Using a Pregnancy Monitoring Service
By Melinda Sunnarborg
Reprinted from the Sept/Oct 2002 Collie Expressions Magazine.
(All rights reserved.)
|"Any sufficiently advanced technology is indistinguishable from magic." - Arthur C. Clarke|
|At some point, most breeders have made or will make what they consider to be a very "special" breeding. Not that all breedings aren't important, but certainly in the eyes of the breeder, some are especially significant. These breedings are different because they have more risk, more unknown variables, or because of the two individuals being bred together, high expectations are riding on the results. Sometimes circumstances dictate that there will be no opportunity to repeat the breeding if no puppies result.|
Fortunately, 21st century medical technology in the form of a whelping monitoring service is now available and affordable to any breeder who wishes to take advantage of it. Veterinary Perinatal Specialties, Inc. (PVS) of Wheat Ridge, Colorado, offers the Whelpwise service, which is currently the only one of its kind in the U.S. Working in conjunction with licensed veterinarians, including the breeder's own veterinarian, the service provides in-home monitoring to assess the presence or absence of labor and to evaluate the fetal condition. Monitoring equipment includes an integrated modem that connects the breeder via phone line with trained technical staff. The service is very affordable, usually running about $350.
Using in-home equipment during the last week of pregnancy, the breeder is able to detect and track uterine contractions, as well as fetal heart rates. Uterine contractions are monitored prior to and during whelping to insure that a normal delivery will occur. Problems such as a stuck puppy can be discovered early enough to seek veterinary intervention, including surgery if needed, and prevent a disaster such as uterine rupture. Conversely, uterine inertia can be detected and treated at home with low-dose medical protocols, such as oxytocin and injectable calcium, which support a normal labor pattern without the danger of over-medication.
The ability to detect and monitor fetal heart rates serves two valuable purposes. It allows the breeder to count the unborn puppies so that it is clear when whelping is over. Also, it can give advanced warning of a puppy in distress, giving the breeder the opportunity to choose whether or not to intervene.
Instead of taking a passive role when it comes to whelping and merely hoping that everything comes out all right, the Whelpwise service provides the breeder a clearer view of what is actually happening prior to and during whelping. Armed with this information, the breeder is then in an excellent position to make the most appropriate choice when it comes to the health and well being of both the dam and her puppies.
This past summer, we chose to use this service for our rough bitch, Cherie. She was eight and one-half years old at the time of the whelping, but had a good track record of being an easy whelper and an excellent, loving mother. Her previous two litters of five puppies each were whelped at age three and age four, resulting in two champion daughters. The breeding we chose this time was a grandmother-to-grandson combination - a variant of the successful grandfather-to-granddaughter formula widely used in all types of animal breeding. However, in reality, the grandmother-to-grandson formula is used much less often than the reverse, primarily due to the age of the dam.
Of course, we were aware of the risk. Older bitches can tend to have smaller litters. Without the degree of stretching of the uterus caused by a medium or large-sized litter, sometimes there is not enough stimulus to cause labor contractions to begin. Occasionally, labor can begin undetected and then stop - with no noticeable external signs. All of these things can spell trouble for the unborn pups.
After careful deliberation, we made the decision to proceed.
May 5 - 12:
Cherie was bred via artificial insemination on Days 12, 15, 17 and 19 of her season. We had done progesterone tests (outsourced through our veterinarian's lab service) for her two previous breedings, since she was shipped by air both times. From these prior tests, we knew that she had been a "late" breeder, meaning Day 15 or later. Based on this knowledge, plus the fact that the better A.I. sessions seemed to be on Day 17 and 19 (May 10 & 12), we assumed that her most likely due dates this time would be July 12 & 14.
Enlisting the Service
I was able to confirm Cherie's pregnancy by palpation at 33 days post-breeding. In the past, I have been able to detect puppies by 28 days after breeding IF the litter is average size - say five puppies or more. This time, I couldn't find anyone at home in there until almost a week later, when I could feel two puppies. I had a sense that the litter might consist of only those two.
I called VPS to sign up and to reserve monitoring equipment for the week prior to Cherie's due dates. I was interviewed over the phone and was asked to provide information about her, including her breed, age, weight, previous breeding and whelping history, current breeding dates, feeding regimen, and any medications or supplements being given to her during her pregnancy.
Even though I felt that Cherie's most likely due dates were to be July 12 & 14, the shipment of monitoring equipment was scheduled for July 1, so that the Fourth of July holiday would not cause a delay - and because of additional possible whelping dates due to the earlier breedings. We did not want the equipment to arrive too late in case she decided to whelp early. The package arrived via Federal Express, as promised, on July 3.
Learning to Monitor
After viewing the instructional videotape (twice), I set up the first session to practice monitoring Cherie's uterine activity. PVS recommended twice daily hour-long sessions, 10-12 hours apart. This involved placing the uterine sensor, which looked like the bell end of a stethoscope, over the uterus and securing it with the harness that was provided. In order for the sensor to make good contact with the skin, I extended the normal pre-whelping belly-shaving pattern up slightly to include the lower side of the abdomen, just in front of the tuck-up.
Once the sensor had been connected to the recorder, was properly secured, and the harness comfortably adjusted, the recorder was placed into the backpack-like pouch. The photo shows Cherie during a monitoring session. The placement of the sensor can be seen. The floral-patterned pouch on her back contains the recorder.
During the recording session, the bitch must remain quiet and not be walking around. I did some sessions with her crated, but the best data collection was obtained when she lay on the floor while I sat by her and read. The most important part of the process was to be sure that the sensor was properly positioned over the uterus and that it did not shift during recording. Fortunately, the recorder will indicate by tone and signal light if the sensor becomes loose or out of position, so it is easy to correct the problem and continue monitoring.
When the time was up, the recorder emitted a beeping signal. I disconnected the sensor, removed Cherie's harness and then plugged the recorder into the base unit to download the data. Afterward, I dialed the 800 number to let the PVS staff member know that I was ready to transmit. Using the base station, which was connected to my phone line, the data was sent in a fashion similar to a fax machine. Once all the information was sent, the staff member came back on the line and told me that Cherie had had three mild contractions during the session - which was normal. During the last week of gestation, bitches will have intermittent mild uterine contractions. As we monitor, we are looking for stronger, more frequent second-stage contractions, usually between six and eight per hour, indicating that labor has actually begun.
The second component of prenatal monitoring is the observance of fetal heart rates using the ultrasound doppler device, which is about the size of a TV remote control. I found this to be the trickiest part to learn, but at the same time it was the most rewarding and fun.
Following a diagram provided in the PVS packet, I used the doppler to search for and count the puppies. Beginning on one side of the bitch and eventually turning her to listen from the other side as well, the doppler is tipped with a nickel-sized blob of ultrasound gel, then placed against the shaved abdominal area. It is rotated and angled in place until a heartbeat is detected. If no heartbeat sounds are heard, then a new spot is tried. It took a while to get the hang of it. The doppler picks up all kinds of abdominal noises - everything from intestinal gas to stomach gurgles - all in a wash of background sounds. It reminded me of static "snow" on TV. However, when the doppler beam landed on a fetal heart, the sound was very distinctive - a hollow "cloppity-clop" like horses' hooves. Within a few seconds, the digital readout on the face of the doppler showed the heart rate in beats per minute, like radar locking in.
The normal heart rate for an unborn puppy is from 170 - 240 beats per minute. The rate is at the lower end of the scale when the puppy is at rest or sleeping, but it will rise rapidly when the puppy stretches or moves. A gentle finger poke will nearly always cause the heartbeat to surge upwards for a few seconds before gradually settling back down. Puppies in distress will have a lower heart rate of around 150 or less.
During this first session, I was able to locate two puppies, each with a baseline heart rate of about 215 and ranging up to about 250.
Interpreting the Data
During the first few sessions, I struggled with the "learning curve." Sometimes it was difficult for me to locate one of the puppies. I could hear one or two hollow "clops" then I couldn't locate the sounds again. It was like searching in a dark cave with a flashlight of sound, instead of light. One time I was locked in on a very strong and steady heartbeat and suddenly it stopped as if someone had flipped a switch! When I told the PVS technician, she laughed and said, "Don't worry! The puppy didn't die. He just turned his back on you!"
As my ear became trained, I found it easier to look away from the digital readout and simply listen to hear that strong staccato "cloppity-clop" racing along like a tiny pony.
VPS participated in a phone consultation with my own veterinarian, who was in agreement with the Whelpwise methods and protocols. Both parties felt that the most likely problem, if any, in Cherie's case might be uterine inertia - because of her age. In preparation for that possibility, my vet sent me home with an assortment of pre-drawn syringes containing oxytocin and calcium gluconate. If needed, these medications were to be administered subcutaneously to Cherie during whelping, as directed by the VPS staff.
July 6, 7 & 8:
The daily uterine monitoring sessions revealed Cherie had no contractions in either the morning or evening sessions. Fetal heart rates were still good, although there was some variation with levels briefly dropping below 200 and then rising again. I began taking her temperature twice daily and the reading was hovering between 99.6 and 100.4 degrees.
There was one contraction in an hour during both of the morning and evening monitoring sessions. The heart rates were good, except for the puppy in the #2 position (closest to the flank). He had fluctuations, dropping briefly to 134 and then rising again to the 170's. Concerned, I had the VPS technician listen to the heartbeat over the phone. She felt that the puppy was still fine and was not currently in distress.
I was reasonably sure that we were still at least a couple of days away from whelping. During her previous pregnancies, Cherie whelped on the 63rd day from the "best" breeding (usually Day 16 or 17). A dramatic temperature drop of below 99 degrees always heralded this event. You could practically set your watch by her.
Five contractions were in the morning session. I set up an extra session at noon, but there was only one lone contraction. By this time, I knew I was hearing four puppies, not the same two from each side. The heartbeats on the left side seemed to be a little slower than those on the right, although just as loud. When doppler targets a heartbeat, the closer it is, the louder it sounds. You can hear a puppy in the left uterine horn from either side, but it will sound louder on the left side than it does on the right.
That evening, I did two more monitoring sessions: one at 5:00 p.m. (three contractions) and one at 11:00 (one contraction). Heartbeats still sounded ok.
More monitoring. Cherie was being a very good sport about the whole ordeal, but her face plainly showed resignation each time I brought out the harness and equipment. ("Again?") More of the same during the morning session: One contraction; heartbeats at 175 - 185. However, her temperature had now dropped to 98.6 degrees and I knew that whelping ought to occur within the next 24 hours. She was also starting to perform some brief "nesting" behaviors, such as digging at her bedding and rooting through the blankets with her nose, but there was nothing intense or frantic about her actions.
The monitoring session at noon was the same story as during the morning.
By evening, however, it was the puppy in the right-hand #1 position (forward of the flank, near the end of the ribcage) whose heartbeat was down to 147, but then it rose back up to 175-185. No indication of any increase in uterine contractions, even though her temperature was still low at 99.1 degrees. There was obviously a pattern of declining heart rates without an onset of real labor. On the phone, PVS said, "You may have to start thinking about a c-section."
Admittedly, I had been hoping to avoid that option. To complicate the decision, a choice must be made regarding at what point is a c-section the answer? If one puppy is distressed, but the rest of the litter is fine, do you risk a surgery to save that one puppy? Often, a puppy that becomes distressed before the onset of labor has a congenital defect and is not meant to survive at all.
I checked the heart rates again at 2:00 a.m. and they actually seemed up a little. Certainly they were not dropping lower. I caught a couple more hours of sleep, but was up before sunrise.
The Decision to Intervene
By 5:30 a.m. the heart rates were low again - especially on the puppies in the left horn. The readings were in the 140's. VPS said, "Yes, now is the time for a c-section."
I asked if I should go to the emergency clinic, since my vet's office would not open for another three hours.
The VPS technician said, "I hate to send you there, but yes, you'd better go. Give me their number and I'll phone ahead for you. Be sure to take the doppler with you so they can see what you're talking about!"
Her words signaled the start of a very hectic three hours...
The emergency clinic, a newly opened facility, was 12 miles away in a neighboring city. However, at 6:00 a.m. in San Francisco bay area commute traffic, the normally 15-minute trip took almost 40 minutes. At the clinic, after paperwork and a not-so-brief wait, the attending veterinarian came into the exam room. As I was waiting, I had taken the doppler out and was checking heart rates. They were all up by about 15 beats per minute - presumably because their dam's heart rate was also elevated due to her apprehension about being at the vet's.
Our stay turned out to be short. I made the decision to not have Cherie's surgery performed at the emergency facility, based on my conversation with the attending veterinarian. After a brief on-the-floor exam - stethoscope, temperature check, looking in the mouth - she told me that there was no surgeon on the premises; he was "on call." He would have to drive in (in commute traffic) to perform the surgery, if there was to be one.
Once we were back home, I phoned my own vet's office (which was open by now) and they quickly scheduled Cherie as the first surgery of the morning.
By 11:30 a.m., I received the phone call that all was well. Cherie was fine and so were her four puppies: two tricolor dogs and two sable bitches. Interestingly, two of the puppies, a dog and a bitch, were quite small - only five and one-half ounces. Both were taken from the left uterine horn, the side where I had most consistently detected lower heart rates.
Also worth noting, my vet observed an abnormality of the uterine wall on the left horn, close to the #2 location. It consisted of a thin, pale area, obviously with reduced blood flow. The area was resected and sent to the lab for analysis, (which revealed nothing alarming), but my vet felt that the area could have ruptured during labor - with very serious consequences.
In light of this information, along with the four new puppies, my vet and I felt confident that an elective c-section had definitely been the right decision in Cherie's case.
Now that several weeks have passed, I look back on the experience of using the Whelpwise system as very educational and positive. I learned something new during nearly every phone conversation with the PVS staff. They are very experienced, knowledgeable, and helpful. Even though they were several states and one time zone away, I felt that the accuracy of their diagnosis was quite good. In addition to the complete data results from the uterine monitoring sessions that they can view minute by minute on their computer screens, they asked pertinent questions during each phone session. How was the bitch doing? Was she still eating? Any panting? Nesting? Temperature drop? It was obvious to me that the staff really does enjoy their job and cares about their clients' bitches and puppies as if they were their own. There are four technicians who work on rotating shifts, so clients may call at any time, 24/7 - 365 days a year. It is like having a canine midwife available around the clock.
In hindsight, the primary thing that I should have done differently was to have a much better contingency plan for after-hours care. I should have made arrangements either with my own vet or another emergency clinic so that someone would always be available to perform an elective c-section within a reasonable timeframe, if needed.
Additionally, I now know that it will feel very different going back to the normal "wait and see" world when it comes to whelping! Quite frankly, I'm not sure I will be satisfied with just watching the calendar and hoping all will go according to plans.
And for those who might criticize and say this process is moving away from allowing dogs to whelp as Nature intended, I offer the following:
There is nothing wrong with availing yourself of information that comes as a result of the advancement of medical science. If the loss of your bitch's life is prevented because you were able to forecast a problem in advance, isn't that a positive thing? If one additional puppy is saved, whether it grows up to be a pet or the next ROM sire or dam, is that not worth the cost of the service? And finally: Would you want your own daughter, sister, or best friend to forego the latest medical advances during her own pregnancy - or would you want her to have the very best health care that is currently available? No need to give birth out in a cornfield if modern facilities and technology can help ensure a healthy mother and baby!
I feel that it is appropriate to add this addendum to the story. Within 12 hours after being born via c-section, it became painfully evident that the two smallest puppies were not viable. We tried every "trick" in our repertoire but it soon became clear that it was not meant to be. Ultimately, the tiny pups were made as comfortable as possible and allowed to quietly slip away. It was very sad for us to lose them, since a team of so many good people worked so hard to help them to be born.
For the record, I do not feel that using the Whelpwise system in any way perpetuates the survival of the weak. However, I feel that it does facilitate the preventable loss of otherwise healthy and very valuable bitches and their unborn puppies. That in itself is a true asset to any breeding program.
Without question, the overall experience of using this service was very rewarding. Certainly, I would not have committed to moving forward with this breeding if the Whelpwise system had not been available. I know of too many other breeders who have had much more devastating and heartbreaking losses when attempting to breed an older bitch. While that may not be true in every case, it made good sense to me to try to make sure that the well-being of both Cherie and her puppies was carefully monitored.
So, did we defy Nature? On some small scale, perhaps. Was it all worth it? Most definitely!
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