Why do newborn puppies come out in a sac, and what is it for?

No, foetal sacks without a puppy is not normal and is an emergency as the pups oxygen and blood supply is likely disrupted, putting the pup at risk. Please have her assessed by an emergency vet to determine if a c section is required.

Puppies are born in sacs filled with fluid. Most of the time the dam tears the sac and cleans the puppy. In some cases such as a c-section, we have to open the sacs, remove the puppy, and wipe the fluid away from the nostrils and airway. The bulb syringe is used to aspirate fluid and mucus out of the oral cavity. You should only have to perform this once or twice.

Typically the membranes pass within 15 minutes of a puppy's delivery, but I would not be overly concerned about the second pup's slower membrane expulsion. Puppies are usually born every 30-60 minutes, but there can be up to 3 hours between puppies, which is all normal. Be sure that Maggie is cleaning and stimulating the puppies to breathe very shortly after birth. If she is not doing this, you can use a clean towel to remove the membranous covering from the puppies' faces and rub their bodies to stimulate them to take a breath. This link also has some helpful information about whelping: http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=678. Congratulations on your new additions!

Most puppies will not need you to aspirate their mouths after birth if it is a normal healthy birth. Usually the puppy will be born and mom will immediately start licking/cleaning the pup and this will stimulate them to start breathing. That being said, it isn't a bad idea to have one on hand as they are inexpensive, and if they are having trouble breathing you can use it. You can read more about birthing puppies/stages of labor/signs of problems at http://www.veterinarypartner.com/Content.plx?P=A

Sometimes the mother will reject puppies that she feels won't make it, and in a large litter with such a small breed dog I would not be surprised if some of the pups just weren't viable. Your best bet in the future is to make sure the puppies are kept well-warmed - a heat lamp is good for this - and also watch the mom closely, especially in the first few days, to make sure that her mothering instincts are taking over and she's not trying to sit on any of the puppies. If you find some of them unresponsive, wrap them in a warm towel and try stimulating them by vigorous rubbing. You can also gently blow into their mouths, and use a bulb syringe to suction any accumulated mucous from the airway.

Your bitch may not act like the typical mother because she is way too young to have a litter, and her mothering instincts may not have kicked in yet. Have a box, lined with warm, soft twels ready. As each pup is born, the mom should cut the cord by "scissoring" it with her teeth. If she does not, tie dental floss about four inches from the pup, and at five inches from the pup. Scrape the section in between the ties with a butter knife (you can go back and forth) until the piece of cord is shredded (shredding instead of cutting "seals" the cord better)As soon aa the cord is cut (or before, if you have to do it yourself), clear the pup's airway with a baby bulb syringe--mouth first, then nose. Finally, rub the pup vigorously with a thick towel to get it mostly dry. Put it in the towel-lined box, Have a low-watt light clipped to one side of the box so the puppy can move into and out of the warm spot on the floor of the box. Watch to be sure a placenta is delivered for each puppy. Finally, between births you can give the pup or puppies to the mom to nurse, but remove them if another pup starts to come so she doesn't hurt them accidently. call the vet for breech (feet first) birth, retained placentas, excessive bleeding, or other concerns.

This could be a prolapsed vagina or even a prolapsed uterus or urinary bladder, You will need to take Katniss and her babies to a vet preferably now. You can put a moist cloth on the red sac to keep it from drying out. It will need to be put back inside so there is no permanent damage to her vagina or uterus. If it is a prolapsed urinary bladder this would be a serious emergency. Please take her now,