While your Shih Tzu is doing her part with the delivery, you can gently but firmly grip the Shih Tzu puppy's sac with the aid of a towel or diaper. Hold the Shih Tzu puppy in a position of presentation to prevent it from being withdrawn back into the birth canal. Each time your Shih Tzu matron has a contraction the Shih Tzu puppy is closer to birth. You, as a Shih Tzu mid-wife need only to the hold the Shih Tzu puppy to prevent withdrawal and allow Nature to work. Sometimes it may be difficult to grip the Shih Tzu puppy's sac. If the head is definitely presented first, break open the sac from around the Shih Tzu puppy's head. Immediately use a pediatric bulb syringe to suction amniotic fluid from the Shih Tzu puppy's mouth. A difficult or large Shih Tzu puppy may require more than two or three contractions. In general, there should be no more than four contractions. If more than four contractures there may be a problem if the Shih Tzu puppy has not been whelped. You may need a professional vet's assistance at this point. A breech delivery Shih Tzu puppy is presented rear-foremost. The hind legs are tucked against the Shih Tzu puppy's abdomen in the direction of the head. This presentation normally does not present a problem for the Shih Tzu puppy or the Shih Tzu matron because the head of a Shih Tzu puppy is larger in circumference than the body. Shih Tzu are generally whelp freely and do not require professional assistance. A breech delivery can be difficult to assist when a Shih Tzu puppy is confined in the slippery sac. Surgical gloves are helpful for securely holding the slippery sac. Gauze pads make a second good choice. A thin towel is adequate as a third choice. If none of these items are available and you must work with your bare hands, use your fingers. Gently secure a grip on each side of the Shih Tzu puppy without applying undue pressures. As each contraction occurs, apply a steady, firm pressure, preventing the Shih Tzu puppy from slipping back inside the birth canal. Never pull!