Bitches that have had previous dystocia(difficulty birthing),cases in which dystocia is anticipated (e.g., there is radiographic evidence that one or more of the puppies’ skulls is larger than the mother’s pelvic canal, such as bitches with pelvic fractures or narrow pelvic canal due to conformation/breed.)

Cesarean section itself does not have a negative impact on fetal survival. Other factors, such as prolonged dystocia ( greater than four hours), placental abnormalities or separation or toxemia can result in higher rates of stillbirth and neonatal death.