Q: My dog is pregnant and I am worried about her having puppies. I know some dogs will require a Caesarean section to deliver the puppies. How do I know when to a C-section is necessary or whether to let her have the puppies naturally?A: Let's review the stages of labor quickly and then go over some indicators that a C-section is on the horizon. Stage 1 labor can last from six to 12 hours and is characterized by behavior changes. Your dog will be anxious, shivering and panting during this time. It will end with complete dilation of the cervix.Stage 2 of labor is the active delivering of the puppies. You will see her strain and contract. A puppy will be expelled during the first one to two hours of this stage. If she doesn't produce a puppy within that time frame, then there may be a problem and a trip to your veterinarian is needed. If she delivers a puppy normally, she should pass into Stage 3 of labor in the next five to 15 minutes and deliver the placenta. A discharge is associated with this stage and is normal.At this point your dog will go back and forth between Stage 2 and Stage 3 of labor as the puppies are born. A resting phase between puppies is quite variable and can last up to four hours. If she goes more than four hours between puppies and you know there are more puppies yet to be delivered, then that is a warning sign that she may need a C-section. Another sign that she may be in trouble is if she actively pushes for 30 to 60 minutes without producing a puppy. So get that stopwatch out and start timing it all.More signs that may indicate a C-section is needed include weak contractions for more than two hours without producing a puppy, signs of illness in the mother dog such as vomiting, fever, pain and bloody discharge. If you see any of these signs, take her into your veterinarian immediately.The veterinarian will X-ray her to determine if there are more puppies yet to be born and examine and palpate her for puppies that may be lodged in the birth canal. Your veterinarian may try a drug called oxytocin to stimulate the birthing process.If this doesn't work, then surgery is needed to get those little guys out. The decision to go into surgery is based on many factors: the stability of the mother dog, the health and strength of the newborn puppies, her past history of having puppies, and the size of the father dog and of the mother dog.The decision to go to surgery should be made with the owner's input and consideration and with the veterinarian's experience and knowledge. Everyone wants a full litter of healthy puppies to be brought into the world. Unfortunately, it doesn't always happen that way. Some puppies are stronger than others and some have congenital malformations that are not conducive to life. But every puppy that does survive becomes a gift. To the breeder they are the accumulation of a lot of hard work and sacrifice. To their new owner, they are friends for a lifetime. And to a veterinarian, they are potential patients for the next 10 to 15 years. Everyone wins with puppies!Send questions for Dr. Allison Dascoli to "Ask the Vet," Charleston Daily Mail, 1001 Virginia St. E., Charleston WV 25301 or e-mail them to firstname.lastname@example.org. Comments or suggestions can be submitted the same way.