.

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