How Your Puppy Can Liver Longer

Elective, Emergency Caesareans or vaginal births? Do bitches have a choice?

Multiple puppies and complications can kill the mother and puppies if there is a delay in an emergency Caesarean delivery.
6 vigorous Shih Tzu puppies - emergency timely Caesarean, Toa Payoh Vet"After 3 or 4 surgeries, I can perform a Caesarean section," Mr Formicelli said.  A top canine breeder, he had seen various veterinarians performing over a hundred Caesarean sections on his bitches over the past ten years. 

He was a hands-on breeder and would always be present whenever his bitch needed an elective (planned) or emergency Caesarean.  If only the law permitted him to practise Caesarean deliveries, he could save on veterinary costs. A penny saved is a penny gained.

It was New Year's Eve and most people would be celebrating. He felt the legs of the puppy inside the birth canal but no puppy was delivered for over an hour.  He had Shih Tzus with multiple puppies giving birth naturally and so, should he wait further?  He decided on an elective Caesarean.

Now, his bitch had been given gas anaesthesia for over 8 minutes. She was still awake. The vagina showed a bulge. Was the puppy already out?  "It's the water bag," I said. "It must have been stuck inside the pelvis."

Mr Formicelli tried not to look anxious. I could not move any faster. His bitch was strong and healthy and such bitches took a long time to be anaesthesized.  It was now 10 minutes. She was moving her legs and crying.  Mr Formicelli checked on the vaginal bulge. If the puppy was out, he could extract it.  A puppy saved is a puppy gained. But nothing came out.

"It is best that I can focus on the anaesthesia," I hinted to Mr Formicelli as his actions could distract me from monitoring the anaesthetic dose and kill the bitch. His help was invaluable when the puppies were taken out as I could focus on the bitch solely after handing him the puppies to revive and clean them.

For the time being, I needed to get the bitch sleeping so that I could put in the endotracheal tube to connect the gas from the machine to the lungs.

The bitch surrendered after 12 minutes. This would be a routine 15-minute Caesarean delivery, I thought. A quick surgery and then I could join my friends at the Sentosa Count Down party started from 6 pm and ending at 6 am.

I incised the abdomen and was about to open up the womb.  The bitch moved her head and panted faster. "She is going to get up," I said. "Increase the anaesthetic gas to 4% for thirty seconds and then reduce back to 2%".

The bitch still struggled.  Mr Formicelli said, "Why not the maximum 5% till the bitch is fully anaesthesized and not moving about"  It sounded logical.    

"No," I replied. "The heart could fail under the stress of multiple puppies pressing on her blood vessels." She was having labour pains and this made her struggle vigorously. This was a very unstable and risky moment. I wanted her not to get up and yet not to go into heart failure which would require me to stop operating to resuscitate her. This would take up much time.

So, what should I do now? The omental fat from the abdomen spilled out onto the skin surface. I pressed them down. What was the best procedure in such a situation?  This was an uncommon situation but I had encountered a few cases before.  The ideal was to be able to proceed with the surgery without the bitch waking up.  A fine balance of anaesthesia. There was no fixed formula.  Careful observations and experience counted.

6 vigorous Shih Tzu puppies - emergency timely Caesarean, Toa Payoh VetsWould Mr Formicelli be able to handle such a situation if he was operating without the knowledge of anaesthetic risks?  He probably would have killed the mother with his suggestion.

The pups were quickly taken out. One had the placenta wrapped around it.   The bitch stopped panting when four out of six big puppies were delivered. I had to feel two puppies deep inside the womb, using my forefinger to hook up the head. This was a complicated emergency Caesarean but the bitch and puppies were in good health.  The puppies should be able to grow up well.


Elective Caesarean in a Yorkshire Terrier, Toa Payoh Vets
Planned (elective) Caesarean versus Emergency Caesarean or vaginal birth.

Emergency Caesareans are taken when the labors fail to progress, fetuses are too big or in the wrong position, multiple fetuses, placentas that block the uterine opening (placenta praevia), infections in the lower vagina or vulva, cardiac diseases like severe hypertension or other complications in the mother and health- or life-threatening problems in the fetus.  Previous Caesarean sections may lead to uterine ruptures. Previous uterine surgery to remove fibroids (women), pre-term babies that will be stressed by vaginal delivery.

Reasons for Elective Caesareans in bitches.


1.  Convenience.  Fit into the work schedules of the breeder. No need to rush to the vet for a midnight Caesarean.

2.  Fear for the puppy's safety.  Each live pup is valuable to the breeder's sustainability of the breeding business.

3.  Naturally small pelvis. Possible pelvic injury that can result in urinary or faecal incontinence following a strenuous vaginal birth. 

4.  Some bitches are afraid of the pain of labour according to some breeders.

5.  Caesarean section can prevent the transmission of certain viruses such as hepatitis and papilloma virus in the vaginal fluids to the puppy.

6. A stronger and happier mother in most cases if the elective Caesarean is timely.


1.  A small risk of a post-operative pulmonary embolism in Caesarean or vaginal delivery or any operation.

2.  A planned Caesarean obviates the need for a far riskier emergency Caesarean should a problem arise during labour. 

3.  A premature puppy can be delivered if there is uncertainty about the mother's due date. There is a delay in the onset of lactation when puppies are born before labour begins. 

A small risk of stillbirths when the pregnancy goes beyond 63 days.

Vaginal births that require the breeder to use fingers or instruments are more likely to result in injuries to the puppy, including nerve injuries, fractures and bleeding.

Which method is safer for a healthy bitch with an uncomplicated surgery?  It is hard to answer this question.
 General anaesthesia is so safe nowadays that normal bitches seldom die or suffer from infections after a Caesarean delivery. The breeder must be aware of the benefits and risks. 

The costs of a Caesarean operation in women in Singapore varies from $1,600 - $2,500 just for the operation. In the dog, a vet starting practice charges around $150 for breeders and that includes surgery and anaesthesia.

Consult another veterinarian if your vet is against planned Caesarean deliveries. 

Shih Tzu had Caesarean on 64th day. Water bag burst l hour ago.1. Bitches normally deliver their puppies from the 58th - 63rd day after the first mating. 

2.  Premature puppies require intensive care by the breeder. The puppies which suckled less and less will die within 7 days despite intensive care by the breeder.  Reasons might be the foetal distress due to  protracted labour and infections.

3. Puppies which are delivered by Caesarean at the correct time usually grow up strong and healthy as for those Shih Tzus shown here. Delays in Caesarean for over 2 hours after the last pup is born or water bag had burst, usually result in weak puppies.

4.  Give a bit of dry meal to 3-week-old puppies. By week 6, they should be weaned off the mother's milk. Some mothers don't mind them suckling at week 6 as for the Shih Tzu mother shown in this webpage.

Extracts from the Book:
Puppies in Singapore:  How Your puppies can live longer.
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS.

Buyers interested in this book to be published in 2004, email to or tel 9668-6468.

This page:

written in 2000.

Patience with a working mummy realtor

A dual income is essential to support many Singaporean families nowadays, especially if one party is a realtor mummy as income fluctuates depending on closure of cases.  

A working mother has so much more responsibilities with a 9-month old.  Waking up the child from the afternoon nap to go with her to work means being late for appointments.  So many things to do on a Saturday afternoon only another working mother will understand. 

Saturday August 19, 2000. 4.15pm.

The mummy realtor's mobile phone was not responding so many times, Assistant James said and had given up calling her.  She was over 30 minutes late for her appointment to open the condo for our expat clientele to view.

We had stalled the expat by showing her all the condo facilities, the neighbouring condos and walked the sprawling grounds. 

The expat was becoming restless in this humid hot Saturday afternoon and was fanning herself with the house-hunting file. She was too polite to say "let's go".  

Keep trying James. 

Or should I call it a day?  Put on my snorkels and join the boy  to appreciate the crystal blue waters and the "brilliant orange corals, fight the  barracudas,  tickle the sea anemones and seek treasures in sunken ships"?
Snorkelling in a safe waters of a Parc Palais Singapore condo
I got her from my mobile.  She said she had arrived.  We knocked the door of her owner's brand new condo.  No response.  No door bell.  Knocked the door again. 

To leave or not to? 

A slow 10 minutes passed by.  Suddenly the mummy realtor  appeared saying she went up the wrong elevator.

A tanned brown lady in a black T-shirt and denim jeans.  No name card but she had co-broked with me before.  That was during her last month of pregnancy and she was   much fairer then.

"Would 3 p.m on Sunday be O.K with you," I asked the mummy realtor for a 2nd appointment.  She said it would be fine.  

Sunday August 20, 2000, 3p.m 

Twenty minutes had passed. The Canadian expat was feeling the heat of the still air though there were occasional breezes.

"Is there no expat interested in this apartment?" asked the expat.   It commanded a city and green hill views from the top floor,  

but had been vacant for around 9 months and she was wary of taking up the unit.  Lights were not installed.

"Most likely the realtor had not been actively advertising the apartment as the advertisement money comes from the realtor, not from the Owner and it is costly to advertise in the newspaper," I said.    

What more could I do to could to stall her? I showed her how the neighbour install their front porch light, a subject of no interest to her.  Neither was the swimming pool with 2 aquariums (click image to view bigger picture) and gym of this new condo.

The mummy realtor appeared suddenly and rushed to the far left unit where I was showing the porch light.  Her key was at the door to open up the apartment for us.

Just like an absent-minded professor? More like a zombie. 

"Wrong apartment! wrong apartment!"  It was not a laughing matter to the expat. Only I was laughing.

I quickly guided her away before the occupants open the door to give us a cold stare or to call the police for attempted trespassing.

Was the daughter keeping her awake at night and making her groggy?  I guided her to the correct apartment. 

She was worried about her daughter at the basement car park and wanted to go down for a while. 

"Just bring your daughter and maid up to the apartment to be with you. No problem with me."  The 9-month old was a lovely girl. 

The Owner was agreeable to the terms and conditions.  I had the letter of intent signed by the expat and handed a good faith deposit cheque to the mummy realtor  All she had to do now was to get the Landlord to sign. 

"You must be a keen golfer?" I asked. She had transformed from a fair lady to a chocolate brown one.  No, her sun-burnt complexion was due to showing houses and apartments and she was fair last time because pregnancy prevented her from being actively working for her numerous clients.   

Do give at least a 30-minute allowance for working mummy realtors with small kids as some cannot be punctual as they need to wake up the child from the afternoon nap to go together on the weekend viewing.

Be patient. No point fuming and cursing.  Enjoy the incidents if you can. 

Patience brought a successful closure in this case, saving lots of time to hunt for more condo.

I doubt whether I will encounter another robotic-like realtor programmed to unlock the wrong apartment.  It was fun if you could see the humorous side of the incident. 


Working mummy realtors:

You got tenant?

If not, place an affordable targeted
internet ad for $13.50 for 90 days, not just one day as in the newspaper. 

You may get the co-broking agent to call you and close early so that you have more time to be with your young ones.

Email your ad to now.
   Last updated: 03 Jan 2004

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