What is dystocia? 

Dystocia means “difficult birth” and occurs when a dog is unable to deliver her puppies without medical assistance. Understanding the normal stages of labor and knowing when to call your veterinarian is key to protecting both the mother and her puppies.

What causes dystocia? 

Dystocia can result from problems related to the mother, the fetus(es), or both. 

Maternal causes include:

• Uterine inertia (weak or absent contractions). This is the most common cause and can be influenced by genetics, environment, low calcium or blood sugar, illness, litter size, or exhaustion from prolonged contractions.
• Obstructions in the birth canal, such as a narrow pelvis, old pelvic fractures, uterine torsion, strictures, or masses.
• Abdominal muscle defects, sometimes from age, breed, poor body condition, or hernias.
• Voluntary inhibition of labor due to nervousness, stress, or pain.

Fetal causes include:

• Oversized puppies
• Abnormal positioning
• Developmental abnormalities
• Deceased fetuses

Which dogs are at higher risk of dystocia?

While dystocia can happen in any breed, some dogs are much more likely to experience it:

• Brachycephalic breeds (Bulldogs, Pugs, Boston Terriers): more than half of births may require intervention because the puppies’ large heads and narrow birth canals make natural delivery difficult.
• Small breeds (Chihuahuas, Yorkshire Terriers): prone to having very small litters where individual puppies are too large to pass easily, or prevent them from going into labor in the first place. They may also be more anxious during labor (voluntary inhibition).
• Dogs with large litters (>8 puppies): the uterus can tire out, leading to weak contractions (uterine inertia).
• Older, overweight, or underweight dogs: all have higher complication rates.

When should I take my dog to the veterinarian during labor?

Call your veterinarian immediately if you see any of the following:

• Green vaginal discharge with no puppy delivered within 15–30 minutes (possible placental separation and fetal distress)
• Fetal membranes protruding for more than 15 minutes without delivery
• Strong contractions lasting more than 20–30 minutes without a puppy
• Weak contractions for more than 1–2 hours with no progress
• More than 2–4 hours between puppies with no active contractions
• Stage 2 labor (active delivery) lasting over 12–24 hours
• Foul-smelling discharge, heavy bleeding, or fever (>103°F)
• Your dog appears very ill, exhausted, painful, or begins vomiting

Prompt action can make the difference between life and death.

How is dystocia diagnosed?

Your veterinarian will start with a history of the labor timeline and a physical exam, including a vaginal exam to check for obstructions.

Diagnostic tools may include:

• Radiographs (x-rays): to determine the number, size, and position of remaining puppies
• Ultrasound: to check fetal heart rates; a heart rate below 160 beats per minute indicates distress and the need for surgery
• Blood work: to evaluate calcium, glucose, electrolytes, and check for infection or anemia

If pregnancy lasts beyond 70–72 days from breeding, dystocia may also be suspected.

How is dystocia treated?

Dystocia is always an emergency. The treatment depends on the cause and severity.

Medical management (only if no obstruction or fetal distress is present and the mother is systemically stable may include:

• Digital vaginal exam: gentle stimulation inside the vaginal vault to trigger contractions via the Ferguson reflex. If the Ferguson reflex is absent, other medical treatments are unlikely to resolve the dystocia.
• Calcium supplementation: triggers stronger contractions
• Oxytocin: to strengthen contractions (if three repeated doses fail, surgery is needed)
• Dextrose: if blood sugar is low

Cesarean section (C-section) is recommended when:

• An obstruction or malposition is present
• Puppies show signs of distress or have died
• High-risk breeds are involved
• The mother is very ill
• Medical treatment fails

In some cases, a spay can be performed at the same time if future breeding is not desired.

What is the prognosis?

If diagnosed and treated quickly, the prognosis for the mother is generally good, though older dogs often have a more guarded prognosis.

For puppies, survival depends heavily on timely intervention. Even with emergency C-sections, mortality rates are 13–20%. Puppies stuck in the birth canal for long periods have a much lower chance of survival.

Can dystocia be prevented? 

The only guaranteed way to prevent dystocia is to spay your dog, eliminating the risk of pregnancy.

For breeders, risk can be reduced by:

• Breeding only healthy, young animals without medical issues
• Keeping dogs at a healthy body weight
• Knowing the expected due date and the normal stages of labor
• Providing a quiet, safe whelping area
• Considering an elective C-section for high-risk dogs (brachycephalics, dogs with very small litters, dogs with prior dystocia, or those with abnormal pelvic anatomy)