It's been nearly 3 hrs since #5 (still born) was delivered. I've seen no contractions at all yet for the next. I do see/feel movement on Elsie's tummy on both sides, so that means at least two more pups in there.
As time passes, we're growing concerned about uterine inertia (common in older dams), a condition where (to put it most simply) the uterus just gets lazy or sluggish or stops contractions all together. The dam will be quite content to nap or care for her pups, despite it's being obvious she has more pups to whelp. And nothing happens.
That's basically where we are right now (but it's only been 3 hours). And remember, it's only been 18 hours since the start of her active Stage Two (it's taken her 24 hours to deliver her last litters). We're okay, I think. Just concerned.
So after more chats with the vet's office, here's what we've decided. If we don't see another pup in the next 90 minutes, we'll haul the whole crew to the hospital (Elsie and pups), where Elsie will be examined to ensure all is well internally, and then (if necessary) she'll be given Oxytocin to stimulate contractions. If Oxytocin doesn't produce the pups, then we may have to consider an emergency C-section (we're not there yet though).
The encouraging thing is that since I sat down to write this, Elsie started panting (the first panting I've seen since her last whelp). Maybe things are starting up again, and she just needed to rest up after the last difficult labor.
And in the last two seconds, she started nesting! Yay!!! :)
Here's hoping we see the remaining pups delivered safely and singing with grand health by the end of the afternoon.