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The 7-year-old Maltese's first pregnancy

"What should I do? What should I do?" Ms Chan asked over the phone on this sunny Monday morning. "My Maltese had been straining and straining for over two hours after her water bag had burst and no puppy is seen."

I had seen the 7-year-old bitch two weeks ago for pregnancy diagnosis. Mrs Chan wanted to know how many puppies the mid-life mother would be carrying in her womb. In 2003, most Singaporeans seldom breed dogs unlike the 1980s as they live a more hectic life. Breeding requiring lots of attention and cleaning up.  Thus I was surprised to find one Maltese pregnant at middle age. Well, she should be 49 human equivalent years.  

I wrapped my left hand round the Maltese abdomen. It was not easy to diagnose precisely how many puppies were present as the foetuses were now enveloped by the amniotic sac. It would be easy to tell at around 3 weeks after breeding.

"Most likely one," I told Ms Chan confidently. "No problem for her to give birth naturally. She is a big girl."

I had not encountered mid-life pregnancies as most professional dog breeders in Singapore stop breeding bitches past the age of six years.

Now the Maltese posed a challenge or a problem depending on how you view this situation. This was Ms Chan's first-time experience with canine maternity. She would have read books about dog births. Two hours would be the limit before you call the vets, according to the books she read.

What shall I advise her via the mobile phone?

"There are 2 choices, " I said. "Wait for another hour or get a Caesarian section." I replied. "It is possible that the puppy may die inside the womb if you delay the Caesarian section and you will still need the Caesarian to take out the dead puppy."

There was a third option. I could use an oxytocin injection at Ms Chan's home to induce birth. But there was no guarantee that the bitch would give birth. If the bitch could not give birth due to uterine inertia (uterine muscles not contracting), much time would have been wasted and the result would be a dead puppy which needed to be removed by Caesarian section.  Definitely, the family members would be most unhappy with me as deaths cause lots of ill will towards the veterinarian, whether justified or not.

But economics always play a big part in the owner's decisions in seeking veterinary advices on dystocias (difficulty birth) in the dog requiring Caesarian section.

She was quoted $500 excluding consultation and medicine from a veterinary practice. This was too much for her and she had asked me for a quotation. Vet hopping, like doctor hopping is not unexpected in Singapore.

But how low a fee can a veterinarian charge for Caesarian section without providing a subsidy to services rendered? It is a major surgery which will cost $3,000 in people.  Yet, there are pet owners who can't afford $500 plus other costs. The goods and service tax adds 4% to the bills in some veterinary practices with more than one-million-dollar annual revenue.

Two and a half hours had passed. Still no sign of a puppy.  What should Ms Chan do? Would she be able to afford the $350 fee for Caesarian section? The severe acute respiratory syndrome (Sars) had survived in Singapore had caused many employers to retrenched workers but I don't know whether Ms Chan was affected.

Ms Chan came to the surgery. The Maltese looked normal. Her rectal temperature was 38.5 degrees Celsius. This was the average but any temperature above 38 degrees in people will be high fever. Presently, to control the Sars outbreak, outsiders entering a government building needs to write his personal particulars in a form. His ear lobe is tugged at by an administrator while a an ear thermometer is pressed against the ear to measure the temperature. Fortunately, Ms Chan did not need to be checked for fever in the veterinary surgery.

The bitch was put on gaseous anaesthesia.  Since she was older, I decided to reduce the maintenance halothane gas to 1% instead of the usual 2%. The puppy's amniotic sac was broken and a white lifeless pup was taken out. No cries on first breath.

Was it dead? I cleared the mucus in the pinkish nose. I rubbed the back of its neck vigorously with the cotton swab. No cries. This one must be dead.

The few seconds passed. I gripped it with both hands, stood with my legs apart and swung her downwards in a arc so as to dislodge the mucus from her nose.

There was not much mucus in this puppy. I swung it one more time. No cries. Its tongue was maroon. Its eyes were closed tightly. In any case, puppies don't open their eyes till they are ten days old and therefore the eyes were not of any use in checking out the life.

Should I give up. Deaths are very emotional issues to the pet owner. I gave the puppy one more vigorous rub on the back of its neck before attempting mouth-to-mouth resuscitation.

A weak cry barely audible. I felt as if the clock of life had started ticking.  A new lease of life.

"The Maltese is breathing very fast," Nurse Ann warned. I put the puppy in a box so that I could suture up the mother. Suddenly, the bitch started to wake up. She strained her abdomen and a loop of her large intestine shot out of the abdomen.

"Increase the anaesthetic gas to 5% now!" I said as I put the surgical drape onto the incision hole to prevent more guts coming out.  The 1% anaesthetic was insufficient in this case.   The 5% should put her back to surgical anaesthesia, in theory.

Nurse Ann observed the rebreathing bag and the Maltese's chest and warned: "The Maltese has stopped breathing!"

This was a life and death emergency. I had less than ten seconds to revive the bitch. A live puppy and a dead mother would be very traumatic to the pet owner. The mother is more important. Seven years of companionship terminated by the veterinarian would cause an unforgiveable and unacceptable grief.

I quickly disconnected the bitch from the anaesthetic gas as I pulled off the endotracheal tube connecting the bitch's lungs to the anaesthetic machine.  I blow into the tube and massaged the heart using my hands.

The halothane gas bounced out from the lungs into my nostrils. I had to get the heart beating now. In theory, the emergency drugs were ready to be injected. Every second counted in the first twenty seconds. The heart massage by hand was more important.

"Start breathing now!" I said to myself. The 5% halothane had caused the heart to stop beating although normally, it had no such effect.

The ticking of the seconds in the wall clock was so much audible now. Was it too late to save the mother? Twenty seconds had passed. No sign of breathing. I continued the heart massage.

The Maltese coughed. She was back to normal. I connected her to the anaesthetic machine at 2.5%. She stablised and was stitched up.

She was all right as she woke up from the anaesthesia five minutes at the end of surgery.  She was groggy and was disinterested in her puppy.

Mrs Chan's mother commented: "The puppy is very cold." She was right. The puppy had been in the air conditioned surgery room for some time. I rubbed the puppy with a piece of cloth and took it outside to be warmed by the hot afternoon sun.

"You have to help the puppy to get its milk," I said to Ms Chan and her mother.  Everything ended well. No more pregnancies for this old Maltese anymore, I advised Ms Chan.
  
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