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Parturition, or giving birth, can look very different in every animal due to a variety of maternal or fetal factors. In dogs, parturition is referred to as whelping and is divided into three stages to help identify what is normal and when problems may occur. 

The Three Stages of Birth

Stage One: Preparation phase

The mother’s body prepares to give birth. The uterus begins to contract, and the cervix dilates. The mother often becomes restless and exhibits nesting behavior, which typically lasts six to 12 hours but can persist for up to 24 hours.

Stage Two: Puppies are delivered

About 24 hours before Stage Two begins, the mother’s rectal temperature drops to about 99°F. The first puppy should be born within four hours of the onset of active labor. During active labor, the mother will experience visible abdominal contractions that may resemble straining. You may also see fluid coming from the vulva, which she will lick. She will also eat the placentas and chew the puppies’ umbilical cords. Each puppy should be delivered within 15 minutes to two hours after the previous puppy, and the delivery time should not exceed two hours.

If birth occurs at home and the number of puppies is unknown, it is crucial to monitor the mother's behavior and timing closely. For example, once the mother begins experiencing abdominal contractions, note that time as the start of active labor. The timing between deliveries is the same. Once the mother appears more relaxed, has not passed a puppy for at least four hours, and there is no foul-smelling vaginal discharge, it is likely she is no longer in active labor.

In the case that the mother is having contractions but no puppy has passed within 30 minutes to two hours, veterinary intervention is recommended.

Stage Three: The placenta is passed

Although this is referred to as the final stage, it overlaps with Stage Two.

Each puppy is attached to a placenta, which is usually delivered and eaten by the mother. It may be hard to document that each placenta has been delivered since the mother usually eats them very quickly. In the unlikely event that a placenta is not delivered, a condition known as retained placenta, poses a significant risk of infection. 

Notify your veterinarian if there is heavy bleeding or foul-smelling discharge, lethargy, vomiting, or lack of appetite.

Over 12 to 15 weeks, the uterus gradually repairs itself and returns to its normal size. A normal vaginal discharge called lochia, which contains birthing fluids, normally lasts for two to three weeks. The discharge may appear dark green to reddish-brown for the first few days, then becomes a thin, clear fluid until it completely stops.

Complications

While these three stages typically occur during normal birth, complications can arise and may necessitate veterinary care. A common complication is dystocia, which is the inability to deliver puppies naturally; this occurs in 5% of all dogs. This is more commonly observed in mothers with a small pelvic size or an abnormal positioning of the puppies, both of which limit the mother's ability to deliver the puppies naturally. If there is any abnormal vaginal discharge, a significant drop in the mother’s temperature, or failure to progress through the stages of parturition, your veterinarian should be contacted immediately.

Diagnostics

Once in the care of a veterinarian, diagnostic tests are run to determine whether intervention, such as a C-section, is necessary. These tests may include a vaginal exam, blood work, and X-rays. One of the most sensitive indicators is an assessment of the fetal heart rate, which is typically below 180 beats per minute, as measured by ultrasound. Based on these findings, the veterinarian may attempt medical treatment or proceed with a C-section.

Cesarean Section

A C-section requires the patient to be placed under general anesthesia. Specific anesthetic drugs are chosen to reduce risks to both the mother and puppies, though anesthesia always carries some risk. The puppies are removed quickly. Immediate care of the puppies focuses on tying off the umbilical cords and stimulating breathing. Once each puppy is removed from the mother, they are handed off to an assistant who holds a warm towel used to gently but vigorously rub the puppy’s chest. Excess fluid is suctioned from each puppy's mouth and nostrils to prevent aspiration. 

For the mother, it is important that she recovers from anesthesia and receives pain medication so that she can nurse her puppies comfortably.

Post-op Care

A C-section is a major abdominal surgery and can have complications. The most common concerns are bleeding and infection, which a veterinarian can usually manage with proper care. Both the mother and her puppies should be closely monitored for the first 72 hours. During this time, it is important to ensure the mother’s rectal temperature remains normal, that everyone is breathing normally, that the surgical incision is healing properly, and that all puppies are able to nurse successfully.

Most C-sections have a good outcome, but proper post-operative care is essential. The mother should be on strict rest for the following two weeks, wear an E-collar, receive prescribed pain medication, and be closely monitored for complications. It is also important that the mother is being fed a high-calorie diet to support milk production. If the mother or puppies show abnormal behaviors, consult your veterinarian right away.

In most cases, a dog can have another litter after a C-section if she is not spayed during the surgery. This should always be discussed with your veterinarian. It is best to wait at least one full heat cycle, typically 6 to 12 months, before breeding again, so the uterus has time to fully recover.