The vast majority of cesarean sections in dogs are unplanned. The dog has often been in labor for several hours, and is likely to be dehydrated to some degree. Administering fluids and electrolytes intravenously is often the first step in stabilizing the mother for surgery. The vet must also determine if the dog is in shock, and treat her accordingly. General anesthesia is damaging to small puppies, and should be used as sparingly as possible. To assist in this measure, all preparation for the surgery should be done before general anesthesia is given. Medication can be given to calm the animal at this time.
The lower abdomen can then be shaved and cleaned. Extra care is needed in keeping the site clean, as antibiotics can present further complications in nursing mothers and young puppies. General anesthesia can then be given, with local anesthesia, such as an epidural, also being used to lessen the amount of general anesthesia needed. Everything done from this point onward should be done both as fast and as carefully as possible.
An incision is made from the bellybutton to the pubis of the dog. Once the abdomen is open, the uterus is brought to the surface. One horn may be pulled up and carefully incised. The hole must be large enough for the pups to be pulled through. The placentas should be gently detached with each pup if possible. The first uterine horn can be placed back in the body, and the process will then repeat with the second uterine horn. Once all puppies are out, the placentas should be counted to ensure none remain in the uterus, as this can lead to infection. Each pup will need to be removed from its sack, and each cord will need to be clamped and then cut. The surgical site will then be sutured shut, with subcuticular stitching so as to not interfere with nursing of the pups.