In 2003 - 2006, I was kept very busy with Caesarean sections from many various dog breeders in Singapore. Digital pictures of most cases were put on toapayohvets.com to enable me to research and review the diverse case problems and solutions.
It was a crazy sleep-deprived period as Caesarean sections happened past midnight. Some clients did not turn up while I waited at the Surgery waiting in the eerie isolated surgery in the neighbourhood of undertakers.

Fees charged were $250 per Caesarean section irrespective of the time, complexity of surgery or the number of pups. Caesarean section is generally advised when the dam looks distressed and cannot give birth after 2 hours of labour/between pups. For Chihuahuas and Yorkshire Terriers with dystocia, a delay of >2 hours usually results in the death of pups. Each case is different from another. Obviously, if the sire is large or there is the single-pup syndrome, elective Caesarean section is prudent to save the pups and reduce distress and death to the dam.  

See your vet earlier if a water bag is seen but no pups are born and/or there is a green vaginal discharge. It takes at least an hour to get to the vet and to start the surgery. Phone your vet early.  

Dams die of septicaemia when the pups had died and decomposed due to delays, despite Caesarean section. A foul stench is usually present when the breeder had delayed for several hours.

I hope these pictorial narratives may be of use to young practising vets, home breeders and puppy buyers surfing the internet - Dr Sing Kong Yuen - April 12, 2008.