After a morning of anal sac rechecks, puppy visits, ear infections (and the sad case of my neighbor's cat dying of heart failure) - typical general practitioner stuff, I had a walk in (what's with these walk-ins?) at about 12:30 today. A 5 year old Yorkie in labor for a couple of hours, and not one but two amniotic sacs coming out (but no puppies).
Here's the deal. I am not an OB-GYN. I see maybe one dystocia (trouble giving birth) case a year. The problem is, there really aren't many (if any) veterinary obstetricians around. It's not a sanctioned specialty. So what do we do? Yes, we wing it!
I did a vaginal exam and could feel the puppy's head right at the entrance of the birth canal. It wasn't stuck or anything, it just wasn't feeling like coming out quite yet. But with those sacs hanging out, I didn't want to wait too long. The textbooks (yes, I often consult textbooks) say that before giving oxytocin (trade name Pitocin) to stimulate contractions, you should take an x-ray to make sure that the puppy is positioned right and that the head doesn't look too big for the birth canal. I've seen puppies get stuck in the birth canal because they've come out breach or they're too big and it's not a good thing.
Anyway, these owners had barely enough money for the exam, let alone an x-ray, let alone a C-section if needed. Again, what's with the clients who walk in instead of calling ahead, and also don't have any money? Great, I thought. If the dog needs a C-section, then their problem becomes MY problem. Because it's not like it can wait for them to come up with the money. I would have to decide if a) I can take the chance that they would pay off the bill eventually (about 50% never do) b) I can get the owner to sign the animal over to me, do the surgery for free, and adopt out the mom and puppies (which is a lot of work, as you can imagine, and not a good way for a business to survive) or c) I could stand the guilt of sending an otherwise healthy dog home to possibly die, along with the puppies. What a mess!
The owners decided to take their chance with an oxytocin injection without an x-ray. I gave the injection and pushed a whole bunch of K-Y jelly up her vagina, and set them up in a room to see if things came out naturally. THANKFULLY, the owners came out 15 minutes later and told us she delivered! Yay! Crisis averted. She then had one more pup and I sent her home to have the rest, as I could feel at least one other puppy in her abdomen. I also sent them home with an estimate for a spay (this was her fourth litter and I think the owners were finally done). I suspect that the first two puppies' amniotic sacs and umbilical cords got sort of twisted up, because she passed the two puppies, then the two placentas, and they were all wrapped up around each other. But, as I've said before, I'm no expert.
Sometime winging it works. But I don't recommend it as a first choice.
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