This page has two C-section surgeries on it. This first one you come to when you scroll down was performed recently, the one further down the page was performed by Dr. Palazzolo 20 years ago. It was posted on this web site in 1999.

A  Caesarean Section (abbreviated as C-Section) is derived from the latin word “caedare”, which means to cut. It is believed that Julius Caesar was the first to be born this way when his mother died during childbirth. Most scholars of ancient history believe this was done long before Julius Caesar was born. Either way, the name sticks.

Even though it is not common, a female dog unable to have pups after straining for several hours can be an emergency. Her calcium level can become so low that she goes into seizures. This is a medical emergency requiring immediate care.

The Long Beach Animal Hospital, staffed with emergency vets, is available until the evenings 7 days per week to help if your dog or cat is having any problem, especially seizures, breathing hard, or bleeding.

Think of us as your Long Beach Animal Emergency Center to help when you need us for everything from minor problems to major a major emergency. We serve all of Los Angeles and Orange county with our Animal Emergency Center Long Beach, and are easily accessible to most everyone in southern California via Pacific Coast Hwy or the 405 freeway.

If you have an emergency that can be taken care of by us at the Animal Emergency Hospital Long Beach always call us first (562-434-9966) before coming.  This way our veterinarians can advise you on what to do at home and so that our staff and doctor can prepare for your arrival. To learn more please read our Emergency Services page.

C-Section #1

Our first patient is a female dog that was able to deliver two pups normally. When we examined her and palpated her abdomen we could feel another puppy. She is exhausted, and has what is called uterine inertia. Her uterus does not have the strength to deliver the last pup. When a female cannot have a pup on her own it is called dystocia.

Low blood calcium

A female with uterine inertia usually has a low calcium. Calcium is needed for muscle contractions, which is why the uterus might have inertia and not be able to contract enough to expel the pup.

Her 3rd pup was stubborn though and did not want to come out, so we had to go in and convince him the time had come to meet his siblings. He fought us every step of the way!

We routinely perform a spay (OVH) on these dogs after we remove the pup. Most of them are not used for breeding, and we don’t want a repeat of the problem.

Before we get to the surgery our nurses just had to hold the two pups that were already born. We need to keep our priorities straight!

Pup in towel

Keeping a pup cozy warm

Face of pup in towel

They remind us of Yoda!

Graphic photos of an actual surgery are on this page. 

X-ray of pup in uterus

We took a radiograph to confirm the size of the pup and look for any problems. It’s a big one, and we can see why it could not come out. Time for a C-Section. 

Two pups nursing

The two that were born naturally had one last meal from their mother before we brought her into surgery

Pups sleeping in blanket

After their meal they were cozied up with blankets and a hot water bottle (at the bottom of the photo) since they cannot regulate their temperature at this stage

Pups sleeping on blanket

We know they were content because they fell asleep. Now we could concentrate on their mother and the remaining pup.

It was time for the C-section.  In this procedure we move fast, real fast, so the remaining pup is not depressed by the anesthesia we give the mother for the C-section. Time is of the essence, and we move rapidly once the decision to perform a C-section has been made.

Surgery Preparation

After we gave the mother a thorough pre-anesthetic exam, and administered intravenous fluids, she was ready for surgery.

Anesthetic exam

Every one of our surgery patients is given a pre-anesthetic exam within 24 hours of surgery

Examining a bearded dragon

Even the reptiles get this exam

While the surgeons are scrubbing in and preparing their instruments we are preparing the mother for surgery. She has her incision site clipped and prepped, a local anesthetic placed on the incision line, and a pain injection.

Surgeon scrubbing hands

While our patient is being prepped our surgeons are scrubbing up

Surgeon organizing instruments

As soon as the surgeon’s are gloved and gowned they go right into the surgery suite to get the instruments ready. We do not want our patient waiting for the surgeons, we want the surgeons waiting for the patient.

Nurse holding mother

After she was clipped Joel brought her in to start the anesthesia


Anesthetic monitor

Our patient is immediately hooked up to our anesthetic machine when brought into the surgery suite. When stable we can start the surgery.

Nurse anesthetist with stethoscope

Even with all of that hi-tech equipment used for monitoring we also monitor anesthesia the old fashioned way with our hands-on approach

Mother's face closeup

Our patient is getting sleepy as we administer her anesthetic. As soon as she is out we move her into surgery. At this point abdomen has already been clipped and scrubbed,  and the local anesthetic is on board.  This allows us to give her less general anesthetic and not depress the remaining puppy.

We have a large amount of detailed information on how we anesthetize a wide variety of species for surgery. Click here to learn more, then come back and let’s see how the surgery is progressing.


Our experienced surgeons usually do their work on their own without the need for an additional surgeon in almost every surgery we perform. In this case, even though the 2nd surgeon is not needed, one doctor can work on the mother while the other simultaneously works on getting the pup out of the uterus.

We move fast in this surgery, and the photos don’t do justice to the speed at which we get in and get that pup out. You will see examples of the two surgeons working as a team in a choreographed manner in the photos below in order to achieve this goal. It all adds up to less anesthetic time for the weak mother, and less anesthetic depression for the pup.

Surgeon draping patient

Dr. Wood, our first surgeon, wastes no time draping our patient for the procedure once our anesthetist confirms our patient is stable

Final patient draping

At this point, our 2nd surgeon, Dr. ridgeway, is scrubbing in and will be in the surgery suite in a few seconds

Surgeon making incision

Our first surgeon wastes no time and makes the initial skin incision as soon as the patient is draped. A local anesthetic was put in this area as part of our pre-surgical prep, enabling us to get into the abdomen faster with no pain for our patient

Surgery team working

Both surgeons working rapidly and efficiently, one on the mother, the other concentrating on the pup still in the uterus

Surgeon finding uterus

This type of teamwork allows one doctor to control bleeding on the incision line while the other doctor identifies the uterus 

Pup in surgeon's hand

This is what the pup looks like in the uterus

Cutting into uterus

A quick incision in the uterus, taking care not to cut the puppy

Surgeon cutting uterus

Same surgeon teamwork here so that pup is not cut while rapidly removing it from the uterus

Pup in membrane

Out he (it’s a boy!) comes covered in a protective membrane

Surgeon clamping umbilicus

Once we remove the membrane the first thing we do is clamp and cut his umbilical cord

Surgeon clamping umbilicus

One of our surgeons starts the suctioning even before the other doctor cuts the umbilicus

Suctioning mucous from mouth

Suctioning is important to get some air into his lungs

Surgeon rubbing pup

After the initial suction a quick rub to stimulate respiration and off to our nurses. While this is going on our other surgeon is starting the spay (OVH) on the mother. 

More suctioning mucous

Our nurses are eagerly waiting for him with a warm towel and more suctioning. Now that the pups are in the safe hands of our nurses our surgeons can concentrate on the mother.

Veterinary surgical team

Now that the pups are in the safe hands and warm towels of the nurses our surgeons can get back to spaying the mother

Over several minutes we gently suction out mucous from the nose and mouth

After we are sure the breathing passages are clear we stimulate him to breathe by gently rubbing him

Pup nursing from syringe

His mom is still in surgery, so we give him a quick meal until he can nurse. Nursing is important because the milk the mother produces contains antibodies he needs to prevent common diseases like Distemper. He cannot produce these antibodies just yet.

Nurses feeding pups

While our doctors are finishing the surgery our nursings staff goes to work making sure these puppies are fed and kept warm until the mother is fully recovered and able to nurse all of them

Nurse feeding pup

The nursing instinct is strong and the puppies greedily suck down the milk

Three pups sleeping

After a gourmet meal of milk all three of them take a well deserved nap

Mother face closeup

We let the mother recover completely before we let the pups nurse. She is exhausted from trying to get this last puppy out and needs some time to rest.

Surgeons holding pups

Once mom was out of surgery and stable our surgeons could not resist, and had to hold the puppies

This was Dr. Wood’s first C-section, and she did a wonderful job! Next time she has to do one in the middle of the night she won’t need to call Dr. P to help her!

C-Section #2

You can see how the quality of the digital photography has dramatically improved over these last 20 years when you compare the following photos to the ones above.

One of the most rewarding surgeries we perform is a Cesarean Section. Usually it is performed on small breed dogs because their pelvic canals are just too small to handle the size of the pups for a natural birth. This is the story of Margarita, a Chihuahua that had 4 large pups in her tank.

The gestation length in most domestic dogs is 63-65 days. When Margarita first came to us one week before she was due we knew a C-Section would be needed from her size and her radiograph.

How many pups do you see in Margarita’s abdomen? The answer to this question will become apparent later on.

On the appointed day Margarita was brought to our hospital for a C-Section by Dr. Palazzolo. On a dog that is this small, and has this many large puppies in its uterus, preanesthetic preparation is important. This consisted of a preanesthetic blood panel and intravenous fluids prior to and during surgery.

Here she is on the surgery table. You can see the green tape covering her IV catheter and if you look closely you might be able to tell that her abdomen has already been shaved. She has also been given a local anesthetic where her incision will be. All of these things are done prior to any anesthesia. They will allow us to use less anesthesia for the actual procedure which is important to minimize any anesthesia that depresses the pups.

Soon she will be given an injectable anesthetic

At this point things start moving fast. Margarita has been given an IV sedative to relax her, the final surgical prep has been applied, and a breathing tube (called an endotracheal tube) is in her windpipe giving her 100% oxygen.

Once she is intubated we move fast, and in the next 5 minutes all of the pups will be out of her uterus. While her anesthesia is being monitored the rest of the team is preparing to receive the pups.

Clipped, scrubbed, and ready for surgery

She is draped and a rapid incision is made in her skin. By giving her the local anesthetic earlier she does not feel the skin incision and we can keep the anesthetic level to a minimum.

The uterus is rapidly located and gently squeezed out of her incision. We make the incision in her abdomen just big enough to gently exteriorize the uterus because she will heal faster and nurse her pups better with a smaller incision.

This is where the experience of our surgeon, Dr. Palazzolo, comes into play.

This is one horn of the uterus and contains 2 of the pups. The other horn of the uterus can be visualized running horizontally at the bottom of the picture.

A scissors is used to cut into the uterus. Special care is taken not to cut the pups that could be moving in the uterus.

The first pup is gently removed with his umbilical cord still attached

You can get a better idea of the amniotic sac that completely covers the pups

The first things our nurses do upon receiving the pups is to rub them gently yet vigorously in a towel. This stimulates them to breathe. They also gently shake them to remove fluid from their lungs.

The nurses use a special bulb syringe to suction fluids from the nostrils and mouth

Any pup that is still not breathing well at this point is giving a drop of respiratory stimulant on the top of its tongue

Once our nurses feel the pup is breathing on its own they tie its umbilical cord

After all four pups are stable they are put under a heat lamp since at this early stage in their lives they do not have a very strong ability to regulate their body temperature

Meanwhile back in surgery Dr. P is checking the abdomen to make sure there is no bleeding prior to suturing the abdomen. In Margarita’s case she was also spayed.

Her muscle layer is carefully sewn back together. These sutures are critical to prevent a hernia from occurring, especially when pups vigorously nurse.

With her skin sutures complete Margarita is now taken off the anesthetic machine and a pain injection is given to her.

Our nurses take care of the feeding while Margarita rests and recuperates. We won’t let four hungry pups nurse until she is strong enough.

Here are our four little piggies all in a row sleeping after their ordeal and their first meal. Their tummies are full and they are keeping each other warm.

In a surgery like this there needs to be close coordination between the surgeon, anesthetist, and nursing staff. You can see how much time and attention our nurses put into doting over these puppies.

Time for a little shut eye, we had a big day!

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